Objective:To compare the efficacies of endovascular therapy (EVT) and standard medical therapy in acute ischemic stroke (AIS) patients aged ≥85 years, and analyze the independent influencing factors for poor prognosis of AIS patients after EVT.Methods:Sixty-nine AIS patients aged ≥85 years admitted to Department of Neurology, Xi'an Third Hospital from January 2018 to April 2024, including 40 accepted EVT and 28 accepted standard medicinal therapy, were enrolled. Modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 90 days after onset. General data, prognosis and complications between the EVT group and standard medical therapy group were compared. General data, treatment processes and complications between patients with good prognosis and poor prognosis in the EVT group were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in AIS patients after EVT.Results:Compared with the standard medical therapy, the EVT group had significantly lower NIHSS score at discharge, greater improvement in NIHSS score (NIHSS score at admission-NIHSS score at discharge), lower mRS score 90 days after onset, higher good prognosis rate, lower mortality rate within 90 days of onset, and longer hospital stay ( P<0.05). In the EVT group, 11 patients (27.5%) had good prognosis and 29 patients (72.5%) had poor prognosis 90 days after onset. Compared with the good prognosis group, the poor prognosis group had significantly higher blood glucose level and lower Alberta Stroke Program Early CT Score (ASPECT) on admission ( P<0.05). Multivariate Logistic regression analysis showed that blood glucose on admission ( OR=2.363, 95% CI: 1.134-4.928, P=0.022) and ASPECT score on admission ( OR=0.273, 95% CI: 0.088-0.854, P=0.026) were independent influencing factors for poor prognosis in AIS patients after EVT. Conclusion:AIS patients aged ≥85 years received EVT have better prognosis compared with those accepted standard medical therapy; these patients with high glucose level and low ASPECT score on admission have poor prognosis.

Objective To analyze the differences and correlations of imaging parameters in patients with Parkinson's disease(PD)combined with cerebral small vessel disease(CSVD)with different cognitive functions based on MRI.Methods A retrospective selection was conducted on 192 PD patients combined with CSVD.According to the Montreal cognitive assessment(MoCA)and mini-mental state examination(MMSE)scores,they were divided into cognitive impairment PD group(n=69)and cognitive normal PD group(n=123),and the clinical data and MRI imaging parameters of the two groups were compared.Results The age and drinking history of the cog-nitive impairment PD group were higher than those of the cognitive normal PD group(P<0.05);the lacune of presumed vascular origin(LPVO)score,periventricular white matter hyperintensity(PVWMH)score,basal ganglia-perivascular space(BG-PVS)score,brain atrophy(BA)score,and CSVD total score in the cognitive impairment PD group were higher than those in the cognitive normal PD group(P<0.05),while there was no statistically significant difference in deep white matter hyperintensity(DWMH)score,cen-trum semiovale perivascular space(CS-PVS)score,and cerebral microbleed(CMB)score between the two groups(P>0.05);Multi-variate logistic analysis showed that age,LPVO score,BG-PVS score,BA score,and CSVD total score were independent influencing factors of cognitive impairment(P<0.05).Conclusion There are differences in imaging parameters such as LPVO score,PVWMH score,BG-PVS score,BA score,and CSVD total score among PD patients combined with CSVD with different cognitive functions,and they are correlated with MMSE and MoCA scores.

Objective To observe the clinical and imaging features of patients with severe cerebral venous sinus thrombosis(CVST).Methods Consecutive severe CVST patients diagnosed at the Affiliated Hospital of Northwestern University(Xi'an NO.3 Hospital)from January 2017 to July 2024 were included.Patients'demographic characteristics,clinical manifestations,risk factors,imaging characteristics,onset mode,D-dimer levels,time from onset to diagnosis,treatment strategies,and prognosis were collected and recorded.Results A total of 17 severe CVST patients were included,of which 4 cases(23.5％)were male and 13 cases(76.5％)were female,with a male-to-female ratio of 1∶3.25.The median age was 41 years(range:19-56 years).The main clinical symptoms were headache,nausea and vomiting,seizures,focal neurological deficits,psychiatric symptoms,disturbance of consciousness,and limited neck mobility.The most common clinical symptoms were headache(15/17),seizures(7/17),and focal neurological deficits(7/17),followed by disturbance of consciousness(4/17).Among the 17 patients,10 cases(58.8％)had ischemic stroke and 9 cases(52.9％)had hemorrhagic stroke.The involvement rates of transverse sinus,superior sagittal sinus,sigmoid sinus,straight sinus and inferior sagittal sinus were 94.1％,64.7％,47.1％,29.4％and 11.8％respectively,and the proportion of patients with involvement of 2 or more venous sinuses reached 88.2％.Among the 17 patients,12 cases exhibited a lack of response to standard anticoagulation therapy and underwent endovascular therapy subsequently,and one of them had new intracranial hemorrhage.Two(11.8％)patients had poor prognosis at 90 d after discharge,with one patient death and one patient with an mRS score of 3.Fifteen patients(88.2％)had a good prognosis(3 cases with an mRS score of 2,5 cases with an mRS score of 1,and 7 cases with an mRS score of 0).Conclusions Severe CVST patients often present with seizures,impaired consciousness,involvement of multiple venous sinuses,ischemic stroke,and hemorrhagic stroke.Early identification,and active anticoagulation or endovascular therapy are crucial to improve the prognosis and reduce the disability and mortality rates of this disease.

