OBJECTIVES: Stroke has become the leading cause of death and disability among adults in China. This study aims to analyze the disease burden based on gender and age and the risk factors for stroke subtypes in China 2019, and to provide reference for targeted stroke prevention and control. METHODS: Based on 2019 data of the Global Burden of Disease (GBD), the gender and age in patients with different stroke subtypes (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage) in China 2019 was described by using disability-adjusted life years (DALY), and attributable burden of related risk factors was analyzed. RESULTS: In 2019, the burden of intracranial hemorrhage was the heaviest one in China, resulting in 22.210 6 million person years of DALY, following by ischemic stroke and subarachnoid hemorrhage, resulting in 21.393 9 and 2.344 7 million person years of DALY, respectively. Among them, except the 0-14 age group, the disease burden of different subtypes of stroke in men was higher than that in women. The disease burden of ischemic stroke was increased with age in both men and women, with the heaviest disease burden in ≥70 years group. The disease burden of intracranial hemorrhage and subarachnoid hemorrhage was the heaviest in males aged 50-69 years old, and in females aged ≥70 years and 50-69 years, respectively. Metabolic factors were the main risk factors in all ages of different stroke subtypes, and the most important risk factor was high systolic blood pressure. Other risk factors were different between men and women. Smoking, high body mass index, high low-density lipoprotein, and outdoor particulate matter pollution were the main risk factors for stroke in men, while high body mass index, outdoor particulate matter pollution, and high fasting blood glucose were the main risk factors of stroke in women. The main risk were different among different age groups. CONCLUSIONS The burden and attributable risk factors for different stroke subtypes are discrepancy in different gender and age groups. Targeted interventions should be conducted in the future to reduce the burden of stroke.
Male ; Adult ; Humans ; Female ; Infant, Newborn ; Infant ; Child, Preschool ; Child ; Adolescent ; Middle Aged ; Aged ; Subarachnoid Hemorrhage/epidemiology* ; Quality-Adjusted Life Years ; Cost of Illness ; Stroke/etiology* ; Risk Factors ; China/epidemiology* ; Particulate Matter ; Ischemic Stroke ; Intracranial Hemorrhages/etiology*

OBJECTIVE: Mechanical thrombectomies with balloon-guide catheters (BGC) are thought to improve successful recanalization rates and to decrease the incidence of distal emboli compared to thrombectomies without BGC. We aimed to assess the effects of BGC on the outcomes of mechanical thrombectomy in acute ischemic strokes.METHODS: Studies from PubMed, EMBASE, and the Cochrane library database from January 2010 to February 2018 were reviewed. Random effect model for meta-analysis was used. Analyses such as meta-regression and the “trim-and-fill” method were additionally carried out.RESULTS: A total of seven articles involving 2223 patients were analyzed. Mechanical thrombectomy with BGC was associated with higher rates of successful recanalization (odds ratio [OR], 1.632; 95% confidence interval [CI], 1.293–2.059). BGC did not significantly decrease distal emboli, both before (OR, 0.404; 95% CI, 0.108–1.505) and after correcting for bias (adjusted OR, 1.165; 95% CI, 0.310–4.382). Good outcomes were observed more frequently in the BGC group (OR, 1.886; 95% CI, 1.564–2.273). Symptomatic intracranial hemorrhage and mortality did not differ significantly with BGC use.CONCLUSION: Our meta-analysis demonstrates that BGC enhance recanalization rates. However, BGC use did not decrease distal emboli after mechanical thrombectomies. This should be interpreted with caution due to possible publication bias and heterogeneity. Additional meta-analyses based on individual patient data are needed to clarify the role of BGC in mechanical thrombectomies.
Bias (Epidemiology) ; Catheters ; Humans ; Incidence ; Intracranial Hemorrhages ; Methods ; Mortality ; Population Characteristics ; Publication Bias ; Stroke ; Thrombectomy

Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology remains unknown, recent genetic studies identified RNF213 in the 17q25-ter region as an important susceptibility gene of MMD among East Asian populations. Possibly because of genetic differences, MMD is relatively common in people living in East Asian countries such as Korea and Japan, compared to those in the Western Hemisphere. The prevalence of MMD appears to be slightly lower among Chinese, compared to Koreans or Japanese. There are two peaks of incidence with different clinical presentations, at around 10 years and 30-40 years. The peak appears to occur later in women than men. In children, ischemic symptoms, especially transient ischemic attacks, are predominant. Intellectual decline, seizures, and involuntary movements are also more common in this age group. In contrast, adult patients present with intracranial hemorrhage more often than pediatric patients. In patients with MMD, intracerebral hemorrhage is more often accompanied by intraventricular hemorrhage than in patients with hypertensive intracerebral hemorrhage. These different age peaks and different clinical presentations in each age group are also observed in MMD patients in the USA. Catheter angiography is the diagnostic method of choice. Magnetic resonance (MR) angiography and computed tomographic angiography are noninvasive diagnostic methods. High-resolution vessel wall MR imaging also helps diagnose MMD by revealing concentric vessel wall narrowing with basal collaterals.
Adult ; Angiography ; Asian Continental Ancestry Group ; Brain ; Carotid Artery, Internal ; Catheters ; Cerebral Hemorrhage ; Child ; Constriction, Pathologic ; Diagnosis* ; Dyskinesias ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Japan ; Korea ; Magnetic Resonance Imaging ; Male ; Moyamoya Disease* ; Prevalence ; Seizures

Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology remains unknown, recent genetic studies identified RNF213 in the 17q25-ter region as an important susceptibility gene of MMD among East Asian populations. Possibly because of genetic differences, MMD is relatively common in people living in East Asian countries such as Korea and Japan, compared to those in the Western Hemisphere. The prevalence of MMD appears to be slightly lower among Chinese, compared to Koreans or Japanese. There are two peaks of incidence with different clinical presentations, at around 10 years and 30-40 years. The peak appears to occur later in women than men. In children, ischemic symptoms, especially transient ischemic attacks, are predominant. Intellectual decline, seizures, and involuntary movements are also more common in this age group. In contrast, adult patients present with intracranial hemorrhage more often than pediatric patients. In patients with MMD, intracerebral hemorrhage is more often accompanied by intraventricular hemorrhage than in patients with hypertensive intracerebral hemorrhage. These different age peaks and different clinical presentations in each age group are also observed in MMD patients in the USA. Catheter angiography is the diagnostic method of choice. Magnetic resonance (MR) angiography and computed tomographic angiography are noninvasive diagnostic methods. High-resolution vessel wall MR imaging also helps diagnose MMD by revealing concentric vessel wall narrowing with basal collaterals.
Adult ; Angiography ; Asian Continental Ancestry Group ; Brain ; Carotid Artery, Internal ; Catheters ; Cerebral Hemorrhage ; Child ; Constriction, Pathologic ; Diagnosis* ; Dyskinesias ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Japan ; Korea ; Magnetic Resonance Imaging ; Male ; Moyamoya Disease* ; Prevalence ; Seizures

PURPOSE: The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. MATERIALS AND METHODS: Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. RESULTS: There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. CONCLUSION: Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA.
Adult ; Aged ; Aneurysm, Ruptured ; Angiography, Digital Subtraction/*methods ; Cerebral Angiography/*methods ; Female ; Humans ; Imaging, Three-Dimensional/*methods ; Incidence ; Intracranial Aneurysm/epidemiology/*radiography/therapy ; Intracranial Hemorrhages/*epidemiology ; Male ; Middle Aged ; Recurrence ; Risk Factors ; Tomography, X-Ray Computed

PURPOSE: The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. MATERIALS AND METHODS: Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. RESULTS: There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. CONCLUSION: Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA.
Adult ; Aged ; Aneurysm, Ruptured ; Angiography, Digital Subtraction/*methods ; Cerebral Angiography/*methods ; Female ; Humans ; Imaging, Three-Dimensional/*methods ; Incidence ; Intracranial Aneurysm/epidemiology/*radiography/therapy ; Intracranial Hemorrhages/*epidemiology ; Male ; Middle Aged ; Recurrence ; Risk Factors ; Tomography, X-Ray Computed

OBJECTIVETo investigate the incidence of constipation after stroke and explore the relationship between post-stroke constipation and brain injury.

METHODSUsing a self-designed questionnaire, we collected the general information of 723 inpatients from 10 hospitals in Guangzhou, including the general demographic information, related factors of brain injury, defecation and previous history.

