Objective To investigate the screening significance of transcranial Doppler (TCD) for patients with patent foramen ovale ( PFO) induced cerebral embolism and to improve the treatment aiming at the causes.Methods Thirty-six patients of less than 60 years old with unknown-cause cerebral embolism and transient ischemic attack were enrolled.Besides conventional examination,the 24 h Holter,transthoracic echocariiography,carotid artery Doppler ultrasonography (CAU),routine TCD,TCD foaming test,transesophageal echocardiography (TEE),CT angiography (CTA) of head and neck,ultrasonography of vein in bilateral lower limbs were examined in all patients.Results All the patients showed no atrial fibrillation.No structural heart disease and intracardiac occupying lesion were shown in transthoracic echocardiography.No carotid stenosis was shown in carotid artery Doppler ultrasonography.Routine TCD showed no intracranial artery stenosis.No thrombus was found in ultrasonography of deep veins in bilateral lower limbs.CTA of head and neck showed everything was normal.Fourteen patients were observed with right-to-left shunt in heart by TCD foaming test,including 10 cases with microbubble signals(MBS) in 10 s,and 4 cases with MBS after Valsalva maneuver.Among 14 patients,12 patients were proved PFO by TEE.Conclusions PFO is one of the causes of cardiogenic cerebral embolism.TCD is accurate and reliable for the screening of PFO.

Objective To investigate the risk factors of hemorrhagic transformation (HT) following thrombolytic therapy in acute cerebral infarct patients. Methods The clinical data of 246 cases with acute cerebral infarct treated with rt-PA within 4.5 h from the onset were reviewed. According to the results of brain CT imaging after intravenous thrombolysis for 24-36 h, the patients were divided into HT group and non HT group. The factors including age, gender, NIHSS scores, drinking, smoking, hypertension, diabetes, atrial fibrillation. The univariate analysis and Losgistic regression analysis were further assessed. Results The results of univariate analysis indicated that there were no significant differences between the two groups in age, gender, smoking , drinking, time from onset to thrombolysis, diabetes (P > 0.05), but there were significant differences between two groups in NIHSS scores [(14.53 ± 6.06) scores vs.(9.98 ± 6.26) scores, P = 0.000], hypertension [86.1%(31/36) vs.70.0%(147/210), P = 0.046] and atrial fibrillation [63.9%(23/36) vs. 24.3%(51/210), P = 0.000]. Logistic regression analysis showed that NIHSS scores (OR = 1.079, 95% CI = 1.014- 1.147, P = 0.016) and atrial fibrillation (OR=3.298, 95%CI=1.481-7.345, P=0.003) were the risk factors associated with hemorrhagic transformation after intravenous thrombolysis for acute cerebral infarction. Conclusions NIHSS scores and atrial fibrillation are the risk factors associated with HT after thrombolytic therapy in acute cerebral infarct patients.

Objective To analyse effect of rt-PA intravenous thrombolytic therapy on serum levels of neuro-specific endolase, C-reactive protein and fatty acid binding protein in patients with early cerebral infarction.Methods 54 patients who were diagnosed with early acute cerebral infarction in Dalian Municipal Central Hospital were collected.All patients were randomly divided into experimental group and control group,27 cases in each group.Two groups were given conventional treatment,such as reduction of intracranial pressure,improve circulation and nutrition brain cells.Control group was given low molecular weight heparin calcium injection 5000U, one times per 12 h for 7 consecutive days, and experimental group was given rt-PA intravenous thrombolytic therapy on the basis of the control group for 7 consecutive days, post-treatment,the serum levels of NSE, CRP and FABP were detected in all patients.Results Compared with control group post-treatment, the serum CRP,NSE and FABP level was lower in experimental group ( P<0.05).Conclusions The rt-PA intravenous thrombolytic therapy can significantly reduce the serum CRP, NSE and FABP levels in the patients with early cerebral infarction, improve the prognosis of patients.

Objective To investigate the risk of hemorrhagic transformation and the curative effect in patients with atrial fibrillation(AF)treated by intravenous thrombolysis with alteplase after acute cerebral infarct. Methods The clinical data of 246 patients with acute cerebral infarct treated with intravenous alteplase within 4.5 h from the onset were analyzed.According to the presence or absence of AF, the patients were divided into AF group (74 cases) and non AF group (172 cases). The outcomes were the incidence of hemorrhagic transformation within 36 h and the curative effect after 2 weeks. Results The incidence of hemorrhagic transformation in AF group was 31.1%(23/74), in non AF group was 7.6%(13/172),and there was significant difference(χ2=22.917,P=0.000).The effective rate in AF group was 54.1%(40/74), in non AF group was 76.7%(132/172), and there was significant difference (χ2=12.665,P=0.000).Conclusions Patients with acute cerebral infarction combined with AF have a high risk of hemorrhagic transformation and poor prognosis after intravenous thrombolysis.