Pharmacological management of migraine should be evidence-based and individualized,combined with patient's education and non-pharmacological management.For acute therapy,simple or combination analgesics (non-steroidal anti-inflammatory drugs) or migraine specific drugs (ergotamines and triptans) are recommended and should be administrated following the concept of stratification or stepwise treatment.For preventive therapy,flunarizine,antidepressant (amitriptyline),antiepileptics (valproic acids and topiramate),and beta-blockers (propranolol and metoprolol) are drugs of first choice and should be chosen individually.Prophylaxis therapy should be evaluated for 4～8 weeks and last for 3～6 months whenever it is effective.

Hyperglycemia has direct and indirect impact on the occurrence and develop-ment of stroke. At present, hyperglycemia is considered as an independent risk factor for stroke. Hyperglycemia directly involves in cellular and vascular injury through activating polyol pathway, forming advanced glycosylation end product, activating protein kinase C and the hexosamine pathway. Moreover, hyperglycemia involves in vascular injury through the indirectly pathway such as lipid metabolism, glycosylated hemoglobin and insulin. Controlling hyperglycemia may effectively reduce the incidence of stroke and improve the prognosis in patients with stroke.

Objective To investigate the differences in neuroimaging between large artery atherosclerosis and small subcortical infarction (SSI). Methods The consecutive hospitalized patients with acute SSI were divided into large atherosclerotic stroke group and small-artery occlusive stroke group according to the evidence-based etiolologic classification of ischemic stroke (the SSS-TOAST criteria). The neuroimaging features between the two groups were compared.Results A total of 118 patients with SSI were recruited. Seven patients with cardiogenic cerebral embolism were excluded from the study. Three were stroke of other determined etiology and 7 were cryptogenic stroke. Twenty-six patients in the large artery atherosclerotic stroke group had new infarcts (3.69 ± 5. 79), 50％ of them were multiple lesions, mainly a half oval in the center (P ＜0. 01); 75 patients in the small-artery occlusive stroke group had new infarcts (1.08 ±0. 51), only 3 (3.7％) were mltiple lesions, and they were in the different artery territories.Compared to the large atherosclerotic stroke group, the white matter lesions was more severe in the small-artery occlusive stroke group (P =0. 04), and most of them were accompanied by silent infarction (P =0. 012). Conclusions The large atherosclerotic SSI was mostly multiple infarcts in a half oval in the center, while the small artery occlusive SSI was mostly single infarct, and was usually accompanied by severe white matter lesions and silent infarction.

Stroke is the most common cause of aphasia. Traditional speech-language therapy remains the mainstay treatment of aphasia, however, its efficacy is uncertain. Although a number of studies have been carried out to investigate the role of pharmacological agents in the treatment of aphasia, the conclusions are controversial, This article reviews the state of pharma-colotherapy for poststroke aphasia.

An increasing numaber of clinical trials have confimed the cholesterol-independent effects of statins.Recent clinical observations have found that using statins before the onset of ischemic stroke and during the acute stage can greatly lessen the severity of neurological defi-cits,reduce the mortality,and improve the prognosis;and that for patients with long-term statius treatmem,who withdraw the drug abruptly,may aggravate stroke lesions,and increase the risk of relapse.Although the use of statius may slightly increase the risk of bleeding,undoubtedly,the use of statins has become one of the most important approaches in the prevention and treatment of ischemic stroke.

