简介：摘要Stroke is the most important cause of death and disability in China, and most strokes (~80-90%) are preventable. Recent advances in a number of measures to reduce stroke are discussed in this narrative review, including smoking cessation, a Mediterranean pattern of eating, salt restriction, B vitamins to lower homocysteine, antiplatelet therapy, anticoagulants and the management of patent foramen ovale and carotid stenosis. Lowering of homocysteine with B vitamins does prevent stroke, but patients with variants of MTHFR require higher doses of folic acid, and because of harm from cyanocobalamin among persons with renal impairment, we should use methylcobalamin or oxocobalamin instead. Aspirin resistance appears to be due to enteric coating, and ＞ 50% of Chinese have a reduced response to clopidogrel because of variants of CYP2C19, required to convert the prodrug to its active form. Direct acting oral anticoagulants (DOACs) have revolutionized anticoagulation; important differences among the DOACs are discussed. Percutaneous closure of patent foramen ovale (PFO) does reduce the risk of stroke, but in most patients with stroke and PFO the PFO is incidental; it is important to identify the subgroup in whom paradoxical embolism was the probable cause of the stroke. Some patients with PFO would be better treated with anticoagulants because of the risk of pulmonary embolism. Carotid stenting carries a higher risk in older patients, and most patients with asymptomatic carotid stenosis would be better treated with intensive medical therapy than with either stenting or endarterectomy; the few who could benefit can be identified.

简介：Themajortherapyforischemicstrokeisthrombolytictreatment,butsevereconsequencesoccurwhenthismethodisusedtotreathemorrhagicstroke.Currently,computedtomographyandmagneticresonanceimagingareusedtodifferentiatebetweentwotypesofstroke,butthesetwomethodsarein-effectiveforpre-hospitalcare.

简介：Strokeisaleadingcauseoflong-termdisability.Moststrokepatientsregaintheirfunctionpartiallyorfullyduringthefirst3–6monthsdependingonlocationandsizeofthelesion.Duringthisfunctionalrecoveryphase,corticalreorganizationorplasticityoccurs,andphysiologicalresponsivenessorneuronalexcitabilityisalteredintheipsilesionalandcontralesionalareas.However,howtodrivesuccessfulplasticchangesorsuccessfulstrokerecoveryarenotfullyelucidatedyet.

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简介：Accordingtothe"InternationalStandardofChineseHeadAcupoints"207patientssufferingfromstrokeweretreatedbyneedlingalongtheanteriorandposteriorobliguelinesofvertex-temporal,andtheline1andline2lateraltovertex.Themarkedlyeffectiverateaccountedfor73.43%ofthetotal,andtheoveralleffectiveraterepresented89.86%.Afterthetreatmentsomesymptomsashemiplegia,lingualdysfunction,facialandtongueparalysiswereobviouslyimproved(P<0.01).ThetherapeuticeffectofheadacupuncturewasobviouslybetterthanthatofWesternmedicine(P<0.01).Comparisonoftherapeuticeffectsmadeamongneedlingalongdifferentlinesandbetweenthoseappliedontheintactandaffectedsidesofthebodyshowedthattheywerealleffectiveinimprovingthesymptoms,buttherewasnosignificantdifference(P<0.05)

简介：Onehundredandseventeenacutecerebralinfarctionpatientswererandomlydivid-edintotwogroups:Scalpacupuncturegroup(GroupA)andpuremedicationgroup(GroupB).Thefunctionofthenervoussystem,brainelectricalactivitymappingandsomatosensoryevokedpotentialswereobservedbeforeandafterthetreatment.Itwasfoundthattheindexesinthetwogroupschangedsignificantly(P<0.05).ThecurativeeffectsinGroupAwerebetterthanthatinGroupB(P<0.001).Thecurativeeffectsofscalpacupunctureonacutecerebralinfarctionwereobjectivelyconfirmedbymeansofelectrophysiologicalstudies.

