Acute ischemic stroke is less likely to be caused by carotid artery occlusion related to compression from the hyoid bone.This case report described a patient with acute ischemic stroke due to hyoid bone compression-induced carotid artery occlusion who presented with speech disorder and hemiplegia,without atherosclerotic factors in the past and with exercise history.Head CT angiography showed no atherosclerosis changes in regions outside the offending vessel.Considering the anatomical relationship between hyoid bone and carotid artery,the most reasonable mechanism might be owed to repetitive mechanical compression from ipsilateral greater horn of hyoid bone.It induced endothelial damage to the carotid artery,leading to occlusion and ischemic stroke consequently.It is extremely rare in patients with ischemic stroke.Accordingly,based on the literature review,this study was conducted to explore clinical and imaging manifestations,pathogenesis,diagnosis,and treatment of this special clinical manifestation.

Objective To investigate the safety and effectiveness of thrombolysis in patients with acute mild ischemic stroke with tumor.Methods All patients with acute mild(National Institute of Health stroke scale[NIHSS]score≤5 at admission)ischemic stroke who received intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)or urokinase from April 1,2017 to July 1,2019 in the effectiveness of intravenous rt-PA versus urokinase for acute ischaemic stroke:a nationwide prospective Chinese registry study(INTRECIS)database were collected retrospectively,and they were divided into two groups according to whether they were accompanied by tumor or not:the combined tumor group and the non-tumor group.Collection of baseline and clinical data for all patients,including sex,age,cerebrovascular disease related risk factors(history of hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,stroke,smoking history,body mass index),baseline NIHSS score,baseline modified Rankin scale(mRS)score,baseline systolic blood pressure,baseline diastolic blood pressure,premedication use(antiplatelet agents,anticoagulants,lipid-lowering drugs),classification according to the trial of Org 10172 in acute stroke treatment,time from door to needle time,types of thrombolytic drugs(rt-PA and urokinase),and the type of tumor.Having a history of tumor is defined as having been diagnosed with a malignant tumor by a professionally certified oncologist prior to the administration of thrombolytic therapy,with no concurrent oncological treatment being received at the time of thrombolysis.Ninety days post-thrombolysis,patients were followed up through outpatient visits or telephone interviews,and their neurological status was assessed using the mRS.Score of mRS≤1 was considered as a good prognosis,while mRS score ≥ 2 indicated a poor prognosis,with a score of 6 representing death.Compare the baseline characteristics,primary safety endpoints,secondary safety endpoints,primary efficacy endpoints,and secondary efficacy endpoint events before and after 1∶1 propensity score matching(PSM)between the two groups with and without a history of tumor.The primary safety endpoint was symptomatic intracranial hemorrhage(defined as intracranial hemorrhage transformation,including parenchymal hematoma type 1,parenchymal hematoma type 2,hemorrhagic infarction type 1,hemorrhagic infarction type 2,observed on head CT within 36 h after thrombolysis,accompanied by worsening symptoms compared to at the time of thrombolysis and an increase in NIHSS score by ≥4 points from baseline)within 36 h after thrombolysis before and after 1∶1 PSM.The secondary safety endpoint is the incidence of various bleeding events within 36 h after thrombolysis,including asymptomatic intracranial hemorrhage(presence of intracranial hemorrhage without worsening of neurological deficit),systemic bleeding(other bleeding events besides intracranial hemorrhage),and mortality within 90 d after thrombolysis.The primary effectiveness endpoint was the proportion of