Search

Stroke is a leading cause of disability with high morbidity and mortality worldwide. Of all strokes, 87% are ischemic. The only approved treatments for acute ischemic stroke are intravenous thrombolysis with alteplase within 4.5 h and thrombectomy within 8 h after symptom onset, which can be applied to just a few patients. During the past decades, ischemic preconditioning has been widely studied to confirm its neuroprotection against subsequent ischemia/reperfusion injury in the brain, including preconditioning in situor in a remote organ (such as a limb) before onset of brain ischemia, the latter of which is termed as remote ischemic preconditioning. Because acute stroke is unpredicted, ischemic preconditioning is actually not suitable for clinical application. So remote ischemic conditioning performed during or after the ischemic duration of the brain was then designed to study its neuroprotection alone or in combination with alteplase in animals and patients, which is named as remote ischemic perconditioning or remote ischemic postconditioning. As expected, animal experiments and clinical trials both showed exciting results, indicating that an evolution in the treatment for acute ischemic stroke may not be far away. However, some problems or disputes still exist. This review summarizes the research progress and unresolved issues of remote ischemic conditioning (pre-, per-, and post-conditioning) in treating acute ischemic stroke, with the hope of advancing our understanding of this promising neuroprotective strategy for ischemic stroke in the near future.

BackgroundThere are fewer reports on systemic lupus erythematosus (SLE) related myelitis, and definite and uniform therapeutic program is not available.ObjectiveTo observe the clinical manifestations, imaging characteristics, results of laboratory examination and treatment of SLE.DesignA retrospective case analysis.SettingDepartment of Neurology, the Second Affiliated Hospital of Sun Yat-sen University.ParticipantsTotally 1 052 SLE inpatients were selected from the Second Affiliated Hospital of Sun Yat-sen University from January 1995 to May 2005, and they all accorded with the diagnostic standards for SLE set by American Rheumatism Association in 1982. 124 of them were diagnosed to have damage of central nervous system. Inclusive criteria: Patients with one of the focal physical signs, including mental and behavior disorders, headache, seizure and involvement of nervous system. Exclusive criteria: Patients with hypertensive encephalopathy, damage of nervous system due to uremia and infection of central nervous system. Spinal cord lesion occurred in 15 female cases of 23–51 years old. Informed consents were obtained from all the participants.MethodsThe physical signs, laboratory examinations, therapeutic program and prognosis were recorded in the 15 patients with symptoms of spinal cord lesions. All the patients underwent MRI scan of brain or lesioned segment of spinal cord, and 8 cases of them underwent lumbar puncture to determine intracranial pressure, routine and biochemical examinations were cerebrospinal fluid were performed. The disease activity of SLE in systems beyond central nervous system was evaluated with modified lupus activity criteria count (LACC).Main outcome measures▪ Incidence of SLE related myelitis, attack age distribution and its association with the activity of SLE; ▪ Comparisons of the clinical characteristics, cranial and spinal cord MRI manifestations, different therapeutic program and prognosis.ResultsAll the 15 SLE patients were involved in the analysis of results. ▪ The incidence of SLE related myelitis was low (1%, 15/1 052). ▪ SLE related myelitis occurred mostly when the SLE symptoms were active, and only a few occurred at the stable period. ▪ Among the SLE patients, MRI displayed abnormal changes in 71% (10/14), the typical changes appeared abnormal signals at corresponding spinal segments, manifested as prolonged T1 and T2 signals, thickened spinal segments. Lumbar segments were mostly involved. ▪ Of the 9 patients treated with hormone impact, 7 cases (78%) had obvious improvements, and the effects were better in those treated with immunosuppressor combined with intravenous immunoglobulin of large dosage.Conclusion▪ Myelitis is a rare complication of SLE. ▪ MRI serves as a valuable supplementary approach in the diagnosis of SLE related myelitis without specificity. ▪ Steroid pulse combined with immunosuppressor and intravenous immunoglobulin of large dosage is effective in the treatment.