Objective To analyze the differences and correlations of imaging parameters in patients with Parkinson's disease(PD)combined with cerebral small vessel disease(CSVD)with different cognitive functions based on MRI.Methods A retrospective selection was conducted on 192 PD patients combined with CSVD.According to the Montreal cognitive assessment(MoCA)and mini-mental state examination(MMSE)scores,they were divided into cognitive impairment PD group(n=69)and cognitive normal PD group(n=123),and the clinical data and MRI imaging parameters of the two groups were compared.Results The age and drinking history of the cog-nitive impairment PD group were higher than those of the cognitive normal PD group(P<0.05);the lacune of presumed vascular origin(LPVO)score,periventricular white matter hyperintensity(PVWMH)score,basal ganglia-perivascular space(BG-PVS)score,brain atrophy(BA)score,and CSVD total score in the cognitive impairment PD group were higher than those in the cognitive normal PD group(P<0.05),while there was no statistically significant difference in deep white matter hyperintensity(DWMH)score,cen-trum semiovale perivascular space(CS-PVS)score,and cerebral microbleed(CMB)score between the two groups(P>0.05);Multi-variate logistic analysis showed that age,LPVO score,BG-PVS score,BA score,and CSVD total score were independent influencing factors of cognitive impairment(P<0.05).Conclusion There are differences in imaging parameters such as LPVO score,PVWMH score,BG-PVS score,BA score,and CSVD total score among PD patients combined with CSVD with different cognitive functions,and they are correlated with MMSE and MoCA scores.

Objective To observe the clinical and imaging features of patients with severe cerebral venous sinus thrombosis(CVST).Methods Consecutive severe CVST patients diagnosed at the Affiliated Hospital of Northwestern University(Xi'an NO.3 Hospital)from January 2017 to July 2024 were included.Patients'demographic characteristics,clinical manifestations,risk factors,imaging characteristics,onset mode,D-dimer levels,time from onset to diagnosis,treatment strategies,and prognosis were collected and recorded.Results A total of 17 severe CVST patients were included,of which 4 cases(23.5％)were male and 13 cases(76.5％)were female,with a male-to-female ratio of 1∶3.25.The median age was 41 years(range:19-56 years).The main clinical symptoms were headache,nausea and vomiting,seizures,focal neurological deficits,psychiatric symptoms,disturbance of consciousness,and limited neck mobility.The most common clinical symptoms were headache(15/17),seizures(7/17),and focal neurological deficits(7/17),followed by disturbance of consciousness(4/17).Among the 17 patients,10 cases(58.8％)had ischemic stroke and 9 cases(52.9％)had hemorrhagic stroke.The involvement rates of transverse sinus,superior sagittal sinus,sigmoid sinus,straight sinus and inferior sagittal sinus were 94.1％,64.7％,47.1％,29.4％and 11.8％respectively,and the proportion of patients with involvement of 2 or more venous sinuses reached 88.2％.Among the 17 patients,12 cases exhibited a lack of response to standard anticoagulation therapy and underwent endovascular therapy subsequently,and one of them had new intracranial hemorrhage.Two(11.8％)patients had poor prognosis at 90 d after discharge,with one patient death and one patient with an mRS score of 3.Fifteen patients(88.2％)had a good prognosis(3 cases with an mRS score of 2,5 cases with an mRS score of 1,and 7 cases with an mRS score of 0).Conclusions Severe CVST patients often present with seizures,impaired consciousness,involvement of multiple venous sinuses,ischemic stroke,and hemorrhagic stroke.Early identification,and active anticoagulation or endovascular therapy are crucial to improve the prognosis and reduce the disability and mortality rates of this disease.

Objective:To compare the efficacies of endovascular therapy (EVT) and standard medical therapy in acute ischemic stroke (AIS) patients aged ≥85 years, and analyze the independent influencing factors for poor prognosis of AIS patients after EVT.Methods:Sixty-nine AIS patients aged ≥85 years admitted to Department of Neurology, Xi'an Third Hospital from January 2018 to April 2024, including 40 accepted EVT and 28 accepted standard medicinal therapy, were enrolled. Modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 90 days after onset. General data, prognosis and complications between the EVT group and standard medical therapy group were compared. General data, treatment processes and complications between patients with good prognosis and poor prognosis in the EVT group were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in AIS patients after EVT.Results:Compared with the standard medical therapy, the EVT group had significantly lower NIHSS score at discharge, greater improvement in NIHSS score (NIHSS score at admission-NIHSS score at discharge), lower mRS score 90 days after onset, higher good prognosis rate, lower mortality rate within 90 days of onset, and longer hospital stay ( P<0.05). In the EVT group, 11 patients (27.5%) had good prognosis and 29 patients (72.5%) had poor prognosis 90 days after onset. Compared with the good prognosis group, the poor prognosis group had significantly higher blood glucose level and lower Alberta Stroke Program Early CT Score (ASPECT) on admission ( P<0.05). Multivariate Logistic regression analysis showed that blood glucose on admission ( OR=2.363, 95% CI: 1.134-4.928, P=0.022) and ASPECT score on admission ( OR=0.273, 95% CI: 0.088-0.854, P=0.026) were independent influencing factors for poor prognosis in AIS patients after EVT. Conclusion:AIS patients aged ≥85 years received EVT have better prognosis compared with those accepted standard medical therapy; these patients with high glucose level and low ASPECT score on admission have poor prognosis.