patients with a good prognosis at 90 d after thrombolysis,and the secondary effectiveness endpoint was the proportion of patients with an NIHSS score≤1 at 1 d after thrombolysis.Before 1∶1 PSM,baseline characteristics that exhibited a P-value＜0.1 when compared between the two groups were included in a multivariate Logistic regression analysis for adjustment.The differences in safety and efficacy endpoint events after intravenous thrombolysis between the two groups were compared before and after adjustment.After 1∶1 PSM,univariate binary Logistic regression analysis was conducted to assess whether there were significant differences in the safety and effectiveness of intravenous thrombolysis among acute mild ischemic stroke patients between those with and without tumor.Results A total of 1 680 patients with acute mild ischemic stroke,aged between 26 and 93 years,with a median age of 63(54,70)years,were included in this study,including 32 patients with tumor(including 3 cases of nasopharyngeal cancer,3 cases of rectal cancer,3 cases of reproductive system cancer,4 cases of breast cancer,5 cases of lung cancer,1 case of liver cancer,and 2 cases of gastric cancer and 11 cases of other tumors)and 1 648 patients without tumor.There were 32 cases in both groups after 1∶1 PSM.(1)Before 1∶1 PSM,patients with tumor group were older than those in the non-tumor group(67[61,74]years vs.62[54,70]years,P=0.01).After 1∶1 PSM,there were no statistically significant differences in baseline characteristics between the two groups(all P＞0.05).(2)Primary safety endpoints:before 1∶1 PSM,there was no patient had symptomatic intracranial hemorrhage,asymptomatic intracranial hemorrhage,systemic bleeding in the group with tumor,while 0.4％(6/1 648),1.0％(17/1 648),0.2％(3/1 648)occurred respectively in the group without tumor.There were no statistically significant differences in both primary and secondary safety endpoints between the two groups(both P=0.99).After 1∶1 PSM,neither group experienced symptomatic intracranial hemorrhage,asymptomatic intracranial hemorrhage,or systemic hemorrhage.No deaths occurred in the tumor group within 90 d after thrombolysis,while one death occurred in the non-tumor group.(3)Primary efficacy endpoints:before 1∶1 PSM,there was no statistically significant difference in the proportion of patients with good prognosis at 90 d after intravenous thrombolysis between the two groups(90.6％[29/32]vs.86.9％[1 432/1 648],P=0.54).After adjusting for confounding factors such as age and coronary heart disease,there was no statistically significant difference(OR,1.58,95％CI0.48-5.26,P=0.45)in the proportion of patients with a good prognosis at 90 d after intravenous thrombolysis between the two groups.After 1∶1 PSM,90.6％(29/32)patients in the tumor group had a good prognosis at 90d after intravenous thrombolysis,while 84.4％(27/32)patients in the non-tumor group,there was no statistically significant difference between the two groups(OR,0.56,95％CI 0.12-2.57,P=0.71).Secondary efficacy endpoint:before 1∶1 PSM,there was no statistically significant difference in the proportion of patients with an NIHSS score≤1 at 1 d after intravenous thrombolysis(37.5％[12/32]vs.48.2％[795/1 648],P=0.23),after adjusting for confounding factors such as age and coronary heart disease,the results suggest that there was no statistically significant difference in the proportion of patients with an NIHSS score≤1 at 1 d after intravenous thrombolysis(OR,0.65,95％CI 0.32-1.34,P=0.24).After 1∶1 PSM,the proportion of patients with an NIHSS score≤1 at 1 d after thrombolysis was 37.5％(12/32)in both patient groups,there was no statistically significant difference between the two groups(OR,1.00,95％CI 0.36-2.75,P=0.99).Conclusions Compared with patients without tumor,acute mild ischemic stroke in China with tumor may exhibit similar safety and effectiveness in receiving intravenous thrombolysis with rt-PA or urokinase.The findings of this study await further validation through randomized controlled trials.

