Aged ; Humans ; Ischemic Attack, Transient ; etiology ; Male ; Polycythemia Vera ; complications ; diagnosis

During cerebral vasospasm (CVS) due to ruptured aneurysm the retinal arteries were photographed and evaluated with angiographic studies at various stages to study any correlation between them. Among 60 cases with angiographic CVS, ophthalmoscopic retinal artery spasm (RAS) was detected in 29 cases. Photographic demonstration of the RAS was possible in 7 cases. In general, in a series of cases, the degree of RAS seems to correspond to the severity of CVS.
Carotid Artery Diseases/complications ; Human ; Intracranial Aneurysm/complications ; Ischemic Attack, Transient/complications* ; Ophthalmoscopy* ; Retinal Artery* ; Retinal Diseases/diagnosis

To investigate the influence of hyperglycemia on ischemic brain damage, we measured brain ATP, lactate and malondialdehyde (MDA) levels in global cerebral ischemic models of Wistar rats. We induced global cerebral ischemia by the 4-vessel occlusion method. After 30 or 60 min of occlusion, and after 30 min of reperfusion, we measured brain ATP, lactate and MDA levels. During the ischemic period, brain ATP levels decreased to 30-70% of sham groups both in normoglycemic and hyperglycemic groups. But during the reperfusion period, the recovery rate of ATP levels was significantly lower in the hyperglycemic than in the normoglycemic groups (p less than 0.05). After 60 min of global ischemia, brain lactate increased much more in the hyperglycemic than in the normoglycemic group, and, during reperfusion, was washed out slowly in the hyperglycemic group. The MDA level, a parameter of lipid peroxidation, increased more in the hyperglycemic group than in the normoglycemic group during reperfusion periods (p less than 0.05). We conclude that hyperglycemia increases lactate accumulation, delays the recovery of energy metabolism, and enhances the lipid peroxidation in the transient global ischemia of rat brain. These findings may suggest the harmfulness of hyperglycemia in clinical cerebral ischemia.
3,4-Methylenedioxyamphetamine/metabolism ; Adenosine Triphosphate/metabolism ; Animals ; Hyperglycemia/complications/*metabolism ; Ischemic Attack, Transient/complications/*metabolism ; Lactates/metabolism ; *Lipid Peroxidation ; Male ; Rats ; Rats, Wistar

OBJECTIVE: The purpose of this study was to analyze the surgical complications of transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation (PSF) in elderly patients. METHODS: A retrospective analysis of 210 patients who underwent TLIF & PSF was performed via the paraspinal transmuscular route from January 2004 to October 2007. Forty-one patients aged 65 years or more at the time of operation (Group 1) and 169 patients under the age of 65 years (Group 2) were involved in this study. Intraoperative and postoperative complications were investigated. RESULTS: The series included 94 men and 116 women. The mean age of the patients at the time of operation was 70.9+/-5.4 years in Group 1 and 49.3+/-9.5 years in Group 2. The minimum follow-up period was 24 months, and the mean follow-up period was 40.7+/-11.5 months. In Group 1, intraoperative complication occurred in 3 patients (7.3%; dural tear), and postoperative complications were postoperative delirium(5 patients, 12.2%), acute myocardial infarction (2 patient, 4.9%), transient ischemic attack (2 patient, 4.9%), spondylodiscitis (3 patients, 7.3%), adjacent segment disease (7 patients, 17.1%) and pedicle screw loosening (4 patients, 9.8%). In Group 2, intraoperative complication occurred in 3 patients (1.8%; dural tear), and postoperative complications were postoperative delirium(3 patients, 1.8%), acute myocardial infarction (1 patient, 0.6%), transient ischemic attack (1 patient, 0.6%), spondylodiscitis (4 patients, 2.4%), adjacent segment disease (4 patients, 2.4%), pedicle screw fracture (5 patients, 3.0%) and pedicle screw loosening (2 patients, 1.2%). Among various complications, dural tear, postoperative delirium, spondylodiscitis, adjacent segment disease and pedicle screw loosening were statistically more frequent in the elderly patients. CONCLUSION: As the TLIF and PSF procedures yielded a relatively high complication rate in elderly patients, delicate intraoperative and postoperative care is needed.
Aged ; Delirium ; Discitis ; Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Ischemic Attack, Transient ; Male ; Myocardial Infarction ; Postoperative Care ; Postoperative Complications ; Retrospective Studies

