AIMS:The effective target for systolic blood pressure (SBP) control in patients with diabetes was inconsistent. We evaluated the emulated effect of maintaining SBP below clinical thresholds on the risk of cardiovascular disease (CVD) and all-cause mortality. MATERIALS AND METHODS:This study included 4264 patients with type 2 diabetes from the Kailaun study. We implemented the parametric g-formula to simulate the hypothetical interventions on reducing SBP below 140, 130 and 120 mmHg over time, accounting for time-varying confounding, reporting risk ratio (RR) and number needed to treat (NNT) for 10-year risk of CVD and all-cause mortality. RESULTS:Maintaining SBP below 140, 130 and 120 mmHg was associated with an 18%, 24%, and 31% relative risk reduction in the risk of CVD, with the RR (95% confidence interval [CI]) of 0.82 (0.75-0.88), 0.76 (0.69-0.86), and 0.69 (0.58-0.84), and the NNT of 32, 24, and 19, respectively, compared to no intervention. However, the benefits in reducing the risk of all-cause mortality did not reach a significant level with maintaining SBP below 140 and 130 mmHg, with the RR (95% CI) of 0.98 (0.93-1.06) and 1.04 (0.95-1.12), respectively. The risk of all-cause mortality significantly increased 15% with maintaining SBP ≤120 mmHg (RR, 1.15; 95% CI, 1.02-1.32). Subgroup analyses showed that maintaining SBP ≤120 mmHg tended to bring more harms than benefits in patients aged ≥60 years or without antihypertensive agents. CONCLUSION:Among Chinese patients with type 2 diabetes, maintaining SBP ≤120 mmHg may not be an optimal target, in terms of the risk-benefit association of CVD and all-cause mortality.

ObjectiveTo explore the incidence, risk factors, and comorbidities of persistent postural-perceptual dizziness (PPPD) after stroke.MethodsPatients with acute stroke and vestibular symptoms were enrolled prospectively and continuously. Baseline information, risk factors, imaging materials, and diagnosis were collected. PPPD, anxiety, depression, and quality of life were followed up in 6 months after stroke. Binary logistic regression was used to identify the risk factors of PPPD.ResultsIn this study, 284 patients (82.0% of males) were enrolled, with a mean age of 56.33 ± 11.87 years. Thirty-five patients (12.3%) had PPPD in 6-month follow-up. Patients with PPPD had a higher proportion of clinically significant anxiety and clinically significant depression and a lower three-level five-dimension EuroQol (EQ-5D-3L) index. Binary logistic regression analysis identified medulla oblongata stroke (OR, 5.549; p < .001), cerebellar stroke in posterior inferior cerebellar artery (PICA) territory (OR, 2.449; p = .026), and clinically significant anxiety at discharge (OR, 5.030; p < .001) were significant predictors for PPPD.ConclusionsAbout 12.3% of stroke patients with vestibular symptoms developed PPPD at 6 months after stroke, with a higher prevalence of psychological comorbidities and decreased quality of life. Medulla oblongata lesion, cerebellar (PICA territory) lesion, and clinically significant anxiety at discharge were independent risk factors for PPPD.

