Cerebral small vessel disease refers to a group of pathological processes, neuroimaging features, and clinical symptoms, with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. The onset of cerebral small vessel disease can be insidious. It has various symptoms, some of which can attack acutely. Acute cerebral small vessel disease is characterized by lacunar stroke and brain parenchymal hemorrhage. The latter mainly includes hypertensive hemorrhage and cerebral amyloid angiopathy. This article summarizes the research advances of acute cerebral small vessel disease from the aspects of pathogenesis, clinical manifestations, neuroimaging features, and treatment methods, discussing characteristics and clinical challenges.
Objective To investigates the metabolic changes in serum between patients with normal cognition of cerebral small vessel disease (CSVD) and those with cognitive impairment of CSVD. It aims to identify distinct metabolic pathways of CSVD-related cognitive impairment, which can provide new research directions for the diagnosis and treatment of this disease. Methods Serum samples from CSVD patients diagnosed in the Department of Neurology, West China Hospital of Sichuan University between July 2021 and December 2023 were used in this study. According to the patients’ Montreal Cognitive Assessment scores, they were divided into cognitively unimpaired CSVD group and cognitively impaired CSVD group. Untargeted metabolomic detection was performed using ultra-high performance liquid chromatography-tandem mass spectrometry. Quality control of the metabolomic data was conducted through correlation analysis of quality control samples. This study constructed an orthogonal partial least squares-discriminant analysis model to examine the relationship between metabolites and sample groups. Different metabolites were selected based on the criteria of P<0.05 and variable importance in projection >1, which were then subjected to metabolic pathway enrichment analysis. Results A total of 157 CSVD patients were included, including 51 cognitively unimpaired CSVD patients and 106 cognitively impaired CSVD patients. Untargeted metabolomics analysis, conducted in both positive and negative ion modes, identified a total of 68 significantly different metabolites between the cognitively unimpaired and cognitively impaired CSVD groups. These metabolites primarily consisted of lipids and lipid-like molecules, amino acids and their metabolites, and steroid hormones. Among these, the serum levels of 21 metabolites were increased in patients with CSVD-related cognitive impairment, while the levels of 47 metabolites were decreased. Further enrichment analysis revealed that these differential metabolites were predominantly enriched in 11 metabolic pathways, which included signaling pathways such as sphingolipid metabolism, protein digestion and absorption, and amino acid biosynthesis. Conclusions Compared with cognitively unimpaired CSVD patients, those with cognitive impairment showed increased levels of endogenous sphingolipids, such as phytosphingosine, and decreased levels of essential amino acids, including valine and leucine, in their serum. This suggests that lipid metabolism reprogramming and energy metabolism disturbances may be the main metabolic features in CSVD-related cognitive impairment. These different metabolites not only serve as promising biomarker candidates for CSVD-related cognitive impairment, but also offer new directions for investigating its pathological mechanisms.
ObjectiveTo conduct an objective record of stroke patient’s retinal diseases by retinal photography, and analyze the incidence of various retinal diseases between different subtypes of stroke.MethodsFrom June to October 2007, the consecutive cases of stroke admitted to the Department of Neurology, West China Hospital of Sichuan University were prospectively registered. Ischemic stroke patients were classified into different subtypes by the Oxfordshire Community Stroke Project criteria, and intracerebral hemorrhage (ICH) patients were classified based on the clinical manifestation and neuroimaging. We collected other clinical data associated with the incidence of stroke. The retinal abnormalities including retinopathy, arteriovenous nicking and arteriolar narrowing were recorded. Multivariate logistic regression was performed to investigate the relationship between retinal abnormalities and stroke.ResultsThis study included 199 patients with ischemic stroke and 95 patients with ICH. Among the patients with ischemic stroke, 43 (21.6%) had retinopathy, 52 (26.1%) presented with arteriovenous nicking, and 43 (21.6%) developed arteriolar narrowing. Among the patients with ICH, retinopathy occurred in 23 (24.2%), arteriovenous nicking occurred in 14 (14.7%), and arteriolar narrowing occurred in 25 (26.3%). In multivariate analysis, retinopathy was independently associated with partial anterior circulation infarct (PACI) (P=0.029) and anterior ICH (P=0.041).ConclusionsRetinopathy is independently associated with PACI and anterior ICH. Further community-based study with large sample should be conducted to confirm the predictive value of retinal diseases on the incidence of anterior stroke.
ObjectiveTo explored the accuracy and effectiveness of “swimming pool” sign in recognizing fluid attenuated inversion recovery sequence (FLAIR) compared with traditional methods, and to solve the difficulties in distinguishing T1 weighted image (TIWI) and FLAIR in clinical medical students and junior residents. Methods Using the observational research method, forty standardized training physicians who rotated in the Department of Neurology, West China hospital of Sichuan University were included as the research objects between September and November 2021. Standardized training physicians were randomly divided into “swimming pool” sign group and control group, with 20 persons in each group. In the same period, 100 patients with central nervous system infection, cerebral vascular disease, dementia syndrome, multiple sclerosis and no obvious intracranial lesions were selected from the Department of Neurology, West China Hospital of Sichuan University between September and November 2021. According to the diagnosis, the patients were divided into 5 groups with 20 cases in each group. Two groups were given the same 20 images respectively, including T1WI and FLAIR. Record the accuracy, total time-consuming and time-consuming per image of each standardized training physicians. Results Each patient had “swimming pool” sign. Under different backgrounds, the accuracy of the “swimming pool” sign group was higher than that of the control group (P<0.001), while the total time-consuming and time-consuming per image were lower than that of the control group (P<0.001). Conclusions In different nervous system diseases, “swimming pool” sign is stable on FLAIR. Compared with traditional methods, “swimming pool” sign can quickly and accurately distinguish T1WI and T2 FLAIR.