To systematically evaluate the risks of cardiocerebral vascular events in patients with primary biliary cholangitis(PBC). Methods We carried out a Meta analysis by RevMan 5.3 software to investigate literatureon the risk of cardiocerebral vascular events in patients with PBC and controls. Results Compared with non-PBC controls,PBC patients had significantly higher risk of coronary events(=1.56,=0.0002);however,the risk of cerebrovascular events showed no significant difference between these two groups(=1.01,=0.94).Subgroup analysis demonstrated a significantly lower risk of transient ischemic attack or carotid stenosis in PBC patients(=0.63,=0.03);however,there was no significant difference in the risk of stroke(=1.11,=0.40). Conclusion Patients with PBC have an increased risk of coronary events but may have a lower risk of transient ischemic attack or carotid stenosis.
Carotid Stenosis ; etiology ; Cholangitis ; complications ; Coronary Disease ; etiology ; Humans ; Ischemic Attack, Transient ; etiology ; Liver Cirrhosis, Biliary ; complications ; Risk Factors ; Stroke ; etiology

OBJECTIVETo investigate the characteristics of cerebral artery lesions in patients with limb-shaking transient ischemic attacks (LS-TIA) and its treatment.

METHODSWe retrospectively analyzed the clinical data of 20 patients with LS-TIA who received treatment in Peking Union Medical College Hospital from 2005 to 2008.

RESULTSCritical stenosis or occlusion of contralateral arteries were found in the siphonic part of internal carotid artery (ICA) in 6 patients, terminal ICA or proximal middle cerebral artery (MCA) in 6 patients, and distal MCA in 1 patient. Seven patients had proximal ICA occlusion. The brain MRI showed typical watershed cerebral infarctions in 8 patients. EEG studies failed to show epileptiform activity associated with LS-TIA, but found focal frontotemporal lobe slow activity in 6 patients, which was consistent with hypoperfusion area in CT perfusion. Six patients received surgical revascularization and no one recurred.

CONCLUSIONIntracranial artery including the siphonic part of ICA, terminal ICA and proximal MCA stenosis is the main underlying cause of LS-TIA in Chinese, and surgical revascularization may be effective in abolishing the attacks.

Adult ; Aged ; Aged, 80 and over ; Cerebral Arteries ; pathology ; Female ; Humans ; Ischemic Attack, Transient ; complications ; pathology ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Tremor ; etiology

BACKGROUND: The age, biomarkers, and clinical history (ABC)-atrial fibrillation (AF)-Stroke score have been proposed to refine stroke risk stratification, beyond what clinical risk scores such as the CHA2DS2-VASc score can offer. This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations. METHODS: A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry (CAFR) between 2013 and 2019 were included. Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk. The ABC-AF-Stroke score was evaluated in terms of discrimination, including concordance index (C-index), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), clinical utilization by decision curve analysis (DCA), and calibration by comparing the predicted risk with the observed annualized event rate. RESULTS: After a median follow-up of 3.5 years, 64 patients experienced thromboembolism events. Age, prior history of stroke/transient ischemic attack (TIA), high-sensitivity cardiac troponin T (cTnT-hs), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were independently associated with thromboembolism risk. The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index (0.67, 95% confidence interval [CI]: 0.59-0.74 vs. 0.60, 95% CI: 0.52-0.67, P = 0.030) and reclassification capacity. The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score. The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population. CONCLUSIONS In this real-world study enrolling non-anticoagulated AF patients following successful ablations, age, prior history of stroke/TIA, level of NT-proBNP, and cTnT-hs were independently associated with an increased risk of thromboembolism. The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.
Humans ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications* ; East Asian People ; Ischemic Attack, Transient ; Registries ; Risk Assessment ; Risk Factors ; Stroke/etiology* ; Thromboembolism/etiology* ; Troponin T

OBJECTIVETo investigate the relationship between cerebral vasospasm and occurrence of delayed ischemic neurological deficit (DIND).

