Brain Circulation最新文献

Solitary intradural plasmacytomas are extremely rare. We present a case of a patient with headache and diagnosis of meningiomatosis. Onset symptoms were abrupt neurological deterioration and paraparesis. The patient underwent surgery by craniotomy and tumor resection, with final pathological findings of solitary extramedullary plasmacytoma without evidence of multiple myeloma. Of note is the great similarity of this infrequent pathology with meningiomas and the need to differentiate it from the dural involvement of multiple myeloma. Treatment always includes tumor resection surgery and postoperative radiotherapy.

Background: Exertional heat stroke (EHS) is a clinical entity characterized by abnormalities of the central nervous system (CNS) and is associated with multiple organ injury, some of which may be irreversible. It is valuable to establish an optimized model of EHS that is able to induce and assess damage to the CNS and multiple organs.

Methods: We induced EHS by using an environmental chamber with adjustable temperature and humidity and a mice forced running wheel. The endpoint for the EHS was defined as either exhaustion or a core temperature of 42.5°C being reached. Injury to the liver, kidney, and CNS of mice in the EHS group was revealed through pathological studies using hematoxylin and eosin staining of harvested organs at different time points and detection of biomarkers. The depressive-like behavior of EHS mice was assessed through open field tests, forced swimming tests, and tail suspension tests.

Results: The favorable environmental conditions for induction of EHS based on this presented model are 38°C, 70% RH. The EHS mice developed thermoregulatory dysfunction and experienced a significantly higher weight loss ratio compared to the SHE (sham heat exercise) group. The liver, kidney, and brain tissues of EHS mice were significantly damaged, and the pathological damage scores for each organ were significantly higher than those of the SHE group. In the open field test (OFT), compared to the SHE group, there was a significant reduction in the number and time of EHS mice entering the center of the open field. Additionally, there was a significant increase in immobile time during forced swimming test (FST) and tail suspension test (TST).

Conclusion: This study presents an improved animal model that has the potential to assess for neurological and multiple organ injury caused by EHS and simultaneously, while accurately reflecting the clinical characteristics observed in EHS patients.

Background: Cerebral vasospasm is a serious sequela of traumatic brain injury (TBI) which leads to further neurologic injury subsequent to the initial trauma. The natural history and associated risk factors are not well understood. The objective of this study is to evaluate the clinical and radiographic characteristics of patients with TBI.

Methods: This is a descriptive case series of all patients with TBI who underwent cerebral angiogram for evaluation and rescue therapy for posttraumatic arterial vasospasm (PTV) between October 2017 and November 2019. The association of clinical and radiographic characteristics with cumulative severity of angiographic vasospasm was evaluated. The clinical characteristics comprised of age, sex, Glascow Coma Scale (GCS) and need for surgery. The radiographic characteristics were presence of subarachnoid hemorrhage (SAH), location of SAH, presence of contusion, presence of subdural hemorrhage (SDH), and presence of pseudoaneurysm.

Results: Twenty-two patients with PTV were identified requiring 69 cerebral angiograms (mean: 3.2; range: 1-9 angiograms per patient) during this period. The average age upon presentation was 40 years old, 81% of the patients were male sex, and the average GCS was 6.8. 67% of the patients underwent craniotomy or craniectomy. All patients had SAH, although only 60% had cisternal SAH. Parenchymal contusion was noted on 90% as well as SDH in 90%. The PTV was noted between 3 and 19 days after trauma. There was more vasospasm involving proximal arteries and higher severity of vasospasm in patients with cisternal SAH. Otherwise, there was no strong association between the clinical or radiographic characteristics and cumulative severity noted on the angiograms for each patient.

Conclusion: Posttraumatic vasospasm can be detected as early as posttrauma day 3-19 in patients with TBI and SAH. The absence of cisternal SAH does not rule out the occurrence of the vasospasm during the course of treatment.