Objective To investigate the prevalence of chronic kidney disease (CKD) in patients with acute stroke and the risk factors and prognostic characteristics in these patients.Methods A total of 270 consecutive hospitalized patients with acute stroke was recruited, and their CKD was evaluated transversally. Various risk factors and short-term prognosis of 53 patients with CKD whose National Institutes of Health Stroke Scale (NIHSS) scores were similar at admission among the 270 patients with stroke were compared to those of 106 patients without CKD. CKD was defined as glomerular filtration rate (GFR) ＜ 60 ml/(min·1.73 m2) and (or) random urinary albumin-to-creatinine ratios (ACR) ＞ 30 mg/g, and continued for more than 3 months. GFR was estimated according to the simplified Modification of Diet in Renal Disease (MDRD) equation, The modified Rankin Scale (mRS) was used to evaluate the shortterm prognosis. Results The prevalence of CKD in these patients was 19.6%, and most of them were early-and middle-stage CKD. The proportions of the histories of hypertension (81.13%), diabetes mellitus (33.96%), and stroke (45.28%) in patients with CKD were significantly higher than those in patients without CKD (64.15%, 18.86% and 27.36%,respectively, all P＜0.05). The mean levels of systolic pressure (151.74±20.98 mm Hg) and low density lipoprotein (3.03±0.96 mmol/L) in patients with CKD were significantly higher than those in patients without CKD (systolic pressure was 144.44±21.13 mm Hg, and low density lipoprotein was 2.75±0.76 mmol/L, all P＜0.05). In addition, the levels of erythrocytes sedimentation rate(median, 39 mm/h), high sensitive C-reactive protein (median,5.12 mg/L) and parathyroid hormone (81.01±26.78 pg/ml) were significantly higher than those in patients without CKD (they were 20 mm/h, 3.36 mg/L, and 46.95±24.63 pg/ml,respectively, all P＜0.05). There was a changing trend in low serum calcium and high serum phosphorus in patients with CKD. The proportion of the patients whose mRS score ≥ 3 at 3 months after the onset in patients with CKD was significantly higher than that in patients without CKD (66.03% vs 46.23%, P＜0.05). The mortality at 3 months (9.43%) also had an increasing tendency (P=0.073). Conclusions The prevalence of CKD was higher among the stroke population, and most of them were early-and middle-stage CKD. The stroke patients with CKD had more risk factors and worse prognosis than those without.

Intravenous recombinant tissue plasminogen activator (rtPA) thrombolysis is the most effective therapy for acute ischemic stroke. Its most serious complication is symptomatic intracerebral hemorrhage. The overall incidence reported in the literature is 6%. It is correlated with the wascular injury and the increased vascular permeability. Some clinical features, imaging and laboratory tests can predict the risks of the complication of intracerebral hemorrhage. The mortality and disability are very high in patients with the complications of intracerebral hemorrhage after thrombolytic therapy, and their prognosis is very poor. This article reviews the classification, incidence, predictive factors, and prognosis of intracerebral hemorrhage after thrombolysis.

Objective To analyze the factors affecting on early efficacy of intravenous thrombolysis with atleplase.Methods The clinical data of 100 acute cerebral infarction patients treated by intravenous thrombolysis with atleplase were retrospectively analyzed.The patients were divided into early effective group and ineffective group,whieh assessed by National Institute of Health Stroke Scale (NIHSS) with criteria of whether there were ＞ 3 or not at 24 hours after therapy.Univariate analysis and multivariate logistic regression analysis were used to determine the differences of clinical data between the two groups.Results Univariate analysis revealed that the early improvement was significantly associated with favorable outcome at 3 month (P =0.000).Multivariate logistic analysis revealed that the systolic pressure at baseline was moderately positively associated with early improvement (OR 1.031,95％ CI 1.008-1.056,P =0.009).Conclusion Moderately lower baseline systolic pressure is associated with early improvement after thrombolytic therapy which is associated with favorable outcome at 3 month.