BACKGROUND:An innovative insulin resistance (IR)-related index of cholesterol, high-density lipoprotein, and glucose (CHG) has been linked to cardiovascular disease (CVD) risk, but there is limited evidence for the effect of a long-term pattern of CHG on CVD and all-cause mortality. This study aimed to examine the associations between cumulative CHG and the occurrence of CVD and all-cause mortality. METHODS:We incorporated 53 700 participants from the Kailuan cohort. Cumulative CHG was computed using data from the 2006 to 2010 surveys and was defined as the average CHG for each pair of subsequent surveys, multiplied by the time intervals between these surveys. A multivariate Cox proportional hazards regression model was employed to evaluate the risk of CVD and all-cause mortality from 2010 to 2021, reporting hazard ratios (HR) and 95% confidence intervals (95% CI). All participants were divided into four groups according to the quartiles of cumulative CHG, and the exposure duration of high CHG was quantified as 0, 2, 4, and 6 years. RESULTS:A total of 3739 CVD and 4853 all-cause mortality events occurred during a median follow-up of 11.06 years. After adjusting for potential covariates, participants in the highest quartile exhibited significantly increased risks of incident CVD (HR, 1.70; 95% CI: 1.55-1.88) and all-cause mortality (HR, 1.22; 95% CI: 1.13-1.33) compared to those in the lowest quartile. Participants in the 6-year exposure to high CHG exhibited significantly increased risks of incident CVD (HR, 1.79; 95% CI: 1.61-1.98) and all-cause mortality (HR, 1.23; 95% CI: 1.13-1.34) compared to those without exposure to high CHG. Receiver operating characteristic curve analysis revealed that cumulative CHG had superior predictive value for CVD and all-cause mortality compared to baseline CHG, outperforming other indices of IR. CONCLUSIONS:The high cumulative CHG was associated with an increased risk of CVD and all-cause mortality, demonstrating superior predictive performance compared to both baseline CHG and other cumulative metabolic indices. The study highlights the significance of the long-term monitoring of the CHG index in clinical practice.

ABSTRACTBackground and PurposeBasilar artery (BA) tortuosity is closely associated with posterior circulation infarction (PCI) and dizziness/unsteadiness. This study aims to determine the relationship between BA tortuosity and the outcome of dizziness and unsteadiness in PCI patients.MethodThis study prospectively recruited PCI patients presenting with dizziness and unsteadiness. BA tortuosity was diagnosed based on Smoker's criteria. The BA tortuosity index (BATI) was measured from magnetic resonance angiography (MRA) images. Posterior circulation was divided into proximal (medulla oblongata and posterior inferior cerebellar), middle, and distal territories. Symptoms, risk of falls, and quality of life were followed up in 3 months after stroke. Logistic regression was used to identify possible factors associated with the persistence of dizziness and unsteadiness.ResultsAmong 182 PCI patients presenting with dizziness and unsteadiness, 97 (53.3%) had BA tortuosity, including 19 (10.4%) with moderate‐to‐severe BA tortuosity. At the 3‐month follow‐up, 58 (31.9%) patients continued to experience dizziness and unsteadiness, with significantly decreased quality of life and a high risk of falls. Binary logistic regression analysis identified moderate‐to‐severe BA tortuosity (OR, 4.474; 95% CI, 1.591–12.579; p = 0.004) and lesions involving the proximal posterior circulation territory (OR, 2.146; 95% CI, 1.097–4.199; p = 0.026) as risk factors for persistent dizziness and unsteadiness after PCI, while thrombolysis (OR, 0.280; 95% CI, 0.079–0.992; p = 0.049) as a protective factor. BATI (OR, 1.072; 95% CI, 1.028–1.119; p = 0.001) was also independently associated with dizziness and unsteadiness after PCI.ConclusionProminent BA tortuosity increases the risk of persistent dizziness and unsteadiness after PCI, leading to a high risk of falls and decreased quality of life. This warrants more attention in clinical practice.

