Nailfold capillary microscopy in lacunar infarction

Relationship between nailfold capillaroscopy parameters and the severity of diabetic retinopathy

PURPOSE

To determine whether non-invasive measurements of the nailfold capillaries (NCs) are associated with the presence and severity of diabetic retinopathy (DR) in patients with type 2 diabetes.

METHODS

Eighty-three eyes of 83 patients with type 2 diabetes were enrolled. Sixty-three age-matched non-diabetic subjects served as controls. Diabetic patients were classified by the severity of their DR: non-DR (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). We used nailfold capillaroscopy to measure NC parameters, including number, length, width, and turbidity.

RESULTS

Four NC parameters in the diabetic patients were significantly lower than in the controls (all P < 0.001). There was a statistically significant decrease in the NC parameters along with the increasing severity of DR (number: P = 0.02; all others: P < 0.001). Logistic regression analysis revealed that combining the systemic characteristics of age, sex, systolic blood pressure, estimated glomerular filtration rate, hemoglobin A1c level, and history of hypertension and dyslipidemia could indicate the presence of DR and PDR (the area under the receiver operating characteristic curve [AUC] = 0.81, P = 0.006; AUC = 0.87, P = 0.001, respectively). Furthermore, the discriminative power of DR was significantly improved (P = 0.03) by adding NC length to the systemic findings (AUC = 0.89, P < 0.001).

CONCLUSION

NC measurement is a simple and non-invasive way to assess the risk of DR and its severity.

Sparing effect of hemiplegia on skin fibrosis and microvascular involvement: reports of two cases of systemic sclerosis and review of the literature

OBJECTIVES

The sparing effect of hemiplegia in rheumatic diseases has been described, but reports on systemic sclerosis (SSc)-spectrum disorders are unusual. SSc-spectrum disorders are complex diseases of unknown origin characterized by multisystem involvement, skin and organ fibrosis, microvascular alterations, and immunologic abnormalities. We describe two cases of patients with hemiplegia who developed Raynaud׳s phenomenon and skin fibrosis of the non-paretic limb.

METHODS

Clinical, laboratory, and investigation findings of two cases with hemiplegia who developed scleroderma spectrum disorders of the non-paretic limb are presented. A review of the medical literature was performed in PubMed for all articles in English.

RESULTS

A total of 46 reports from 1935 to 2012 were identified, especially on osteoarthritis and rheumatoid arthritis. Only two case reports on patients with SSc describe asymmetric SSc skin involvement and unilateral acro-osteolysis on x-ray images of the non-paretic limb. By contrast, we report the first description of capillaroscopic microvascular changes in patients with hemiplegia and asymmetric SSc skin involvement.

CONCLUSIONS

Our cases point out the potential role of a "cross-talk" between the nervous system and the skin in SSc-spectrum disorders and suggest future directions for research in studies of pathogenesis.

Systemic small-vessel disease is not exclusively related to lacunar stroke. A pilot study

BACKGROUND AND PURPOSE

Lacunar infarcts usually results from a vasculopathy of the small vessels of the brain. It is not known whether this small-vessel disease is exclusively related to the brain or part of a more systemic small-vessel disease. In this study, patients with a lacunar stroke were investigated for manifestations of extracerebral small and large-vessel disease in comparison with cortical stroke patients.

METHODS

Twenty-nine patients with a lacunar stroke, presumably caused by small-vessel disease, and 30 patients with a cortical stroke, presumably caused by large-vessel disease, entered the study. Extracerebral large-vessel disease was investigated using carotid and renal duplex scanning and Doppler sonography of the large leg vessels. Extracerebral small-vessel disease was studied from photographs of the retina, renal perfusion scintigraphy before and after angiotensin-converting enzyme inhibition, plasma renin measurement, and capillary microscopy of the nailfold.

RESULTS

Vascular risk factor profile was similar in both stroke subgroups. Carotid large-vessel disease (stenosis > or =50%) was significantly less frequent among lacunar stroke patients (lacunar 3% v cortical 50%, (c)OR=0.04; 95% CI, 0.01 to 0.21, P<.01). Large-vessel disease of the renal artery (lacunar 23% v cortical 27%), and the legs (lacunar 38% v cortical 37%) was similar in both stroke groups. There was a high frequency of mild retinal arteriolosclerosis in both groups (lacunar 92% v cortical 80%). Renal blood flow changes were abnormal in 40% of the lacunar and 38% of the cortical stroke patients as a sign of renal small-vessel disease. Plasma renin concentrations did not differ between both groups. Both lacunar and cortical stroke patients had normal nailford capillary morphology, but red blood cell dynamics were reduced in both stroke groups, indicating small-vessel dysfunction.

CONCLUSION

Lacunar and cortical stroke patients have both manifestations of systemic small-and large-vessel disease. Therefore, systemic small-vessel disease is not exclusively related to lacunar stroke patients who presumably have cerebral small vessel disease. A similar conclusion can be reached in cortical stroke patients.