Wake-up stroke (WUS) patients are those who go to sleep without stroke symptom and wake up with stroke symptom. WUS is very common in clinical practice. One out of every five new ischemic strokes is WUS. These patients are usually excluded from thrombolytic therapy because their exact onset time is unknown. The latest research have shown that reperfusion therapy is safe and effective in selected WUS patients based on multimodal imaging. This article reviews the imaging -guided reperfusion therapy for WUS.

Objective To investigate the expression of IGF-1 in cerebral tisse,and its correlation with Glutamate expression and neuronal apoptosis,and to study the role of IGF-1 in the pathophysiologie process of ICH.Methods ICH model was induced in rats by infusing 50?l autologous blood into the eaudate nucleus with stereotaetie device.The animals were randomly divided into sham-operation group,ICH group and exogenous IGF-1 intervention group.Every rat was killed and brain tissue was collected.Immunohistoehemitry assay was used to detect the expression of IGF-1 and Glutamate,and TUNEL method used to detect apoptosis in cerebral tissues.Result At 2 hours after ICH,IGF-1 positive cells appeared around the hematoma in the brain,peaked after 24 hours,and returned to normal level on the 7th day. Glutamate positive cells appeared around the hematoma at 2 hours,peaked on the 3rd day,and its high level expression lasted to the 7th day.TUNEL- positive cells appeared at 8 hours,peaked on the 3rd day,and few apoptotic ceils could be found on the 7th day.The expression of IGF-1 was positively correlated with apoptotie cells and the expression of Glutamate.The amounts of Glutamate positive cells and TUNEL positive cells were significantly reduced after intervention with exogenous IGF-1.Conclusion IGF-1 participated in the pathophysiologic course of ICH.IGF-1 repaired and protected the brain tissue from damage after ICH.

ObjectiveTo study the relation ship between progressive cerebral infarction and thyroid hormone level,and analyze the risk factors of progressive cerebral infarction.MethodsThe thyroid hormone,triglyceride esters and fasting glucose levels of 48 patients with progressive cerebral infarction,138 patients with non-progressive cerebral infarction and 60 healthy subjects as control group were measured.ResultsCompared with the patients with non-progressive cerebral infarction,serum T3 of patients with progressive cerebral infarction was lower( P ＜0.05),and the levels of triglyceride ( TG),C-reactive protein ( CRP),and fasting blood glucose were higher ( all P ＜ 0.01 ).ConclusionPatients with progressive cerebral infarction were in a low level of thyroid hormones,and the increasing levels of TG,CRP,and fasting blood glucose were risk factors for progressive cerebral infarction.

This article summarizes the components,the formation and development of carotid atherosclerotic plaque,the factors affecting the stability of plaque,the mechanisms of plaquecaused ischemic cerebrovascular disease as well as the diagnosis of plaques and the treatmentstatus.

Objective:To explore the clinical characteristics and complementary tests of a Chinese patient with central mixed phenotype acute leukemia and improve the awareness and diagnosis of MPAL among clinicians.Methods:Retrospectively analyzed a patient's clinical feature, laboratory examination, diagnosis and literature review who had headache as the first symptom and finally diagnosed with MPAL.Results:A 59-year-old female presented with recurrent headaches and can not relieved, at last , was confirmed as mixed phenotype acute leukemia by flow cytometry of cerebrospinal fluid、immunophenotyping and molecular biology of bone marrow. Remission was achieved after chemotherapy for lymphoid and myeloid leukemia.Conclusion:Patients with an unclear diagnosis of central nervous system disease, leukemia should be considered, and cerebrospinal fluid flow cytology and bone marrow biopsy should be refined.

Poststroke cognitive impairment (PSCI) is a common complication after ischemic stroke, which seriously affects the recovery of neurologic function and lowers the quality of daily life of patients. In a considerable portion of patients, the PSCI is reversible. This article reviews the influencing factors of cognitive impairment after ischemic stroke, including genetic predisposition, demographic factors, lifestyles, clinical manifestations, imaging findings and drug administration, etc. to provide references for prevention and intervention of PSCI.

Objective:To study the clinical characteristics and risk factors of carotid artery plaques in patients with type 2 dia-betes mellitus(T2DM ) and ischemic stroke .Methods :A total of 185 patients with ischemic stroke from Jul 2013 to Dec 2013 were divided into T2DM group(n=72) and non-T2DM group(n=113) .All the patients underwent ultrasonic examination to confirm the incidence of carotid artery plaques .And 22 patients received computed tomographic arteriography (CTA) for further diagnosis of carotid artery plaques .The relationships of glucose metabolism and lipid metabolism with the size of carotid artery plaquewereanalyzed.Results:Theincidencerate,natureandsizeofcarotidarteryplaque,intima-mediathickness(IMT)ofca-rotid artery in T2DM group were significantly different from those in non-T2DM group(P<0 .05) .The main factors affecting the sizes of carotid artery plaques were T 2DM ,2 h postprandial blood glucose(2 h PBG) ,homeostatic model assessment for in-sulin resistance(HOMA-IR) ,fasting blood glucose(FBG) ,low density lipoprotein-cholesterol(LDL-C) , P<0 .05 .There was significant difference in the degree of lumen stenosis detected by ultrasound and CTA in the 22 patients(P<0 .05) .Conclu-sions:The size of carotid artery plaque in patients with ischemic stroke are influenced by T 2DM ,2 h PBG ,HOMA-IR ,FBG and LDL-C .The incidences of plaques as well as vulnerable plaques increases when patients suffer with T 2DM simultaneously .Ul-trasound can be applied as the preferred method for carotid artery plaque screening .CTA manifests as a more promising manner to demonstrate the characteristics of the plaques and the severity of lumen stenosis .