Objective To examine the risk factors for increased burden of cerebral small vessel diseases(CSVD)in middle-aged and elderly patients with sudden sensorineural hearing loss(SSNHL).Methods The data were retrospec-tively collected from middle-aged and elderly patients who were admitted to the hospital due to SSNHL between May 2019 and May 2023.The patients were analyzed for their clinical manifestations,hearing test results,and radiological features.All enrolled patients were assessed for total CSVD burden,and patients with varying degrees of burdens(0,1,2,and≥3 points)were compared for their differences in the clinical features and hearing features.Ordinal logistic regression was conducted to identify the independent risk factors for increased total CSVD burden in middle-aged and elderly patients with SSNHL.Results A total of 206 patients with SSNHL were enrolled,including 94 males and 112 females,with an average age of(58.70±7.98)years.The numbers of patients with a total CSVD burden of 0、1、2,and≥3 points were 108(52.4%),54(26.2%),29(14.0%),and 15(7.2%),respectively.Univariate analysis showed significant differences between different CSVD burden groups in age,hypertension status,history of drinking,low-density lipoprotein>3.1 mmol/L,and presence of dizziness at the onset of disease(P<0.05).Logistic regression analysis demonstrated that aging(OR=1.050;95%CI 1.023-1.077),hypertension(OR=1.584;95%CI 1.036-2.422),history of drinking(OR=2.304;95%CI 1.415-3.754),and presence of dizziness at the onset of disease(OR=1.691;95%CI 1.085-2.637)were independent risk factors for in-creased CSVD burden in SSNHL patients aged 45 years and above.Conclusion Aging,hypertension,history of drink-ing,and dizziness at the onset of disease are independent risk factors for increased CSVD burden in middle-aged and el-derly patients with SSNHL.Clinicians should conduct radiological evaluations on these patients to identify pa-tients with CSVD at an early stage.

Objective: To compare the differences in clinical symptoms and the time required for diagnosis of benign paroxysmal positional vertigo (BPPV) between older patients and young and middle-aged patients in the structured inquiry of dizziness history. Methods: The medical records of 6 807 patients diagnosed with BPPV from the Vertigo Database of Vertigo Clinical Diagnosis, Treatment, and Research Center of Beijing Tiantan Hospital, Capital Medical University, between January 2019 and October 2021 were retrospectively analyzed. The data included basic demographic information, clinical symptoms in a structured medical history questionnaire, and the time interval from the appearance of BPPV symptoms to diagnosis consultation. The patients were divided into the young and middle-aged group (<65 years old) and the older group (≥65 years old). The differences in clinical symptoms and consultation time were compared between these two groups. Categorical variables were represented by numbers (%), and compared using Chi-squared tests or Fisher's exact probability test for analysis; whereas, continuous variables conforming to normal distribution were represented by mean±standard deviation. Both data groups were compared and analyzed by Student's t-test. Results: The mean age of the older group was 65-92 (71±5) years, while the mean age of the middle-aged group was 18-64 (49±12) years. The incidence of vertigo (42.5% vs. 49.1%, χ2=23.69, P<0.001); vertigo triggered by changes in position of the head or body (52.4% vs. 58.7%, χ2=22.31, P<0.001); and autonomic symptoms (10.1% vs. 12.4%, χ2=7.09, P=0.008) were lower, but hearing loss (11.8% vs. 7.8%, χ2=27.36, P<0.001) and sleep disorders (18.5% vs. 15.2%, χ2=11.13, P=0.001) were higher in the older group than in the young and middle-aged group. The time from the appearance of dizziness to diagnosis was commonly longer in the older patient group than the other group (55.0% vs. 38.5%, χ2=55.95, P<0.001). Conclusions: Older patients with BPPV have more atypical symptoms and complex concomitant symptoms than young and middle-aged patients. For older patients with dizziness, positional testing is needed to confirm the possibility of BPPV even if the clinical symptoms are atypical.

目的 探索性研究伴前庭症状的急性轻型卒中患者卒中后6个月焦虑抑郁状态的危险因素及神经功能恢复情况.方法 前瞻性连续收集2020年9月—2022年9月首都医科大学附属北京天坛医院神经内科住院患者中伴发前庭症状的急性轻型卒中患者的人口学信息、卒中危险因素、发病前mRS评分、入院时NIHSS评分、卒中类型和部位.评估住院期间及卒中后6个月HAMA和HAMD评分.根据卒中后6个月HAMA和HAMD评估结果将患者分为焦虑抑郁组和非焦虑抑郁组,采用二元logistic回归分析影响患者卒中后6个月焦虑抑郁状态的危险因素,同时随访mRS以评估神经功能恢复情况.结果 共纳入患者230例,平均年龄(56.2±11.9)岁,全部患者发病6个月均预后良好(mRS评分<2分).卒中后6个月时30例患者(13.0％)存在焦虑和(或)抑郁状态.二元logistic回归分析结果显示,住院期存在焦虑和(或)抑郁状态(OR 3.734,95％CI 1.659～8.400,P=0.001)是卒中后6个月存在焦虑和(或)抑郁状态的危险因素.结论 伴前庭症状的急性轻型卒中患者整体神经功能预后良好,住院期间存在焦虑和(或)抑郁状态的患者更易在卒中后6个月继发焦虑和(或)抑郁状态.

