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  1. Acute bilateral medial medullary infarct with hypoplastic vertebral artery
    Tai ML, Katiman E, Rahmat K, Tan CT
    Clin Neurol Neurosurg, 2012 Dec;114(10):1365-7.
    PMID: 22512947 DOI: 10.1016/j.clineuro.2012.03.031
    Matched MeSH terms: Cerebral Infarction/diagnosis; Cerebral Infarction/drug therapy; Cerebral Infarction/etiology*
  2. Fulltext Role of Transcranial Doppler in the Evaluation of Vasculopathy in Tuberculous Meningitis
    Tai MS, Sharma VK
    PLoS One, 2016;11(10):e0164266.
    PMID: 27723828 DOI: 10.1371/journal.pone.0164266
    Vascular complications are important causes of cerebral infarction in tuberculous meningitis (TBM).Transcranial Doppler ultrasonography (TCD) is a non-invasive tool that can provide real-time information about cerebral hemodynamics. However, the literature on the role of TCD in the diagnosis or monitoring of vasculopathy associated with TBM is scarce. We explored the role of TCD in the diagnosis and monitoring of TBM-related vasculopathy of the major intracranial arteries.
    Matched MeSH terms: Cerebral Infarction
  3. Emerging paradigms in treating cerebral infarction with nanotheranostics: opportunities and clinical challenges
    Almalki WH, Alghamdi S, Alzahrani A, Zhang W
    Drug Discov Today, 2021 03;26(3):826-835.
    PMID: 33383212 DOI: 10.1016/j.drudis.2020.12.018
    Interest is increasing in the use of nanotheranostics as diagnosis, imaging and therapeutic tools for stroke management, but movement to the clinic remains challenging.
    Matched MeSH terms: Cerebral Infarction/diagnosis; Cerebral Infarction/drug therapy*; Cerebral Infarction/physiopathology
  4. An uncommon mediastinal cyst with a rare neurologic consequence
    Sivalingam S, Qureshi AU, Chern LM, Latiff HA
    Ann Thorac Surg, 2014 Apr;97(4):e93-5.
    PMID: 24694456 DOI: 10.1016/j.athoracsur.2013.12.060
    Enteric cysts are uncommon posterior mediastinal cysts, usually presenting with respiratory symptoms in infancy. We present a rare case of posterior mediastinal enteric cyst extending from below the diaphragm and perforating into the left atrium, causing a thromboembolic cerebral infarct in a 5-year-old boy.
    Matched MeSH terms: Cerebral Infarction/etiology*
  5. Risk factors and aetiology of cerebral infarction in young adults: a comparative study between Malaysia and Australia
    Tan KS, Tan CT, Churilov L, MacKay MT, Donnan GA
    Int J Stroke, 2010 Oct;5(5):428-30.
    PMID: 20854631 DOI: 10.1111/j.1747-4949.2010.00478.x
    Matched MeSH terms: Cerebral Infarction/etiology*; Cerebral Infarction/epidemiology
  6. Fulltext Cerebral infarction pattern in tuberculous meningitis
    Tai MS, Viswanathan S, Rahmat K, Nor HM, Kadir KA, Goh KJ, et al.
    Sci Rep, 2016 12 13;6:38802.
    PMID: 27958312 DOI: 10.1038/srep38802
    Tuberculous meningitis (TBM) causes significant morbidity and mortality. The primary objective was to re-examine the concept of "TB zone" and "ischaemic zone" in cerebral infarction in patients with tuberculous meningitis. The secondary objective was to evaluate cerebral infarction, vasculitis and vasospasm in tuberculous meningitis infections. Between 2009 and 2014, TBM patients were recruited. Neuroimaging was performed and findings of cerebral infarction, vasculitis and vasospasm were recorded. Infarcts were classified based on arterial supply and Hsieh's classification. Fifty-one TBM patients were recruited of whom 34 patients (67%) had cerebral infarction. Based on Hsieh's classification, 20 patients (59%) had infarcts in both "TB zone" and "ischaemic zones". 12 patients (35%) had infarcts in "ischaemic zone" and two (6%) patients had infarcts in "TB zone". In terms of vascular supply, almost all patients (35/36) had infarcts involving perforators and cortical branches. 25 patients (73%) and 14 patients (41%) had infarcts supplied by lateral lenticulostriate and medial lenticulostriate arteries respectively. 15 patients (37%) had vasculitis. Vasospasm was present in six patients (15%). 29 patients (85%) with cerebral infarction also had leptomeningeal enhancement (p = 0.002). In summary, infarcts involved mainly perforators and cortical branches, rather than "TB zone" versus "ischaemic zone".
