Wake-up stroke accounts for about 25％ of all new ischemic stroke.Many patients with wake-up stroke can not receive thrombolytic therapy because the uncertainty of onset time.Recent studies have shown that the multimodal imaging may screen suitable patients with wake-up stroke for early thrombolysis treatment.

Cystatin C is a cysteine protease inhibitor. It is widely found in the nucleated cells and body fluids of various tissues. It is a low molecular weight basic non-glycosylated protein. Previous studies have confirmed that cystatin C is an ideal endogenous marker reflecting early renal damage. Recent studies have shown that cystatin C is involved in the pathophysiological processes of a various cardiocerebrovascular diseases.This article reviews the correlation between cystatin C and cardiocerebralvascular diseases.

Objective To investigate the correlation between lesion pattern and etiological mechanism in acute isolated pontine infarction.Methods The clinical data in patients with acute isolated pontine infarction were collected retrospectively. Diffusion weighted imaging (DWI) was used to identify the lesion patterns. The correlation between the lesion pattern and etiological subtype was analyzed. Results A total of 146 patients with acute isolated pontine infarction were enrolled in the study, including 136 unilateral infarctions and 8 bilateral infarctions. The DWI lesion pattern analysis showed that there were 98 patients with paranasal infarction, 11 with anterolateral infarction, 18 with tegmentum infarction, and 19 with multiple infarction. Among all the etiological subtypes, basilar artery branch disease (BABD) accounted for the greatest proportion (n = 72, 49.3%), followed by large arterial occlusive disease ( n = 32, 21.9%), small arterial occlusive disease ( n = 25, 17.1%), and other causes/unknown causes ( n = 12, 8.2%). Cardioembolism was minimal (n =5, 3.4%). The distribution patterns of DWI lesions in acute isolated pontine infarction were significantly correlated with the etiological subtypes (C = 0.516, P < 0.001). Among them, 60 patients with paramedian infarction ( χ2 =16.915, P <0.001), 1 with anterolateral infarction ( χ2 =7.701, P = 0.006), 1 with tegmentum infarction ( χ2 =17.401, P <0.001) were closely associated with BABD; 9 patients with paramedian infarction ( χ2 =12.534, P <0.001), 6 with anterolateral infarction ( χ2 =24.365, P <0.001), and 10 with tegmentum infarction ( χ2 =18.312, P < 0.001) were significantly associated with small arterial occlusive disease. Conclusions There are significant correlation between the lesion pattern and etiological mechanism in acute isolated pontine infarction. The cause of acute isolated pontine infarction can be predicted in early stage by DWI revealed infarction distribution characteristics.

The incidence of variation of cerebrovascular structure is higher in population.Previous studies have shown that the variation of the cerebrovascular structure is an independent risk factor for ischemia stroke.This article reviews the common cerebrovascular variation and its relationship with ischemic stroke.

Vertebrobasilar dolichoectasia (VBD) is a rare posterior circulation vascular variant disease.Studies have shown that VBD has an effect on the outcome of ischemic stroke.This article reviews the relationship between VBD and ischemic stroke.

Moyamoya disease (MMD) is a chronic progressive steno-occlusive vasculopathy that involves terminal portions of the bilateral internal carotid arteries and/or the initial segment of the middle cerebral arteries and/or the initial segment of the anterior cerebral arteries. Ring finger protein 213 gene (RNF213) is considered as the major susceptibility gene of MMD.RNF213p.R4810K is mainly distributed in East Asians and is the founder variant of Asian patients with MMD.RNF213p.R4810K is associated with the incidence, prevalence, severity of illness and clinical manifestations of MMD. The biochemical mechanisms ofRNF213p.R4810K are still unclear and may affect angiogenesis of endothelial cells through both cell cycle-dependent and cell cycle-independent mechanisms. This paper reviews the research progress ofRNF213p.R4810K and the related mechanisms in MMD.

