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| 1 | Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery显示文摘BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring. | Xiao-ru Che Yong-jie Wang Hai-yan Zheng | 2020 | World Journal of Emergency Medicine2020，11，3： | 41 |
| 2 | Stenting for symptomatic intracranial arterial stenosis in China:1-year outcome of a multicentre registry study显示文摘background and purpose A multicentre prospective registry study of individually tailored stenting for a patient with symptomatic intracranial atherosclerotic stenosis(ICAS)combined with poor collaterals in China showed that the short-term safety and efficacy of stenting was acceptable.However,it remained uncertain whether the low event rate could be of a long term.We reported the 1-year outcome of this registry study to evaluate the long-term efficacy of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals.Methods Patients with symptomatic ICAS caused by 70%-99% stenosis located at the intracranial internal carotid,middle cerebral,intracranial vertebral or basilar arteries combined with poor collaterals were enrolled.Balloon-mounted stent or balloon plus self-expanding stent were selected based on the ease of vascular access and lesion morphology determined by the operators.The primary outcome was the rate of 30-day stroke,transient ischaemic attack and death,and 12-month ischaemic stroke within the same vascular territory,haemorrhagic stroke and vascular death after stenting.results From September 2013 to January 2015,300 patients(ages 58.3±9.78 years)were recruited.Among them,159 patients were treated with balloon-mounted stent and 141 with balloon plus self-expanding stent.During the 1-year follow-up,25 patients had a primary end point event.The probability of primary outcome at 1 year was 8.1%(95% CI 5.3% to 11.7%).In 76 patients with digital subtraction angiography follow-up,27.6%(21/76)had re-stenosis≥50% and 18.4%(14/76)had re-stenosis≥70%.No baseline characteristic was associated with the primary outcome.Conclusion The event rate remains low over 1 year of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals.Further randomised trial of comparing individually tailored stenting with best medical therapy is needed. | Ning Ma Yong Zhang Jie Shuai Changchun Jiang Qiyi Zhu Kangning Chen Li Liu Baomin Li Xiangqun Shi Lianbo Gao Yajie Liu Feng Wang Yongli Li Tieyan Liu Hongbo Zheng Dapeng Mo Feng Gao Yilong Wang Yongjun Wang Lei Feng Zhongrong Miao | 2018 | Stroke & Vascular Neurology2018，3，3： | 29 |
| 3 | Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke显示文摘Purpose: Retrievable stents are widely used in acute ischemic stroke(AIS); however, the results remain unclear in Chinese patients. This study aimed to explore the usefulness of Solitaire AB stents in AIS. Materials and Methods: Seventy-three AIS patients treated with Solitaire AB stents for thrombectomy of large artery occlusion of anterior circulation in January 2014-June 2015 were retrospectively evaluated. Recanalization was assessed with the Thrombolysis In Cerebral Ischemia(TICI) scale. Clinical outcomes were assessed according to the National Institute of Health Stroke Scale(NIHSS) and the modified Rankin Scale(mRS). Operation-related complications were recorded. The main factors affecting successful recanalization with Solitaire AB were analyzed. Results: The 73 patients enrolled included 39 males and 34 females(median age of 59 [31-78] years); 77 Solitaire AB stents were used. The initial recanalization rate with Solitaire AB as the first thrombectomy method was 53.42%(39/73; recanalization group). Among the 34 patients with failed stent retrieval, 32 underwent other treatments; the final arterial recanalization rate was 89.04%(65/73). Perioperative embolization events and symptomatic intracranial hemorrhage(sICH) occurred in 5 and 8 patients, respectively. The mean NIHSS score was 9.12±3.86 one week after thrombectomy, significantly lower compared with admission values. In 31 patients(42.47%), NIHSS score decreased by >8. Good functional independence(mRS score≤2) was achieved in 39 patients(53.42%) at 90 days; 12 patients(16.44%) died. Compared with the recanalization group, the remaining patients showed lower AF and higher LAA percentages. Conclusion: Solitaire AB stents are useful in the endovascular treatment of AIS. | Teng-Fei Zhou Liang-Fu Zhu Tian-Xiao Li Zi-Liang Wang Wei-Xing Bai Jiang-Yu Xue Guang Feng Li Li Ying-Kun He Li-Heng Wu Bu-Lang Gao | 2018 | Journal of Interventional Medicine2018，1，2： | 21 |
