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J Clin Sleep Med 2021 May 7. Epub 2021 May 7.

Sleep Disorders Center, Neurological Institute, Cleveland Clinic.

Abstract: Obstructive sleep apnea (OSA) is associated with an increased risk of acute ischemic cerebrovascular accidents in adults. However, this association has not been well established in the pediatric population. We report a case of acute right internal capsule lacunar infarct manifesting as left-sided hemiplegia in an adolescent with severe obesity. Read More

Sci Rep 2021 May 6;11(1):9700. Epub 2021 May 6.

Stroke Center and Department of Neurology, National Taiwan University Hospital, No 7, Chung-Shan South Road, Taipei, 100, Taiwan.

Chinese have a higher stroke incidence and a different distribution of ischemic stroke (IS) subtypes as compared with Caucasians. Herein we aimed to investigate the prevalence and associations of major risk factors in IS and its subtypes in Chinese patients. From 2006 to 2011, we included 4953 acute IS patients consecutively recruited in National Taiwan University Hospital Stroke Registry (mean age 68 years; male 59%). Read More

Cerebrovasc Dis 2021 May 6:1-9. Epub 2021 May 6.

Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.

Lacunar stroke (LS) accounts for about one-quarter of all acute ischemic strokes, represents an important marker of cerebral small vessel disease (CSVD), and has prognostic significance in terms of recurrent vascular events and vascular cognitive impairment. Our understanding of the etiology and pathogenesis of LS is largely based on the meticulous postmortem work of C. Miller Fisher in the late 1960s, with scarce subsequent pathological analysis of the "lacunar hypothesis" and no reliable approaches for direct in vivo imaging of the small intracranial vessels. Read More

Eur J Neurol 2021 May 3. Epub 2021 May 3.

Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France.

Background And Purpose: The objectives of the present analysis were to assess 28-day stroke case fatality according to the stroke aetiology and to identify associated factors.

Methods: All stroke events in adults aged ≥35 years between 2008 and 2017 were collected in a population-based stroke registry in northern France.

Results: Out of a total of 2933 strokes, there were 479 (16%) haemorrhagic strokes and 2454 (84%) ischaemic strokes; the 28-day case fatality rates were 48% and 15%, respectively. Read More

Brain Commun 2021 1;3(2):fcab064. Epub 2021 Apr 1.

CarMeN Laboratory, Univ Lyon, INSERM U1060, INRAE 1397, Université Claude Bernard Lyon 1, Lyon, France.

Atherosclerosis is a chronic systemic inflammatory disease, inducing cardiovascular and cerebrovascular acute events. A role of neuroinflammation is suspected, but not yet investigated in the gyrencephalic brain and the related activity at blood-brain interfaces is unknown. A non-human primate model of advanced atherosclerosis was first established using longitudinal blood samples, multimodal imaging and gene analysis in aged animals. Read More

Cells 2021 Apr 9;10(4). Epub 2021 Apr 9.

Department of Neuroscience, School of Medicine, West Virginia University, Morgantown, WV 26506, USA.

Chronic brain hypoperfusion is the primary cause of vascular dementia and has been implicated in the development of white matter disease and lacunar infarcts. Cerebral hypoperfusion leads to a chronic state of brain inflammation with immune cell activation and production of pro-inflammatory cytokines, including IL-1β. In the present study, we induced chronic, progressive brain hypoperfusion in mice using ameroid constrictor, arterial stenosis (ACAS) surgery and tested the efficacy of an IL-1β antibody on the resulting brain damage. Read More

Zh Nevrol Psikhiatr Im S S Korsakova 2021 ;121(3. Vyp. 2):46-52

Privolzhsky Research Medical University, Nizhny Novgorod, Russia.

Cerebral amyloid angiopathy (CAA) is caused by the deposition of β-amyloid in small vessels in the cerebral cortex and leptomeninges. Nowadays, CAA is recognized more often due to the development of neuroimaging technologies. The frequency of CAA increases in old age that explains its frequent association with cardiovascular diseases. Read More

J Stroke Cerebrovasc Dis 2021 Apr 24;30(7):105824. Epub 2021 Apr 24.

Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain.; Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain. Electronic address:

Introduction: Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease (CSVD). We assessed whether the topography of RSSI was related to CSVD markers on magnetic resonance imaging (MRI).

Material And Methods: We screened the local registries of two independent stroke centers in Catalonia and selected patients with a symptomatic RSSI on MRI performed during admission. Read More

Stroke 2021 Apr 27:STROKEAHA120033041. Epub 2021 Apr 27.

Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain (J.C.-M., N.C., E.M., C.G.-F., M.L., I.F.-C.).

Background And Purpose: MMP (matrix metalloproteinase) levels have been widely associated with ischemic stroke risk and poststroke outcome. However, their role as a risk factor or as a subeffect because of ischemia is uncertain.

Methods: We performed a literature search of genome-wide studies that evaluate serum/plasma levels of MMPs. Read More

Int J Stroke 2021 May 7:17474930211012837. Epub 2021 May 7.

Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.