目的 比较青年与中老年椎动脉夹层伴缺血性卒中患者的危险因素、临床特征及影像学表现.方法 本研究为横断面研究,回顾性分析2018年10月—2023年1月在首都医科大学附属北京天坛医院住院,诊断为急性缺血性卒中且病因诊断为椎动脉夹层的患者.将患者分为青年组(＜45岁)和中老年组(≥45岁),比较两组危险因素、临床特征及影像学表现的差异.结果 共纳入74例符合入组标准的患者,青年组45例,中老年组29例.青年组有头晕/眩晕症状的患者比例高于老年组(97.8％vs.79.3％,P=0.008).青年组伴有高血压、糖尿病、高脂血症、缺血性心脑血管病病史、动脉粥样硬化的比例低于中老年组.青年组发生颅内椎动脉夹层的比例低于中老年组(26.7％vs.69.0％),颅外椎动脉夹层的比例高于中老年组(73.3％vs.31.0％).结论 在椎动脉夹层所致缺血性卒中人群中,与中老年患者相比,青年患者伴有血管危险因素的比例低,颅内椎动脉夹层的发生率低,颅外椎动脉夹层的发生率高.

Objective:To analyze the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in the oldest old.Method:The clinical data of elderly patients (≥60 years old) with BPPV diagnosed in the Clinical Center for Vertigo and Balance Disturbance of Capital Medical University between January 2019 and October 2021 was collected, including basic information, clinical symptoms in a structured medical history questionnaire and the time interval from the appearance of symptoms to medical consultation. According to the age, patients were divided into elderly group (60-74 years old) and the oldest old group (≥75 years old), and the demographic information, clinical symptoms and consultation time were compared between the two groups.Results:A total of 3 019 patients with BPPV were included in analysis; there were 415 patients in the oldest-old group with the age of (79.54±3.62) years, and 2 604 patients in the elderly group with the age of (65.59±3.88) years. The incidence of vertigo, dizziness or vertigo triggered by position changes of head or body, headache and autonomic symptoms in the eldest-old group were less common than that in the elderly group (all P<0.05). But hearing loss and other types of dizziness (unable to determine the nature of dizziness or vertigo, or without typical symptoms such as dizziness, balance disorders, or instability) were more common in the eldest-old group than those in the elderly group (all P<0.05). Among 3 019 patients, 1 137 had definite time from symptom onset to diagnosis (1 004 in the elderly group and 133 in the oldest-old group), the proportion of patients with the time from the onset to diagnosis>7 days in the oldest-old group was higher than that in the elderly group ( P<0.05). Conclusion:The oldest old patients with BPPV have more atypical symptoms than the younger elderly patients.