| 4 | 颅内动脉瘤手术治疗的研究进展显示文摘颅内动脉瘤(intracranial aneurysms,IA)是颅内动脉壁瘤样异常突起,人群中患病率约为2%-7%,任何年龄均可发病,以40-60岁常见,女性发病率大于男性。据统计90%左右的颅内动脉瘤来自大脑前循环系统,颅内多发动脉瘤约占20%,且有多个动脉瘤患者的动脉瘤破裂发生率高于单发者。 | 盛宁 李爱民 孙勇 | 2017 | 临床神经外科杂志2017，14，2： | 18 |
| 5 | Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms显示文摘Background Endovascular treatment of intracranial aneurysms usually involves stent-assisted coiling(SAC)and flow diverters.Glycoprotein IIb/IIIa inhibitors such as tirofiban and dual antiplatelet therapy(DAPT)are required to prevent thromboembolic complications afterwards.We sought to determine the safety of tirofiban and DAPT in these cases.Methods We conducted a retrospective analysis of our database for patients with intracranial aneurysms who underwent SAC or flow diversion.The tirofiban-DAPT protocol used is described.Data regarding duration of infusion,placement of external ventricular devices(EVDs),complications,haemoglobin levels and platelet count before and 24 hours after antiplatelet therapy were collected and analysed.results One-hundred and forty-one patients with 148 aneurysms/procedures were included.110 aneurysms were treated acutely and 38 electively.Minor and major haemorrhagic events were recognised in 20%(30/148)aneurysms.Only 5(3.4%)intracerebral haemorrhages were symptomatic:3 cortical/SAH and 2 EVD-related.The average blood volume in symptomatic haemorrhages was 24.8 cc versus 5.42 cc in asymptomatic haemorrhages(p=0.002).The rate of EVD-related haemorrhages was 15.7%(19/121)and only 2(1.7%)were symptomatic.Most haemorrhagic events occurred in ruptured aneurysms(90.1%,p=0.01).No significant change in platelet count or haemoglobin levels before and 24 hours after administration of tirofiban and DAPT was documented.Concomitant administration of heparin did not increase haemorrhagic events.Conclusion The use of the GP IIb/IIIa inhibitors tirofiban and DAPT in this series was safe.Tirofiban and DAPT did not affect platelet count or haemoglobin levels and did not increase rate of symptomatic haemorrhages or thromboembolic complications. | Edgar A Samaniego Emilee Gibson Daichi Nakagawa Santiago Ortega-Gutierrez Mario Zanaty Jorge A Roa Pascal Jabbour David M Hasan | 2019 | Stroke & Vascular Neurology2019，4，1： | 17 |
| 6 | Noninvasive three-dimensional computed tomographic angiography in preoperative detection of intracranial arteriovenous malformations显示文摘Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective evaluation at a single institute over a 2 year period included 23 patients suspected of intracranial AVMs All patients underwent 3D CTA and digital subtraction angiography (DSA) Results from both procedures were compared Results 3D CTA imaging provided excellent visualization of intracranial AVMs The false positive error and false negative error were zero in our sample The details of arterial supply (numerical measure, orientation, caliber and routing) and vascular nidus (size, morphosis and location) provided by 3D CTA images were the same as DSA and the details of venous drainage were an approximate match Additionally, 3D CTA can depict tridimensional anatomical information for AVMs and their relationship to adjacent structures, a function not possible with DSA This assisted the surgeons in making better surgical planning and reduced trauma As a non invasive course, there were no related complications in the course of 3D CTA processing