Background: Pulmonary arteriovenous malformations (PAVMs) can cause acute ischemic strokes (AISs) through paradoxical embolism. The clinical and imaging features of AIS due to PAVMs have not been studied. We report a case and perform a systematic review of the clinical and imaging characteristics of patients with AIS due to PAVMs. This may provide clues to screen patients with AIS for PAVMs and treat them appropriately to prevent further strokes.

Materials and methods: MEDLINE, EMBASE, and Web of Science databases were searched from inception to October 2023. We included patients of any age with AIS attributed to PAVM. Studies without clinical data were excluded. Demographics, AIS characteristics (location and arterial territories), and PAVM characteristics (location, size, and treatment) were recorded.

Results: A 47-year-old female presented with acute vertigo and gait imbalance. Magnetic resonance imaging showed AIS in the right cerebellum. CT chest confirmed a PAVM in the right lower lobe. Endovascular coil closure was performed. We identified 102 patients from 96 records. The mean age was 47.4 ± 17 years (67% female). Seventy percent had single AIS and 30% had multiple. The location was anterior circulation in 50%, posterior in 37%, and both in 13%. The most common arterial territory was middle-cerebral (51%), followed by posterior-cerebral (25%). PAVMs were mostly single (78%) and in the lower lobes (66%). Thirty-three had hereditary hemorrhagic telangiectasia (HHT) (33%).

Conclusions: PAVM-related strokes occur at a young age and may have a high propensity for multifocality and posterior circulation location. Patients with PAVMs and AIS should be screened for HHT and venous thromboses.

Introduction: Although systemic heparinization is a widely used technique during digital subtraction angiography (DSA), heparin is associated with a variety of complications including hemorrhage, thrombocytopenia, and hematomas. This study aimed to investigate the safety and efficacy of microdose systemic heparinization or no heparinization on cerebral angiography for cerebrovascular diseases.

Materials and methods: We conducted a prospective, single-blind, randomized controlled study on patients who ought to be experienced cerebrovascular examination and underwent DSA. Participants were randomized into three groups: regular-dose systemic heparinization, microdose systemic heparinization, and no heparinization. Information on patient demographics, laboratory tests, perioperative complications, and back pain scores was collected. Safety endpoints were defined as cerebral ischemic events and local complications of the puncture site. Efficacy endpoints were defined as the recovery of the patients.

Results: A total of 180 patients were enrolled in the study and randomized into one of three groups. Patients were on average 54.4 ± 10.6 years old and 71.6% were male. Among the three groups, there was no significant difference in the incidence of postoperative thrombotic or ischemic events (regular dose vs. microdose vs. no heparinization: 1.7% vs. 3.3% vs. 1.7%, P = 0.774). The microdose or no heparinization group; however, experienced a significantly lower rate of postoperative subcutaneous hematoma (15.0% vs. 3.3% vs. 0%, P = 0.002), as well as significantly less back pain (21.7% vs. 5.0% vs. 1.7%, P < 0.001) compared to the regular-dose heparinization group.

Conclusions: Microdose heparinization or heparin-free cerebral angiography demonstrated similar safety to conventional heparinization but significantly reduced local complications of the puncture site and accelerated recovery.

Trial registration: ClinicalTrials.gov, identifier NCT06365398.

Introduction: Antithrombotic therapy prevents adverse ischemic events following acute ischemic stroke (AIS). Intravenous tirofiban provides desirable antiplatelet effects, especially in patients who are vulnerable to neurological deterioration (ND).

Aim: The aim of the study was to test the hypothesis that intravenous administration of tirofiban, initiated within 24 h of ictus and continued for consecutive 72 h, would be more effective than aspirin in reducing the risk of ND within 72 h of enrollment among patients with potentially atherothrombotic ischemic stroke.

Methods: The Safety and Efficacy of Tirofiban in Preventing Neurological Deterioration in Acute Ischemic Stroke (TREND) trial is an investigator-initiated, multicenter, prospective, randomized, open-label, masked endpoint study. Its eligibility criteria included AIS secondary to potential atherosclerosis, a National Institutes of Health Stroke Scale (NIHSS) score ranging from 4 to 20 points, ineligibility for recanalization therapy, and administration within 24 h postsymptom onset. Randomization was performed at a 1:1 ratio to allocate 420 patients into two groups to receive an intravenous tirofiban bridge to oral antiplatelet drugs or direct oral antiplatelet drugs.

