Objective:To investigate the clinical and imaging features of Wallerian degeneration in adults with stroke.Methods:Adult stroke patients with Wallerian degeneration admitted to Shengjing Hospital of China Medical University from October 2018 to September 2019 were enrolled retrospectively. Combined with the related literature, the clinical and imaging features of Wallerian degeneration after stroke were investigated.Results:A total of 4 patients with Wallerian degeneration after stroke were enrolled, including 3 males and 1 female, aged 56-63 years. The main clinical symptoms were dysarthria ( n=3), poor physical activity ( n=3), dysphagia ( n=1), and dizziness ( n=1). The National Institutes of Health Stroke Scale score was 1-6. The initial MRI and CT findings after stroke were consistent with the diagnosis of acute cerebral infarction. During the follow-up of 3 to 7 months after the onset, MRI revealed Wallerian degeneration, which showed hyperintensities along nerve fibers on T 2 and Fluid-Attenuation Inversion Recovery (FLAIR) sequence images. Diffusion-Weighted Imaging (DWI) in almost all cases also found hyperintensities along nerve fibers. Conclusions:After acute stroke (including ischemic and hemorrhagic stroke) in the territory of the internal carotid artery, ipsilateral pyramidal tract damage may occur, affecting the long-term motor function of patients. After unilateral pontine stroke, bilateral pontine arm damage may occur, affecting ataxia and balance function of the patients. Wallerian degeneration after stroke is a special neurodegenerative process. Its imaging manifestations are similar to those of new cerebral infarction. Correct understanding of this phenomenon can avoid misdiagnosis.

Although there is no definite definition,the stroke that has no abnormalities before going to sleep and finds a neurological deficit after waking up are classified as wake-up strokes (WUS) in most of the literature.WUS account for 15％ ～30％ of all stroke cases,and little is known about its pathogenesis.Studies have shown that there is no significant difference in risk factors,clinical features,especially initial severity and outcome between WUS and non-WUS.The current research focuses on the benefits and risks of intravenous thrombolysis and endovascular treatment in WUS.

Objective The aim of this study was to examine the association between plasma Pentraxin 3(PTX3) levels with acute ischemic stroke and carotid artery atherosclerosis.Methods We enrolled 103 patients with acute ischemic stroke (AIS)and 83 control subjects.The levels of plasma PTX3 were measured by using Enzyme-linked immunosorbent assay (ELISA) at admission and after 7 days treatment in the AIS group.The carotid artery plaques in the AIS group were detected by using Color Doppler Ultrasound.Patients with AIS were divided into two groups according to the stability of carotid artery atherosclerosis plaques.The association between plasma PTX3 levels with acute ischemic stroke and the stability of carotid artery atherosclerosis plaques was examined.Results ① The plasma PTX3 levels were significantly higher in the AIS group than in the control group (P＜0.05).After 7 days standard treatment,the plasma PTX3 levels in AIS group were significantly decreased (P＜0.05),but still higher than those in control group (P＜0.05).Multivariable logistic regression suggested that the plasma PTX3 levels had a close relationship with AIS (OR=15.043,95％CI:3.46～65.45,P＜0.001).② In the AIS group,the plasma PTX3 levels before and after treatment were significantly higher in unstable plaque group than in no plaque and stable plaque group(P＜0.05).Conclusion The plasma PTX3 levels are higher in patients with acute ischemic stroke.The plasma PTX3 levels are significantly higher in AIS group with unstable plaque.The plasma PTX3 levels are closely associated with acute ischemic stroke.

ObjectiveTo investigate the associations of fetal-type posterior cerebral artery (FTP) with infarction distribution and stroke severity in patients with acute ischemic stroke.MethodsThe patients with acute ischemic stroke were enrolled.They were divided into either a FTP group or a non-FTP group according to the results of magnetic resonance imaging.The former group was further divided into complete FTP (cFTP) and partial FTP (pFTP).According to the results of diffusion-weighted imaging, the infarction distribution was divided into the territory of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar artery.According to the National Institutes of Health Stroke Scale (NIHSS), the stroke severity was assessed, <8 was defined as mild stroke, and ≥8 was defined as moderate to severe stroke.Multivariate logistic regression analysis was used to determine the associations of FTP with infarction distribution and stroke severity.ResultsA total of 647 patients with acute ischemic stroke were enrolled, and 201 (31.1%) had FTP, including 162 (25.0%) cFTP and 39 (6.0%) pFTP.Multivariate logistic regression analysis showed that cFTP and pFTP were the independent risk factors for MCA infarction (cFTP: odds ratio [OR] 24.714, 95% confidence interval [CI] 10.952-45.766, P<0.001;pFTP: OR 14.526, 95% CI 6.832-25.931, P<0.001), and the independent protective factors for PCA infarction (cFTP: OR 0.214, 95% CI 0.022-0.531, P<0.001;pFTP: OR 0.326, 95% CI 0.018-0.739, P<0.001), they were also the independent risk factor for the severity of acute ischemic stroke (cFTP: OR 22.138, 95% CI 12.492-64.067, P<0.001;cFTP: OR 19.510, 95% CI 8.956-23.514, P<0.001).ConclusionscFTP and pFTP are the independent risk factors for MCA infarction, and the independent protective factors for PCA infarction, and at the same time, they were also the independent risk factors for the moderate to severe stroke.FTP is associated with the infarction distribution and the stroke severity in acute ischemic stroke.

