Objective To investigate the clinical and imaging features of aortic dissection(AD) with damage in nervous system.Methods The clinical data were retrospectively analyzed in 14 cases of AD with damage in nervous system.Results 13 patients(92.9%) were over age 40.All cases were acute onset and 9 cases had history of hypertensive disease.During onset,the blood pressure was elevated in 9 cases,decreased in 3 cases and could not be measured in 2 cases.The clinical manifestations of patients presented severe pectoralgia in 5 cases,chest-back complaint in 4 cases,bellyache,lumbago with emesia in 2 cases,shock in 2 cases.The appearances of nervous system:circumgyration in 5 cases,conscious disturbance in 4 cases,hemiparalysis in 2 cases,barylalia in one case,paraplegina in 2 cases and hypesthesia in 3 cases(meta-body in 1 case,below T 4 or T6 in 2 cases).The breast and abdominal part CT and CTA of all cases showed clearly the true and false lumens,the position of intimal slit(according Debakeys,2 cases were typeⅠ,7 cases were typeⅡ,5 cases were type Ⅲ) and mural thrombosis.The breast and abdominal part MRI in 8 cases could show conspicuous true and false lumens.The true lumen was presented flow and inane signals but the false lumen was presented higher signals in T1 and T2 WI.Conclusions The clinical manifestations of AD with damage in nervous system are main the ischemic impaired symptoms and signs of brain and spinal cord.Both CT and MRI can show the false lumen and vascular intimal slit of AD.

Objective To investigate the relationship between white matter lesions(WML) and cognitive impairment in migraine with and without aura.Methods 56 migraine without aura patients (MwoA group),22 migraine with aura patients(MA group) and 30 normal controls were recruited.All of them were performed head MRI examination and were evaluated by operational definitions of ARWMC and Mattis Dementia Ratiing Scale(DRS),and compare among three groups,discuss the relationship between WML and cognitive impairment.Results (1) Compared with control group,the occurrence rate of WML in MA group was significantly higher(40.9％ vs 13.3％,x2=22.74,P＜0.01).The OD-ARWMC score was significantly higher in both MA and MwoA groups((0.73±l.12) vs (0.13±0.35),t=2.76,P＜0.01;(0.36±0.67) vs (0.13±0.35),t=1.75,P＜0.05).Compared with MwoA group,the occurrence rate of WML and the OD-ARWMC score of MA group was significantly higher(t=22.80,P＜0.01;t=1.79,P＜0.05).(2) During the attack period,the DRS total scale and its 5 factors (attention,initiation/perseveration,concept formation,construction and memory) were significantly lower in both MwoA and MA group(P＜0.05 or 0.01) than control group,while the DRS total scale and its two factors (attention,concept formation) of MA group were significantly lower than that of MwoA group (P＜ 0.01).During the intermission period,the concept formation and memory scale in MA group was significantly lower than control group(P＜0.05),only memory factor in MwoA group was significantly lower than control group(P＜0.05),while the initiation/perseveration factor scale of MA group was significantly lower than MwoA group(P＜0.05).(3) There Was a negative correlation between OD-ARWMC scale and the total DRS scale as well as its three factors (attention,concept formation,memory)during attack period in MA group(r=-0.584,P＜0.01;r=-0.465,P＜0.05;r=-0.558,P＜0.01;r=-0.439,P＜0.05).There was a negative correlation between OD-ARWMC scale and the total DRS scale as well as concept formation factor during attack period in MwoA group (r=-0.328,P＜ 0.05;r =-0.276,P＜ 0.05).Conclusion Migraine patients may have white matter lesions and cognitive impairment,especially in MA patients and during attack period.

Objective To evaluate the injury of optic radiation after ischemic stroke with diffusion tensor imaging (DTI). Methods From September, 2014 to September, 2015, twenty-one ischemic stroke inpatients with visual field defects were tested with DTI, and measured the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of both sides in different time. The correlation of FA and ADC to visual field mean defect (MD) in the same time was analyzed. Results The FA of affected sides was lower than that of healthy sides twenty-four hours (t=2.38, P<0.05), one week (t=15.60, P<0.01) and four weeks (t=19.13, P<0.01) after stroke, and the ADC was also lower twenty-four hours (t=10.13, P<0.01) and one week (t=6.06, P<0.01) after stroke. The FA correlated with MD one (r=0.581, P<0.01) and four weeks (r=0.703, P<0.01) after stroke, and the ADC correlated with MD twenty-four hours after stroke (r=0.519, P<0.05). The FA of one (r=0.525, P<0.05) and four weeks (r=0.762, P<0.01) after stroke correlated with MD six months after stroke. Conclusion DTI can be used to evaluate the injury of optic radiation after ischemic stroke.

Objective To investigate the characteristics of resting-state functional magnetic resonance imaging (fMRI)in patients post-stroke depression (PSD).Methods Resting-state fMRI scans were performed in 13 patients with and without post-stroke depression.A regional homogeneity (ReHo) approach was used as an indicator.The brain function was analyzed in patients with post-stroke depression.Results Compared to a control group,the ReHo values decreased significantly in a PSD group in the left middle frontal gyrus,right superior frontal gyrus,right middle frontal gyrus,right anterior cingulate gyrus,right posterior cingutate gyrus,left insular lobe,left caudate nucleus,and left hippocampus.Conclusions The patients with PSD had restingstate neural circuit dysfunction,suggesting that the need to focus on the emotional state of stroke patients in the clinical treatment process.

