Cerebral small vessel disease (CSVD) is a senile brain lesion caused by the abnormal structure and function of arterioles, venules and capillaries in the aging brain. The etiology of CSVD is complex, and disease is often asymptomatic in its early stages. However, as CSVD develops, brain disorders may occur, such as stroke, cognitive dysfunction, dyskinesia and mood disorders, and heart, kidney, eye and systemic disorders. As the population continues to age, the burden of CSVD is increasing. Moreover, there is an urgent need for better screening methods and diagnostic markers for CSVD, in addition to preventive and asymptomatic- and mild-stage treatments. Integrative medicine (IM), which combines the holistic concepts and syndrome differentiations of Chinese medicine with modern medical perspectives, has unique advantages for the prevention and treatment of CSVD. In this review, we summarize the biological markers, ultrasound and imaging features, disease-related genes and risk factors relevant to CSVD diagnosis and screening. Furthermore, we discuss IM-based CSVD prevention and treatment strategies to stimulate further research in this field.
Humans ; Integrative Medicine ; Brain/pathology* ; Cerebral Small Vessel Diseases/pathology* ; Stroke/complications* ; Cognitive Dysfunction/complications* ; Magnetic Resonance Imaging

OBJECTIVE: To investigate the clinical features and implication of restless legs syndrome (RLS) in ischemic stroke patients. METHODS: A total of 199 ischemic stroke patients were enrolled and assessed by polysomnography (PSG). RLS was identified according to criteria of International Restless Legs Syndrome Study Group. Epworth Sleepiness Scale (ESS), Mini-mental State Examination (MMSE) and Patient Health Questionnaire (PHQ-9) were used to evaluate the sleep quality, cognitive function and post-stroke depression, respectively. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the neurological function 3 months after stroke onset. Gender-and age-matched non-ischemic stroke patients with RLS (primary PLS) were selected as controls. RESULTS: Twenty-two cases of RLS were identified among 199 ischemic stroke patients (11.1%). Generalized linear model and logistic regression showed that low serum ferritin level (=-133.3 mg/L, 95%:-200.4--0.1, <0.01), subcortical infarction (=4.05, 95%:1.15-14.18, <0.05) and female (=2.54, 95%:1.04-6.23, <0.05) were identified as the risk factors of RLS in ischemic stroke patients. Compared with ischemic stroke patients without RLS, ESS increased by 4.37 (95%:2.33-6.41, <0.01), PHQ-9 increased by 2.17 (95%:0.39--3.94, <0.05), and reduced NIHSS from the baseline deceased by 0.97 (95%:-1.79--0.15, <0.05) in ischemic stroke patients with RLS. In addition, the incidence of moderate-severe depression increased (=4.27, 95%:1.40-13.10, <0.05) in ischemic stroke patients with RLS. The index of periodic leg movements of sleep (PLMS) with arousal in ischemic stroke patients with RLS was significantly higher than that in patients with primary RLS (=12.85, 95%:2.04-23.67, <0.05). CONCLUSIONS RLS is common in ischemic stroke patients and has adverse influences on patients.
Brain Ischemia ; complications ; pathology ; Depression ; complications ; Female ; Humans ; Male ; Polysomnography ; Restless Legs Syndrome ; complications ; pathology ; Stroke ; complications ; pathology

Brain ; blood supply ; pathology ; surgery ; Diagnosis, Differential ; Humans ; Middle Aged ; Pituitary Neoplasms ; cerebrospinal fluid ; complications ; diagnosis ; Stroke ; cerebrospinal fluid ; complications ; diagnosis ; Tuberculosis ; cerebrospinal fluid ; complications ; diagnosis