Conclusions DSA is still regarded as the gold standard for intracranial AVMs detection The modality of 3D CTA is accurate, noninvasive, nearly risk free and low price; we could routinely use it instead of or as a supplement to DSA, in the preoperative detection of suspected intracranial AVMs and postoperative radiological follow up 3D CTA adds tridimensional aspect and assists the surgeon in a the more accurate therapeutic scheme Preliminary data suggest that 3D CTA is playing a favorable role in the assessment of patients with intracranial | 吴劲松 陈衔城 史玉泉 陈爽 | 2000 | Chinese Medical Journal2000，，10： | 17 |
| 7 | Intracranial pressure monitoring:Gold standard and recent innovations显示文摘Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate noninvasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortionproduct oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard. | Deb Sanjay Nag Seelora Sahu Amlan Swain Shashi Kant | 2019 | World Journal of Clinical Cases2019，7，13： | 16 |
| 8 | Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes显示文摘Background The effect of cerebral small vessel disease(CSVD)and intracranial arterial stenosis(ICAS)on stroke outcomes remains unclear.Methods Data of 1045 patients with minor stroke or transient ischaemic attack(TIA)were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events(CHANCE)trial.We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale(mRS)scores using ordinal logistic regression models.Results Among the 1045 patients,CSVD was present in 830 cases(79.4%)and ICAS in 460(44.0%).Patients with>1 ICAS segment showed the highest risk of new strokes(HR 2.03,95%CI 1.15 to 3.56,p=0.01).No association between CSVD and the occurrence of new strokes was found.The presence of severe CSVD(common OR(cOR)2.01,95%CI 1.40 to 2.89,p<0.001)and>1 ICAS segment(cOR 2.15,95%CI 1.57 to 2.93,p<0.001)was associated with higher mRS scores.Severe CSVD(HR 10.70,95%CI 1.16 to 99.04,p=0.04),but not ICAS,was associated with a higher risk of bleeding events.Six-point modified CSVD score improved the predictive power for bleeding events and disability.Interpretation CSVD is associated with more disability and bleeding events,and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months.CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes. | Huimin Chen Yuesong Pan Lixia Zong Jing Jing Xia Meng Yuyuan Xu Hongyi Yan Xingquan Zhao Liping Liu Hao Li S Claiborne Johnston Yongjun Wang Yilong Wang | 2020 | Stroke & Vascular Neurology2020，5，2： | 13 |
| 9 | Stenting for intracranial stenosis:potential future for the prevention of disabling or fatal stroke显示文摘Intracranial stenosis is a common cause of ischaemic strokes,in particular,in the Asian,African and Hispanic populations.The randomised multicentre study Stenting and Aggressive Medical Management for the Prevention of Recurrent stroke in Intracranial Stenosis(SAMMPRIS)showed 14.7% risk of stroke or death in the stenting group versus 5.8% in the medical group at 30 days,and 23% in the stenting group versus 15% in the medical group at a median follow-up of 32.4 months.The results demonstrated superiority of medical management over stenting and have almost put the intracranial stenting to rest in recent years.Of note,16 patients(7.1%)in the stenting group had disabling or fatal stroke within 30 days mostly due to periprocedural complications as compared with 4 patients(1.8%)in the medical group.In contrast,5 patients(2.2%)in the stenting group and 14 patients(6.2%)in the medical group had a disabling or fatal stroke beyond 30 days,indicating significant benefit of stenting if periprocedural complications can be reduced.Recently,the results of the Chinese Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial and the Wingspan Stent System Post Market Surveillance Study(WEAVE trial)showed 2%-2.7% periprocedural complications.It is time to evaluate the role of intracranial stenting for the prevention of disabling or fatal stroke. | Wengui Yu Wei-Jian Jiang | 2018 | Stroke & Vascular Neurology2018，3，3： | 11 |