Outcomes: The primary outcome is the proportion of patients with a ≥4-point increase in NIHSS score within 72 h of intervention compared to the score at enrollment. The key secondary outcomes include changes in NIHSS score, modified Rankin scale (mRS) score at 90 days, and dichotomized mRS scores (0-2 vs. 3-6 and 0-1 vs. 2-6) at 90 days. The safety variables are symptomatic intracerebral hemorrhage, any intracerebral hemorrhage, and systemic hemorrhage within 72 h after randomization and 90-day mortality.

Conclusions: The TREND trial may identify the suitability of intravenous tirofiban as a routine clinical strategy to prevent ND in patients with AIS within 24 h of the onset of symptoms.

Trial registration: http://www.clinicaltrials.gov (identifier: NCT04491695).

Background: Electroacupuncture (EA) is a promising alternative therapy for migraine, with mitochondrial dysfunction hypothesized as a pivotal mechanism in migraine pathophysiology. This research endeavors to investigate the therapeutic potential of EA in addressing migraines and shed light on the associated mechanisms linked to mitochondrial anomalies.

Materials and methods: Migraine in rats was induced by 10 mg/kg nitroglycerin, followed by 2/15 Hz EA treatment at GB20 and LR3. Nociceptive behavior was recorded via a camera and analyzed using EthoVision XT 12.0 software. The hind-paw withdrawal threshold was assessed using the von Frey test. We assessed the levels of calcitonin gene-related peptide (CGRP), nitric oxide (NO), and endothelin (ET) - key parameters in migraine pathophysiology using immunohistochemistry and enzyme-linked immunosorbent assay. Mitochondrial morphology in brain tissues was observed through transmission electron microscopy. Reactive oxygen species (ROS) level in mitochondria was measured by flow cytometry. The levels of PINK1 and Parkin were assessed using Western blot analysis.

Results: EA at GB20 and LR3 decreased nociceptive behaviors (resting and grooming) and increased exploratory and locomotor behaviors in migraine rats. The hind-paw withdrawal threshold in migraine rats was significantly elevated following EA treatment. Post-EA treatment, levels of CGRP and NO decreased, while ET level increased, suggesting an alteration in pain and vascular physiology. Notably, EA treatment mitigated the mitochondrial damage and reduced ROS level in the brain tissues of migraine rats. EA treatment upregulated the expression of PINK1 and Parkin in migraine rats.

Conclusion: EA at GB20 and LR3 may treat migraine by alleviating PINK1/Parkin-mediated mitochondrial dysfunction.

Background: Disorders of consciousness (DOC) incorporate stages of awareness and arousal. Through coma arousal therapy sensory deprivation experienced by patients with DOC can be mitigated. Nevertheless, consensus concerning its effectiveness on these patients is still fractional.

Purpose: This review aims to investigate the effectiveness of coma arousal therapies on patients with DOC.

Methods: A meta-analysis was performed by searching electronic databases using search terms, the studies investigating the effect of coma arousal therapy in patients with DOC using the Coma Recovery Scale-Revised and Glasgow Coma Scale as outcome measures were included. The risk of bias was assessed, using Cochrane and Joanna Briggs Institute critical appraisal tools. Further, analysis was conducted for the included studies.

Results: Out of 260 studies, 45 trials were reviewed and assessed for bias, with 31 studies included for analysis. The analysis demonstrates a significant difference in pre- and post - sensory stimulation, vagus nerve stimulation, transcranial magnetic stimulation, and transcranial direct current stimulation. Sensory stimulation showed the greatest mean difference of -4.96; 95% CI = -5.76 to - 4.15. The patients who underwent intervention after 3 months of illness showed significant improvement.

Conclusion: The result shows that sensory stimulation, transcranial magnetic stimulation, and transcranial direct stimulation can improve behavioral outcomes of patients with DOC, wherein sensory stimulation is found to be more effective.