    Matched MeSH terms: Cerebral Infarction/complications*; Cerebral Infarction/pathology*
  7. Fulltext Cerebral infarction and cerebral salt wasting syndrome in a patient with tuberculous meningoencephalitis
    Loo KL, Ramachandran R, Abdullah BJ, Chow SK, Goh EM, Yeap SS
    Southeast Asian J. Trop. Med. Public Health, 2003 Sep;34(3):636-40.
    PMID: 15115143
    A 38-year old female with underlying systemic lupus erythematosus was admitted with tuberculous meningoencephalitis. After an initial good response to anti-tuberculous treatment, she developed cerebral infarction and profound hyponatremia. This was due to cerebral salt wasting syndrome, which has only previously been described in 2 cases. The difficulties in diagnosis and management of this case are discussed.
    Matched MeSH terms: Cerebral Infarction/complications*; Cerebral Infarction/microbiology
  8. Triple Therapy Prevention of Recurrent Intracerebral Disease Events Trial: Rationale, design and progress
    Anderson CS, Rodgers A, de Silva HA, Martins SO, Klijn CJ, Senanayake B, et al.
    Int J Stroke, 2022 Dec;17(10):1156-1162.
    PMID: 34994269 DOI: 10.1177/17474930211068671
    BACKGROUND: Patients who suffer intracerebral hemorrhage (ICH) are at very high risk of recurrent ICH and other serious cardiovascular events. A single-pill combination (SPC) of blood pressure (BP) lowering drugs offers a potentially powerful but simple strategy to optimize secondary prevention.

    OBJECTIVES: The Triple Therapy Prevention of Recurrent Intracerebral Disease Events Trial (TRIDENT) aims to determine the effects of a novel SPC "Triple Pill," three generic antihypertensive drugs with demonstrated efficacy and complementary mechanisms of action at half standard dose (telmisartan 20 mg, amlodipine 2.5 mg, and indapamide 1.25 mg), with placebo for the prevention of recurrent stroke, cardiovascular events, and cognitive impairment after ICH.

    DESIGN: An international, double-blind, placebo-controlled, randomized trial in adults with ICH and mild-moderate hypertension (systolic BP: 130-160 mmHg), who are not taking any Triple Pill component drug at greater than half-dose. A total of 1500 randomized patients provide 90% power to detect a hazard ratio of 0.5, over an average follow-up of 3 years, according to a total primary event rate (any stroke) of 12% in the control arm and other assumptions. Secondary outcomes include recurrent ICH, cardiovascular events, and safety.

    RESULTS: Recruitment started 28 September 2017. Up to 31 October 2021, 821 patients were randomized at 54 active sites in 10 countries. Triple Pill adherence after 30 months is 86%. The required sample size should be achieved by 2024.

    CONCLUSION: Low-dose Triple Pill BP lowering could improve long-term outcome from ICH.

    Matched MeSH terms: Cerebral Infarction
  9. Fulltext The predictors of subclinical cerebral infarcts in ischaemic stroke patients
    Hamidon BB, Joseph JP, Raymond AA
    Med J Malaysia, 2007 Jun;62(2):114-6.