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Objeetive To investigate the clinical and imaging features in patients with clinically confirmed acute ischemic stroke and negative diffusion-weighted imaging (DWI).Methods The clinical and imaging data in patients with clinically confirmed acute ischemic stroke and initial negative DWI were collected retrospectively.According to the repeat DWI findings,they were divided into either a persistentnegative DWI group or a faise-negative DWI group.The demographics,and data of clinical and imaging at baseline between the 2 groups were compared,and the causes of the initial negative DWI were analyzed.Results A total of 15 patients with clinically confirmed acute ischemic stroke and initial negative DWI were enrolled,including 9 in the persistent-negative DWI group (9/15,60.0％) and 6 in the false-negative DWI group (6/15,40.0％),and 8 with minor stroke (National Institute of Health Stroke Scale score ≤3;8/15,53.3％).The time from onset to admission ranged from 1 to 48 h.The time from onset to initial DWI examination ranged from 5 to 65 h.The time from onset to repeat DWI ranged from 38 to 190 h.There were no significant differences in demographics,and data of clinical and imaging at baseline between the 2 groups.In 6 patients with false-negative DWI findings,5 were posterior circulation stroke (5/6,83.3％) and 1 was anterior circulation stroke (1/6,16.7％);1 might have a second infarct,1 might be associated with shorter examination time (5 h after onset),1 was associated with not reaching the diffusion limited threshold and the influence of MRI artifact before symptom aggravation,and the remaining 3 might be associated with smaller lesions and locating in the posterior circulation.The causes of 9 patients with persistent-negative DWI ffndings were unknown.Conclusions There were no significant differences in features of clinical and imaging at baseline between persistent-negative and false-negative DWI findings.False-negative DWI findings in acute ischemic stroke can be mainly seen in patients with posterior circulation stroke and minor stroke.

Objective To investigate the effect of basilar artery hypoplasia (BAH) on the outcomes in patients with acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke admitted to hospital within 7 d after onset were enrolled.The modified Rankin Scale was used to assess the functional outcomes at discharge and 90 d after onset,and 0-2 was defined as a good outcome.BAH was defined as the basilar artery uniform and fine and its diameter ＜2 mm in the level of pons.Demography,vascular risk factors,vascular variation,baseline clinical data,and laboratory examinations were compared between the good outcome group and the poor outcome group.Multivariate logistic regression analysis was used to determine the independent influencing factors of outcomes in patients with acute ischemic stroke.Results A total of 334 patients with acute ischemic stroke were enrolled,including 112 (33.5％) females and 222 (66.5％) males,with an average age of 67.3 ± 12.0 years;28 (8.4％) patients had BAH,260 (77.8％) had good outcomes at discharge,258 (77.2％) had good outcomes at 90 d after onset.The age,baseline National Institutes of Health Stroke Scale (NIHSS) score,fasting blood glucose level,and the proportions of atrial fibrillation,anterior circulation infarction,and non-BAH in the poor outcome group were significantly higher than those in the good outcome group at discharge (all P ＜ 0.05).Multivariable logistic regression analysis showed that the higher baseline NIHSS score (odds ratio [OR] 1.170,95％ confidence interval [CI] 1.088-1.258;P ＜ 0.001) and fasting blood glucose (OR 1.155,95％ CI 1.049-1.272;P =0.004) were the independent risk factors for poor outcome,and BAH (OR 0.190,95 ％ CI 0.039-0.920;P =0.039) was an independent predictor of good outcome at discharge.The age,fasting blood glucose,low-density lipoprotein cholesterol,baseline NIHSS score,and the proportions of smoking,atrial fibrillation,anterior circulation infarction,and non-BAH in the poor outcome group were significantly higher than those in the good outcome group at 90 d after onset (all P ＜0.05).Multivariate logistic regression analysis showed that higher baseline NIHSS score (OR 1.172,95％ CI 1.089-1.262;P ＜0.001) and higher fasting blood glucose (OR 1.156,95％ CI 1.048-1.275;P =0.004) were the independent risk factors for poor outcome,and BAH (OR 0.195,95％ CI 0.040-0.940;P =0.042) was an independent predictor of good outcome at 90 d after the onset.Conclusion BAH is the independent predictor of good outcome in patients with acute ischemic stroke.