Central post-stroke pain: advances in clinical and preclinical research

卒中后中枢疼痛: 临床和临床前研究进展

Central poststroke pain (CPSP) is a medical complication that arises poststroke and significantly impacts the quality of life and social functioning of affected individuals. Despite ongoing research, the exact pathomechanisms of CPSP remain unclear, and practical treatments are still unavailable. Our review aims to systematically analyse current clinical and preclinical studies on CPSP, which is critical for identifying gaps in knowledge and guiding the development of effective therapies. The review will clarify the clinical characteristics, evaluation scales and contemporary therapeutic approaches for CPSP based on clinical investigations. It will particularly emphasise the CPSP model initiated by stroke, shedding light on its underlying mechanisms and evaluating treatments validated in preclinical studies. Furthermore, the review will not only highlight methodological limitations in animal trials but also offer specific recommendations to researchers to improve the quality of future investigations and guide the development of effective therapies. This review is expected to provide valuable insights into the current knowledge regarding CPSP and can serve as a guide for future research and clinical practice. The review will contribute to the scientific understanding of CPSP and help develop effective clinical interventions.

中风后中枢性疼痛 (CPSP) 是中风后出现的医学并发症，严重影响受影响个体的生活质量和社会功能。尽管正在进行研究，但CPSP的确切发病机制仍不清楚，并且仍无法获得实用的治疗方法。我们的综述旨在系统分析当前关于CPSP的临床和临床前研究，这对于确定知识差距和指导有效疗法的发展至关重要。该综述将根据临床调查阐明CPSP的临床特征，评估量表和当代治疗方法。它将特别强调由卒中发起的CPSP模型，阐明其潜在机制并评估在临床前研究中验证的治疗方法。此外，该综述不仅强调了动物试验的方法学局限性，而且还为研究人员提供了具体建议，以提高未来研究的质量并指导有效疗法的开发。这篇综述有望为当前关于CPSP的知识提供有价值的见解，并可以作为未来研究和临床实践的指南。该审查将有助于对CPSP的科学理解，并有助于制定有效的临床干预措施。

REF: Yuan X, Hu S, Fan X, et al. Central post-stroke pain: advances in clinical and preclinical research. Stroke Vasc Neurol. Published online September 28, 2024. doi:10.1136/svn-2024-003418 PMID: 39343438

Angioplasty and/or stenting following successful mechanical thrombectomy for intracranial atherosclerosis-related emergent large vessel occlusive stroke (ASSET): protocol of a multicentre randomised trial

颅内动脉粥样硬化相关突发大血管闭塞性卒中 (ASSET) 机械取栓成功后的血管成形术和/或支架置入术: 多中心随机试验方案

The management of residual stenosis after mechanical thrombectomy in patients with intracranial atherosclerotic stenosis-related emerge large vessel occlusive (ICAS-LVO) stroke is still unclear question in clinical practice. To demonstrate the design of a clinical trial on emergency balloon angioplasty and/or stenting (BAS) combined with standard medical treatment (SMT) for residual stenosis of ICAS-LVO stroke patients with successful recanalisation. The ASSET trial is designed to provide strong evidence on the effectiveness and safety of emergency BAS to treat residual stenosis after successful recanalisation in patients with ICAS-LVO stroke.

颅内动脉粥样硬化性狭窄相关的大血管闭塞 (ICAS-LVO) 卒中患者机械取栓后残余狭窄的处理在临床实践中仍不清楚。为了证明紧急球囊血管成形术和/或支架置入术 (BAS) 与标准药物治疗 (SMT) 相结合的ICAS LVO卒中成功再管患者残余狭窄的临床试验设计。ASSET试验旨在为ICAS LVO卒中患者成功再行血管后，急诊BAS治疗残余狭窄的有效性和安全性提供有力的证据。

REF: Liao G, Qiao H, Dai C, et al. Angioplasty and/or stenting following successful mechanical thrombectomy for intracranial atherosclerosis-related emergent large vessel occlusive stroke (ASSET): protocol of a multicentre randomised trial. Stroke Vasc Neurol. Published online September 28, 2024. doi:10.1136/svn-2024-003435 PMID: 39343437

Predictors of malignant swelling in space-occupying cerebellar infarction

占位性小脑梗死恶性肿胀的预测因素

Malignant swelling is a fatal complication that can occur abruptly in space-occupying cerebellar infarction. We aimed to establish markers that predict malignant swelling in cerebellar infarction. Infarct volume was the key significant predictor of malignant swelling in space-occupying cerebellar infarction. With many cases of malignant swelling occurring after more than 72 hours, we advocate prolonged neurological monitoring.