| 10 | Association between coexisting intracranial artery and extracranial carotid artery atherosclerotic diseases and ipsilateral cerebral infarction: a Chinese Atherosclerosis Risk Evaluation (CARE- II) study显示文摘Background To evaluate the association between coexisting intracranial and extracranial carotid artery atherosclerotic diseases and ipsilateral acute cerebral infarct(ACI)in symptomatic patients by using magnetic resonance(MR)vessel wall imaging.Methods Symptomatic patients were recruited from a cross-sectional,multicentre study of Chinese Atherosclerosis Risk Evaluation(CARE-II).All patients underwent MR imaging for extracranial carotid arterial wall,intracranial artery and brain.Coexisting intracranial stenosis≥50%and extracranial carotid artery mean wall thickness(MWT)≥1 mm and plaque compositions at the same side were evaluated and the ipsilateral ACI was identified.The association between coexisting atherosclerotic diseases and ACI was evaluated using logistic regression.Results 351 patients were recruited.Patients with ipsilateral ACI had significantly greater prevalence of coexisting intracranial stenosis≥50%and carotid MWT≥1 mm(20.5%vs 4.9%,p<0.001),calcification(15.1%vs 4.4%,p=0.001)and lipid-rich necrotic core(LRNC)(19.2%vs 7.8%,p=0.002)compared with those without.Coexisting intracranial artery stenosis≥50%and carotid MWT≥1 mm(OR 5.043,95%CI 2.378 to 10.694;p<0.001),calcification(OR 3.864,95%CI 1.723 to 8.664;p=0.001)and LRNC(OR 2.803,95%CI 1.455 to 5.401;p=0.002)were significantly associated with ipsilateral ACI.After adjusting for confounding factors,the aforementioned associations remained statistically significant(intracranial stenosis≥50%coexisting with carotid MWT≥1 mm:OR 4.313,95%CI 1.937 to 9.601,p<0.001;calcification:OR 3.606,95%CI 1.513 to 8.593,p=0.004;LRNC:OR 2.358,95%CI 1.166 to 4.769,p=0.017).Conclusions Coexistence of intracranial artery severe stenosis and extracranial carotid artery large burden and intraplaque components of calcification and LRNC are independently associated with ipsilateral ACI.Trial registration number http://gffzz1caf53c915c04334sqf090kokff5n6566.ffgz.tsg.suse.edu.cn/.Unique identifier:NCT02017756. | Chunxiu Jiang Jing Zhang Jianbin Zhu Xianlong Wang Zhibo Wen Xihai Zhao Chun Yuan On behalf of CARE-II Investigators | 2021 | Stroke & Vascular Neurology2021，6，4： | 11 |
| 11 | Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke显示文摘Background and purpose Transient ischaemic attack(TIA),transient symptoms with infarction(TSI)and diffusion-weighted imaging(DWI)-negative acute ischaemic stroke(AIS)share similar aetiologies but are considered to have a rather benign prognosis.We intended to investigate the association between intracranial atherosclerotic stenosis(ICAS),extracranial atherosclerotic stenosis(ECAS)and the prognosis of patients with TIA,TSI and DWI-negative AIS.Methods Clinical and imaging data of eligible participants were derived from the Chinese Intracranial Atherosclerosis study,according to symptom duration,acute infarction on DWI and discharge diagnosis.Based on the severity and location of arterial atherosclerosis,we categorised the study population into four groups:no or<50% ICAS and no ECAS;≥50% ICAS but no ECAS;no or<50%ICAS with ECAS;and concurrent≥50% ICAS and ECAS.Using multivariable Cox regression models,we analysed the relationship between the severity and distribution of large artery atherosclerosis and the prognosis of TIA,TSI and DWI-negative AIS.Results A total of 806 patients were included,67.3% of whom were male.The median age of the study participants was 63 years.Patients in the concurrent≥50% ICAS and ECAS subgroup had both a significantly higher 1-year recurrence rate(adjusted HR 3.4(95%CI 1.15 to 10.04),p=0.027)and a higher risk of composite vascular events(adjusted HR 3.82(95%CI 1.50 to 9.72),p=0.005).Conclusions Concurrent ICAS and ECAS is associated with a higher possibility of 1-year recurrent stroke or composite vascular events.Large artery evaluation is necessary to assess patients with transient ischaemic symptoms or DWI-negative AIS.Progress in shortening the time interval between symptom onset and large vessel evaluation is needed. | Yue Suo Jing Jing Yuesong Pan Weiqi Chen Hongyu Zhou Hao Li Yuehua Pu Liping Liu Xingquan Zhao Yilong Wang Xia Meng Yongjun Wang | 2021 | Stroke & Vascular Neurology2021，6，1： | 10 |
