The causes of transient ischemic attack (TIA) are diverse and complex.It often attacks repeatedly and its early risk of stroke is high.Identifying etiology and pathogenesis and start the correct treatment in time are the important measures for the prevention of cerebral infarction.However,the conventional CT and MRI reveal no abnormalities in patients with TIA,and it brings difficulties to the clinical diagnosis and treatment.CT perfusion imaging can reflect abnormal cerebral blood flow perfusion in patients with TIA.CT perfusion imaging in combination with CT angiography may visually display its corresponding abnormal changes in the feeding artery and provide the valuable diagnostic information for the location of vascular stenosis,severity,plaque characteristics and collateral circulation.It has very an important significance for guiding clinicians to choose the best treatment options,improve clinic efficiency and observe efficacy.

Objective To detect the relationship between ecNOS gene polymorphism and ischemic stroke in Dalian,China.Methods The polymorphism of intron 4 of ecNOS gene was analyzed in normal group(90 cases) and ischemic stroke group(170 cases) by a combination of polymerase chain reaction(PCR).Results In ischemic stroke group,hypertension, diabete mellitus, smoking, fibrinogen and internal carotid artery narrow were significantly different from those of control group(all P

Objective To study clinical characters and diagnosis of Creutzfeldt Jakob disease (CJD), which will raise the rate of confirmed diagnosis.Methods The clinical manifestation, the results of light microscope and electron microscope in 4 patients with CJD proved by pathological examination were analyzed.Results There was typical clinical manifestation in the 4 patients,neuron degenerative death,gliocyte hyperplasia,no inflammatory change were observed in pathological examination. Degeneration and oncotic of axon in some myelin sheath were found by electron microscope examination.Conclusion CJD is a sporadic desease,no special effective therapy and worse prognosis. Clinical pathological examination is the best method for the diagnosis of CJD.

Objective To observe the changes of regional cerebral blood flow and blood-supply artery and study the value of computerized tomography perfusion imaging (CTPI) and computerized tomography angiography (CTA) in the clinical diagnosis of transient ischemic attack (TIA) of internal carotid artery system to further explore the etiological factors and pathophysiological mechanism of TIA of internal carotid artery system.Methods Thirty-five patients with TIA of internal carotid artery system,admitted to our hospital from April 2008 to January 2009,were enrolled into patient group,and 22 healthy subjects without TIA of internal carotid artery system symptoms and negative CTA features were enrolled as control group.These patients were examined with 16 slice CTPI and CTA in head and neck within 48 h of onset; the mean transmit time (MTT),cerebral blood flow (CBF) and cerebral blood volume (CBV) in the region of interests (ROIs) between the two sides of the patient group and between patient group and control group were analyzed,and the relationship with CTA features and clinical manifestations were discussed.Results Twenty-eight of 35 patients (80％) with TIA of internal carotid artery system revealed abnormal perfusion regions corresponding to clinical symptoms in CTPI,of which there were 28 revealing abnormal perfusion regions on MTT maps,23 on CBF maps,and only 15 on CBV maps.Other 7 patients showed normal results in CTPI.The correspondence relationship between CTPI and CTA abnormality had the following 4 types:(1) there were 25 patients (71％) with perfusion abnormalities accompanied by abnormal vascular supplying the abnormal perfusion region (convict vascular); among them,16 had carotid artery stenosis,13 had many weak vascular plaques,and 6 had carotid artery dysplasia; the coexistence of a number of factors and situation existed.(2) There were 3 patients (9％) with perfusion abnormalities in CTPI but without abnormal vascular in CTA.(3) There were 3 patients (9％) with abnormal vascular in CTA but without perfusion abnormalities in CTPI.(4) There were 4 patients (11％) had neither abnormal vascular nor perfusion abnormalities.Conclusions MTT is the most sensitive and primary indicator in CTPI of TIA of internal carotid artery system; the changes of CBF and CBV can reveal the various pathophysiological state of TIA of internal carotid artery system.The hypoperfusion is one of the pathophysiological bases of TIA of internal carotid artery system,and carotid artery stenosis and many weak vascular plaques may be the etiological factors of TIA of internal carotid artery system.CTPI combined with CTA is important to study the etiology of TIA.

Objective:To assess the value of amide proton transfer weighted (APTw) imaging in the evaluation of pH changes in infarct core (IC) and ischemic penumbra (IP) in subacute cerebral infarction.Methods:The data of twenty-three subacute cerebral infarction patients with unilateral steno-occlusive disease of the middle cerebral artery (subacute infarction group) from April to November 2019 in the First Affiliated Hospital of Dalian Medical University were prospectively analyzed. Fifteen healthy volunteers were enrolled in this study as the control group. All subjects underwent conventional MRI, DWI, 3D-pseudo continuous arterial spin labeling (3D-pCASL) and APTw sequences. Based on DWI images, relative cerebral blood flow (rCBF) and APTw images to determine the region of IC, blood flow penumbra [cerebral blood flow(CBF)-DWI mismatch area, IP CBF] and metabolic penumbra (APTw-DWI mismatched area, IP APT). 3D ROIs were used to semi-automatically measure the APTw signals and the volume of IC and IP CBF of the patients in subacute infarction group. The comparison of APTw signals between the infarct side and the contralateral side in the subacute infarction group, the comparison of bilateral APTw signals in the control group, and the comparison of APTw signals in the IC and IP CBF regions were performed by paired-sample t test or Wilcoxon signed-rank test. The paired-sample t test or Mann-Whitney U test was used to compare the APTw signals between the two groups. The Friedman test was applied to compare the difference of volumes among IP CBF1.5, IP CBF2.5 and IP APT . Results:There was no significant difference of the APTw signals among the IC, the contralateral side in the subacute infarction group and the control group ( P>0.05). The APTw signals of IP CBF and IC of the infarction group were statistically different ( P<0.05). Compared with the contralateral side of IP CBF1.5 (3.7±1.7, -1.84±1.48, 5.57±2.75), the APTwmax (3.07±1.41, t=-3.012, P=0.006), APTw min [-1.30 (-1.74, -0.57), Z=-2.099, P=0.036], and APTwmax-min(4.51±2.58, t=-3.273, P=0.003) signals in the IP CBF1.5 were decreased ( P<0.05). Compared with the contralateral side of IP CBF2.5 [-1.53 (-2.80, -0.91), 5.31±2.61], the APTw min [-1.08 (-1.60, -0.49), Z=-2.616, P=0.009] and APTwmax-min (4.41±2.72, t=-3.228, P=0.004) signals in the IP CBF2.5 were decreased. The volumes of IP CBF1.5 [107.51(50.08, 138.61)mm 3], IP APT [99.00 (53.27, 121.335) mm 3] and IP CBF2.5 [89.91 (51.53, 139.87) mm 3] were successively reduced (χ2=7.913, P=0.019), and the volume of IP CBF2.5 was significantly smaller than that of IP CBF1.5 ( P=0.037). Conclusion:The acid-base metabolism in the IC of subacute cerebral infarction is not obvious, but the blood flow penumbra has local acid-base metabolism imbalance, and the range of metabolic penumbra coincides with the blood flow penumbra.