Severe Reversible Cerebral Vasoconstriction Syndrome with Large Posterior Cerebral Infarction

Brain Vascular Dysfunction in Mothers and Their Children Exposed to Preeclampsia

Preeclampsia is a maternal syndrome characterized by the new onset of hypertension and proteinuria after 20 weeks of gestation associated with multisystemic complications, including brain alterations. Indeed, brain complications associated with preeclampsia are the leading direct causes of fetal and maternal morbidity and mortality, especially in low- and middle-income countries. In addition to the well-recognized long-term adverse cardiovascular effects of preeclampsia, women who have had preeclampsia have higher risk of stroke, dementia, intracerebral white matter lesions, epilepsy, and perhaps also cognitive decline postpartum. Furthermore, increasing evidence has also associated preeclampsia with similar cognitive and cerebral disorders in the offspring. However, the mechanistic links between these associations remain unresolved. This article summarizes the current knowledge about the cerebrovascular complications elicited by preeclampsia and the potential pathophysiological mechanisms involved, emphasizing the impaired brain vascular function in the mother and their offspring.

Initial symptoms of vertebrobasilar artery occlusions and the outcomes after endovascular treatment

BACKGROUND

Acute vertebrobasilar artery occlusion (VBAO) is a devastating disease in stroke patients. This study was aimed to identify the initial symptoms of patients with acute VBAO receiving endovascular treatment and determine its associations with clinical outcomes.

METHODS

Patients with VBAO receiving endovascular treatment at 21 stroke centres in China were recruited for this derivation cohort A data-driven approach of latent class analysis was applied to identify distinct symptom typologies of VBAO patients. Multivariable binary and ordinary logistic regressions were used to evaluate the associations between symptom subtypes and clinical outcomes.

RESULTS

A total of 548 patients were analysed in this study. Four distinct subgroups were defined: the vestibular symptom group (32.8%), anterior circulation mimic group (26.5%), non-specific symptom group (14.8%) and severe VBAO symptom group (25.9%). Compared with severe VBAO symptoms, non-specific symptoms were independently associated with higher rates of favourable outcome and functional independence at the 3 months [odds ratio (OR) 2.46, 95% confidence interval (CI) 1.15-5.28; OR 3.46, 95% CI 1.54-7.79]and 1 year follow-up (OR 2.25, 95% CI 1.05-4.82; OR 2.69, 95% CI 1.22-5.92), and better functional improvement (shift in mRS score) at the 3 months (OR 2.05, 95% CI 1.15-3.67).

CONCLUSION

We identified four distinctive subtypes based on the initial symptoms of VBAO patients. Severe VBAO symptoms were associated with poor outcomes while non-specific and vestibular symptoms were indicators of a favourable outcome.

Bilateral posterior cerebral artery territory infarction in a SARS-Cov-2 infected patient: discussion about an unusual case

In time of SARS-Cov2 pandemic, neurologists need to be vigilant for cerebrovascular complications of Covid-19. We present a case of bilateral occipito-temporal infarction revealed by a sudden cortical blindness with haemorrhagic transformation after intravenous thrombolysis in a diabetic patient infected by Covid-19. Differential diagnoses are discussed in front of this unusual presentation and evolution.

Protective effect of edaravone on blood-brain barrier by affecting NRF-2/HO-1 signaling pathway

Protective effect of edaravone on blood-brain barrier (BBB) in experimental cerebral infarction rats was investigated. SD rats were prepared as the permanent middle cerebral artery occlusion model and randomly divided into 4 groups: cerebral infarction model group, edaravone low, medium and high dose groups. Healthy rats only for operation and no filament were selected as the sham operation control group. Rats in the cerebral infarction model group and the control group were given normal saline, and those in the edaravone low, medium and high dose groups were given edaravone 10, 15 and 20 mg/kg, respectively. The survival status, the body weight and neurological function score before and after treatment, the brain water content and the permeability of the blood-brain barrier after treatment were measured. The expression levels of NFE2-related factor 2 (NRF2) and hemeoxygenase 1 (HO-1) in rat brain tissue were detected by western blotting. Levels of peripheral blood malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH) were detected by ELISA. The state of the rats in three edaravone groups was improved compared with that of the cerebral infarction group. Compared with the cerebral infarction model group, the body weight was significantly increased after treatment and the neurological function score, brain tissue water content and BBB permeability were significantly decreased in three edaravone groups (P<0.05). Compared with the model group of cerebral infarction, the expression of NRF-2 and HO-1 in the brain of the three edaravone groups was significantly higher (P<0.05). Compared with the model group of cerebral infarction, the expression of MDA and GSH in the three edaravone groups was significantly decreased, GSH and SOD was increased (P<0.05), in a dose-dependent manner. Edaravone might play a protective role in the BBB by activating the NRF-2/HO-1 signaling pathway.