Stroke classified into ischemic and hemorrhagic subtypes, is among the most devastating diseases for human being. Certain drugs could increase the blood viscosity, thereby increasing the potential risk of ischemia. Anti-platelet and anti-coagulation drugs, as the treatment of first choice, increase the risk of intracranial hemorrhage and death. Here, we are the first to propose the concept of drug-related stroke, and discuss the treatment strategy for patients who are complicated with intracranial hemorrhage or plan to receive neurosurgical operation during either anti-platelet or anti-coagulation medication. We hope to arouse the attention for drug related stroke among the clinicians and offer recommendation for clinical intervention.
Drug-Related Side Effects and Adverse Reactions ; pathology ; Humans ; Intracranial Hemorrhages ; complications ; Stroke ; chemically induced ; prevention & control ; therapy

PURPOSE: Leptomeningeal collateral, in moyamoya disease (MMD), appears as an ivy sign on fluid-attenuated inversion-recovery (FLAIR) images. There has been little investigation into the relationship between presentation of ivy signs and old brain lesions. We aimed to evaluate clinical significance of ivy signs and whether they correlate with old brain lesions and the severity of clinical symptoms in patients with MMD. MATERIALS AND METHODS: FLAIR images of 83 patients were reviewed. Each cerebral hemisphere was divided into 4 regions and each region was scored based on the prominence of the ivy sign. Total ivy score (TIS) was defined as the sum of the scores from the eight regions and dominant hemispheric ivy sign (DHI) was determined by comparing the ivy scores from each hemisphere. According to the degree of ischemic symptoms, patients were classified into four subgroups: 1) nonspecific symptoms without motor weakness, 2) single transient ischemic attack (TIA), 3) recurrent TIA, or 4) complete stroke. RESULTS: TIS was significantly different as follows: 4.86+/-2.55 in patients with nonspecific symptoms, 5.89+/-3.10 in patients with single TIA, 9.60+/-3.98 in patients with recurrent TIA and 8.37+/-3.39 in patients with complete stroke (p=0.003). TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35+/-4.22 vs. 7.49+/-3.37, p=0.032). We found a significant correlation between DHI and motor symptoms (p=0.001). CONCLUSION: Because TIS has a strong tendency with severity of ischemic motor symptom and the presence of old lesions, the ivy sign may be useful in predicting severity of disease progression.
Adolescent ; Adult ; Aged ; Brain/metabolism/*pathology ; Cerebral Arteries/*pathology ; Child ; Child, Preschool ; Collateral Circulation ; Disease Progression ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Meninges/*pathology ; Middle Aged ; Moyamoya Disease/complications/*pathology ; Severity of Illness Index ; Stroke ; Young Adult

OBJECTIVETo summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.

METHODSIt was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.

RESULTSTechnical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type I endoleak disappeared spontaneously, and 1 type II endoleak disappeared after secondary intervention.

CONCLUSIONSEndovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes. It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement. The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group. Stroke is a critical fatal complication and should be attached attention.

Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting ; surgery ; Aorta ; pathology ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Aortic Diseases ; surgery ; Blood Vessel Prosthesis Implantation ; Endoleak ; complications ; Endovascular Procedures ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; complications ; Survival Rate ; Tomography, X-Ray Computed

OBJECTIVETo discuss the relationship between tongue manifestation and the degree of neurological impairment in the patients with acute cerebral infarction.

METHODSTwo hundred patients with first unilateral cerebral infarction were recruited. The relationship between different tongue manifestation and National Institute of Health Stroke Scale (NIHSS) were analyzed.

RESULTSNIHSS scores in the patients from different tongue color groups were analyzed and further analysis demonstrated that the NIHSS score was higher in the patients with red or bluish-purple tongue than that of those with the pink (P <0.01). On tongue fur, the NIHSS score in the patients with thick fur was higher than that of those with the thin (P=0.003). NIHSS score in patients with slippery, moist or dry fur was significant different (P=0.003), Further analysis demonstrated that the NIHSS score was higher in the patients with dry fur than that of those with moist fur, and had statistical significance (P=0.01). The NIHSS score was higher in patients from greasy fur group than that of the non-greasy (P=0.002). There was significant difference of NHISS score in the patients with different fur color (P=0.000), and further analysis demonstrated that the NHISS score in white-yellow, yellow fur group were higher than that of the white (P=0.06 or 0.000).

