卒中后癲癇（Post-stroke epilepsy，PSE）是指繼發于腦卒中的癲癇發作且既往無癲癇發作史，其病因包括出血性腦卒中和缺血性腦卒中。雖然缺血性 PSE 的發生率低于出血性腦卒中，但由于缺血性卒中患病率遠高于出血性腦卒中，從而缺血性 PSE 患者也多于出血性 PSE 患者。作為腦卒中的常見并發癥，卒中后早期癲癇發作會加重腦組織損傷，直接影響患者預后。為了研究缺血性 PSE 的發病機制，制定合理的治療方案，構建了各種動物模型。文章就缺血性 PSE 動物模型研究進展進行綜述。
ObjectiveTo systematically review the correlation between atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis.
MethodsLiterature search was carried out in PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2014), CBM and WanFang Data up to April 2014 for the domestic and foreign cohort studies on atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2.
ResultsA total of 7 cohort studies were finally included involving 69 017 cases. The results of meta-analysis showed that, compared with patients without atrial fibrillation, atrial fibrillation reduced 3-month favourable nerve function of patients with atrial fibrillation (OR=0.85, 95%CI 0.73 to 0.98, P=0.03) but did not influence the risk of death after intravenous thrombolysis (OR=1.47, 95%CI 0.75 to 2.86, P=0.26); and increased the risks of intracranial haemorrhagic transformation (OR=1.36, 95%CI 1.26 to 1.47, P < 0.001) and symptomatic intracranial hemorrhage after intravenous thrombolysis (OR=1.43, 95%CI 1.02 to 1.99, P=0.04).
ConclusionFor patients with ischemic stroke, atrial fibrillation does not influence the risk of death, but it increases the risks of intracranial hemorrhage, and worsens 3-month favourable nerve function of after intravenous thrombolysis. For those patients, more assessment before intravenous thrombolysis and more monitoring after intravenous thrombolysis are necessary. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.
Objective To systematically assess the clinical efficacy and safety of cilostazol for preventing ischemic stroke recurrence. Methods Such databases as PubMed, The Cochrane Library, EMbase, CNKI, CBM, and VIP were searched for randomized controlled trials (RCTs) on the use of cilostazol to prevent ischemic stroke recurrence (up to November, 2010). Two researchers selected studies and extracted data independently using a designed extraction form. The quality of included trials was evaluated and RevMan 5.0 software was used for meta-analyses. Results Four RCTs involving 3 916 patients were included. The results of meta-analyses showed that there were significant differences between cilostazol and aspirin in terms of hemorrhagic stroke occurrence (RR=0.39, 95%CI 0.24 to 0.61, Plt;0.000 1), headache occurrence (RR=1.99, 95%CI 1.16 to 3.43, P=0.01) and dizziness occurrence (RR=1.43, 95%CI 1.13 to 1.79, P=0.002). Whereas, no significant difference was found between the two groups in terms of ischemic stroke recurrence (RR=0.80, 95%CI 0.61 to 1.04, P=0.10) and transient ischemic attack occurrence (RR=0.93, 95%CI 0.45 to 1.92, P=0.85). Conclusion The current evidence indicates that cilostazol is as effective as aspirin in preventing ischemic stroke recurrence, but with less incidence of hemorrhagic stroke.
Objective The baseline, clinical characteristics, and risk factors were analyzed in the stroke registry program of the Xinjiang Production Constraction Corp’s Hospital aimed to aid the clinical management and stroke prevention. Method A single center prospective method based on Lausanne Stroke Registry was used in this study. Patients generally, past history, living conditions, onset to treatment time, the stroke scale were collected with 1 year follow up. The investigators of follow up were single blinded. Result Eight hundred and ten ischemic stroke patients were included, of which 478 (59.01%) were male, 332 (40.99%) were female. The average age of these patients was 66.50±10.66 years. One year loss rate of follow up was 4.64%. Seven hundred and sixty-nine patients were diagnosis as acute cerebral infarction, 41 patients were TIA. The median time from onset to treatment was 15 hours. Lacunar infarction was the most common type with 334 (43.43%) patients. The average score of the National Institutes of Heath Stroke Scale was 5.55±7.24. The incidence of carotid artery plaque was 82.2%. Conclution Xinjiang region has its own characteristics of stroke with a higher carotid artery plaque rate and thrombolytic therapy ratio. Good stroke registration system could standardize the clinical behavior and promote the continuous improvement of medical quality.
ObjectiveTo investigate the relationship between the level of homocysteine (HCY) and the overall burden of cerebral small vessel disease (CSVD) in patients with ischemic stroke.MethodsA total of 322 patients with first-ever ischemic stroke admitted to the People’s Hospital of Deyang City between January 2016 and December 2017 were enrolled. The patients’ demographic information, clinical information, and serum HCY concentration were collected after admission. The presence or absence of a CSVD was assessed by MRI and the overall burden score for the CSVD was determined. Multivariate logistic regression analysis was used to assess whether serum HCY level was associated with the overall burden of CSVD.ResultsThe median level of HCY was 13.2 μmol/L (inter-quartile range: 4.3 to 22.6 μmol/L). Univariate analysis showed that the difference of HCY levels among patients with different total CSVD scores was statistically significant (F=6.874, P=0.001); Spearman correlation analyses showed that the HCY level grouped by quartiles was correlated to the number of lacunar infarctions (rs=0.267, P=0.001), Fazekas score of white matter lesions (rs=0.122, P=0.042), and enlarged perivascular space (EPV) score (rs=0.319, P=0.001), but was not correlated to cerebral microhemorrhage (rs=?0.010, P=0.869). After multivariate regression analysis to adjust the effects of other factors, compared with the patients with HCY levels in the lowest quartile group, the patients with HCY levels in the highest quartile group were more likely to develop lacunar infarction [odds ratio (OR)=1.892, 95% confidence interval (CI) (1.012, 2.987)], white matter lesions [OR=1.548, 95%CI (1.018, 1.654)], severe EPV [OR=6.347, 95%CI (3.592, 13.978)], and the increase in the CSVD score [OR=2.981, 95%CI (1.974, 5.398)].ConclusionIn patients with ischemic stroke, elevated HCY levels may be associated with the overall burden of the CSVD.