目的 探讨急性轻型卒中患者出现卒中相关前庭症状的临床特征、演变规律,分析其持续存在的危险因素.方法 前瞻性连续纳入2020年9月-2021年9月首都医科大学附属北京天坛医院神经病学中心发病7?d内,存在前庭症状的急性轻型(NIHSS<6分)卒中(包括缺血性卒中和脑出血)住院患者,收集基线人口学信息、症状、既往史、影像学信息、入院NIHSS、最终诊断等资料.入院时采用汉密尔顿焦虑量表和汉密尔顿抑郁量表评估患者有无焦虑和(或)抑郁状态.在住院期间不同时间点和发病后3个月连续随访患者的前庭症状演变情况,采用二元logistic回归分析卒中后3个月前庭症状持续存在的危险因素.结果 最终纳入完成3个月随访的153例患者,平均年龄55.3±11.6岁,男性占85.0％(130/153).发病时前庭症状以头晕最常见(137/153,89.5％),其次为姿势性症状(107/153,69.9％)和眩晕(67/153,43.8％),前庭-视觉症状最少见(15/153,9.8％),74.5％(114/153)合并有2种或以上前庭症状.卒中后2周50.3％(77/153)的患者前庭症状缓解.卒中后3个月随访时,43例(28.1％)仍存在前庭症状,110例(71.9％)前庭症状已缓解.有前庭症状的患者仍以头晕(38/43,88.4％)和姿势性症状(29/43,67.4％)为主,仅4.6％(2/43)的患者存在眩晕,所有患者均无前庭-视觉症状.单因素分析显示,卒中后3个月前庭症状持续组后循环近段卒中比例高于无前庭症状组(58.1％?vs.?32.7％,P=0.004).二元logistic回归分析显示后循环近段卒中(OR?3.75,95％CI?1.71～8.25,P=0.001)和入院时NIHSS高(OR?1.35,95％CI?1.06～1.73,P=0.017)是患者发病后3个月前庭症状持续存在的独立危险因素.结论 急性轻型卒中患者存在的卒中相关前庭症状以头晕和姿势性症状为主,常为多种症状共存.前庭症状短期恢复情况较好,后循环近段卒中和入院时NIHSS高是卒中后3个月前庭症状持续存在的独立危险因素.

头晕和眩晕等前庭症状是社区人群和急诊科患者就诊的常见主诉,卒中是引起前庭症状的重要原因,而前庭症状的持续存在可能延缓或加重卒中患者其他功能的恢复.此外,患者既往长期存在的或卒中前新发的前庭症状可能影响患者卒中后的神经功能恢复.目前卒中相关前庭症状的临床特点、演变形式和发生机制尚不完全明了,患者的预后,尤其是卒中后持续存在的前庭症状与情绪情感障碍的关系还有待进一步研究.本文首次提出"卒中相关前庭症状"这一概念,围绕卒中事件发生前、中、后三个时期,对其临床特点、演变规律和相应的辅助检查方法的研究现状和进展进行综述.

Sneddon综合征(SS)是一种由于中小动脉闭塞引起的以广泛的皮肤网状青斑及CNS症状为特征的罕见神经皮肤综合征.在临床中,皮肤科常将其神经系统症状漏诊,误诊为"特发性网状青斑";而神经科医生往往会漏诊皮肤网状青斑.因此,SS常被误诊.现报告1例如下.

1 病例介绍 本文中的5个病例均经首都医科大学附属北京天坛医院神经病学专家,对神经系统疾病进行全面评估后,高度怀疑卵圆孔未闭(patent foramen ovale,PFO)为致病因素,完善对比增强经颅多普勒超声(contrast-enhanced transcranial doppler,cTCD)发泡试验及经食道超声心动图右心声学造影(contrast transesophageal echocardiography,cTEE)检查确诊PFO,并确定PFO大小,解剖情况及右向左分流量(right-to-left shunt,RLS).符合经皮PFO封堵适应证患者接受介入封堵治疗.封堵术后次日复查胸片和经胸超声心动图,观察封堵器如形态良好,无移位,无心房间残余分流,即可出院.出院后服用阿司匹林100 mg/d,6个月,氯吡格雷75 mg/d,3个月.