简介：BACKGROUND:Strokepresentsasatransientorchronicbraindysfunctionandisassociatedwithhighmorbidityandhighmortality.Thedoctorsandscientistswouldliketoarguehowtoenhancethevalidityoftherehabilitationtreatmentandhowtofurtherimprovetheleveloftreatmentonstroke.OBJECTIVE:TheaimofthisstudywastoquantitativelyanalyzethecurrentworldwideprogressinresearchonstrokerehabilitationtreatmentbasedonWebofSciencedatabaseandClinicalTrial.govinthepast10years.METHODS:WeconductedaquantitativeanalysisofclinicaltrialarticlesregardingstrokerehabilitationpublishedinEnglishfrom2003to2013andindexedintheNationalInstitutesofHealthClinicalTrialsregistryandWebofSciencedatabases.DataweredownloadedonMarch15,2013.RESULTS:(1)From2003to2013,2654clinicaltrialsinvestigatingstrokewereindexedinClinicalTrials.gov.Therewereonly58clinicaltrialsregisteredin2003,andtherewasamarkedincreasefrom2005.Atotalof605clinicaltrialsontherehabilitationofstrokewereconductedinthepast10years.(2)TheanalysisshowedthatmostofthetrialsinthefieldwereregisteredbyNorthAmericaninstitutions.WithrespecttotheAsiancountries,ChinaandTaiwanareaofChinaalsopublishedareasonableproportionofthetrials,butcomparativelyspeaking,thenumberoftrialsisreallyrare.Mostoftheinterventionsweredrugs,followedbythedevices,andbehavioralinterventionswererankedthird.(3)Inthepast10years,therewere4052studiesonstrokeindexedbyWebofSciencedatabase.CONCLUSION:Fromperspectiveofresearchprogress,wefoundthatthenumberofclinicaltrialsandpapersonstrokerehabilitationhasincreasedsignificantlyinthepast10years,betweenthemaremarkablepositivecorrelationexists.

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简介：Toinvestigatethetreatmenteffectof2-seleniumbridgedβ-cyclodextrin(2-SeCD),aGPXmimic,onthestrokeofstroke-pronespontaneouslyhypertensiverats(SHRSP),fifty-twoSHRSPof8-weekoldwererandomlydividedintofourgroupsA,B,CandcontrolgroupD.TheratsofgroupsA,B,CandDweregiven1.0%-1.5%NaClmassfractionasdrinkingfluid.Afteronsetofstroke,groupsA,BandCweregivenorally16.05,160.5and1605mg*kg-1*day-1of2-SeCD,respectively,andgroupDwasgivenwaterfor2weeks.Theclinicalscoreofstroke,systolicbloodpressure(SBP),survivaltimeofratswererecordedandthehistopathologicexaminationsoftheirbrainandcarotidarteryweremadeafterdecapitation.Theclinicalscoresofstrokeaftertreatmentwith160.5mg*kg-1*day-1(GroupB)and1605mg*kg-1*day-1(GroupC)of2-SeCDare2.55±0.98and1.98±0.79,respectively,thoseareobviouslylowerthanthatofgroupD(3.41±0.83,p<0.01).ThesurvivaldaysingroupB(10.0±8.6)andgroupC(14.4±7.9)arelongerthanthatforgroupD(4.7±2.9,p<0.01).TheelectronmicroscopestudyshowedthattheendotheliumofcarotidarterywasneartonormalingroupBandgroupC,whileitwasseriouslyinjuredincontrolgroupDandmildlyinjuredingroupA.2-SeCDmayeffectivelybeusedtotreatthestrokeforSHRSP.

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简介：AccordingtothemethodofpuncturingthetwelveJing(well)acupointstotreathemiplegiafollowYinbai(SP1),Dadun(LR1),Shangyang(LI1)andGuanchong(TE1),combiningwithselectedacupointsaccordingtothepresentingsyndromes,totreat114casesofhemiplegiafollowingastroke,thetotaleffectiveratewas91.1%.

简介：目的：观察头针、体针结合治疗中风后共济失调的临床疗效。方法：选择符合诊断标准的中风后共济失调患者124例，采用头针、体针结合治疗，观察治疗前后脑血管血液流速变化及总体治疗效果。结果：根据Berg平衡量表评定结果，总有效率93．5％。治疗前后日常生活活动能力（ActivitiesofDailyLiving，ADL）指数比较，总有效率91．1％。治疗前后椎基底动脉血液流速比较差异具有统计学意义（P〈0．05）。结论：针刺治疗中风共济失调疗效明显。

简介：血管内治疗是急性缺血性卒中治疗的有效方法,但是受到时间窗的限制。在缺血的情况下神经组织迅速死亡,因此缩短治疗时间是卒中治疗的主要目标。在2015年以前,静脉溶栓是治疗急性缺血性卒中唯一有效的手段。

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简介：Strokeisthemostcommoncomplicationofatrialfibrillation(AF).GuidelinesrecommendanticoagulanttreatmentinpatientswithCHA2DS2VAScscoresof>2.RegistrydatasuggeststhatalmosthalfofpatientswhoshouldbeontherapeuticanticoagulationforstrokepreventioninAF(SPAF)arenot.Warfarinandmorerecentlydevelopedagents,the"novelanticoagulants"(NOACs)reducetheriskofembolicstrokes.Inaddition,theNOACsalsoreduceintracranialhemorrhage(ICH)byover50%comparedtowarfarin.Anticoagulationandbridgingstrategiesinvolvingcardioversion,catheterablation,andinvasive/surgicalproceduresarereviewed.ThedevelopmentofreversalagentsforNOACsandtheintroductionofleftatrialappendageoccludingdeviceswillevolvetheuseofnewerstrategiesforpreventingstrokeinhighriskAFpatients.

