Objective To investigate the associations of left atrial enlargement and the severity and lesion patterns of cardioembolic stroke in patients with nonvalvular atrial fibrillation (NVAF).Methods The patients with NVAF diagnosed as cardiogenic stroke within 48 h after onset were enrolled.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke,and ≥ 10 was defined as moderate to severe stroke,and ＜ 10 was defined as mild stroke.Transthoracic echocardiography was used to measure the left atrial diameter.The patients were divided into normal group,mild,moderate,and severe left atrial enlargement groups.According to the lesion patterns revealed by the diffusion weighted imaging,they were divided into either a multiple infarctions group or a single infarction group.Results A total of 137 patients were enrolled,including 86 patients with mild stroke (62.8％),51 with moderate to severe stroke (37.2％),69 with multiple infarctions,and 68 with single infarction (49.6％).Left atrial enlargement was found in 103 cases,in which 35 (25.5％) were mild enlargement,40 (29.2％) were moderate enlargement,and 28 (20.4％) were severe enlargement.Multivariate logistic regression analysis showed that the risk of severe stroke in patients with mild (odds ratio [OR] 15.662,95％ confidence interval [CI] 1.821-134.677;P =0.012),moderate (OR 26.435,95％ CI 3.201-218.319;P =0.002),and severe (OR 75.763,95％ CI 8.536-672.441;P＜0.001) left atrial enlargement were increased significantly,and there were no significant differences in the lesion patterns among the different severity of left atrial enlargement groups (x2 =7.050,P =0.07).Conclusions Left atrial enlargement may be independently associated with the severity of cardiogenic stroke in patients with NVAF,but it is not associated with the lesion patterns.

Objective To investigate the associations of serum soluble CD40 ligand (sCD40L) levels with stroke risk,severity,and infarct volume.Methods Consecutive inpatients with acute ischemic stroke were recruited as a patient group.Healthy subjects were used as a control group.The demographics,vascular risk factors,and clinical data were collected from the patient group and control group.The serum sCD40L levels were measured by enzyme linked immunosorbent assay.According to the baseline National Institutes of Health Stroke Scale (NIHSS) scores,they were divided into a mild stroke group (＜ 8) and a moderate to severe stroke group (≥ 8).According to the median of infarct volume,the patients with ischemic stroke were divided into either a large infarction group or a small infarction group.Results A total 106 patients with acute ischemic stroke were recruited,including 47 females (44.3％) and 59 males (55.7％),and the mean age was 71.31 ± 11.27 years.There were 86 healthy subjects in the control group,including 41 females (47.7％) and 45 males (52.3％),the mean age was 73.56±9.32 years;there were.41 patients (38.7％) in large infarction group (≥1.8 cm3) and 65 (61.3％) in the small infarction group (＜1.8 cm3);there were 69 patients (65.1％) with mild stroke and 37 (34.9％) with moderate to severe stroke.The baseline serum sCD40L level in the patient group was significantly higher than that in the control group (5.61 ± 1.68 mg/L vs.3.56 ± 1.32 mg/L;t =9.236,P ＜0.01),the serum sCD40L level at day 14 after admission (4.19 ± 1.45 mg/L) in the patient group was significantly lower than the baseline level (P ＜0.01),but it was still higher than the control group (P ＜ 0.01).Multivariate logistic regression analysis showed that the higher low-density lipoprotein cholesterol (odds ratio [OR] 3.358,95％ confidence interval [CI] 2.681-4.056;P＜0.001) and serum sCD40L (OR 5.103,95％ CI 2.317-8.903;P＜0.001) levels were the independent risk factors for ischemic stroke;the higher serum sCD40L level (fourth vs.first quartile,OR 4.017,95％ CI 1.608-10.037;P =0.003),large atherosclerotic stroke (OR 2.321,95％ CI 1.014-5.314;P =0.046),cortical-subcortical infarcts (OR 2.679,95％ CI 1.111-6.460;P =0.028),and larger infarct volume (OR 3.216,95％ CI 1.398-7.395;P=0.006) were the independent risk factors for moderate to severe stroke;the higher serum sCD40L level (fourth vs.first quartile,OR 3.142,95％ CI 1.274-7.745;P =0.013),large atherosclerotic stroke (OR 2.956,95％ CI 1.299-6.767;P =0.010),cortical-subcortieal infarcts (OR 4.750,95％ CI 1.909-11.818;P ＜0.001),and baseline NIHSS score ≥8 (OR 8.509,95％ CI 3.432-21.094;P ＜ 0.001) were the independent risk factors for large infarction.Conclusion The serum sCD40L levels are closely associated with the risk,severity and infarct volume of ischemic stroke.

Fetal-type posterior cerebral artery is a common embryonic derivation type of the Willis.This article reviews the definition and typing of the fetal-type posterior cerebral artery,and its relationship with collateral circulation,ischemic stroke,and intracranial aneurysm,etc.