Nontraumatic convexal subarachnoid hemorrhage is a rare type of nonaneurysmal subarachnoid hemorrhage.Its etiologies and clinical manifestations are diverse.This article reviews nontraumatic convexal subarachnoid hemorrhage from the aspects of etiology, clinical manifestation, imaging, diagnosis, treatment, and prognosis.

Objective To investigate the associations of left atrial enlargement and the severity and lesion patterns of cardioembolic stroke in patients with nonvalvular atrial fibrillation (NVAF).Methods The patients with NVAF diagnosed as cardiogenic stroke within 48 h after onset were enrolled.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke,and ≥ 10 was defined as moderate to severe stroke,and ＜ 10 was defined as mild stroke.Transthoracic echocardiography was used to measure the left atrial diameter.The patients were divided into normal group,mild,moderate,and severe left atrial enlargement groups.According to the lesion patterns revealed by the diffusion weighted imaging,they were divided into either a multiple infarctions group or a single infarction group.Results A total of 137 patients were enrolled,including 86 patients with mild stroke (62.8％),51 with moderate to severe stroke (37.2％),69 with multiple infarctions,and 68 with single infarction (49.6％).Left atrial enlargement was found in 103 cases,in which 35 (25.5％) were mild enlargement,40 (29.2％) were moderate enlargement,and 28 (20.4％) were severe enlargement.Multivariate logistic regression analysis showed that the risk of severe stroke in patients with mild (odds ratio [OR] 15.662,95％ confidence interval [CI] 1.821-134.677;P =0.012),moderate (OR 26.435,95％ CI 3.201-218.319;P =0.002),and severe (OR 75.763,95％ CI 8.536-672.441;P＜0.001) left atrial enlargement were increased significantly,and there were no significant differences in the lesion patterns among the different severity of left atrial enlargement groups (x2 =7.050,P =0.07).Conclusions Left atrial enlargement may be independently associated with the severity of cardiogenic stroke in patients with NVAF,but it is not associated with the lesion patterns.

Objective To investigate the associations of serum soluble CD40 ligand (sCD40L) levels with stroke risk,severity,and infarct volume.Methods Consecutive inpatients with acute ischemic stroke were recruited as a patient group.Healthy subjects were used as a control group.The demographics,vascular risk factors,and clinical data were collected from the patient group and control group.The serum sCD40L levels were measured by enzyme linked immunosorbent assay.According to the baseline National Institutes of Health Stroke Scale (NIHSS) scores,they were divided into a mild stroke group (＜ 8) and a moderate to severe stroke group (≥ 8).According to the median of infarct volume,the patients with ischemic stroke were divided into either a large infarction group or a small infarction group.Results A total 106 patients with acute ischemic stroke were recruited,including 47 females (44.3％) and 59 males (55.7％),and the mean age was 71.31 ± 11.27 years.There were 86 healthy subjects in the control group,including 41 females (47.7％) and 45 males (52.3％),the mean age was 73.56±9.32 years;there were.41 patients (38.7％) in large infarction group (≥1.8 cm3) and 65 (61.3％) in the small infarction group (＜1.8 cm3);there were 69 patients (65.1％) with mild stroke and 37 (34.9％) with moderate to severe stroke.The baseline serum sCD40L level in the patient group was significantly higher than that in the control group (5.61 ± 1.68 mg/L vs.3.56 ± 1.32 mg/L;t =9.236,P ＜0.01),the serum sCD40L level at day 14 after admission (4.19 ± 1.45 mg/L) in the patient group was significantly lower than the baseline level (P ＜0.01),but it was still higher than the control group (P ＜ 0.01).Multivariate logistic regression analysis showed that the higher low-density lipoprotein cholesterol (odds ratio [OR] 3.358,95％ confidence interval [CI] 2.681-4.056;P＜0.001) and serum sCD40L (OR 5.103,95％ CI 2.317-8.903;P＜0.001) levels were the independent risk factors for ischemic stroke;the higher serum sCD40L level (fourth vs.first quartile,OR 4.017,95％ CI 1.608-10.037;P =0.003),large atherosclerotic stroke (OR 2.321,95％ CI 1.014-5.314;P =0.046),cortical-subcortical infarcts (OR 2.679,95％ CI 1.111-6.460;P =0.028),and larger infarct volume (OR 3.216,95％ CI 1.398-7.395;P=0.006) were the independent risk factors for moderate to severe stroke;the higher serum sCD40L level (fourth vs.first quartile,OR 3.142,95％ CI 1.274-7.745;P =0.013),large atherosclerotic stroke (OR 2.956,95％ CI 1.299-6.767;P =0.010),cortical-subcortieal infarcts (OR 4.750,95％ CI 1.909-11.818;P ＜0.001),and baseline NIHSS score ≥8 (OR 8.509,95％ CI 3.432-21.094;P ＜ 0.001) were the independent risk factors for large infarction.Conclusion The serum sCD40L levels are closely associated with the risk,severity and infarct volume of ischemic stroke.

Perihematomal edema (PHE) is the key factor to lead to the secondary brain injury after intracerebral hemorrhage,and it can affect the outcomes of patients.This article reviews the pathophysiological mechanisms and treatment strategies of PHE.

Endovascular therapy is another revascularization therapy after intravenous thrombolysis, but it is strictly limited by the time window as with the venous thrombolysis.For patients exceeding the time window, there is a tendency to use imaging means to assess their benefits and risks to guide decisions, which are particularly important for the assessment of collateral circulation. This article reviews collateral circulation assessment and its application in endovascular treatment of acute ischemic stroke.