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简介：AbstractBackground:Intravenous thrombolysis (IVT) is an effective way for treating acute ischemic stroke (AIS). However, its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for >4.5 h.Methods:We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT (IVT group) and placebo or usual care (control group [CG]) in AIS patients with disease onset for >4.5 h. The outcomes of interest included the favorable functional outcome (defined as modified Rankin Scale [mRS] scores 0-1) at 90 days, the functional independence (defined as mRS scores 0-2) at 90 days, proportion of patients with symptomatic intracerebral hemorrhage (sICH) and death at 90 days. We assessed the risk of bias using the Cochrane tool. Pre-specified subgroup analyses were performed by age (≤70 years or >70 years), National Institute of Health Stroke Scale (NIHSS, ≤10 or >10) and time window (4.5-9.0 h or >9.0 h).Results:Four trials involving 848 patients were eligible. The risk of bias of included trials was low. Patients in the IVT group were more likely to achieve favorable functional outcomes (45.8% vs. 36.7%; OR 1.48, 95% CI 1.12-1.96) and functional independence (63.8% vs. 55.7%; OR 1.43, 95% CI 1.08-1.90) at 90 days, but had higher risk of sICH (3.0% vs. 0.5%; OR 5.28, 95% CI 1.35-20.68) at 90 days than those in the CG. No significant difference in death at 90 days was found between the two groups (7.0% vs. 4.1%; OR 1.80; 95% CI 0.97-3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days, although IVT may induce increased risk of sICH. Care of these patients should well balance the potential benefits and harms of IVT.

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简介：摘要ObjectiveTo determine the mechanisms on cognitive improvement with repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex(L-DLPFC) in subacute stroke patients.MethodsTwenty-eight first-ever stroke patients with cognitive impairment were recruited. All subjects were randomly assigned to real or sham stimulation group and completed 10 sessions of rTMS for 2 weeks. 10 Hz of navigation rTMS were applied (5 s stimulation and 25 s resting, total 1500 pulses) on the L-DLPFC at 80% of resting motor threshold (rMT). At the time of baseline, 1 month and 3 months after stroke onset, all subjects received the Korean-mini mental state examination (K-MMSE), Korean-Montreal Cognitive Assessment (K-MOCA), Upper Fugl-Meyer Assessment (U-FMA), Korean-Modified Bathel Index (K-MBI), European Quality of life 5 Dimension (EQ-5D), Korean-Geriatric Depression Scale (K-GDS). In addition, the continuous performance test (CPT), vascular cognitive impairment harmonization standards (VCIHS), motor evoked potentials (MEP), event-related potentials (ERPs), resting state functional magnetic resonance imaging (RS fMRI) and diffusion tensor imaging (DTI) were completed at baseline and 3 months after stroke onset.ResultsAfter the intervention period, the real stimulation group improved significantly in the K-MMSE, K-MOCA, K-MBI and K-GDS compared with sham stimulation group. And these effects lasted after three months in MOCA. There was no significant time × group effect among the U-FMA, EQ-5D, and CPT. Among the VCIHS parameters, Z-scores of executive and memory function showed higher delta value between baseline and 3months timepoints in rTMS group. The MEP showed higher TIME × GROUP interaction in the intracortical inhibition value on right hand. It suggests that there is beneficial effect on premotor cortical excitability of rTMS. The change of P300 amplitude on F3 and C3 was more increased in real stimulation group significantly only in the auditry Oddball paradigm. The RS fMRI analysis results showed more increased functional connectivity of Cingulate Gyrus, Supramarginal Gyrus, Cerebelum Crus2, Precentral gyrus, Middle temporal gyrus and Inferial temporal gyrus after stimulation compared with the sham group. Brain activation in the cingulum showed a tendency that after 3 months, fractional anisotropy (FA) and fiber number (FN) in real group were larger than sham group, however there was no significant effect. The relationship between the change of K-MOCA and fractional anisotropy of the cingulum was found positive correlation in all subjects.ConclusionsThese results suggest that high frequency rTMS on the L-DLPFC improves cognitive function and functional network activity in subacute stroke. The rTMS seems to be a recommendable treatment in stroke patients with cognitive impairment.