Objective To compare the predictive effectiveness of the Glasgow coma scale(GCS),GCS-pupils scale(GCS-P),Glasgow-Pittsburgh coma scale(GPCS),full outline of unresponsiveness scale(FOUR),and coma recovery scale-revised(CRS-R)in forecasting the prognosis of severe stroke patients.Methods A prospective,consecutive cohort of severe stroke patients admitted to the Department of Neurology,First Medical Center of Chinese PLA General Hospital from September 2021 to April 2024 was enrolled.Demographic and clinical data were collected,including age,sex,length of hospital stay,diagnosis(severe ischemic stroke,severe cerebral hemorrhage,aneurysmal subarachnoid hemorrhage),medical history(hypertension,diabetes,coronary artery disease),smoking and drinking habits,vital signs upon admission(temperature,pulse,respiration,blood pressure),neurological examination findings(including speech and brainstem reflexes)at admission,head imaging results(CT,MRI)within 24 h of admission to assess the presence of brain herniation,and whether intubation occurred within 24 h of admission.Patients underwent GCS,GCS-P,GPCS,FOUR,and CRS-R scoring within 8h of admission.Telephone follow-up was conducted at 6 months post-stroke to assess outcomes using the modified Rankin scale(mRS),with mRS scores of 0-2 classified as the good prognosis group and 3-6 as the poor prognosis group.The receiver operating characteristic(ROC)curve was used to assess the prognostic prediction value of the five scales for poor outcomes at 6 months.The area under the ROC curve(AUC)was calculated,and pairwise comparisons of AUC were performed using the Delong test.Results A total of 179 severe stroke patients were enrolled,including 116 males and 63 females.The group consisted of 132 patients with severe ischemic stroke,30 with severe intracerebral hemorrhage,and 17 with aneurysmal subarachnoid hemorrhage.At 6months,126patients had a poor prognosis and 53 had a good prognosis.(1)There were statistically significant differences in age,temperature,pulse,history of coronary artery disease,smoking and drinking habits,presence of speech impairment,abnormal brainstem reflexes,brain herniation,intubation within 24 h of admission,and GCS,GCS-P,GPCS,FOUR,and CRS-R scores between the poor and good prognosis groups(all P＜0.05).(2)ROC analysis revealed that the AUC(95％CI)for predicting poor outcomes at 6 months in severe stroke patients for GCS,GCS-P,GPCS,FOUR,and CRS-R were 0.808(0.742-0.863),0.815(0.750-0.869),0.828(0.765-0.880),0.841(0.780-0.892),and 0.831(0.768-0.883),respectively.Sensitivities were 76.98％,78.57％,82.54％,84.13％,and 82.54％,and specificities were 73.58％,73.58％,67.92％,71.70％,and 73.58％,respectively.The FOUR had the highest AUC,with an optimal cutoff value of 13.(3)Pairwise comparisons of AUC showed a statistically significant difference between the FOUR and GCS(the difference value of AUC is 0.034,95％CI 0.004-0.064,Z=2.194,P=0.028),but no significant differences were observed between other scales(all P＞0.05).Conclusion Compared to GCS,GCS-P,GPCS,and CRS-R,FOUR may provide more valuable prognostic information for severe stroke patients.