OBJECTIVETo investigate whether DTI abnormalities in patients with nondemented subcortical ischemic vascular disease (SIVD) are correlated to general cognitive function and executive function independent of conventional MRI parameters.

METHODSSixty-six SIVD patients including 30 with cognitive impairment without dementia (VCIND) and 36 with normal cognition (NCI) underwent DTI and cognitive assessment of the general cognitive function and executive function. Conventional MRI parameters and DTI parameters were measured within the white matter lesions (WMLs), normal-appearing white matter (NAWM) and normal-appearing gray matter (NAGM). The independent predictors of general cognitive function and executive function in SIVD patients was analyzed.

RESULTSNCI and VCIND patients showed significant differences in the periventricular WMLs, ADC valus in NAWM and WMLs of the centrum semiovale, and FA values in NAWM of the anterior periventricular. Except for ADC values of the caudate nucleus, ADC and FA values in the subcortical NAGM showed significant difference between the two groups. After controlling for age and education, PVLs and ADC values in the WMLs and NAWM of the centrum semiovale and putamen, and FA values in the anterior periventricular NAWM, WMLs and putamen showed significant correlations to MMSE; the number of lacunar infarcts, ADC values in posterior periventricular NAWM and caudate nucleus, and FA values in anterior periventricular NAWM and thalamus showed significant correlations to CDT. Multivariate analysis showed independent correlations of the ADC values in WMLs and NAWM of the centrum semiovale to MMSE, and demonstarted correlations of the ADC values of the caudate nucleus and number of lacunar infarcts to CDT.

CONCLUSIONIn nondemented SIVD subjects, the integrity of the white matter in the centrum semiovale strongly correlates to the general cognition, and the microstructural damage of the caudate nucleus head predicts executive function impairment independent of other MRI variables.

Brain Ischemia ; pathology ; physiopathology ; psychology ; Case-Control Studies ; Caudate Nucleus ; pathology ; Cerebral Cortex ; pathology ; Cognition ; physiology ; Cognition Disorders ; pathology ; physiopathology ; Diffusion Tensor Imaging ; Humans ; Magnetic Resonance Imaging

Objective To observe the expression of peroxisome proliferator-activated receptor γ (PPARγ) in hippocampus neurons in rats after different time of neuron oxygen deprivation/oxygen supply, and to investigate the role of PPARγ in neuron ischemia reperfusion injury.Methods One day old newborn SD rats were chosen. Primary cultured hippocampus neurons were used to establish neuron ischemic reperfusion model in vitro by oxygen and glucose depriving 15 minutes and supplying again, and then the neuron structure was observed by transmission electron microscope of JEM-200EX.The expression of PPARγ mRNA and protein were detected by RT-PCR and Western blot, respectively.Results Neuron structure was damaged after neuron oxygen deprivation/oxygen supply. There was no significant difference between 0 h oxygen supply group and the control group.The expression of PPARγ was decreased both at mRNA and protein level after 6 h of oxygen supply. The difference between 6 h oxygen supply group and the control group was significant(P<0.01), which decreased with the length of reperfusion and the lowest was at 48 h after the reperfusion. The difference among the different reperfusion groups and the control group was significant(P<0.01). Conclusion PPARγ may participate in the pathological damage course of neuron ischemical reperfusion injury, and may become a new intervention target of treatment for ischemic cerebrovascular disease.

Objective To study the relationships between cognitive impairment in patients with lacunar infarcts and quantitative CT measures and to determine the independent correlative factors of cognitive impairment. Methods Neuropsychological examination was conducted for 128 patients with acute lacunar infarct. Number, location, and volume of infarcts, cerebral atrophy index and severity of white matter lesions (WMLs) were measured and recorded. Results The number of lacunar infarcts in cognitive impairment (CI) group was significantly larger than that in cognitive normal (CN) group. Mean width of sulcus and sylvian fissure, index of frontal horn and ventricular-brain ratio (VBR) were significantly different in both groups. There were more patients with 3 grades or 4 grades WMLs in CI group (62%) than those in CN group (22%). The total volume of lacunar infarcts showed no statistically significant difference. Logistic regression analysis indicated that the number of lacunar infarcts in frontal subcortex and thalamus, the volume of infarcts in anterior periventricular white matter, width of cerebral sulcus and sylvian fissure were correlated with cognitive impairment respectively. Additionally, age and education were correlative factors of cognitive impairment in patients with lacunar infarct. Conclusion Correlative factors of cognitive impairment in patients with lacunar infarct are not merely one feature, but a combination of infarct features (number, location, and volume), cortical atrophy and host factors (age and education).