Objective To investigate the clinical efficacy and safety of tirofiban and rt-PA alteplase in the treatment of minor stroke patients.Methods A total of 171 patients with minor stroke ad-mitted to Department of Neurology of Zhengzhou People's Hospital from January 2021 to January 2024 were prospectively and continuously enrolled,and were randomly divided into tirofiban group(84 cases)and rt-PA group(87 cases).The tirofiban group received intravenous infusion of tirofiban but not intravenous thrombolysis therapy.The rt-PA group was treated with intravenous thrombolysis.The 90-day mRS score was observed in all patients.NIHSS was used to score the improvement of neurological function.3-month all-cause death was observed during follow-up.Results The tirofiban group had a significant larger proportion of mRS score of 0-1 at 90 d(92.86％vs 82.76％,P＜0.05),lower NIHSS scores at 24 h and 7 d after treatment and smaller proportion of early neurological deterioration than the rt-PA group(P＜0.05).Larger proportion of mRS score of 0-2 in the 90 day and slightly smaller proportion of the score of 4-6 at 90 d were observed in the tirofiban group than the rt-PA group(P＞0.05).There were no statistical difference in the incidence of 3-month all-cause death between the two groups(P＞0.05).Conclusion Compared with rt-PA,tirofiban can significantly improve the clinical prognosis of pa-tients with minor stroke,reduce the risk of early neurological deterioration,and has higher safety.

Objective To investigate the effects of cerebral microbleeds（CMB）on the prognosis of patients with acute cerebral infarction（ACI）treated with intravenous thrombolysis（IVT）or mechanical thrombectomy（MT）. Methods A total of 738 patients with ACI treated with IVT or MT who were hospitalized in People's Hospital of Zhengzhou from January 2015 to June 2022 were consecutively included. They were evaluated for CMB at admission and the modified Rankin Scale（mRS）score at 3 months. The effects of the presence，location，and load of CMB on the mRS score at 3 months were analyzed. Subgroup analyses were performed for patients with successful recanalization. Results For all patients，the presence or absence of CMB was not significantly associated with the 3-month prognosis（38.0% vs 44.2%，P=0.295），while for the patients with successful recanalization，those without CMB had a significantly higher percentage of a favorable prognosis than those with CMB（56.9% vs 35.8%，P=0.011）. The multivariable logistic regression analysis showed that for all patients，only high-load CMB was significantly associated with the prognosis at 3 months（odds ratio OR=0.017，95% confidence interval CI 0.112-0.808，P=0.017）；in the patients with successful recanalization，the presence of CMB（OR=0.422，95% CI 0.214-0.832，P=0.013），lobar CMB（OR=0.379，95% CI 0.157-0.920，P=0.032），and high-load CMB（OR=0.207，95% CI 0.056-0.760，P=0.018）were significantly associated with the 3-month prognosis. Conclusion The adverse effects of CMB for patients with successful recanalization are more marked as compared with patients with failed recanalization. The presence of CMB，lobar CMB，and high-load CMB are independent predictors of a poor outcome at 3 months in patients with successful recanalization.

Objective:To investigate the risk factors for hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS), and the predictive value of Neutrophil to lymphocyte ratio (NLR).Methods:Consecutive patients with AIS received IVT in Zhengzhou People’s Hospital from January 2021 to December 2022 were retrospectively enrolled. HT was defined as no intracranial hemorrhage was found on the first imaging examination after admission, and new intracranial hemorrhage was found on the imaging examination 24 h after IVT or when symptoms worsened. sHT was defined as HT and the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 compared to admission or required surgical treatment such as intubation and decompressive craniectomy. The baseline clinical and laboratory data of the patients were collected, and NLR, lymphocyte to monocyte ratio (LMR), and platelet to neutrophil ratio (PNR) were calculated. Multivariate logistic regression analysis was used to identify the independent predictors of HT and sHT, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for HT and sHT after IVT. Results:A total of 196 patients were included (age 65.37±13.10 years, 124 males [63.3%]). The median baseline NIHSS score was 4 (interquartile range: 2-10). Twenty patients (10.2%) developed HT, and 12 (6.1%) developed sHT. Univariate analysis showed that there were statistically significant differences in age, baseline NIHSS score, creatinine, NLR, and stroke etiology type between the HT group and the non-HT group (all P<0.05); there were statistically significant differences in age, NLR, PNR, creatinine, baseline NIHSS score, and stroke etiological type between the sHT group and the non-sHT group (all P<0.05). Multivariate logistic regression analysis showed that NLR was an independent predictor of HT (odds ratio [ OR] 1.375, 95% confidence interval [ CI] 1.132-1.670; P=0.001) and sHT ( OR 1.647, 95% CI 1.177-2.304; P=0.004) after IVT. The ROC curve analysis showed that the area under the curve for predicting HT by NLR was 0.683 (95% CI 0.533-0.833; P=0.007), the optimal cutoff value was 5.78, the sensitivity and specificity were 55.0% and 84.1%, respectively. The area under the curve for predicting sHT by NLR was 0.784 (95% CI 0.720-0.839; P=0.001), the optimal cutoff value was 5.94, the sensitivity and specificity were 66.67% and 84.24%, respectively. Conclusions:A higher baseline NLR is associated with an increased risk of HT and sHT after IVT in patients with AIS, and can serve as a biomarker for predicting HT and sHT after IVT.