Objective To investigate the relationship between the cerebral microbleeds (CMBs) and changes of cognitive function,and the possible mechanism of cognitive impairment caused by CMBs.Methods Sixty-eight micro-hemorrhage patients on susceptibility weighted imagine (SWI) sequences composed positive group,and sixty-eight patients selected without micro-hemorrhage in the SWI sequence and meeting the selection criteria as control group.At the same time,both two groups were assessed by MoCA and CDT scale inspection.Results CDT scores of CMBs group (2.00±0.88) were significantly lower than those of control group (3.76±0.53),and there was significantly different in the two groups (t=-3.27,P=0.00).At the same time,MoCA total scores and executive functions,naming,calculation,language,abstraction,recall scores of CMBs group were significantly lower than those of control group,and all of the groups were significantly different (t=-5.48,P=0.00; t=-4.36,P=0.00; t=-2.35,P=0.01 ; t=-2.49,P=0.02; t=-4.09,P=0.00; t=-4.63,P=0.00).CDT scores,MoCA total scores,executive functions,language,abstraction,memory scores between CMBs groups and control group were significantly different at all levels (P＜0.05).Executive functions,languages and calculated inter-group of mild CMBs,moderate CMBs,severe CMBs were significantly different (P＜0.05).The number of CMBs was negative correlation with total scores,executive function,language,and abstract (r=-0.675,P=0.000; r=-0.689,P=0.000; r=-0.536,P=0.000; r=-0.636,P=0.000).Conclusion The existence of CMBs and the number of CMBs are closely related to cognitive dysfunction.The more of CMBs,the more of obvious cognitive impairment.

Objective To investigate the risk factors for reduced renal function in patients with ischemic stroke.Methods The medical records of patients with ischemic stroke were analyzed retrospectively.They were divided into normal renal function group and reduced renalfunction group.Reduced renal function was defined as estimated glomerular filtration rate (eGFR) ＜60 ml/(min·1.73 m2).Multivariate logistic regression analysis was used to identify the risk factors for reduced renal function in patients with ischemic stroke.Results A total of 805 patients with ischemic stroke were enrolled in the study.8.8％ of patients had a reduced renal function.There was no significant differences in the proportion of patients with mild and moderate neurological deficit between the reduced renal function group and the normal renal function group (all P ＞ 0.05),however,the proportion of patients with severe neurological deficit was significantly higher than that in the normal renal function group (8.4％vs.2.6％,x2 =5.573,P =0.017).The proportion of small artery occlusion in the reduced renal function group was sigaificantly higher than that in the normal renal function group (66.2％ vs.46.5％,x2 =9.962,P =0.002),and the proportion of large artery atherosclerosis was significantly lower than that in the normal renal function group (19.7％ vs.43.5％,x2 =15.045,P =0.000).Multivariate logistic regression analysis indicated that old age (odds ratio [ OR] 3.301,95％ confidence interval [ CI],1.575 to 6.918; P=0.002) was the most important independent risk factor for reduced renal function,then was female (OR,2.291,95％ CI 1.355to 3.872; P=0.002) and hyperlipidemia (OR,2.527,95％ CI 1.095 to 5.831; P=0.030).Conclusions Reduced renal function in patients with ischemic stroke is strongly associated with old age,female,and hyperlipidemia.

Objective To investigate the correlations of high mobility group protein box-1 (HMGB1) level with severity and prognoses of acute cerebral infarction.MethodsBetween April 2018 and October 2018, 300 patients with acute cerebral infarction and 122 healthy control subjects were enrolled. According to National Institute of Health stroke scale (NIHSS) scores, patients with acute cerebral infarction were divided into group A (NIHSS scores<5), group B (5≤NIHSS scores≤15) and group C (NIHSS scores≥16). According to modified Rankin Scale (mRS) scores, patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores>2) after 3 months of follow up. The serum levels of HMGB1, low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in different groups were detected and compared. Pearson correlation analysis and receiver operating characteristic curve were used to analyze the correlations of serum HMGB1 level with other indicators and evaluate their predictive values in poor prognosis.Results The serum HMGB1 level in the acute cerebral infarction patients was significantly higher than that in the controls ([7.98±3.99]μg/Lvs. [4.61±1.02]μg/L,P<0.05); the serum HMGB1 level in the group C was significantly higher than that in group B ([12.86±1.91]μg/Lvs. [7.30±1.07]μg/L,P<0.05), and that in group B was statistically higher than that in group A ([7.30±1.07]μg/Lvs. [3.78±0.95]μg/L,P<0.05). Serum HMGB1 level was positively correlated with LDL-C level and NIHSS scores (r=0.521,P=0.000;r=0.931,P=0.000), and negatively correlated with HDL-C level (r=-0.114,P=0.001). The serum HMGB1 level in good prognosis group was significantly lower than that in poor prognosis group ([6.52± 3.29]μg/Lvs. [9.88±4.03]μg/L,P<0.05), and the serum HMGB1 level was positively correlated with mRS scores (r=0.160,P=0.000). The area under the curve of HMGB1 predicting poor prognosis of acute cerebral infarction (0.736[95％CI: 0.677-0.795]) was larger than that under the curve of LDL-C predicting poor prognosis of acute cerebral infarction (0.634[95％CI: 0.570-0.698]).ConclusionSerum HMGB1 level in patients with acute cerebral infarction is significantly increased, which is related to severity of disease, and has certain predictive value in prognoses of acute cerebral infarction.