Objective To analyze the whole-brain structural-functional coupling imaging characteristics of patients with cerebral small vessel disease(CSVD)based on multiparametric functional and structural MRI,and to explore their correlation with cognitive function.Methods A prospective,consecutive study enrolled 60 CSVD patients from the Department of Neurology,the Second Affiliated Hospital of Anhui Medical University,between May 2021 and December 2023,and 47 controls matched for age,sex,education level,and handedness recruited from the community during the same period.Baseline data,including demographic information(age,sex,education),cognitive function,and imaging data,were collected for both groups.All participants underwent standardized neuropsychological assessments in a quiet environment.Emotional function was assessed using the patient health questionnaire-9(PHQ-9).Global cognitive function was screened using the Montreal cognitive assessment scale(MoCA)and Alzheimer's disease 8-item questionnaire(AD-8).Executive function was evaluated using the trail making test-B(TMT-B),the TMT time difference(TMT-B time minus TMT-A time),and the verbal fluency test(VFT).Attention and processing speed were assessed using TMT-A and the digit span test(DS).Memory function was evaluated using the Chinese auditory verbal learning test(AVLT),including learning,immediate recall,and delayed recall.Multimodal brain functional and structural MRI images were acquired for all participants.Fractional amplitude of low-frequency fluctuations(fALFF)and gray matter volume(GMV)were calculated using the DPABI software.A structure-function coupling index was computed by integrating the fALFF and GMV values of corresponding voxels.Structural-function coupling changes in CSVD patients and controls were assessed,and the correlations between fALFF,GMV,fALFF/GMV and cognitive function were explored.Results(1)Compared to the control group,CSVD patients showed significant lower scores in MoCA score(21.5[20.0,24.0]vs.24.3[23.0,26.0],Z=-4.094),higher PHQ-9 score(5.4±5.0vs.2.1±2.2,t=4.150),less VFT(15.5±3.8 vs.17.2±4.3,t=-3.258),increased TMT-B time([164.4±72.7]s vs.[123.6±45.7]s,t=3.307),TMT-A time([83.8±34.3]s vs.[62.9±22.7]s,t=3.704),and less DS forward span(6.3[5.0,8.0]vs.7.4[6.0,8.0],Z=-3.679),DS backward span(3.7±1.2 vs.4.5±1.4,t=-3.119),AVLT-learning(7.0±1.8 vs.8.7±1.9,t=-4.523),A VLT-immediate recall(7.2[6.0,9.0]vs.9.6[7.2,11.8],Z=-4.105),AVLT-delayed recall(6.9±3.1 vs.9.6±3.0,t=-4.310;all P＜0.01).No significant differences were observed in age,education,sex,AD-8 score,or TMT time difference(all P＞0.05).(2)CSVD patients showed decreased fALFF values in the right anterior cingulate gyrus(1.00±0.06 vs.1.07±0.06,t=-4.66)and increased fALFF values in the left superior parietal lobule(1.14±0.07 vs.1.07±0.07,t=5.68)and the right postcentral gyrus(1.08±0.05 vs.1.01±0.05,t=5.22;both P＜0.01).CSVD patients had increased GMV in the bilateral caudate nucleus(right:[0.27±0.06]mm3 vs.[0.21±0.04]mm3,t=6.12,left:[0.27±0.05]mm3 vs.[0.22±0.04]mm3,t=6.67;both P＜0.01)but decreased fALFF/GMV in the bilateral caudate nucleus(left:6.27±0.97 vs.7.75±1.70,t=-7.33;right:3.12±0.97 vs.4.18±0.95,t=-5.96)and the right globus pallidus(14.11±4.14 vs.19.99±4.03,t=-6.36;all P＜0.01).(3)Right anterior cingulate gyrus fALFF positively correlated with DS backward scores(R=0.348,P=0.013).Left superior parietal lobule fALFF negatively correlated with PHQ-9 scores(R=-0.308,P=0.029)and TMT time difference(R=-0.360,P=0.012).Right postcentral gyrus fALFF negatively correlated with TMT-A time(R=-0.419,P=0.003).Right caudate nucleus GMV positively correlated with TMT time difference(R=0.293,P=0.042),while left caudate nucleus GMV negatively correlated with AD-8 score(R=-0.284,P=0.043).fALFF/GMV in the right caudate nucleus(R=0.288,P=0.046)and right globus pallidus(R=0.290,P=0.045)positively correlated with VFT.After multiple comparison corrections,only the negative correlation between right postcentral gyrus fALFF and TMT-A time remained significant(P(alse discovery rate adjusted=0.024).Conclusions CSVD patients exhibit significant structure-function decoupling values in bilateral caudate nucleus and right globus pallidus are reduced,and this reduction is associated with a decline in verbal fluency.The results of this study still need to be further validated in larger sample size studies.

