Objective To investigate the relationship between the stress induced glucose up-regulation and brainstem infarction. Methods Three hundred and sixty-six patients of cerebral infarction in the department of neurology were included in this study. Stress induced glucose up-regulation was reflected by stress induced glucose up-regulation ratio (SIGUT), and the level of SIGUT was compared between groups of brainstem and non-brainstem infarction. SIGUT was categorized into 4 groups according to the quartiles, and relative variables were compared among 4 groups. The level-risk relationship between high level of SIGUT and brainstem infarction was performed through logistic regression. Results The level of SIGUT was higher in group of brainstem infarction than that in group of non-brainstem infarction: 1.060 ± 0.272 vs.1.159 ± 0.301(P＝0.020). The percent of male, diabetes, brainstem infarction and level of FBG, HbA1c, NIHSS was obviously different in the 4 groups of SIGUT according to the quartiles (P<0.05). High level of SIGUT was correlated to brainstem infarction in the single-factor or multivariable logistic regression adjusted for relative variable (P < 0.05). Conclusions Stress induced glucose up-regulation is correlated to the brainstem infarction, which is prone to happen in brainstem infarction, and the magnitude is more prominent.

Objective:To investigate whether the basal blood glucose level before cerebral infarction has an impact on acute stress hyperglycemia.Methods:A total of 366 patients with cerebral infarction admitted into the neurology department of our hospital from February 2008 to May 2012 were enrolled in this study. Acute stress hyperglycemia was reflected by stress-induced glucose up-regulation ratio (SIGUR), and the basal glucose before cerebral infarction was reflected by glycosylated hemoglobin A1c (HbA1c). The correlation between SIGUR and HbA1c was analyzed in the different populations. The difference in SIGUR was compared among the non-diabetic group, diabetes with poor blood glucose control group (HbA1≥6.5%) and diabetes with well blood glucose control group (HbA1c<6.5%). The relationship between high level of SIGUR (Q4) and HbA1c was performed through logistic regression analysis.Results:SIGUR was correlated with HbA1c, no matter in the non-diabetic, diabetic or total populations ( r=-0.200, 0.195 and 0.324, P=0.010, 0.011 and 0.000). The level of SIGUR was higher in diabetes with poor blood glucose control group than in the non-diabetes and diabetes with well blood glucose control group ( F=25.842, P=0.000), but there was no significant difference between the non-diabetic group and diabetes with well blood glucose control group ( P>0.05). Logistic regression analysis showed that the high level of SIGUR was correlated to HbA1c in the total populations ( OR=1.460, P=0.000). In the diabetic group, the probability of higher SIGUR level was increased along with the increased HbA1c level ( OR=1.237, P=0.021), while the probability of higher SIGUR level was decreased along with the increased HbA1c level in the non-diabetic group ( OR=0.233, P=0.010). Conclusions:Acute stress hyperglycemia is correlated to the basal blood glucose before cerebral infarction, and blood glucose increases more prominently in those patients with high basal blood glucose level, especially in the diabetic patients.

Ten patients with allergic granulomatosis with polyangiitis (AGPA) were admitted in Nanjing Drum Tower Hospital during January 2013 to August 2019, among whom 5 cases with neurologic involvement. The clinical features, laboratory findings and clinical outcome of the 5 patients were analyzed and literature review was performed. Among 5 cases of AGPA with neurologic involvement, 3 presented with peripheral neuropathy as the initial symptom, 2 had multiple mononeuropathy, 3 had distal asymmetric or symmetric polyneuropathy. All five patients had acute or subacute onset, and the symptoms of limb numbness or pain were prominent. Electrophysiological examination showed that sensory and motor conduction amplitude significantly decreased or disappeared. Eight of the 10 AGPA patients were treated with corticosteroid combined with immunosuppressants, 2 were treated with corticosteroid alone. Eight patients had good prognosis and 2 patients died. The results suggest that peripheral neuropathy is common in AGPA. When the patients present with acute or subacute onset of axonal impairment of peripheral neuropathy and elevated eosinophils, AGPA should be considered.