恶性肿胀是一种致命的并发症，可在占位性小脑梗死中突然发生。我们旨在建立预测小脑梗死恶性肿胀的标志物。梗死体积是占位性小脑梗死恶性肿胀的关键重要预测指标。由于许多病例在超过72小时后发生恶性肿胀，我们主张延长神经系统监测。

REF: Baki E, Baumgart L, Kehl V, et al. Predictors of malignant swelling in space-occupying cerebellar infarction. Stroke Vasc Neurol. Published online September 13, 2024. doi:10.1136/svn-2024-003360 PMID: 39209704

Optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset: a prospective cohort study

症状发作72小时内轻微卒中双联抗血小板治疗的最佳持续时间: 一项前瞻性队列研究

Despite the potential spillover effect, the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain. Short duration of DAPT (10-21 days) is superior to SAPT in minor stroke within 72 hours, reducing 90-day composite vascular events without increasing bleeding risk.

尽管存在潜在的溢出效应，但对于症状发作后72小时内的轻微卒中，双重抗血小板治疗的最佳持续时间仍不确定。短期DAPT (10-21天) 在72小时内的轻微卒中中优于SAPT，减少90天复合血管事件而不增加出血风险。

REF: Liu T, Wang Y, Zhang K, et al. Optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset: a prospective cohort study. Stroke Vasc Neurol. Published online September 13, 2024. doi:10.1136/svn-2023-002933 PMID: 39277180

Sex differences in the epidemiology of spontaneous and traumatic cervical artery dissections

自发性和创伤性颈部动脉夹层流行病学的性别差异

Recent studies show cervical artery dissection (CeAD) is equally common between sexes, and that the incidence of CeAD has risen at a greater rate in females than males. In this population-based study, we identify sex differences in patients diagnosed with spontaneous and traumatic CeAD. These findings underscore the importance of understanding CeAD through the lens of sex differences and may explain the significant rise in the diagnosis of CeAD in females. These findings support the importance of considering sex-specific risk factors and medical comorbidities with sex predilection in the diagnosis and management of CeAD. Furthermore, it emphasises the importance of female patients understanding risk factors and presenting signs that should prompt evaluation for CeAD.

最近的研究表明，颈部动脉夹层 (CeAD) 在男女之间同样常见，并且CeAD的发病率在女性中比男性更高。在这项基于人群的研究中，我们确定了诊断为自发性和创伤性CeAD的患者的性别差异。这些发现强调了通过性别差异来理解CeAD的重要性，并可能解释了女性CeAD诊断的显着增加。这些发现支持在CeAD的诊断和管理中考虑性别特异性危险因素和具有性别倾向的医学合并症的重要性。此外，它强调了女性患者了解危险因素并呈现应提示评估CeAD的迹象的重要性。

REF: Schipani E, Griffin KJ, Oakley CI, Keser Z. Sex differences in the epidemiology of spontaneous and traumatic cervical artery dissections. Stroke Vasc Neurol. Published online September 11, 2024. doi:10.1136/svn-2024-003282 PMID: 39266209

miR-19-3p/GRSF1/COX1 axis attenuates early brain injury via maintaining mitochondrial function after subarachnoid haemorrhage

miR-19-3p/GRSF1/COX1轴通过维持蛛网膜下腔出血后的线粒体功能减轻早期脑损伤

Guanine-rich RNA sequence binding factor 1 (GRSF1) is an RNA-binding protein, which is eventually localised to mitochondria and promotes the translation of cytochrome C oxidase 1 (COX1) mRNA. However, the role of the miR-19-3p/GRSF1/COX1 axis has not been investigated in an experimental subarachnoid haemorrhage (SAH) model. Thus, we investigated the role of the miR-19-3p/GRSF1/COX1 axis in a SAH-induced early brain injury (EBI) course. The miR-19-3p/GRSF1/COX1 axis may serve as an underlying target for inhibiting SAH-induced EBI by maintaining mitochondrial integrity.