    PMID: 18705441
    Subclinical cerebral infarcts (SCI) have been increasingly shown to cause a significant clinical impact. However, there are limited data available on Asian patients. The objectives of this study were to determine the prevalence of SCI in ischaemic stroke patients seen in the Hospital Universiti Kebangsaan Malaysia (HUKM) and to identify its associated risk factors. We evaluated the brain computed tomography (CT) evidence of subclinical infarcts in ischaemic stroke patients. The patients were selected from those who were on regular follow up in the neurology clinic following an ischaemic stroke. The risk factors associated with subclinical infarct were documented. The brain CTs were done during acute admission and reviewed for SCI. Sixty-one patients were enrolled in this study. Twenty-two (36.1%) out of the 61 patients had SCI. The risk factors for SCI in our study were hypertension (OR 14.16 CI 2.04-97.89), diabetes mellitus (OR 12.48; CI 1.95-79.77) and leukoaraiosis (OR 28.39; CI 2.33-284.16). Subclinical cerebral infarcts were present in about one third of our ischaemic stroke patients. This finding is higher than in previous studies done on Caucasians. Hypertension, diabetes mellitus and leukoaraiosis independently predict SCI.

    Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
    Matched MeSH terms: Cerebral Infarction/epidemiology*
  10. A validation study of the Siriraj Stroke Score
    Kan CH, Lee SK, Low CS, Velusamy SS, Cheong I
    Int J Clin Pract, 2000 Dec;54(10):645-6.
    PMID: 11221275
    A cross-sectional study was conducted on 160 Malaysian patients to validate the usefulness of the Siriraj Stroke Score (SSS) for differentiating intracerebral haemorrhage and infarction following acute strokes. Our results indicate that the score lacks sensitivity and specificity. It should thus not be used in epidemiological studies to determine stroke types in a community. More importantly, in the absence of information from neuroimaging of the brain, it cannot be used safely by physicians to assess the need or otherwise of thrombolytic and/or anticoagulant therapy after an acute stroke.
    Matched MeSH terms: Cerebral Infarction/diagnosis*
  11. Cerebral infarction in juvenile rheumatoid arthritis
    Gururaj AK, Chand RP, Chuah SP
    Clin Neurol Neurosurg, 1988;90(3):261-3.
    PMID: 3197355
    Cerebral involvement associated with juvenile rheumatoid arthritis is rare. It is not influenced by treatment and the presentation can be varied. We describe a case of cerebral infarction secondary to vasculitis in a child with juvenile rheumatoid arthritis.
    Matched MeSH terms: Cerebral Infarction/etiology*
  12. The speech evoked potential in normal subjects and patients with cerebral hemispheric lesions
    Pratap RC
    Clin Neurol Neurosurg, 1987;89(4):237-42.
    PMID: 3690926
    The present study deals with observations on the "speech evoked potential"-a late positive potential evoked by word repetition. These potentials, evoked by "silent" repetition of polysyllabic words, were averaged and recorded from the scalp overlying the inferior frontal regions on both sides in 20 normal healthy subjects of ages ranging from 13-58 years. The potential had a triphasic negative, positive, negative morphology and was present over both hemispheres in left as well as right handed subjects. The main positive deflection and mean latencies of 219.2 msec and 221.6 msec and mean amplitude of 6.2 muv and 6.5 muv respectively on the left and right sides. Though there were interindividual variations in latency, amplitude and morphology, there was a high degree of intraindividual similarity and reproducibility in subjects. The variations in these parameters with age, sex and handedness are discussed. In 10 patients with cerebral lesions, the evoked potential was normal in 5 cases with right frontal lesions and showed abnormalities in 3 of 5 cases with left frontal lesions. The speech evoked potential may be useful in the further study of electrical correlates of speech output in speech disorders.
    Matched MeSH terms: Cerebral Infarction/complications
  13. Fulltext Left ventricular outflow tract (LVOT) vegetations and spontaneous obliteration of a large ruptured intracranial mycotic aneurysm in a case of infective endocarditis
    Quah BS, Selladurai BM, Jayakumar CR, Mahendra Raj S
    Singapore Med J, 1993 Apr;34(2):172-4.