Objective To investigate the change and possible role of bilirubin between with and without diabetes mellitus in the population of acute ischemic stroke. Methods ⑴A total of 610 hospitali-zation patients at the Department of Neurology in Affiliated Drum Tower Hospital of Nanjing University Medi-cal School from October 2008 to September 2012, who were diagnosed as acute ischemic stroke was divided into two groups based on diabetes mellitus or not, and 138 hospitalization patients with vertigo or dizzy diag-nosed as posterior ischemic while had no acute ischemic stroke were set as a control, divided into two groups based on the same standard too. Also, serum direct bilirubin and total bilirubin and new infarction or not were recorded. ⑵The levels of direct bilirubin and total bilirubin were compared between groups of diabetes and without diabetes, whatever in the population of acute ischemic stroke or not. Results ⑴The levels of serum total bilirubin and direct bilirubin were decreased obviously in the group of diabetes mellitus compared to the group of non-diabetes mellitus in the population of acute ischemic stroke [(17. 085 ± 0. 595)μmol/L vs (18. 920 ± 0. 487)μmol/L, P=0. 024;(4. 362 ± 0. 147)μmol/L vs (4. 876 ± 0. 135)μmol/L, P =0. 019 ] . ⑵There were no obvious difference of serum total bilirubin and direct bilirubin between the groups of diabetes mellitus and non-diabetes mellitus in the population of non-ischemic stroke ( P>0. 05 ) . Con-clusions Induction of bilirubin by acute ischemic stroke can be inhibited by diabetes mellitus, which may be one of the mechanisms of deteriorative brain damage by diabetes mellitus after acute ischemic stroke.

Objective:To investigate the clinical and imaging characteristics of isolated cortical vein thrombosis (ICVT) in order to improve the understanding of this rare disease.Methods:From December 2013 to September 2019, patients with ICVT admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were collected retrospectively. Their clinical manifestations, imaging examination, treatment and prognosis were analyzed.Results:A total of 6 patients with ICVT were enrolled in the study, including 3 males and 3 females, with an average age of 37 years. The main clinical manifestations were acute seizures (5/6, 83.3%), focal neurological deficits (3/6, 50.0%), and headache (3/6, 50.0%). In the imaging examination, the direct signs of ICVT were spot sign and cord sign, and the indirect signs were cerebral lobe hemorrhage, infarction, or edema.Conclusions:Seizures, focal neurological deficits and headaches are common manifestations of ICVT. Multimodality imaging examinations are helpful for early diagnosis of the disease.

Objective:To investigate the clinical and imaging characteristics of deep cerebral vein thrombosis (DCVT).Methods:From December 2006 to December 2019, patients with DCVT admitted to Nanjing Drum Tower Hospital were enrolled retrospectively. The clinical manifestations, imaging examinations, treatment and prognosis of the patients were analyzed.Results:A total of 11 patients with DCVT were enrolled in the study, including 4 females and 7 males. Their average age of onset was 41.6 years. Their most common clinical manifestations were acute or subacute onset headache (11/11, 100%), disturbance of consciousness (5/11, 45.5%), and seizures (4/11, 36.4%). All 11 patients involved straight sinus, 9 involved the great cerebral vein, 5 involved the internal cerebral vein, and 1 involved the basilar vein. All patients were complicated with other venous sinus thrombosis, and 3 were complicated with superficial cortical venous thrombosis. Early CT plain scan (within 1 week of onset) of 8 patients (72.3%) showed high-density point sign of great cerebral vein or cord sign of straight sinus. Head MRI showed that 90.9% (10/11) of patients had brain parenchymal damage, thalamic involvement (5/11, 45.5%) was the most common, followed by deep white matter (4/11, 36.4%). One patient received urokinase interventional thrombolysis and died on the 6 th day of onset. The remaining 10 patients improved after receiving anticoagulant therapy. Follow up of 4 months to 13 years showed that 4 patients left with mild to moderate disability (the modified Rankin scale score 1-3), and 6 returned to normal. Conclusions:Headache, disturbance of consciousness and seizures are common clinical manifestations of DCVT. Imaging examination shows that the possibility of DCVT should be warned when the thalamus or deep white matter is involved. It is necessary to pay attention to the high-density thrombus spot sign and cord sign on early CT plain scan. DCVT patients with cortical venous thrombosis progressed rapidly in the acute phase, and the outcomes were poor.