Objective To describe the clinical features and magnetic resonance imaging (MRl) findings of brainstem infarction producing internuclear ophthalmoplegia (INO) as an predominant clinical manifestation.Methods The clinical data of 9 patients diagnosed with brainstem infarction presenting with INO by angiography and MRI diagnosis in our hospital were collected from January 2010 to October 2016.The clinical features and imaging findings of these patients were analysed,and the pathogenesis mechanisms was analysed by literature research.Results The median age of the 9 patients was 56 years old,and there were 5 young and middle aged cases (under 60 years old),accounted for 55.6％.Among them,8 cases (88.9％) with INO typically presenting with horizontal diplopia,the most common accompanied symptom was dizzness (accounted for 55.6％),and most of them (accounted for 77.8％) were unilateral.A total of 6 cases were anterior INO,3 cases were both anterior and posterior INO.Five cases (55.6％) retained converging movement.The MRI showed that paramedian ventral infarcts located in the the cerebral aqueduct were responsible for INO in 1 case,and paramedian dorsal infarcts located in the pons were responsible for INO in 8 cases.The magnetic resonance angiography (MRA) indicated that vascular occlusion or stenosis was found in posterior circulation in 6 patients,there were 5 cases with stenosis of the posterior cerebral artery which was the most common.The ocular symptoms,including diplopia and blurred vision,of 6 cases (66.7％) disappeared during their hospital stay (range:13-23 d,median:14 d).During following up,ocular symptoms of 1 case finally disappeared within 3 months.Conclusion Brainstem infarction presenting with INO is mainly caused by paramedian dorsal infarcts located in the pons,and most of the patients complicated with posterior circulation atherosclerotic lesions.The pathogenesis varies,and the patients have a good clinical prognosis.For the young and middle-aged patients presenting with diplopia as an initial symptom,it should pay more attention to differential diagnosis.

Objective This study aimed to investigate the clinical characteristics of cryptogenic stroke as the first manifestation of occult systemic malignancy (OSM) and to determine whether plasma D-dimer levels and lesions in multiple vascular regions could predict occult systemic malignancy in patients with cryptogenic stroke. Methods Data from 83 patients including 9 patients with OSM and 74 patients without OSM were extracted from the stroke database of Beijing Shijitan Hospital. Clinical variables were analyzed between cryptogenic stroke patients with OSM and without OSM. The relationshiop between plasma D-dimer levels or lesions in multiple vascular regions and OSM were analyzed by multiple logistic regression analysis. Results Compare to patients without OSM, patients with OSM was older (66.8± 7.5 vs.56.4±15.7,P=0.004)and had lower hemoglobin levels (127.9±19.8 vs.143.6±17.7,P=0.015),higher conut score [3(1,3) vs. 1(0,2), P=0.011], higher plasma D-dimer levels (77.7% vs. 13.5%, P<0.001) and more common lesions in multiple vascular regions(100% vs.23.0%, P<0.001).Multiple logistic regression analysis revealed that high plasma D-dimer levels are independent risk factors for OSM (OR=26.250,95%CI:3.041-226.604,P=0.003).Conclusions Patients with OSM are elderly people and have poorer nutritional status, higher plasma D-dimer levels and more common lesions in multiple vascular regions. High plasma D-dimer levels can be useful to predict OSM in patients with cryptogenic stroke at earlier stages.

Objective To compare the differences of clinical and neuroimaging features between ischemic stroke patients with and without cancer. Methods From January 2013 and July 2017, 41 patients with active cancer diagnosed as acute ischemic stroke were retrospectively analyzed as research group. Besides, 41 age-and sex-matched patients diagnosed as acute ischemic stroke without cancer were selected as control group. The clinical date of both groups were collected and analyzed statistically. Results The percentages of hypertension, hyperlipidemia and past stroke were lower (χ2 > 5.549, P < 0.05), and the percentage of patients with cryptogenic stroke was higher in the research group than in the control group (χ2 > 17.537, P < 0.05). The hemoglobin level was lower (t = 4.609, P < 0.001), the D-dimer level was higher (t = -5.796, P < 0.001) in the research group than in the control group. Multiple vascular lesions of 53.7% patients in the research group were higher than 4.9% in the control group. The percentage of DWI lesions involving three vessel territories was higher in the research group than in the control group (χ2 > 17.995, P < 0.01). The percentage of multiple small lesions, and lesions located in cortical/subcortical lesions or cerebellum was higher in the research group than in the control group (χ2 > 8.159, P < 0.01). The 30 days mRS score after ischemic stroke (t = -3.222, P < 0.01) and the mortality rate within 30 days (P < 0.05) were higher in the research group than in the control group. Conclusion Compared with ischemic stroke patients without cancer, there were more cryptogenic stroke, higher D-dimer levels and poor prognosis in patients with active cancer. In ischemic stroke, patients with active cancer has a unique focal distributions characterized by more multiple vascular lesions involving three vessel territories and more lesions located in cortical/subcortical and cerebellum. The patients with ischemic stroke who conform to above characteristic should be paied attention to tumor screening.