    PMID: 8266164
    A 10-year-old girl with mild aortic regurgitation presented with cerebral infarction. Two-dimensional echocardiography showed vegetations on the septal wall of the left ventricular outflow tract without involvement of the aortic valve itself. After successful antibiotic treatment the patient developed an intra-cranial haemorrhage due to rupture of a large intracranial mycotic aneurysm. Consent for surgical treatment of the mycotic aneurysm was not obtained. Twelve months later repeat angiography showed that the aneurysm had undergone spontaneous obliteration.
    Matched MeSH terms: Cerebral Infarction/etiology
  14. Fulltext Recurrent cerebral infarcts secondary to marantic endocarditis in a patient with adenocarcinoma of the lung
    Tai ML, Tan EC, Ang CC, Liam CK
    Singapore Med J, 2016 Sep;57(9):524-5.
    PMID: 27663211 DOI: 10.11622/smedj.2016157
    Matched MeSH terms: Cerebral Infarction/complications*
  15. Fulltext Can We Use 2,3,5-Triphenyltetrazolium Chloride-Stained Brain Slices for Other Purposes? The Application of Western Blotting
    Sanchez-Bezanilla S, Nilsson M, Walker FR, Ong LK
    Front Mol Neurosci, 2019;12:181.
    PMID: 31417355 DOI: 10.3389/fnmol.2019.00181
    2,3,5-Triphenyltetrazolium chloride (TTC) staining is a commonly used method to determine the volume of the cerebral infarction in experimental stroke models. The TTC staining protocol is considered to interfere with downstream analyses, and it is unclear whether TTC-stained brain samples can be used for biochemistry analyses. However, there is evidence indicating that, with proper optimization and handling, TTC-stained brains may remain viable for protein analyses. In the present study, we aimed to rigorously assess whether TTC can reliably be used for western blotting of various markers. In this study, brain samples obtained from C57BL/6 male mice were treated with TTC (TTC+) or left untreated (TTC-) at 1 week after photothrombotic occlusion or sham surgery. Brain regions were dissected into infarct, thalamus, and hippocampus, and proteins were extracted by using radioimmunoprecipitation assay buffer. Protein levels of apoptosis, autophagy, neuronal, glial, vascular, and neurodegenerative-related markers were analyzed by western blotting. Our results showed that TTC+ brains display similar relative changes in most of the markers compared with TTC- brains. In addition, we validated that these analyses can be performed in the infarct as well as other brain regions such as the thalamus and hippocampus. Our findings demonstrate that TTC+ brains are reliable for protein analyses using western blotting. Widespread adoption of this approach will be key to lowering the number of animals used while maximizing data.
    Matched MeSH terms: Cerebral Infarction
  16. The protective mechanisms of polydatin in cerebral ischemia
    Tang KS, Tan JS
    Eur J Pharmacol, 2019 Jan 05;842:133-138.
    PMID: 30385347 DOI: 10.1016/j.ejphar.2018.10.039
    The prevalence of stroke is high in both developing and developed nations. It causes a heavy social and financial burden to the sufferers and their caregivers. Thrombolytic therapy is the only pharmacological treatment available for stroke. However, thrombolytic agents do not provide substantial improvement on long term motor and cognitive disabilities. Thus, there is a need to explore for new compounds that can halt or reverse the deterioration of neurons in the stroke patients' brain. Polydatin, a precursor of resveratrol, is a natural stilbene commonly found in food. This review article describes how different parameters were altered with ischemic injury and polydatin treatment, why it is important and how it could be beneficial or useful in future studies. Our review of polydatin provides convincing evidence regarding the potential of polydatin to be developed into preventive or therapeutic products for ischemic stroke. Nevertheless, additional studies are necessary in order to properly elucidate the biological mechanisms of polydatin, especially its molecular mechanisms of protection and target proteins, in cerebral ischemia.
    Matched MeSH terms: Cerebral Infarction
  17. Fulltext A Brief Psychotic Episode with Depressive Symptoms in Silent Right Frontal Lobe Infarct
    Badrin S, Mohamad N, Yunus NA, Zulkifli MM
    Korean J Fam Med, 2017 Nov;38(6):380-382.