Objective To investigate the value of prothrombin channel detection index from the thrombelastography (TEG) in evaluation of the high platelet reactivity (HPR) and further prediction of recurrent ischemic events. Methods In-patients with acute ischemic cerebrovascular disease who were admitted to Center of Neurology, Beijing Tiantan Hospital, Capital Medical University and eligible for inclusion criteria were continuously enrolled into study. TEG was tested after dual antiplatelet therapy with aspirin and clopidogrel for 5 days. According to platelet inhibition rate in TEG at baseline, the patients were divided into the normal platelet reaction (NPR) group and the high platelet reaction (HPR) group. The prothrombin channel detection indexs from the TEG test were compared between the two groups. Multivariate Logistic regression analysis was used to analyze independent correlative factor for HPR. The recurrent ischemic events were followed up at month 3 and month 6 after discharge from hospital. The association between prothrombin channel detection index from the TEG and recurrent ischemic events was analyzed. Results A total of 374 patients were recruited in the study. Compared with the NPR group (n=287), the patients with HPR group (n=87) had a lower K level (P=0.047), but a higher Angle levels (P=0.026) and maximum amplitude (MA) (P=0.007). Multivariate logistic regression analysis showed that: previous history of ischemic stroke or transient ischemic attack (TIA) (OR 1.723, 95%CI 1.037-2.863,P=0.036) and Angle level (OR 1.090, 95%CI 1.008-1.180,P=0.032) was independently associated with HPR. There were 355 patients who fuliflled the 6 month follow-up, among which, there were 47 cases of recurrent ischemic events. Comparison was made between recurrent ischemic events group (n=47) and non-recurrent ischemic event group (n=308) , and there were no signiifcant differences in the K, Angle, MA and R levels of the endpoint. Conclusion Prothrombin channel detection index from the TEG is helpful to evaluate the HPR in patients with acute ischemic cerebrovascular disease, but a further study is needed to investigate value for TEG in predicting the recurrent ischemic events.

每年的8月13日是“国际左撇子日”。这个听起来有些“无厘头”的国际日，是上世纪九十年代，从美国一群“左撇子”建立的名为“左撇子国际”的组织演变产生的。该组织设立的初衷是希望把全世界的“左撇子”联合起来，消除人们对“左撇子”的偏见，争取权益。而提到“左撇子”，又会有许多人把这类人群与天才、艺术家、大师等“身份”联系起来，认为“左撇子”都是聪明人。在人类文明史上，拿破仑、歌德、毕加索、达芬奇等一批颇具“影响力”的人物，也的确都是“左撇子”。人们不禁要问：是不是“左撇子”真的比惯用右手的人聪明？它与大脑有何关系？它与健康有何关系？谈起这一切，还得先从大脑的分工说起。

OBJECTIVES:To study the relationship between plasma oxidized low-density lipoprotein (ox-LDL) and carotid plaque, including plaque stability, of patients with acute ischemic stroke among Chinese Han ethnic group.METHODS:A total of 181 patients with acute ischemic stroke were recruited and enrolled. The subjects were divided into a carotid plaque group and a no-plaque group by carotid ultrasound. The stability of carotid atheromas was assessed by ultrasound echo density, and the carotid plaque group was further divided into a vulnerable plaque group and a stable plaque group based on the echo results.RESULTS:The study showed that the correlation between age [odds ratio (OR): 1.047; 95% confidence interval (CI): 1.014-1.082; P<0.01] and carotid plaque was significant. Plasma ox-LDL (OR: 1.020; 95%CI: 1.010-1.030; P<0.001) was also found to be significantly correlated with carotid plaque. Age was irrelevant to plaque stability (P = 0.0685). The ox-LDL of the vulnerable plaque group was found to be significantly higher than that of the stable plaque group (P = 0.015). By measuring the plasma ox-LDL in patients with ischemic stroke, the proportion under the receiver operating characteristic curve of vulnerable carotid plaques was 0.690 with a 95%CI of 0.613-0.767 (P<0.001). The point of cut-off was 94.5943, the sensitivity was 0.805, and the specificity was 0.505.CONCLUSION:The plasma ox-LDL level and age are possible risk factors for carotid plaque among patients with ischemic stroke of the Chinese Han ethnic group. This study suggests that ox-LDL could be used as a biomarker in screening for vulnerable carotid plaque in clinical practice.