| 12 | High-resolution MRI of intracranial large artery diseases:how to use it in clinical practice?显示文摘High-resolution MRI(HRMRI)has emerged as a useful tool for clinical research in recent years.Compared with traditional cranial and vessel imaging,HRMRI provides more additional valuable pathophysiology information that is helpful for the differential diagnosis of intracranial atherosclerosis,dissection and vasculitis.However,there are some points that a neurologist should keep in mind.First,although enhanced vessel wall imaging is widely applied for research purposes,it is not appropriate for routine clinical use.Any injury or inflammation within vessel wall can result in enhancement,which is unspecific for a diagnosis.Second,although plaque components identified on HRMRI arouse researchers’interest,they may have limited positive predictive value for future stroke.Ruptured plaques may have higher prevalence in asymptomatic patients than expected.More prospective observational studies are required.Third,the vessel wall morphology features remain the useful and reliable clue for a diagnosis.It is true that eccentric vessel wall lesions most likely represent atherosclerosis if vessel dissection is easily excluded.For concentric wall lesions,however,the underlying pathophysiology is complicated,either atherosclerotic or non-atherosclerotic.Fourth,HRMRI can show luminal thrombus directly and provide valuable details.All in all,when HRMRI is used by a neurologist,it should not be viewed as the only key for a diagnosis.The diagnosis should be made based on patient history,lab works,other imaging technique and even genetic examinations. | Weihai Xu | 2019 | Stroke & Vascular Neurology2019，4，2： | 10 |
| 13 | Correlation between MMP-2 and NF-κ B expression of intracranial aneurysm显示文摘Objective:To investigate the correlation between expressions of MMP-2 and NF-κB in the intracranial aneurysm wall,and explore their role in the mechanism of the occurrence,growth and rupture of intracranial aneurysms.Methods:RT-PCR was used to detect the expression of MMP-2 and NF-κB mRNA of 30 cases of intracranial aneurysm tissue and 10 cases of normal intracranial arterial tissue:Immunohistochemical method was used to detect the expression of MMP-2 and NF-κB protein.Results:the semi-quantitative analysis of MMP-2 and NF-κB in aneurysms tissues and normal tissues were statistically significant different from each other(P<0 05).Immunohistochemical staining results showed NF-κB was expressed in different layers.The expression of them were positive in intimal and medial,and the expression sites were located in the nucleus.MMP-2 were expressed in different layers of the aneurysm wall,and the expressions were positive in media and extima.The MMP-2 and NF-κB-positive expression of aneurysm wall were significantly higher than in normal cerebral arteries(P<0.05).MMP-2 and NF-κB mRNA expression showed positive correlation in the aneurysm wall tissue(r = 0.689,P = 0.005). Conclusions:The expressions of MMP-2 and NF-κB in the intracranial aneurysm wall tissue were significantly higher than in the normal intracranial arterial tissues.They have a synergistic effect on the formation of intracranial aneurysms. | Wei-Tao Cheng Ning Wang | 2013 | Asian Pacific Journal of Tropical Medicine2013，6，7： | 10 |