    PMID: 29209479 DOI: 10.4082/kjfm.2017.38.6.380
    Psychiatric symptoms may be related to a silent cerebral infarct, a phenomenon that has been described previously in literature. Acute psychosis or other neuropsychiatric symptoms including depression may present in stroke patients and patients with lesions either within the prefrontal or occipital cortices, or in subcortical areas such as the basal ganglia, thalamus, mid-brain, and brainstem. Psychosis in clinical stroke or in silent cerebral infarction is uncommon and not well documented in the literature. Neurological deficits are the most common presentation in stroke, and nearly a third of patients that suffer a stroke may experience psychological disorders such as depression and anxiety, related to physical disability. The present case report describes an elderly female patient who presented with hallucinations and depressive symptoms, and was discovered to have a recent right frontal brain infarction, without other significant neurological deficits.
    Matched MeSH terms: Cerebral Infarction
  18. Brain calcification in patients with cerebral lupus
    Raymond AA, Zariah AA, Samad SA, Chin CN, Kong NC
    Lupus, 1996 Apr;5(2):123-8.
    PMID: 8743125 DOI: 10.1177/096120339600500207
    Cerebral lupus (CL) is a common cause of morbidity and mortality in patients with SLE. The brain CTs of 27 consecutive adult patients with SLE and various neurological presentations were reviewed. The median age and duration of neurological symptoms at the time of the brain CT were 30 years (range = 14-51 years) and six days (range = 1 day-22 years), respectively. Eleven patients (41%) had normal CTs. The abnormalities in the remaining patients could be divided into six categories: (a) cerebral atrophy alone (two patients); (b) calcification alone (three patients); (c) infarct(s) alone (five patients); (d) cerebral atrophy and calcification (three patients); (e) cerebral atrophy and infarct(s) (one patient) and (f) cerebral atrophy, calcification and infarct(s) (two patients). Altogether eight patients (30%) (age range = 17-47 years) had intracerebral calcification: the globus pallidus was involved in all, putamen in two, head of the caudate nucleus in one, thalamus in one, centrum semiovale in two and cerebellum in three patients. Two patients had extensive calcifications of most of the basal ganglia, centrum semiovale and cerebellum. There was no relationship between the presence/degree of calcification and age of patients/duration or type of neurological presentation. The pathogenesis of cerebral calcification in CL is unknown. Cerebral lupus must now be included in the differential diagnosis of intracerebral calcification.
    Matched MeSH terms: Cerebral Infarction/pathology
  19. Fulltext Clinical profile, risk factors and aetiology of young ischaemic stroke patients in Asia: A prospective, multicentre, observational, hospital-based study in eight cities
    Kay, Sin Tan, Navarro, Jose C, Ka, Sing Wong, Yi, Ning Huang, Hou, Chang Chiu, Poungvarin, Niphon, et al.
    Neurology Asia, 2014;19(2):117-127.
