Strokc is one of the most feared perioperative complications.This article systematically reviews the incidence, mechanisms, risk factors stratification,and relief of perioperative stroke.Aiming at the risk factors and pathogeneses,it is hopeful to improve from the aspect of operative methods.techniques,and medication,and thus to decrease the risks of perioperative stroke and improve prognosis.

The morbidity and mortality of intracerebral hemorrhage (ICH) are very high. Brain injury involves in several mechanisms after ICH, including the direct tissue destruction by the mechanical force on brain tissue surrounding the hernatoma in the process of hematoma formation, the release of clot-derived factors (thrombin, hemoglobin degradation products), inflammatory response and complement cascade reaction, etc. This article reviews the above mechanisms

Secondary brain injury is closely associated with brain edema, inflammation response and other injury factors after intracerebral hemorrhage, such as the complement system activation, excitatory amino acid toxicity, the release of vasoactive substances and free radical damage. The main mode of neuronal death during secondary brain injury after intracerebral hemorrhage are necrosis and apoptosis.

Objective To observe the patients with subcortical cerebral infarction in the acute period, disabled in the motor function, and explore the extent of impact of several predictive factors to the recovery of motor function, including diffusion tensor imaging (DTF) displaying the involving extent of pyramidal tract, in order to find the most reliable and closely predictors. Methods 82 patients with acute cerebral infarction and disability (mRS score ≥ 3 points) were followed up on the 90 d after the symptom onset, respectively. Combining the baseline clinical characteristics, the laboratory and imaging auxiliary examination and treatment methods, choosing gender, age, hypertension, diabetes, hypercholesterolemia,atrial fibrillation or angina history, smoking history, alcohol history, the initial disability level,homocysteine, C-reactive protein, treatment modalities, the volume of infarction and the involving extent of pyramidal tract as observed indicators. According to mRS result, the outcome of the patients were divided into disabled groups ( mRS 3-5) and non-disabled group ( mRS 0-2). Results Using chi-square test to make univariate analysis, results showed that age (χ2 = 47.492, P ＜ 0. 01 ), diabetes ( χ2 = 5. 126, P =0. 024), hypercholesterolemia(χ2 =6. 242 ,P = 0. 012), the initial degree of disability (χ2 =45. 359, P ＜0. 01 ) and the involving extent of pyramidal tract (χ2 = 51. 467, P ＜ 0. 01 ) could effect patients gaining recovering. Using multivariate Logistic regression analysis to make a multivariate regression analysis, results suggest that age ( OR = 0. 068, P = 0. 042), the involving extent of pyramidal tract ( OR = 0. 026, P = 0. 002 )are independent predictors of recovery of motor function in patients, diabetes mellitus, hypercholesterolemia,initial disability level have no significant correlation. Conclusion The involving extent of pyramidal tract reflected by DTT is the best predictor of recovery in patients with subcortical cerebral infarction in the acute period.

Homocystine (Hcy) is an important intermediate product of amino acid metabolism.It is dual-regulated by both gene and environmental factors.The key enzyme of metabolic reaction is dependent on vitamin B class.The studies of in vitro experiment and animal models have demonstrated that Hcy may aggravate atherosclerosis by reducing the nitric oxide activity,enhancing intracellular oxidative stress,and promoting thrombosis,etc.Epidemiological studies have also demonstrated that hyperhomocystinemia (HHcy) is an independent risk factor for atherosclerosis.However,large randomized controlled trials have failed to confirm the close correlation between HHcy and ischemic stroke.By supplementing vitamin B class to decrease the Hcy level is still controversial in the primary and secondary prevention.The therapeutic dose of vitamin B class may be unable to obtain additional benefits in patients with ischemic stroke.