Lateral posterior choroidal artery aneurysm is rare.The authors reported a patient diagnosed as lateral posterior choroidal artery aneurysm with intracerebral hemorrhage as the first manifestation,and discussed its pathogenesis,diagnosis and treatment.

DSA is an essential technology for diagnosing and treating cerebrovascular diseases.Detailed vascular structures and hemodynamic information can be acquired through image post-processing technology from raw DSA images.Presently,DSA image analysis technology encompasses several methodologies,including automatic vascular segmentation and feature extraction,hemodynamic parameter derivation,and more intricate multimodal imaging fusion.This review elaborated on the development status of these techniques at the current stage and their probable application in clinical practice.

Cerebral autoregulation(CA)refers to the ability of cerebral blood vessels to maintain stable cerebral hemodynamics in response to changes in factors such as carbon dioxide concentration,mean arterial pressure,or cerebral perfusion pressure.Acute ischemic stroke has a high incidence,disability rate,and mortality rate.Previous studies have confirmed varying degrees of impairment in CA among patients with acute ischemic stroke after the onset of the disease,but the specific mechanisms remain not fully understood.This article reviewed the mechanisms of CA,assessment methods,and its application progress in acute ischemic stroke,with the intention of providing references for related research and clinical diagnosis and treatment.

Stroke is a common central nervous system disease,with over 50％of stroke survivors experiencing gastrointestinal dysfunction,such as dysphagia,gastrointestinal bleeding,bowel obstruction,constipation,and fecal incontinence,which can lead to poor prognosis and increased mortality.In recent years,the interaction between the brain and gut has been a hot topic of research.Bidirectional communication between the brain and gut post-stroke can trigger changes in the gut microbiota,thereby affecting intestinal barrier function,immune activation,and metabolic products.Therefore,restoring the health and diversity of gut microbiota is crucial for the prevention and treatment of post-stroke gastrointestinal dysfunction.The authors reviewed the gastrointestinal complications following stroke,the changes in gut microbiota,and their impact on gastrointestinal function,and summarized relevant research advancements targeting gut microbiota as a therapeutic approach,with the aim of providing new insights for clinical treatment.

Endovascular treatment has become the first-line treatment for stroke caused by acute intracranial large vessel occlusion(LVO).Acute intracranial LVO caused by intracranial atherosclerosis(ICAS)is a common cause of thrombus removal in Chinese people,but it was difficult and complex for the surgical operation treatment.This consensus was based on the latest progress of domestic clinical research on ICAS-LVO and combined with the experience summary of clinical experts to summarize the identification,imaging features,surgical strategies,and perioperative management of ICAS-LVO.It aims to quickly identify ICAS-LVO,standardize its endovascular treatment strategies and techniques,reduce the disability and mortality rates of patients,and provide assistance for standardized clinical management.

Objective To investigate the neurovascular coupling(NVC)status in the acute phase of patients with minor ischemic stroke(MIS)or transient ischemic attack(TIA)due to intracranial large artery moderate-to-severe stenosis or occlusion using multimodal MRI techniques and to explore its correlation with quality of life(QoL).Methods This prospective,consecutive study enrolled patients with MIS or TIA due to intracranial large artery moderate-to-severe stenosis or occlusion form the Department of Neurology,the First Affiliated Hospital of Xi'an Jiaotong University,between June 2022 and October 2023.Recruit healthy subjects with matched age,sex,and handedness form the community during the same period.Patients were divided into left-sided involvement and right-sided involvement groups based on the affected side of the responsible vessel,while the healthy subjects were set as the healthy control group.Post-hoc power analysis was performed using G*Power 3.1 software.General characteristics(age,gender,body mass index,education level)were collected and compared across all three groups.Clinical data and QoL assessment were collected and compared between