    MyJurnal
    Background and Objective: There is a lack of international collaborative studies on young adults with ischaemic stroke in Asia. The aim of this study was to investigate risk factors, aetiology and outcome at hospital discharge of these patients across 8 participating countries in Asia. Methods: This was a prospective, observational, multicentre, hospital based cohort study. Consecutive young stroke patients with confirmed cerebral infarction between the ages of 18-49 were recruited from December 2011 to May 2012. Data was collected for patient demography, risk factors, investigations, clinical profile and TOAST classification. Outcome measures were death and independence (modified Rankin score≤ 2) at hospital discharge. Results: Two hundred and eighteen patients with the mean age was 40.8±6.7 years were recruited. There was a larger proportion of male patients with a ratio of 1.9:1. Traditional risk factors observed were hypertension (n=103; 47.3%), dyslipidaemia (n=93; 42.4%), smoking (n=85; 38.8%), diabetes (n=53; 24.3%), alcohol use (n=33; 15.0%), a previous history of stroke and transient ischaemic attacks (6.4%), family history (n=12; 5.5%), migraine (n=6;2.8%), pregnancy related (n=5; 2.3%) and numerous cardiac risk factors (0.9-5.5%). The majority suffered arterial infarction; n=216 (99.4%) while n=2 (0.6%) had venous strokes. The predominant stroke subtypes were large artery atherosclerosis (LAA); 29.8% and small vessel occlusion (SVO); 20.2%. LAA and SVO accounted for 37.5% of all stroke subtypes in the ≤36 year age-group. Cardioembolism (15.1%) and stroke of determined aetiology (14.7%) contributed to the other categories of identified stroke subtypes. Mortality on hospital discharge was 3.1% while 65.1% of patients were independent on discharge. Conclusion: This study demonstrated the substantial presence of premature atherosclerosis and conventional risk factors in young ischaemic stroke patients from 8 Asian cities. Venous infarction from cerebral venous thrombosis was rare in this study. Outcome on hospital discharge was poorer compared to Western studies. Detection of vascular risk factors and primary prevention measures should be initiated during late adolescence or early adulthood in urban Asia.
    Matched MeSH terms: Cerebral Infarction
  20. Demethylnobiletin ameliorates cerebral ischemia-reperfusion injury in rats through Nrf2/HO-1 signaling pathway
    Huang D, Awad ACA, Tang C, Chen Y
    Environ Toxicol, 2024 Mar;39(3):1335-1349.
    PMID: 37955318 DOI: 10.1002/tox.24036
    BACKGROUND: Demethylnobiletin (DN), with a variety of biological activities, is a polymethoxy-flavanone (PMF) found in citrus. In the present study, we explored the biological activities and potential mechanism of DN to improve cerebral ischemia reperfusion injury (CIRI) in rats, and identified DN as a novel neuroprotective agent for patients with ischemic brain injury.

    METHODS: Rat CIRI models were established via middle cerebral artery occlusion (MCAO). Primary nerve cells were isolated and cultured in fetal rat cerebral cortex in vitro, and oxygen-glucose deprivation/reperfusion (OGD/R) models of primary nerve cells were induced. After intervention with DN with different concentrations in MCAO rats and OGD/R nerve cells, 2,3,5-triphenyltetrazolium chloride staining was used to quantify cerebral infarction size in CIRI rats. Modified neurological severity score was utilized to assess neurological performance. Histopathologic staining and live/dead cell-viability staining was used to observe apoptosis. Levels of glutathione (GSH), superoxide dismutase (SOD), reactive oxygen species (ROS) and malondialdehyde (MDA) in tissues and cells were detected using commercial kits. DN level in serum and cerebrospinal fluid of MCAO rats were measured by liquid chromatography tandem mass spectrometry. In addition, expression levels of proteins like Kelch like ECH associated protein 1 (Keap1), nuclear factor erythroid 2-related factor 2 (Nfr2) and heme oxygenase 1 (HO-1) in the Nrf2/HO-1 pathway, and apoptosis-related proteins like Cleaved caspase-3, BCL-2-associated X protein (Bax) and B-cell lymphoma-2 (Bcl-2) were determined by Western blot and immunofluorescence.

    RESULTS: DN can significantly enhance neurological function recovery by reducing cerebral infarction size and weakening neurocytes apoptosis in MCAO rats. It was further found that DN could improve oxidative stress (OS) injury of nerve cells by bringing down MDA and ROS levels and increasing SOD and GSH levels. Notably, DN exerts its pharmacological influences through entering blood-brain barrier. Mechanically, DN can reduce Keap1 expression while activate Nrf2 and HO-1 expression in neurocytes.

    CONCLUSIONS: The protective effect of DN on neurocytes have been demonstrated in both in vitro and in vivo circumstances. It deserves to be developed as a potential neuroprotective agent through regulating the Nrf2/HO-1 signaling pathway to ameliorate neurocytes impairment caused by OS.

    Matched MeSH terms: Cerebral Infarction
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