| 14 | RELATIONS OF INTRACRANIAL PRESSURE, CREATINE KINASE AND BRAINSTEM AUDITORY EVOKED POTENTIAL IN PATIENTS WITH TRAUMATIC BRAIN EDEMA显示文摘We studied the relations of intracranial pressure (ICP),creatine kinase (CK) and bralnstem auditory evoked potential (BAEP) in 44 patients with traumatic brain edema who were admitted to our hospital from June 1990 to February 1991. There were 30 males and 14 females, with age range from 9 to 67 years. The results showed that the abnormal BAEP could reflect the severity of cerebral edema in acute head injury and was related to ICP and serum CK levels. When ICP>30 mmHg (4kPa), the abnormality of BAEP was more obvious than that of the control group (P<0.05); the serum CK levels were also elevated markedly. In patients with ICP over and below 4kPa, the rate of abnormal BAEP was 38.46% and 77.78% respectively (P<0.05). The serum CK level in the normal group or in the group with moderate abnormality of BAEP was significantly different from that in the group with severe abnormality or lack of BAEP (274.8± 98.24 U/L vs 705.3± 364.27 U/L; P<0.001). After treatment, the ICP returned to normal, and the BAEP | 王维平 裘明德 任海军 张星虎 | 1994 | Chinese Medical Journal1994，，3： | 9 |
| 15 | Rhombencephalitis caused by Listeria monocytogenes with hydrocephalus and intracranial hemorrhage:A case report and review of the literature显示文摘BACKGROUND Listeria monocytogenes(L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L.monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage,which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance.His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus.Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage.Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes. | Jing-Jing Liang Xiao-Yan He Hong Ye | 2019 | World Journal of Clinical Cases2019，7，4： | 9 |
| 16 | 高分辨率磁共振成像评估大脑中动脉粥样硬化性狭窄研究进展显示文摘颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)是缺血性脑卒中的主要发病机制之一,因大脑中动脉(middle cerebral artery,MCA)的供血区域广泛,且易发生粥样硬化性狭窄,其供血区域的缺血性卒中发生率高,严重威胁中国人群的健康。研究显示,颅内动脉粥样硬化易损斑块破裂是缺血性卒中发生的主要促进因素。 | 高根善 卢祖能 | 2016 | 卒中与神经疾病2016，23，2： | 9 |
| 17 | Update on the natural history of intracranial atherosclerotic disease: A critical review显示文摘Intracranial atherosclerotic disease (ICAD) contributes to a significant number of ischemic strokes. There is debate in the recent literature concerning the impact of the location of stenosis in ICAD on outcome. Some reports have suggested that disease processes and outcomes vary by vessel location, potentially altering the natural history and indications for intervention. Here we have performed a comprehensive, critical review of the natural history of ICAD by vessel in an attempt to assess the differences in disease specific to each of the vascular territories. Our assessment concludes that only minor differences exist between patients with different vessels affected in vessel-specific ICAD. We have found that middle cerebral artery disease confers a lower mortality than vessel-specific ICAD in other intracranial vessels, asymptomatic disease follows a more benign course than symptomatic disease, andthat plaque progression or the detection of microemboli on transcranial Doppler may predict poor outcome. Given the expanding indications for treatment of ICAD and rapidly developing endovascular techniques to confront this disease, a thorough understanding of the natural history of ICAD aids the interventional neuroradiologist in determining when to treat and how to predict outcome in this patient population. | Ricardo J Komotar Christopher P Kellner Daniel M Raper Dorothea Strozyk Randall T Higashida Philip M Meyers | 2010 | World Journal of Radiology2010，2，5： | 8 |
