Objective:To investigate the predictors of early neurological deterioration (END) in patients with acute ischemic stroke (AIS) based on the Oxfordshire Community Stroke Project (OCSP) classification system.Methods:Patients with AIS admitted to the Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from February 2018 to November 2020 were enrolled retrospectively. According to the OCSP criteria, the patients were classified into total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI), and lacunar infarct (LACI). END was defined as the National Institutes of Health Stroke Scale (NIHSS) total score within 72 h after onset increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Multivariate logistic regression analysis was used to determine the independent risk factors for END in AIS patients with different OCSP types. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of each index for END in AIS patients with different OCSP types. Results:A total of 405 patients with AIS were enrolled. Their age was 68.84±12.27 years, and 250 were males (61.7%); 132 patients (32.6%) were in the TACI group, 108 (26.7%) were in the PACI group, 61 (15.1%) were in the POCI group, and 104 (25.7%) were in the LACI group. END occurred in 136 patients (33.6%). Multivariate logistic regression analysis showed that homocysteine (Hcy) (odds ratio [ OR] 1.065, 95% confidence interval [ CI] 1.012-1.212; P=0.015), baseline NIHSS score ( OR 1.209, 95% CI 1.095-1.335; P<0.001) and the time from onset to admission ( OR 1.663, 95% CI 1.282-2.082; P<0.001) were significantly and independently correlated with END in the TACI group. Hcy ( OR 1.137, 95% CI 1.040-1.244; P=0.005), fasting blood glucose ( OR 1.714, 95% CI 1.272-2.311; P<0.001), neutrophil to lymphocyte ratio (NLR) ( OR 1.370, 95% CI 1.016-1.848; P=0.039) and the time from onset to admission ( OR 1.266, 95% CI 1.056-1.519; P=0.011) were significantly and independently correlated with END in the PACI group. NLR ( OR 1.446, 95% CI 1.031-2.027; P=0.033) was significantly and independently correlated with END in the POCI group. Fasting blood glucose ( OR 1.301, 95% CI 1.006-1.683; P=0.045), NLR ( OR 1.393, 95% CI 1.025-1.894; P=0.034) and the time from onset to admission ( OR 1.171, 95% CI 1.008-1.361; P=0.039) were significantly and independently correlated with END in the LACI group. ROC curve analysis showed that the areas under the curve (AUC) of Hcy and baseline NIHSS score for predicting END in the TACI group were 0.617 (95% CI 0.521-0.713; P=0.021) and 0.784 (95% CI 0.706-0.862; P<0.001). The optimal cut-off values were 15.91 μmol/L and 19.5 points, respectively. The sensitivity and specificity were 63.7% and 85.2%, 62.0% and 86.9%, respectively. The AUC of Hcy, fasting blood glucose and NLR for predicting END in the PACI group were 0.672 (95% CI 0.548-0.797; P=0.005), 0.794 (95% CI 0.697-0.891; P<0.001) and 0.674 (95% CI 0.560-0.788; P=0.005), respectively. The optimal cut-off values were 15.2 μmol/L, 6.85 mmol/L, and 3.71, respectively. The sensitivity and specificity were 61.3% and 77.9%, 80.6% and 72.8%, 67.7% and 79.4%, respectively. The AUC of NLR for predicting END in the POCI group was 0.850 (95% CI 0.735-0.964; P<0.001). The optimal cut-off value was 5.2. The sensitivity and specificity were 84.2% and 81.4% respectively. The AUC of fasting blood glucose and NLR for predicting END in the LACI group were 0.728 (95% CI 0.614-0.842; P<0.001) and 0.731 (95% CI 0.614-0.842; P<0.001), respectively. The optimal cut-off values were 5.44 mmol/L and 2.71 respectively. The sensitivity and specificity were 80.0% and 62.7%, 76.0% and 79.2%, respectively. Conclusion:The predictors of END in AIS patients with different OCSP types are different.

Objective To study the clinical features of patients with neuromyelitis optica (NMO) having initial symptom of intractable hiccup and nausea (INH) to improve the recognition of the disease.Methods Fourteen patients with NMO having INH as onset,admitted to our hospital from January 2015 to April 2016,were chosen.The onset characteristics,cerebrospinal fluid (CSF) results,serum aquaporins (AQP)4 antibody level,head and neck MR imaging of these patients were retrospectively analyzed.Results NMO with INH as onset was more common in young and middle-aged women;and the symptom was stubborn.Leukocyte increased slightly and total protein was normal or slightly increased in CSF.The positive rate of AQP4 antibody in serum was 79％ and oligoclonal band in CSF was 17％.MR imaging showed 8 patients (57％) had lesions in bulbar tegmentum and area postrema,6 patients (43％) had high cervical cord lesions without medullary lesion;most of the lesions in medulla oblongata and high cervical cord were linear;5 patients (36％) had abnormal signal of brain stem,corpus callosum and cerebral cortex.It was isointense or hypointensity on T1WI and hyperintense on T2WI and FLAIR sequences.Conclusions Antiemetic therapy of NMO with INH as onset is ineffective;the initial symptom is INH,followed by optic neuritis and/or myelitis symptoms.MR imaging shows lesions including bulbar tegmentum and area postrema,or linear signal changes in medulla and spinal cord.

Objective To investigate the influence of lengthening or tortuous basilar artery (BA) on the BA hemodynamic parameters measured by transcranial doppler (TCD).Methods 153 cases with CTA and TCD simultaneously evaluating the BA were included.According to CTA criterion,144 cases were with lengthening and/or tortuous BA and 9 cases were without lengthening and/or tortuous BA.The TCD cerebral hemodynamic parameters included peak systolic velocity (PSV),mean blood flow velocity (MFV),end diastolic velocity (EDV),pulsatility index (PI) and resistant index (RI).The relationship between the grading of lengthening/tortuous of BA and TCD parameters were analyzed.Results ①The TCD parameters (PSV,MFV,EDV,PI,RI) showed no significant statistical differences among the grades of lengthening BA.The correlation between the TCD paremeters (PSV,MFV,EDV,PI,RI) and the grades of lengthening BA showed no significant statistical differences.②The TCD parameters (PSV,MFV,PI,RI) showed significant statistical differences among the grades of tortuous BA.The TCD parameters (PSV,MFV,PI,RI) showed significant statistical differences between grade 0 and grade 3 of tortuous BA.The significant negative correlation between the TCD parameters (PSV,MFV,EDV,PI,RI) and the grades of tortuous BA was found.Conclusion The tortuosity of BA can lead to hemodynamic alterations,whereas the lengthening of BA does not affect cerebral hemodynamics significantly.