Objective To assess the interrater reliability and proportion of subtypes of the new classification system(K-TOAST) and compare those with TOAST.Methods A total of 408 consecutive patients with acute ischemic stroke were enrolled.All patients received prospective examination and were classified according to K-TOAST and TOAST,respectively.The interrater reliability and proportion of subtypes were assessed.Results The most frequent subtype of K-TOAST was atherothrombosis,followed by small artery disease,stroke of undetermined disease,cardioembolism,and stroke of other determined etiology.The most frequent subtype of the classic TOAST classification was large artery atherosclerosis,followed by small artery disease,stroke of other undetermined etiology,cardioembolism,and stroke of other undemonstrated etiology.The Kappa value of the K-TOAST was 0.83(P0.01).Conclusions K-TOAST classification system may reduce the number of stroke patients with other undetermined etiology and has high interrater reliability.

目的探讨不同亚型内分水岭脑梗死(IBI)与颈内动脉(ICA)或大脑中动脉(MCA)狭窄程度的关系。方法将130例缺血性卒中内分水岭梗塞患者根据核磁共振弥散成像(DWI)的形态学特征分为融合性内分水岭梗塞(CIBI)49例(融合组)、局灶性内分水岭梗塞(PIBI)59例(局灶组)和串珠样脑梗死22例(串珠组),分析其神经影像学特点。结果局灶组病灶直径明显小于融合组,P<0.01;严重狭窄发生率明显低于融合组与串珠组,P<0.01。结论 CIBI和串珠样脑梗死是ICA或MCA严重狭窄的有效预测因子。

OBJECTIVE:Elevated homocysteine level is a risk factor for ischemic stroke and associated with small vessel disease such as confluent leukoaraiosis in white and black population. We investigated the relationship between the total serum homocysteine level and ischemic stroke subtypes in Chinese population.METHODS:Three hundred and seventy-seven acute ischemic stroke and 106 transient ischemic attack patients were consecutively enrolled into this study. Demographic information and traditional risk factors were collected. Stroke subtypes were classified using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Leukoaraiosis was graded from 0 to 3 according to the severity. Small vessel disease patients were further categorized into two subgroups of having or without confluent leukoaraiosis.RESULTS:The highest homocysteine level was found in small vessel disease patients after adjusting for age, gender, traditional vascular risk factors and renal function. Homocysteine level was significantly different between the ischemic stroke and transient ischemic attack groups. Elevated homocysteine level was significantly correlated with the severity of leukoaraiosis in all patients with stroke and small vessel disease. Small vessel disease patients with leukoaraiosis had significant higher homocysteine levels than those without leukoaraiosis.CONCLUSIONS:In this group of Chinese patients studied, small vessel disease patients with confluent leukoaraiosis had the highest homocysteine levels.

Objective Proton magnetic resonance spectroscopy(MRS) can be used to study metabolite abnormalities in the brains of patients with stroke. We have used it to approach aphasia pathogenesis by observing metabolic changes of language areas on functional magnetic resonance in order to provide theoratic instruction to language rehabilitation of aphasia patients. Methods Between May 2003 and February 2005, 58 in-patients in the Neurology Ward of Beijing Tiantan Hospital, who had been diagnosed with cerebral ischemic by CT or MRI and had language disorders were enrolled for this study. We classified the aphasia types according to by the Western Aphasia Battery, Broca’s aphasia and Wernicke’s aphasia patients were examin with magnetic resonance spectroscopy(MRS). We measured the Broca’s or Wernicke’s areas macromolecules and micro molecules, in such as N-acetylaspartate(NAA), choline(Cho), creatine(Cr) and lactate(Lac), and compared the results with that of the mirror hemisphere. Results Of 58 cases, there were 39 male and 19 female. The average age was (64.02±3.87) years. There were 12 Broca’s aphasia cases and 21 Wernicke’s aphasia cases, rest the other were aphasia types. The results of NAA, Cr, Cho, Lac showed that there were statistically significant differences in the amount of NAA and Cho between Broca’s or Wernicke’s areas and the mirror hemisphere, but there were no significant differences in Cr. Lactate peak appeared in Broca’s or Wernicke’s areas, but not appeared in the mirror hemisphere, with significant differences between them. Conclusion Language areas of patients with aphasia are in a state of hypometabolism which may be one of the mechanisms of aphasia.