| 18 | Pathophysiology of cerebral oedema in acute liver failure显示文摘Cerebral oedema is a devastating consequence of acute liver failure(ALF)and may be associated with the development of intracranial hypertension and death.In ALF,some patients may develop cerebral oedema and increased intracranial pressure but progression to lifethreatening intracranial hypertension is less frequent than previously described,complicating less than one third of cases who have proceeded to coma since the advent of improved clinical care.The rapid onset of encephalopathy may be dramatic with the development of asterixis,delirium,seizures and coma.Cytotoxic and vasogenic oedema mechanisms have been implicated with a preponderance of experimental data favouring a cytotoxic mechanism.Astrocyte swelling is the most consistent neuropathological finding in humans with ALF and ammonia plays a definitive role in the development of cytotoxic brain oedema.The mechanism(s)by which ammonia induces astrocyte swelling remains unclear but glutamine accumulation within astrocytes has led to the osmolyte hypothesis.Current evidence also supports an alternate‘Trojan horse’hypothesis,with glutamine as a carrier of ammonia into mitochondria,where its accumulation results in oxidative stress,energy failure and ultimately astrocyte swelling.Although a complete breakdown of the blood-brain barrier is not evident in human ALF,increased permeation to water and other small molecules such as ammonia has been demonstrated resulting from subtle alterations in the protein composition of paracellular tight junctions.At present,there is no fully efficacious therapy for cerebral oedema other than liver transplantation and this reflects our incomplete knowledge of the precise mechanisms underlying this process which remain largely unknown. | Teresa R Scott Victoria T Kronsten Robin D Hughes Debbie L Shawcross | 2013 | World Journal of Gastroenterology2013，19，48： | 8 |
| 19 | Dual antiplatelet therapy may increase the risk of non-intracranial haemorrhage in patients with minor strokes: a subgroup analysis of the CHANCE trial显示文摘Aim:The aim of this study was to explore the difference between haemorrhagic events among those patients on either aspirin or aspirin plus clopidogrel who were enrolled in the Clopidogrel in High-Risk Patients with Acute Non-disabling Ischemic Cerebrovascular Events(CHANCE)trial.Methods:This was an ad hoc analysis of the CHANCE trial;data on all patients with any haemorrhagic event were reviewed and analysed.Cox proportional hazards regression was used to determine factors association with any bleeding.Results:In the CHANCE trial,there were a total of 101(2%)haemorrhagic events reported from 50 different hospitals.The clopidogrel–aspirin group had 60(2.3%)cases and the aspirin group had 41(1.6%,p=0.09).Moderate or severe haemorrhagic events occurred in 7 patients(0.3%)in the clopidogrel–aspirin group and in 8(0.3%)in the aspirin group(p=0.73).Of 36(0.7%)cases of intracranial haemorrhages,20(0.4%)were in the clopidogrel–aspirin group and 16(0.3%)in the aspirin group.Each group had 8(0.3%)cases of symptomatic haemorrhagic strokes.Other common haemorrhagic events included 24(0.5%)cases of skin bruises,13(0.3%)gastrointestinal haemorrhages,9(0.2%)gum haemorrhages and 8(0.2%)intraocular haemorrhages.Conclusions:There was no overall significant difference in haemorrhagic events(p=0.29),especially in the rate of intracranial haemorrhages between the 2 treatment groups.However,patients enrolled with minor strokes had an increased risk of haemorrhagic events regardless of treatment group,not seen in patients with high-risk transient ischaemic attacks.Being elderly,of male gender and with a history of aspirin or proton pump inhibitor usage were associated with increased risk of haemorrhage.Patients with higher body mass index had lower risk of haemorrhagic events. | David Wang Li Gui Yi Dong Hao Li Shujuan Li Huaguang Zheng Anxin Wang Xia Meng Li-Ping Liu Yi-Long Wang Guangyao Wang Jing Jing Zixiao Li Xing-Quan Zhao Yong-Jun Wang on behalf of the investigators for the CHANCE trial | 2016 | Stroke & Vascular Neurology2016，1，2： | 8 |
| 20 | 重型颅脑损伤术后颅内压监测及护理显示文摘重型颅脑损伤患者病死率极高,达到35%左右[1]。其主要原因是早期颅内压(intracranial pressure,ICP)急剧升高持续颅内压增高可引起脑血流量降低,脑供血不足,造成脑缺血、缺氧,严重者发生急性脑肿胀死亡[2]。早期持续颅内压监测有利于及时观察颅内压变化,并得到相应处理,改善患者预后,降低病死率。2010年1月至12月, | 况贝贝 方敏 汪蓉 郭学珍 | 2014 | 山西医药杂志2014，43，22： | 7 |
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