CONCLUSIONThe changes of tongue manifestation might be associated with the degree of neurological impairment in the patients with acute cerebral infarction.

Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; complications ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; National Institutes of Health (U.S.) ; Nervous System ; pathology ; physiopathology ; Pigmentation ; Pilot Projects ; Stroke ; pathology ; physiopathology ; Tongue ; pathology ; United States

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 +/- 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.
Age Factors ; Aged ; Alzheimer Disease/diagnosis ; Brain/*radiography ; Cross-Sectional Studies ; Dementia/pathology/prevention & control ; Diabetes Complications/diagnosis ; Female ; Humans ; Hyperlipidemias/complications ; Hypertension/complications ; Interviews as Topic ; Male ; Middle Aged ; Odds Ratio ; Periodontal Diseases/complications/*diagnosis ; Predictive Value of Tests ; Risk Factors ; Stroke/pathology/prevention & control ; Tomography, X-Ray Computed ; Tooth Loss

Periodontal disease is a potential predictor of stroke and cognitive impairment. However, this association is unclear in adults aged 50 yr and above without a history of stroke or dementia. We evaluated the association between the number of teeth lost, indicating periodontal disease, and cognitive impairment in community-dwelling adults without any history of dementia or stroke. Dental examinations were performed on 438 adults older than 50 yr (315 females, mean age 63+/-7.8 yr; 123 males, mean age 61.5+/-8.5 yr) between January 2009 and December 2010. In the unadjusted analysis, odds ratios (OR) of cognitive impairment based on MMSE score were 2.46 (95% CI, 1.38-4.39) and 2.7 (95% CI, 1.57-4.64) for subjects who had lost 6-10 teeth and those who had lost more than 10 teeth, respectively, when compared with subjects who had lost 0-5 teeth. After adjusting for age, education level, hypertension, diabetes, hyperlipidemia, and smoking, the relationship remained significant (OR, 2.0; 95% CI, 1.08-3.69, P=0.027 for those with 6-10 teeth lost; OR, 2.26; 95% CI, 1.27-4.02, P=0.006 for those with more than 10 teeth lost). The number of teeth lost is correlated with cognitive impairment among community-dwelling adults aged 50 and above without any medical history of stroke or dementia.
Aged ; Aged, 80 and over ; Cognition Disorders/*diagnosis/etiology ; Cohort Studies ; Dementia/pathology ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Periodontal Diseases/complications ; Residence Characteristics ; Stroke/pathology ; *Tooth Loss

BACKGROUNDThe risk of clinical deterioration still exists in the acute phase despite the fact that patients with minor stroke may display less severe symptoms. The impact of this clinical deterioration on long-term outcomes is unknown. We characterized the clinical features of neurological deterioration (ND) in the acute phase of minor ischemic stroke (MIS) and investigated its impact on mid- and long-term outcomes.

METHODSThis was a multi-centered, prospective clinical study involving patients with MIS (the National Institutes of Health Stroke Scale, NIHSS ≤3) recruited from the China National Stroke Registry. Patients were included who had been hospitalized within 24 hours of stroke onset. Baseline characteristics, complication rates during hospitalization, etiology of stroke, as well as 3-, 6-, and 12-month post-stroke outcomes were compared between patients with and without ND during the acute phase.

RESULTSA number of 368 (15.2%) out of 2424 patients included in the study exhibited ND in the acute phase. Compared to patients without ND, patients with ND had longer hospital stay, increased rate of baseline diabetes, and multiple complications. Multivariate Logistic regression indicated that ND in acute phase was an independent factor predictive of increased dependence (adjusted odds ratio = 5.20, 95% CI, 3.51-7.70, P < 0.001) at 12-month post-stroke.

CONCLUSIONSThe risk of ND in the acute phase is high in patients with MIS. ND in the acute phase is an independent predictor for poor outcomes at 12 months post-stroke onset.

Aged ; China ; Female ; Humans ; Male ; Middle Aged ; Nervous System Diseases ; etiology ; physiopathology ; Prognosis ; Prospective Studies ; Risk Factors ; Stroke ; complications ; pathology