Objective To explore the risk factors and imaging features of silent brain infarction (SBI).Methods The patient with SBI from the clinic were enrolled in the study,and the patients with symptomatic non-lacunar infarction served as controls.The risk factors and imaging features of both groups were compared.Results Among 145 patients with SBI,133 (91.72％) had two or more lesions,mainly in the centrum semiovale (73.10％).The proportion of patients with white matter lesions in the group of SBI in a single location was significantly lower than that in the group of SBI in multiple locations (41.67％ vs.73.68％ ;x2 =5.484,P =0.019).Compared to the patients with SBI,the age in patents with symptomatic non-lacunar infarction was older (72.42 ± 11.79 vs.67.03 ± 12.04 years; t =3.545,P =0.000),the proportions of male (63.55％ vs.46.21％ ;x2 =7.447,P =0.006),hypertension (80.37％ vs.64.14％ ; x2 =7.887,P =0.005) and atrial fibrillation (31.78％ vs.8.97％,x2 =21.113,P =0.000),as well as the levels of fasting glucose (6.09 ±1.23 mmol/Lvs.5.65± 1.18 mmol/L; t=2.863,P=0.005),total cholesterol (5.53± 0.74 mmol/Lvs.5.27 ± 0.90 mmol/L; t =2.554,P =0.011),triglycerides (1.89 ± 0.20 mmol/L vs.1.77 ± 0.18 mmol/L; t =4.910,P=0.000) and homocysteine (1 4.88 ±4.97 mmol/L vs.11.94 ±4.61 mmol/L; t =4.432,P =0.000)were higher.However,the lipoprotein (a) level was lower (0.18 ± 0.06 g/L vs.0.27 ± 0.18 g/L; t =-5.489,P =0.000).Among patients with SBI,33.8％ and 43.5％ had lesions in two and three locations,respectively;among patients with symptomatic non-lacunar infarction,66.4％ and 27.1％ had lesions in a single location and two locations,respectively (P ＜ 0.001).Multivariate logistic regression analysis showed that lipoprotein (a)was the independent risk factor for SBI (odds ratio 5.988,95％ confidence interval 2.421-14.706; P =0.000).Conclusions Although they shared a variety of common risk factors,patients with SBI had less atherosclerotic risk factors than those with symptomatic non-lacunar infarction.Most patients with SBI had lesions in multiple locations.

Objective To explore the changes of glutathione and nicotinamide adenine dinucleotide phosphate levels and their significances among elderly patients with acute myocardial infarction,elderly patients with angina pectoris and elderly people with normal coronary artery.Methods Totally 64 elderly patients with acute myocardial infarction were selected according to the clinical manifestation,electrocardiogram and myocardial markers.68 elderly patients with angina pectoris and 66 subjects with normal coronary artery (control group) were enrolled according to the coronary artery radiography.Peripheral venous blood in all subjects were taken and plasma glutathione (reduced form GSH and oxidized form GSSG) and nicotinamide adenine dinucleotide phosphate (reduced form NADPH and oxidized form NADP+) were measured.The GSH/GSSG ratio and NADPH/NADP+ redox potentials were calculated according to Nernst equation.Results Compared with control group,GSH level in acute myocardial infarction group and angina pectoris group significantly increased(4.04 ± 0.77 μmol/L,5.89 ± 0.85 μmol/L,7.55 ± 0.93 μmol/L; P＜0.05 or 0.01),GSSG decreased(0.70±0.05 μmol/L,0.61±0.04 μmol/L,0.53±0.03 μmol/L;P＜0.05 or 0.01),GSH/GSSG ratio increased(5.18±1.06,9.76±1.67,12.80±1.93; P＜0.05 or 0.01).The GSH/GSSG redox potentials decreased(-123.49 ± 1.18 mV,-126.21 ± 1.01mV,-128.71 ±1.29 mV;P＜0.05 or 0.01).Compared with control group,NADPH in acute myocardial infarction group increased(5.72 ± 0.44 nmol/L,6.83± 0.55 nmol/L ; P＜0.05),NADPH/NADP ratio increased (2.29±0.10,2.58±0.26,P＜0.05),the NADPH/NADP+ redox potentials significantly decreased (-306.3±2.44 mV,-312.1±2.53 mV; P＜0.05).Conclusions The imbalance of plasma redox status migrating to oxidization may have close relationships with atheromatous plaque formation,plaque rupture and thrombosis.