ObjectiveTo investigate the associations of fetal-type posterior cerebral artery (FTP) with infarction distribution and stroke severity in patients with acute ischemic stroke.MethodsThe patients with acute ischemic stroke were enrolled.They were divided into either a FTP group or a non-FTP group according to the results of magnetic resonance imaging.The former group was further divided into complete FTP (cFTP) and partial FTP (pFTP).According to the results of diffusion-weighted imaging, the infarction distribution was divided into the territory of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar artery.According to the National Institutes of Health Stroke Scale (NIHSS), the stroke severity was assessed, <8 was defined as mild stroke, and ≥8 was defined as moderate to severe stroke.Multivariate logistic regression analysis was used to determine the associations of FTP with infarction distribution and stroke severity.ResultsA total of 647 patients with acute ischemic stroke were enrolled, and 201 (31.1%) had FTP, including 162 (25.0%) cFTP and 39 (6.0%) pFTP.Multivariate logistic regression analysis showed that cFTP and pFTP were the independent risk factors for MCA infarction (cFTP: odds ratio [OR] 24.714, 95% confidence interval [CI] 10.952-45.766, P<0.001;pFTP: OR 14.526, 95% CI 6.832-25.931, P<0.001), and the independent protective factors for PCA infarction (cFTP: OR 0.214, 95% CI 0.022-0.531, P<0.001;pFTP: OR 0.326, 95% CI 0.018-0.739, P<0.001), they were also the independent risk factor for the severity of acute ischemic stroke (cFTP: OR 22.138, 95% CI 12.492-64.067, P<0.001;cFTP: OR 19.510, 95% CI 8.956-23.514, P<0.001).ConclusionscFTP and pFTP are the independent risk factors for MCA infarction, and the independent protective factors for PCA infarction, and at the same time, they were also the independent risk factors for the moderate to severe stroke.FTP is associated with the infarction distribution and the stroke severity in acute ischemic stroke.

Nontraumatic convexal subarachnoid hemorrhage is a rare type of nonaneurysmal subarachnoid hemorrhage.Its etiologies and clinical manifestations are diverse.This article reviews nontraumatic convexal subarachnoid hemorrhage from the aspects of etiology, clinical manifestation, imaging, diagnosis, treatment, and prognosis.

Pentraxin (PTX) 3 is a typical long PTX. As an inflammatory marker, the plasma PTX3 level is elevated in atherosclerosis, cardiovascular disease, infection, inflammation, autoimmune disease and tissue injury. Recently studies have shown that the plasma PTX3 level rapidly increased during the acute phase of ischemic cerebrovascular disease. Detection of plasma PTX3 level may be contribute to the diagnosis, treatment and prognostic judgment of acute cerebral infarction.

Objective To investigate the correlation between thyroid antibody level and carotid atherosclerotic plaque in patients with acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke were enrolled retrospectively.They were divided into a non-plaque group and a plaque group according to the findings of carotid artery color-Doppler ultrasonography.The plaque group was redivided into a stable plaque subgroup and a non-stable plaque subgroup.Chemiluminescence method was used to measure the serum thyroperoxidase antibodies (TPOAb) and thyroglobulin antibodies (TGAb) levels and they were compared.Results A total of 383 patients were enrolled in the study,including 116 (30.3％) did not have plaque and 267 (69.7％) had plaque,68 of them had unstable plaque,and 199 had stable plaque.The level of TGAb in the plaque group was significantly higher than that in the non-plaque group (Z =-4.826,P ＜0.001).Multivariate logistic regression analysis showed that the level of TGAb might be an independent risk factors for carotid plaque (odds ratio 1.007,95％ confidence interval 1.001-1.012;P =0.016).The serum level of TPOAb in the stable plaque group was significantly higher than that in the unstable plaque group (Z =-2.114,P=0.035),but multivariate logistic regression analysis showed that it was not the independent risk factor for unstable plaque (odds ratio 1.001,95％ confidence interval 0.996-1.006;P =0.786).Conclusions The level of serum thyroid antibodies increased in patients with acute ischemic stroke,especially the increased level of TGAb might be associated with the occurrence and development of carotid atherosclerotic plaque,however,it was not associated with the plaque stability.

Perihematomal edema (PHE) is the key factor to lead to the secondary brain injury after intracerebral hemorrhage,and it can affect the outcomes of patients.This article reviews the pathophysiological mechanisms and treatment strategies of PHE.

Left atrial enlargement is an independent risk factor for ischemic stroke and other cardiovascular adverse events. It can affect stroke severity and increase the risk of recurrence. The mechanisms associated with left atrial enlargement and ischemic stroke are not yet clear. It may be associated with atrial thrombosis or co-morbidity, such as atrial fibrillation and hypertension. How to conduct primary and secondary prevention of stroke patients with left atrial enlargement still need further clinical trials to determine.

Objective To study the clinical and imaging characteristics of cerebral venous sinus thrombosis(CVST).Methods Clinical data of 9 cases with CVST were retrospectively analyzed.Results All patients had headache,nausea and vomiting; 5 patients had epilepsy; 3 patients had focal neurological deficits; 3 patients had fever; 3 patients had palilledema; 3 patients had disturbance of consciousness. CSF examination showed prominent high intracranial pressure, but conventional and biochemical examinations were normal. 8 patients did CT scan, but the diagnosis was not clear. All patients first MRI showed venous sinus and related brain areas long T1 and T2 signal; MRV showed that the involved venoussinus had non-visualized signal. MRI in chronic phase showed slightly higher T1 and T2 signal; MRV showed sinus enhancement.The outline of uncomplete reconalzation was unclear. Conclusions The common high intracranial pressure is unspecific sign and symptom of patients with CVST. CSF examination show that the intracranial pressure is prominent high, but conventional and biochemical examination are normal. MRI can show that the normal flow void of the dural sinus is disappeared, instead of abnormal high or equality intensities. The characters of CVST in MRV are those the blood flow signal of involved venous sinus be disappeared or showed anormalism.