the two patient groups.Collected clinical data including type of cerebrovascular events(TIA,MIS),the National Institutes of Health stroke scale(NIHSS)score at admission,the responsible vessel(internal carotid artery,middle cerebral artery)and its side location,the degree of responsibility artery stenosis(moderate-severe stenosis[50%-99%stenosis rate],occlusion[100%stenosis rate]),the intracranial collateral circulation status(American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology[ASITN/SIR]collateral circulation grading),cerebrovascular risk factors(hypertension,diabetes,hyperlipidemia,smoking history),and the laboratory test indicators at admission(glycated hemoglobin,triglycerides,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,blood uric acid,blood homocysteine).QoL was assessed using the stroke impact scale(SIS),covering eight functional domains and a patient-reported overall recovery item.Multimodal MR data were acquired for all subjects.Whole-brain cerebral blood flow(CBF)images were generated using statistics parameter mapping 12(SPM 12)software,while regional homogeneity(ReHo)images were generated using DPABI software.The voxel-wise ratio of CBF to ReHo(CBF/ReHo)was calculated as the regional NVC parameter.Differences in regional NVC characteristics were compared between patient groups and the healthy control group.Correlations between NVC parameters and SIS scores within patient groups were explored.Results(1)A total of 38 patients with MIS or TIA due to intracranial large artery moderate-to-severe stenosis or occlusion were included(26 males,12 females,aged 36-69 years,with mean age of[52±11]years),with 23 in the left-sided involvement group and 15 in the right-sided involvement group.Nineteen healthy subjects were included(10 males,9 females,aged 37-67 years,with mean age of[53±10]years).Post-hoc power analysis showed statistical power of 0.808 for comparing the left-sided involvement group with the healthy control group and 0.762 for comparing the right-sided involvement group with control group.(2)No statistically significant differences were found on gender,age,education level,or body mass index across the three groups(all P＞0.05).No statistically significant differences were observed on the type of cerebrovascular event,cerebrovascular risk factors,distribution of the responsible vessel,degree of stenosis in the responsible vessel,admission NIHSS score,or laboratory test results between the two patient groups(all P＞0.05).There were no statistically significant differences in the total SIS score and the scores of subscales between the two patient groups(all P＞0.05).(3)Compared with the healthy control group,the left-sided involvement group exhibited reduced CBF/ReHo values in the left superior and middle temporal gyri,supramarginal gyrus,middle and inferior frontal gyri,precentral gyrus,angular gyrus,postcentral gyrus,insula,and posterior cerebellar lobe(FDR-corrected,all P＜0.05).In the right-sided involvement group,reduced CBF/ReHo values were observed in the right supramarginal gyrus,right postcentral gyrus,inferior temporal gyrus,and insula(FDR-corrected,all P＜0.05).(4)Correlation analysis revealed that the SIS total score in the left-sided involvement group negatively correlated with CBF/ReHo values in the right inferior frontal gyrus(T=-5.91)and the right middle temporal gyrus(T=-6.65,FDR-corrected,both P＜0.05).The SIS subscale score for activities of daily living in the left-sided involvement group showed negative correlations with CBF/ReHo values in the right angular gyrus(T=-7.36),right medial superior frontal gyrus(T=-6.97),right orbitofrontal cortex(T=-8.99),and left thalamus(T=-7.51,FDR-corrected,all P＜0.05).No significant correlation was observed between the SIS total score and CBF/ReHo values in patients with right-sided involvement group.The SIS subscale for communication score in the right-sided involvement group correlated with CBF/ReHo in the left lingual gyrus(T=-12.15),left olfactory cortex(T=-7.68),and right anterior cingulate and paracingulate cortex(T=-9.46,FDR-corrected,all P＜0.05).Conclusions Patients with MIS or TIA due to intracranial large artery moderate-to-severe stenosis or occlusion show abnormal NVC in the acute phase,especially those with left hemisphere involvement,who exhibit more extensive impairments.QoL in left-sided involvement patients is strongly linked to NVC in the right orbitofrontal cortex and right middle temporal gyrus.These findings require further validation in larger-scale studies.