Background And Aim: Whether cerebral microbleeds cause cognitive impairment remains uncertain. We analyzed whether cerebral microbleeds are associated with cognitive dysfunction in patients with symptomatic cerebral small vessel disease, and whether this association is independent of other neuroimaging markers of cerebral small vessel disease.

Methods: We analyzed consecutive patients with MRI-confirmed lacunar stroke included in DNA-Lacunar-2 multicenter study. Read More

Eur J Hum Genet 2021 Apr 9. Epub 2021 Apr 9.

Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Genetic alterations in COL4A2 are less common than those of COL4A1 and their fetal phenotype has not been described to date. We describe a three-generation family with an intragenic deletion in COL4A2 associated with a prenatal diagnosis of recurrent fetal intracerebral hemorrhage (ICH), and a myriad of cerebrovascular manifestations. Exome sequencing, co-segregation analysis, and imaging studies were conducted on eight family members including two fetuses with antenatal ICH. Read More

J Postgrad Med 2021 Apr-Jun;67(2):93-95

IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy.

Agraphia is defined as the disruption of the previously intact writing skills due to an acquired brain damage. Stroke remains the most common cause of language impairment; however, writing disorders, including agraphia, are underestimated in patients with stroke. In this regard, we report two patients presenting with pure agraphia as an early symptom of stroke. Read More

Angiol Sosud Khir 2021 ;27(1):97-106

Chair of Cardiovascular and Endovascular Surgery, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia.

Surgical revascularization of the carotid basin in the acutest period of ischaemic stroke, i.e., within 72 hours, will make it possible to prevent the development of recurrent stroke by removing an embologenically dangerous atherosclerotic plaque of the symptomatic carotid artery and to improve cerebral blood supply, having eliminated haemodynamic stenosis of the carotid artery. Read More

BMC Neurol 2021 Apr 6;21(1):148. Epub 2021 Apr 6.

Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.

Background: Neurodegenerative disorders are characterized by insidious progression with poorly-delineated long latent period. Antecedent clinical insult could rarely unmask latent neurodegenerative disorders. Here, we report an autopsy-proven case of corticobasal degeneration which was preceded by a lacunar infarction. Read More

Eur Stroke J 2021 Mar 5;6(1):81-88. Epub 2020 Jun 5.

Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.

Background: Cerebral small vessel disease is a major cause of dementia and stroke, visible on brain magnetic resonance imaging. Recent data suggest that small vessel disease lesions may be dynamic, damage extends into normal-appearing brain and microvascular dysfunctions include abnormal blood-brain barrier leakage, vasoreactivity and pulsatility, but much remains unknown regarding underlying pathophysiology, symptoms, clinical features and risk factors of small vessel disease. The Mild Stroke Study 3 is a prospective observational cohort study to identify risk factors for and clinical implications of small vessel disease progression and regression among up to 300 adults with non-disabling stroke. Read More

Rheumatology (Oxford) 2021 Mar 27. Epub 2021 Mar 27.

Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China.

Objectives: We aimed to investigate the clinical features of Takayasu arteritis (TA) with cerebral infarction (CI) and the risk factors for CI.

Methods: The study analysed 122 consecutive patients with TA retrospectively. The clinical characteristics of TA patients with and without CI were compared. Read More

Lancet Neurol 2021 05 25;20(5):351-361. Epub 2021 Mar 25.

Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

Background: The genetic basis of lacunar stroke is poorly understood, with a single locus on 16q24 identified to date. We sought to identify novel associations and provide mechanistic insights into the disease.

Methods: We did a pooled analysis of data from newly recruited patients with an MRI-confirmed diagnosis of lacunar stroke and existing genome-wide association studies (GWAS). Read More

Lancet Neurol 2021 05 25;20(5):329-330. Epub 2021 Mar 25.

Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz 8036, Austria; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz 8036, Austria.

Adv Clin Exp Med 2021 Mar;30(3):349-356

Department of Neurology, Wroclaw Medical University, Poland.

Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. The changes affect arterioles, capillaries and small veins supplying the white matter and deep structures of the brain. It is the most common incidental finding on brain scans, especially in people over 80 years of age. Read More

Neurology 2021 04 24;96(17):e2192-e2200. Epub 2021 Mar 24.

From the Departments of Neurology (D.K., E.Z., J.S., R.J.v.O.) and Radiology and Nuclear Medicine (S.M.W., J.F.A.J., W.H.B.), Maastricht University Medical Center, the Netherlands.

Objective: To investigate the 2-year change in parenchymal diffusivity, a quantitative marker of microstructural tissue condition, and the relationship with baseline blood-brain barrier (BBB) permeability, in tissue at risk, i.e., the perilesional zone surrounding white matter hyperintensities (WMH) in patients with cerebral small vessel disease (cSVD). Read More

Cerebrovasc Dis 2021 Mar 22:1-7. Epub 2021 Mar 22.

Department of Neurology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA,

Introduction: Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. Read More

Brain Behav 2021 Mar 10:e02106. Epub 2021 Mar 10.

Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.

