Gao Hua, Xuanwu Hospital, Capital Medical University In June 2009, the “Ministry of Health Stroke Screening and Prevention Project” was officially launched, which is a systematic project that includes standardized examination, health education, life guidance, disease management and standardized treatment. Currently, there are four hospitals in Beijing that can do stroke screening: Xuanwu Hospital, Tiantan Hospital, Anzhen Hospital and Dongfang Hospital. These hospitals will screen people over 50 years old with high risk factors for stroke, such as hypertension, diabetes, coronary heart disease, hyperlipidemia and smoking, and establish health management files to guide patients to prevent and treat stroke. Since stroke screening was launched in major hospitals, people from all over the country have been coming to Xuanwu Hospital, Capital Medical University, to have their stroke screened. Through standardized screening, people have a new understanding of their health status and medical knowledge related to stroke prevention and treatment. However, many patients are too optimistic or too pessimistic in the face of the screening report form due to misconceptions, and do not have a comprehensive understanding of their condition, leading to delays or negative emotions affecting their lives. Myth 1: Cerebral white matter degeneration is Alzheimer’s disease History playback: 56-year-old Ms. Li came to Xuanwu Hospital Stroke Screening Clinic after watching a promotional video on TV. After a series of tests, the results were “no significant abnormalities”. However, the only report on the CT scan of the head said “white matter degeneration”. This frightened Ms. Li, thinking that this might be a precursor to Alzheimer’s disease, she was disturbed every day and fell into a deep fear. The white matter of the brain is mainly composed of nerve fibers and glial cells, and the diffuse hypointense lesions in the white matter of the brain on CT and the diffuse high signal on T2-weighted images on MRI can be called “white matter degeneration”. In the literature, there are different names for these imaging manifestations, such as cerebral white matter lesions, white matter hypersignal, cerebral white matter sparing, etc. Professor Ji Xunming of Xuanwu Hospital pointed out, “The white matter of the brain itself is ischemic and vulnerable. The white matter of the adult brain accounts for about 50% of the whole brain volume, and the tissue metabolic rate is only slightly lower than that of the gray matter, which can be damaged by mild ischemia. Age and hypertension are currently considered to be the main risk factors, with increased T2 high signal in the white matter of the brain with increasing age. Large white matter T2 hyperintensities impair motor, cognitive, and psychological performance and are associated with stroke, dementia, and death. It is important to note that T2 hyper-signal in the white matter of the brain can be detected at a very early stage of disease onset and may be too sensitive to changes in the white matter, and increased water in the white matter does not necessarily indicate loss of function. Preclinical cerebral white matter T2 hyper-signal appears to be benign and progresses slowly, correlating poorly with cognitive impairment, with functional decline entering an accelerated phase only when damage accumulates to a certain level and functional reserves are depleted.” With the progressive increase in the frequency of application of modern neuroimaging techniques, white matter damage is seen clinically in many diseases of the central nervous system. Numerous studies have shown that a significant amount of white matter damage is also found in the normal elderly. Ischemic damage to the white matter can be exacerbated in the presence of cerebral ischemia or the occurrence of hypoperfusion. Myth 2: Carotid plaques are all high-risk Case history playback: 60-year-old Ms. Bai came to Xuanwu Hospital Stroke Screening Clinic with the attitude of health care after being introduced by her friends. The result was a shock. The ultrasound of the carotid vasculature showed “intimal thickening of the internal carotid artery with multiple plaques”, and when Ms. Bai looked at the report card, she was worried that the plaques were too large and that they would fall off. The whole family was in a fog of worry. Carotid plaque is a mass-like structure formed by multiple risk factors that cause damage to the carotid vessel wall and deposition of cholesterol in the vessel wall. The formation of plaque is a complex and long process, just like the accumulation of grease in the sewer pipe, which will lead to the blockage of the pipe over time. Professor Ji Xunming of Xuanwu Hospital pointed out, “Not all plaques are high-risk. The danger of carotid plaque mainly lies in the instability of plaque, that is, plaque that is not firm in the vessel wall and easy to fall off. Once the plaque is dislodged, it becomes an embolus in the blood flow and reaches the brain with the blood flow to block the distal cerebral arteries, leading to the occurrence of blood clots. Many people will ask: what kind of plaque is a stable plaque in the end? Experts suggest that plaque can appear in any part of the blood vessel. Carotid plaque mostly occurs in the bifurcation of the carotid artery, followed by the beginning segment of the carotid artery and the common carotid artery. According to the internal echogenicity, they are divided into the following types: hypoechoic – the main component is thrombus, bleeding or cholesterol; isoechoic – the main component is fibrous tissue; strong echogenicity – the main component is calcification. According to the morphology, they are further divided into flat plaques and irregular plaques. Generally speaking, plaques with strong echogenicity and flat shape are more stable. When you find a plaque that is described as “hypoechoic or unevenly echogenic” by carotid ultrasound, it is more likely to fall off and cause a stroke. Don’t panic if you have plaque. With strict control of lipids, unstable plaques can be calcified and turned into stable plaques. It is recommended that those who have already had a stroke should have their carotid ultrasound reviewed regularly to track the size and stability of the plaque. It is also advisable to screen the carotid ultrasound during regular health check-ups to detect carotid plaque as early as possible, so that the size and nature of the plaque can be observed and the neurologist can be consulted in time to adjust the medication to control the development of the disease. Myth 3: People with normal blood lipids do not need to take lipid-lowering drugs. He was prescribed lipid-lowering medication for this condition. Six months after taking the medication regularly, Mr. Ren found that all the indicators related to lipids were below the normal range at his follow-up appointment, but the doctor still told him not to stop taking the lipid-lowering medication, so he had this question: Why did the doctor continue to let me take the lipid-lowering medication even though my blood lipids were already below the normal range? In addition, he heard his relatives and friends say, “You can’t take lipid-lowering drugs for a long time, they can do more harm than good to your body.” After thinking about it, Mr. Ren decided to stop the lipid-lowering drugs on his own. Professor Ji Xuanwu Hospital pointed out, “This is a big misunderstanding. In the clinic, people often ask, “My blood lipids are normal, so I don’t need to take medicine. First of all, your normal blood lipids are lowered after taking medication, while cholesterol and triglycerides are constantly being metabolized and may rise again if not controlled by medication. Therefore, we require that if the lipid control is at the target value, the medication must be continued for a long time, but the dose of medication can be reduced according to the extent of lipid reduction, muscle enzyme spectrum and liver function, and the medication can be adjusted dynamically. As for when and how to reduce the lipid-lowering drugs, it is best to go to a regular hospital to have a look, and never stop the drugs privately. Secondly, a lipid test result in the normal range does not mean that treatment is not necessary, because the requirements for lipid indicators vary from person to person. For example, the normal value of LDL cholesterol on the laboratory test is between 2.08-3.12mmol/l, but if the patient has plaque, LDL cholesterol should be lowered to below 2.59mmol/l. If the patient has narrowed blood vessels, unstable plaque or metabolic syndrome, the lipid needs to be more strictly controlled, and LDL cholesterol needs to be lowered to 2.01mmol/l or lower.” It is well known that the determinants of cardiovascular events depend on the stability of atherosclerotic plaques, and statin lipid-lowering drugs can not only lower lipids, but also stabilize and reverse plaques, exerting cardiovascular protective effects beyond the lipid-lowering effect of the drug. After strict lipid-lowering treatment, the prognosis of patients can be significantly improved and the occurrence of cardiovascular and cerebrovascular events can be reduced.