RESULTSThe total incidence of post-stroke constipation was 34.6% in these patients. The incidence of constipation was 31.0% in ischemic stroke patients, 44.8% in hemorrhagic stroke patients, and 47.4% in patients with cerebral hemorrhage and infarction, showing a significant difference between stroke types (χ(2)=12.369, P=0.002). In terms of stages following stroke, the incidence was 41.6% in the acute phase, 31.5% in the recovery phase, and 22.6% in the sequelae phase. In light of lesion locations, the incidence was significantly higher in patients with basal ganglia involvement than in those without (P<0.001). Logistic multivariate analyses showed that stroke type, post-stroke stage, lesion number and basal ganglia involvement were significantly associated with the incidence of constipation.

CONCLUSIONConstipation often occurs in the acute stage following stroke (especially hemorrhagic stroke), and the incidence is higher in patients with basal ganglia involvement.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries ; epidemiology ; Brain Ischemia ; epidemiology ; Cerebral Hemorrhage ; epidemiology ; Constipation ; complications ; epidemiology ; Female ; Humans ; Intracranial Hemorrhages ; epidemiology ; Male ; Middle Aged ; Risk Factors ; Stroke ; complications ; Surveys and Questionnaires ; Young Adult

Age Distribution ; Blood Coagulation Factors ; therapeutic use ; Child ; Child, Preschool ; Developed Countries ; Developing Countries ; Factor VIII ; therapeutic use ; Hemarthrosis ; epidemiology ; etiology ; prevention & control ; Hemophilia A ; complications ; drug therapy ; epidemiology ; Humans ; Intracranial Hemorrhages ; epidemiology ; etiology ; prevention & control ; Joint Diseases ; prevention & control ; Quality of Life ; Severity of Illness Index

The factors related to death and functional recovery after primary pontine hemorrhage (PPH) in Koreans has not been well defined. The authors sought to identify independent predictors of death and functional recovery after PPH using data obtained at a single institute. Data were collected retrospectively on 281 patients with PPH admitted to the Stroke Unit at our hospital between January 1, 2000 and December 31, 2009. Multivariate logistic regression analysis was used to evaluate the associations between selected variables and 30-day mortality and 90-day functional recovery after PPH. One-hundred and ten patients (39.1%) died within 30 days of PPH and 27 patients (9.6%) achieved functional recovery within 90 days. By multivariate analysis, unconsciousness, dilated pupils, abnormal respiration, systolic blood pressure < 100 mmHg, hydrocephalus, and conservative treatment were found to be predictors of 30-day mortality, whereas consciousness, intact motor function, no history of hypertension or diabetes mellitus, intact eye movement, a hematoma volume of < 5 mL, no ventricular hemorrhage, and normally sized ventricle were found to be predictors of 90-day functional recovery. The present findings suggest that systolic hypotension of less than 100 mmHg may predict 30-day mortality and a history of underlying hypertension and diabetes mellitus may predict 90-day functional recovery.
Adult ; Aged ; Aged, 80 and over ; Blood Pressure ; *Brain Stem ; Diabetes Complications ; Female ; Humans ; Hydrocephalus/complications ; Hypertension/complications ; Intracranial Hemorrhages/complications/epidemiology/*mortality ; Logistic Models ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; *Recovery of Function ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Time Factors ; Unconsciousness/complications

Background: Intracranial haemorrhage is a common emergency with high mortality and neurological sequelae Objectives: The aim of study were to estimate the distribution of intracranial haemorrhage between the groups of age in children and the relationship of epidemiologic characteristics to the etiology.Subjects and method: We gathered prospectively data on 621 children (0-15 ans of age) with intracranial haemorrhage in 3 years (2000, 2001, 2002) hospital records in the National Hospital Pediatrics. Results: There are annual 200 patients (0-15 ans of age) of administration. 1) Neonatal infants consisted of 97 (15,6%) patients and 35 (36,1%) of death. Some of epidemiologic characteristics associated with the etiology were premature, asphyxial over 3500 gram birth weight, interventional birth infants and infants with congenital and acquis coagulation disorders. 2) Breastfed infants consisted of 469 (75,5%) patients of administration and 52 (11,1%) of death. Infants at 29 days to 3 months of age were the most frequence (92,3%). The etiology was associated with coagulation disorders (82,9%), cholestasis (6,2%). 3)Children (1-15ans) consisted of 55 (8,9%) and 7,3% of death, specially adolescent children (7-15ans) occupied 86,3% patients in this group. The etiology could be cerebral vasculare malfmation. Conclusion: There are different distribution of administration, mortality, etiology between neonate, breastfed infants, children (1-15 ans of age)
Intracranial Hemorrhages/ epidemiology ; Child ; Infant ; Infant ; Newborn ;