METHODSThe clinical records and radiographic images of 118 patients with subarachnoid hemorrhage admitted during last 5 years were reviewed. The incidence,degree and localization of cerebral vasospasm were evaluated, and morbidity of related DIND was analyzed. Patients with cerebral vasospasm were divided into three groups: Group MCA (middle cerebral artery), Group ACA (anterior cerebral artery) and Group ICA (intracranial carotid artery) according to the location of cerebral vasospasm. The consistency of DIND and image of cerebral infarction were examined.

RESULTThere was a weak correlation between cerebral vasospasm and incidence of DIND (r=0.22; P=0.016). The incidence of DIND was increased with severity of cerebral vasospasm (U=2.589, P<0.05). The group MCA had a significantly higher incidence of DIND than that of ACA and ICA groups (68.0% compared with 36.7% and 25.0%, respectively, chi(2)=8.195, P=0.004), the difference between later two groups was not statistically significant (chi(2)=0.646, P=0.421).

CONCLUSIONCerebral vasospasm may be an important factor leading to DIND occurrence; the severity and location of cerebral vasospasm is related to the incidence of DIND.

Adult ; Aged ; Aneurysm, Ruptured ; complications ; Carotid Artery, Internal ; Female ; Humans ; Intracranial Aneurysm ; complications ; Ischemic Attack, Transient ; etiology ; Male ; Middle Aged ; Rupture, Spontaneous ; Subarachnoid Hemorrhage ; complications ; Time Factors ; Vasospasm, Intracranial ; etiology

OBJECTIVE: To investigate the relationship between the clinical features of carotid transient ischemic attacks (TIA) and the intracranial or extracranial angiostenosis. METHODS: Location and degree of stenosis of involved arteries were examined by the digital subtraction angiography in 52 patients with carotid TIA. RESULTS: Intracranial or extracranial vascular lesions of different degrees were revealed in 45 patients (86.5%), and 29 out of 45 (64.4%) had more than one site. Severe stenosis and occlusion occurred more frequently in TIA patients with short duration (less than 1 hour) and multiple attacks (more than twice). CONCLUSION Most patients with TIA of carotid systems have stenosis in intracranial or extracranial arteries. TIA with short duration and multiple attacks always accompany with severe stenosis or occlusion in intracranial or extracranial arteries. Digital subtraction angiography helps to identify the vascular etiology of TIA and provides the instruction of therapeutic regimen.
Adult ; Aged ; Angiography, Digital Subtraction ; Carotid Stenosis ; complications ; diagnostic imaging ; pathology ; Cerebral Angiography ; Cerebrovascular Disorders ; complications ; diagnostic imaging ; pathology ; Female ; Humans ; Ischemic Attack, Transient ; diagnostic imaging ; pathology ; Male ; Middle Aged

Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder characterized by bilateral stenosis of the intracranial portion of the internal carotid artery. Symptoms including transient ischemic attacks, seizures, intracranial hemorrhage and cerebral infarction, are variable. There are few case reports of moyamoya disease in pregnancy. Since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, cesarean section has been recommended to avoid neurologic complications for pregnant women with moyamoya disease. The optimal anesthetic management for cesarean section in these patients has not been discussed. We report a case of moyamoya disease in a patient presenting for cesarean section at 40 weeks' gestation. Epidural anesthesia was administered using 0.5% bupivacaine and fentanyl. Intraoperative hemodynamic state was stable. The patient has no significant postoperative complications.
Anesthesia* ; Anesthesia, Epidural ; Brain Ischemia ; Bupivacaine ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebrovascular Disorders ; Cesarean Section* ; Constriction, Pathologic ; Emergencies* ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Moyamoya Disease* ; Postoperative Complications ; Pregnancy ; Pregnant Women ; Seizures