Objective To enhance recognition of the clinical and radiological features of nonaneurysmal subarachnoid hemorrhage (SAH) and its prognosis, and to provide guidance for the diagnosis and treatment in clinical practice. Methods Patients with spontaneous SAH, whose initial 3-dimensional digital subtraction angiography (DSA) were negative, received a second DSA after 2 to 3 weeks.Nonaneurysmal was diagnosed as SAH when both DSA were negative. All subjects were divided into 2 subgroups, perimesencephalic nonaneurysmal subarachnoid hemorrhage ( PNSAH ) group and nonperimesencephalic nonaneurysmal subarachnoid hemorrhage ( n-PNSAH ) group. Results Among 49 patients with nonaneurysmal SAH, 24 patients were PNSAH and 25 patients were n-PNSAH. Two patients died and 47 patients recovered and discharged with an average follow-up of 26 months. Conclusion The clinical course and prognosis of patients with PNSAH were good, better than that of patients with n-PNSAH.

The occurrence of cerebral vasospasm (CVS) following aneurysmal subarachnoid hemorrhage is a multi-factor participatory process.Its pathogenic mechanism is complex.The clinical presentation and imaging findings are not consistent.Theoretically,by the measures of blocking calcium channels,inhibiting Rho kinase,removing oxygen free radicals and antagonizing endothelin receptors and other measures can prevent and treat CVS,but the actual clinical effects of various drugs are not satisfactory,especially in the aspects of improving clinical outcomes.The clinical application of the 3H therapy has been limited because of having many potential complications,and the intra-arterial interventional treatment is limited by the technology,equipment,indications,and other factors.Therefore,the prevention and treatment of CVS is still facing many challenges.

The incidence,morbidity and mortality of stroke are very high.The evaluation of ischemic penumbra has very important significance for guiding clinical treatment and assessing prognosis.Currently,ischemic penumbra can be evaluated using imaging technologies,such as MRI,CT,positron emission tomography,and single photon emission computed tomography.

Objective To investigate the long-term outcome of intra-arterial thrombolysis in patients with acute ischemic stroke and its influencing factors.Methods Patients with acute ischemic stroke received intra-arterial thrombolysis were included in the study.The neurological outcome at day 90 was assessed using the modified Rankin Scale (mRS).They were divided into the good outcome group (mRS scores,0 to 2) and the poor outcome group (mRS scores,3 to 6)according to the evaluation results; the degree of recanalization after thrombolysis was assessed by the grading criteria of the Thrombolysis in Myocardial Infarction (TIMI) trial; the incidence of intracerebral hemorrhage within 7 days after thrombolytic therapy and the mortality at 3months were recorded.Univariate analysis and multivariate logistic regression analysis were used to screen the influencing factors of long-term outcome of arterial thrombolysis.Results A total of 42 patients were included,of them,19 (45.2％) with good outcome and 23 (54.8％) with poor outcome after intra-arterial thrombolysis; 27 patients (64.5％ ) with good recanalization (TIMI grade,2 to 3); 13 patients (31.0％) occurred intracranial hemorrhage within 7 days,and 8 of them (19.0％ ) had symptomatic intracranial hemorrhage; 11 (26.2％ ) died within 90 days.Univariate analysis showed that the baseline blood glucose levels (P=0.019),the baseline National Institutes of Health Stroke Scale (NIHSS) scores (P =0.014),symptomatic intracranial hemorrhage (P =0.005),and the degree of recanalization (P =0.002) could influence the longterm outcome of patients with intra-arterial thrombolysis.Multivariate logistic regression analysis indicated that the lower level of basdine glucose and good recanalization were the independent predictive factors of the good long-term outcome after intra-arterial thrombolysis in patients with acute ischemic stroke.Conclusion After the exclusion of contraindications,the intra-arterial thrombolysis was safe and effective for patients with acute ischemic stroke.The lower blood glucose levels on admission and the good recanalization after thrombolysis were associated with the good long-term outcome of intm-arterial thrombolysis.

Acute ischemic stroke is characterized by high morbidity, high disability and high mortality. The effectiveness and safety of endovascular therapy in the treatment of acute ischemic stroke have been recognized, but there are few studies on perioperative blood pressure control, and the best blood pressure control management strategy has not yet reached a consensus. This article reviews the blood pressure management during the perioperative period of endovascular treatment.