Background: Cerebral small vessel disease (SVD) leads to reduced quality of life (QOL), but the mechanisms underlying this relationship remain unknown. This study investigated multivariate relationships between radiological markers of SVD and domain-specific QOL deficits, as well as potential mediators, in patients with SVD.

Methods: Clinical and neuroimaging measures were obtained from a pooled sample of 174 SVD patients from the St. Read More

Front Neurol 2021 5;12:640498. Epub 2021 Mar 5.

Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.

Lacunar strokes are a common type of ischemic stroke. They are associated with long-term disability, but the factors affecting the dynamic of the infarcted lesion and the brain imaging features associated with them, reflective of small vessel disease (SVD) severity, are still largely unknown. We investigated whether the distribution, volume and 1-year evolution of white matter hyperintensities (WMH), one of these SVD features, relate to the extent and location of these infarcts, accounting for vascular risk factors. Read More

Int J Med Sci 2021 23;18(8):1840-1847. Epub 2021 Feb 23.

Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China.

High temperature requirement protein A1 (1) was identified as the causative gene of autosomal recessive arteriopathy and associated with lacunar ischemic stroke (IS) in European. This study aimed at evaluating the association of with IS and four tagging single-nucleotide polymorphisms (SNPs) were genotyped in a cohort of 4,098 Chinese. The mRNA level of in 72 IS cases and 72 hypertension controls were measured and compared. Read More

J Atheroscler Thromb 2021 Mar 21. Epub 2021 Mar 21.

Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University.

Aim: This study aimed to investigate the associations of leukocyte count with the risks of stroke and coronary heart disease among the general Japanese population.

Methods: A total of 5,242 residents aged 40-69 years living in two Japanese communities underwent leukocyte count measurements between 1991 and 2000, and the data were updated using 5- or 10-year follow-ups or both. Participants who had histories of stroke, coronary heart disease, or high values of leukocyte count (＞130×10 cells/mm) were excluded. Read More

BMJ Case Rep 2021 Mar 18;14(3). Epub 2021 Mar 18.

Department of Neurology, Royal Berkshire NHS Foundation Trust, Reading, UK.

Stroke has been called apoplexy since the ancient times of Babylonia. Johann Jakob Wepfer, a Swiss physician, first described the aetiology, clinical features, pathogenesis and postmortem features of an intracranial haemorrhage in 1655. Haemorrhagic and ischaemic strokes are the two subtypes of stroke. Read More

Front Neurol 2021 1;12:634460. Epub 2021 Mar 1.

Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom.

Lacunar strokes are a common type of ischemic stroke. They are known to have long-term cognitive deficits, but the influencing factors are still largely unknown. We investigated if the location of the index lacunar stroke or regional WMH and their change at 1 year could predict the cognitive performance at 1 and 3 years post-stroke in lacunar stroke patients. Read More

J Int Med Res 2021 Mar;49(3):300060520972601

Department of Neurology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China.

Cerebrovascular diseases mainly affect the blood supply of the brain, which has a high demand for oxygen and glucose for the nerve tissues to perform its nerve functions. Ischemic cerebrovascular disease can not only cause stroke, but is also associated with a high incidence of asymptomatic infarction and minimal bleeding that can lead to cognitive and behavioral changes. These changes ultimately manifest as vascular dementia or cognitive impairment. Read More

Neurol Genet 2021 Feb 21;7(1):e548. Epub 2021 Jan 21.

Department of Clinical Sciences Lund, Neurology (A.I., E.K., A.G.L., A.P.), Lund University; Section of Neurology (A.I., E.K., A.G.L., A.P.), Skåne University Hospital, Lund; Department of Clinical Genetics and Pathology (E.E., S.S.), Laboratory Medicine, Region Skåne; Department of Clinical Sciences Lund (E.E.), Division of Pathology, Lund University; Bioinformatics Core Facility (K.T.), Sahlgrenska Academy at University of Gothenburg, Sweden; Neurology (N.M.-M., J.P.), University of Helsinki, and Helsinki University Hospital, Finland; Department of Imaging and Function (C.H.), Skånes University Hospital, Lund; and Department of Clinical Sciences, Diagnostic Radiology (C.H.), Lund University, Sweden.

Objective: To describe a possible novel genetic mechanism for cerebral small vessel disease (cSVD) and stroke.

Methods: We studied a Swedish kindred with ischemic stroke and intracerebral hemorrhage, tremor, dysautonomia, and mild cognitive decline. Members were examined clinically, radiologically, and by histopathology. Read More

Int J Stroke 2021 Apr 7:17474930211006243. Epub 2021 Apr 7.

Department of Neurology and Cerebrovascular Center, 65462Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.

Background And Aims: This study explores the relationship between systolic blood pressure during the acute period of stroke and poor functional outcome in patients with lacunar stroke, emphasizing a possible time-dependent nature of the relationship.

Methods: Based on multicenter stroke registry data, patients with acute lacunar stroke were identified, and systolic blood pressure levels at eight time points (1, 2, 4, 8, 16, 24, 48, and 72 h) after stroke onset were extracted at the 15 participating centers in South Korea. Poor functional outcome was defined as a three-month modified Rankin Scale score of 2-6. Read More