富含鸟嘌呤的RNA序列结合因子1 (GRSF1) 是一种RNA结合蛋白，最终定位于线粒体并促进细胞色素C氧化酶1 (COX1) mRNA的翻译。然而，尚未在实验性蛛网膜下腔出血 (SAH) 模型中研究miR-19-3p/GRSF1/COX1轴的作用。因此，我们研究了miR-19-3p/GRSF1/COX1轴在SAH诱导的早期脑损伤 (EBI) 过程中的作用。miR-19-3p/GRSF1/COX1轴可以作为通过维持线粒体完整性来抑制SAH诱导的EBI的潜在靶标。

REF: Gao G, Sun X, Xu J, Yu J, Wang Y. miR-19-3p/GRSF1/COX1 axis attenuates early brain injury via maintaining mitochondrial function after subarachnoid haemorrhage. Stroke Vasc Neurol. Published online September 11, 2024. doi:10.1136/svn-2024-003099 PMID: 39266212

Asymptomatic carotid artery stenosis is associated with increased Alzheimer’s disease and non-Alzheimer’s disease dementia risk

无症状颈动脉狭窄与阿尔茨海默病和非阿尔茨海默病痴呆风险增加相关

In the absence of a cerebrovascular accident, whether asymptomatic extracranial carotid atherosclerotic disease (aECAD) affects Alzheimer's disease (AD) and non-AD dementia risk is not clear. Understanding whether aECAD is associated with an increased risk for AD is important as it is present in roughly 10% of the population over 60 and could represent a modifiable risk factor for AD and non-AD dementia. aECAD is associated with an increased risk of developing AD and non-AD dementias. These findings underscore the need for further prospective evaluation of interactions between aECAD and dementia, with potential implications for change of clinical care in both of these large patient populations.

在没有脑血管意外的情况下，无症状颅外颈动脉粥样硬化性疾病 (aECAD) 是否影响阿尔茨海默病 (AD) 和非AD痴呆风险尚不清楚。了解aECAD是否与AD风险增加相关很重要，因为它存在于大约10% 的60岁以上人群中，并且可能代表AD和非AD痴呆的可改变风险因素。aECAD与发展AD和非AD痴呆症的风险增加有关。这些发现强调了对aECAD和痴呆之间的相互作用进行进一步前瞻性评估的必要性，这对这两个大型患者群体的临床护理变化具有潜在意义。

REF: Vitali F, Torrandell-Haro G, Branigan G, et al. Asymptomatic carotid artery stenosis is associated with increased Alzheimer's disease and non-Alzheimer's disease dementia risk. Stroke Vasc Neurol. Published online September 11, 2024. doi:10.1136/svn-2024-003164 PMID: 39266210

Association between ASPECTS region of infarction and clinical outcome in non-acute large vessel occlusion ischaemic stroke after endovascular recanalisation

血管内再通后非急性大血管闭塞缺血性卒中的梗死区与临床结局之间的关系

This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score (ASPECTS) regions is associated with clinical outcome in patients with symptomatic non-acute internal carotid or middle cerebral artery occlusion who underwent endovascular recanalisation (ER). Lenticular nucleus and M2 region infarction were independent predictors of poor 90-day outcome and postprocedural cerebral oedema, respectively, in patients with non-acute anterior circulation large artery occlusion who underwent ER.

这项研究回顾性调查了接受血管内再通 (ER) 的有症状非急性颈内动脉或大脑中动脉闭塞患者的特定艾伯塔省卒中计划早期CT评分 (ASPECTS) 区域的梗塞是否与临床结局相关。在接受ER的非急性前循环大动脉闭塞患者中，晶状体核和M2区梗死分别是90天预后不良和术后脑水肿的独立预测因子。

REF: Lu J, Lu Z, Li Y, et al. Association between ASPECTS region of infarction and clinical outcome in non-acute large vessel occlusion ischaemic stroke after endovascular recanalisation. Stroke Vasc Neurol. Published online September 11, 2024. doi:10.1136/svn-2024-003355 PMID: 39266208