Objective To systematically evaluate the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. Methods Databases including PubMed, EMbase, BIOSIS and CNKI were electronically searched from establishment dates of databases to June 2012 to retrieve animal experiments on the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. The relevant studies were identified according to the predefined inclusion and exclusion criteria, the data were extracted, and the quality was evaluated. Then meta-analysis was performed using RevMan 5.1 software. Results Eight studies were included. The results of meta-analysis showed that no significant difference was found between the alcohol intervention group and the control group (MD=?6.98%, 95%CI ?20.38% to 6.43%, P=0.31). However, compared with the control group, low dose of acute alcohol intervention (less than 2 g/kg) improved the prognosis of ischemic stroke with a significant difference (MD=?22.83%, 95%CI ?38.77% to ?6.89%, P=0.005), and highly-concentrated of chronic alcohol intervention worsened the cerebral ischemic damage of rats and mice with a significant difference (MD=24.06%, 95%CI 10.54% to 37.58%, P=0.000 5). Conclusion Low dose of acute alcohol intervention (less than 2 g/kg) could improve the prognosis of rats and mice with ischemic stroke which has the potential neuro-protective effects. However, highly-concentrated chronic alcohol intervention could worsen the cerebral ischemic damage. Due to the limitations of the included studies such as publication bias, the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke could be overestimated.
Objective To formulate an evidence-based treatment plan for a patient with ischemic stroke accompanied by hypertension and atrial fibrillation. Methods We searched The Cochrane Library (Issue 4, 2006), SUMsearch (January 1980 to December 2006) and PubMed (January 1980 to December 2006) to identify randomized controlled trials (RCTs), systematic reviews (SRs) and meta-analyses about the efficacy and safety of anticoagulant therapy for ischemic stroke coupled with atrial fibrillation, and blood pressure lowering therapy for ischemic stroke coupled with hypertension. We evaluated the validity, reliability and feasibility of each study to identify the current best evidence. Results Four guidelines, 3 SRs and 6 RCTs were included. The evidence showed that low-intensity anticoagulant therapy was safe and effective for this patient, and that rapid blood pressure lowering therapy was not suitable for acute ischemic stroke. According to the current evidence, as well as the patient’s clinical condition and preference, low-intensity warfarin was given with a target INR (international normalized ratio) of 2.0. During convalescence, he was given oral fosinopril and indapamide. His symptoms were relieved after two weeks of treatment, and follow-up at one month indicated that this plan was suitable for the patient. Conclusions Anticoagulant therapy is still preferred for acute ischemic stroke accompanied by hypertension and atrial fibrillation. The current evidence suggests that warfarin is superior to other anticoagulants. The target INR should be adjusted individually, especially in old patients. The maintenance of a low INR level, if necessary, could maximise utility and minimise the risk of hemorrhage. Aspirin is recommended when anticoagulants cannot be tolerated. Intensive blood pressure lowering therapy is not reasonable for patients with acute ischemic stroke. Antihypertensive drugs like ACEI and low-dose diuretics may be chosen during convalescence.
ObjectiveTo observe and compare the efficacy and safety of intravenous thrombolysis with alteplase or urokinase in the first-ever acute ischemic stroke patients arriving at the hospital 3.5-4.5 h after onset.MethodsClinical data of patients with acute ischemic stroke treated in Shihezi People’s Hospital between January 2019 and October 2020 were prospectively collected. The National Insititutes of Health Stroke Scale (NIHSS) score on the 7th day and the 90th day, the modified Rankin Scale (mRS) score and the Blessed Behavior Scale (BBS) score on the 90th day, and symptomatic bleeding within 36 h after thrombolysis were analyzed and compared between the patients receiving alteplase threatment (the alteplase group) and the ones receiving urokinase treatment (the urokinase group).ResultsTotally 96 patients were treated with intravenous thrombolysis. Among them, 58 patients received alteplase threatment and 38 received urokinase treatment. The difference in NIHSS, mRS, or BBS scores between the two groups before treatment was not statistically significant (P>0.05). On the 90th day after treatment, the NIHSS, mRS, and BBS scores of the alteplase group were 3.59±3.73, 2.26±1.26, and 15.33±8.28, respectively, and those of the urokinase group were 5.95±4.88, 3.00±0.87, and 20.37±11.80, respectively; the differences between the two groups were all statistically significant (P<0.05). There was no significant difference in the rate of symptomatic intracerebral hemorrhage between the two groups within 36 h after treatment (P>0.05). Multiple linear regression analyses showed that the treatment method was related to the NIHSS score on the 7th day, the NIHSS score on the 90th day, the mRS score on the 90th day, and the BBS score on the 90th day (P<0.05), the history of heart disease was related to the mRS score on the 90th day (P<0.05), and the income was related to the BBS score on the 90th day (P<0.05).ConclusionFor the hyperactue ischemic stroke, the overall effect of alteplase treatment may be better than that of urokinase treatment.