Objective:To investigate the relationship between the overall burden score of cerebral small vessel disease (CSVD) and sudden sensorineural hearing loss (SSNHL) and its severity.Methods:Patients with SSNHL admitted to Zhengzhou People’s Hospital from January 2019 to June 2022 were used as the case group, and age- and gender-matched patients with tension headache or benign positional vertigo were used as the control group. MRI was used to evaluate the phenotype of CSVD, including white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), enlarged perivascular spaces (EPVS), and lacune of presumed vascular origin, and then the total burden score of CSVD was calculated. Multivariate logistic regression analysis was used to determine the independent factors of SSNHL. Ordinal logistic regression analysis was used to investigate the relationship between the overall burden of CSVD and the severity of hearing loss in patients with SSNHL. Results:A total of 86 patients with SSNHL and 90 age- and gender-matched controls were included. There were statistically significant differences in triglycerides, high-density lipoprotein cholesterol, fasting blood glucose levels, WMHs overall score classification, periventricular WMHs score classification, deep WMHs score classification, CMBs, moderate to severe EPVS, CSVD overall burden score and classification between the two groups (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for high-density lipoprotein cholesterol, fasting blood glucose ≥6.1 mmol/L (odds ratio [ OR] 2.149, 95% confidence interval [ CI] 1.042-4.432; P=0.038), triglycerides ≥1.7 mmol/L ( OR 7.012, 95% CI 2.962-16.597; P=0.000), CSVD overall burden score >1 (compared to 0 point, 2 points: OR 4.095, 95% CI 1.364-12.291, P=0.012; 3 points: OR 5.776, 95% CI 1.888-17.614, P=0.002; 4 points: OR 7.900, 95% CI 2.526-24.706; P=0.000) were significantly independently correlated with SSNHL. Ordinal logistic regression analysis showed that after adjusting for age and fasting blood glucose, the flat decline type hearing loss ( OR 1.276, 95% CI 1.131-1.618; P=0.044) and total deafness type hearing loss ( OR 1.029, 95% CI 1.002-1.058; P=0.038), and the overall burden of CSVD being moderate ( OR 1.318, 95% CI 1.036-1.677; P=0.025) and severe ( OR 2.330, 95% CI 1.232-4.406; P=0.009) were significantly independent associated with the degree of hearing loss in patients with SSNHL. Conclusion:The CSVD total burden score of moderate to severe degree is independently associated with SSNHL and the degree of hearing loss.

Objective:To investigate associations of cerebral perfusion impairment with early neurological deterioration (END) and poor outcome in patients with acute small subcortical infarction (SSI).Methods:Patients with SSI in the perforator artery region admitted to the Department of Neurology, Zhengzhou People's Hospital between January 2020 and November 2022 were prospectively included. END was defined as an increase of ≥2 in the total score of the National Institutes of Health Stroke Scale (NIHSS) or an increase of ≥1 in the motor function score within 72 h after admission. Poor outcome was defined as the modified Rankin Scale score of 2 at 90 d after onset. Cerebral perfusion impairment was defined according to MRI perfusion-weighted imaging parameters. The demographic, baseline clinical and imaging data were collected. Multivariate logistic regression analysis was used to determine associations of cerebral perfusion impairment and END and poor outcome in patients with SSI. Results:A total of 100 patients with SSI were enrolled, including 56 males (56.0%), and aged 69.2±5.8 years. Among them, 19 patients (19.0%) developed END, 27 (27.0%) had poor outcome, and 51 (51.0%) had significant cerebral perfusion impairment. There were statistically significant differences in high sensitivity C-reactive protein, white matter hyperintensities (WMHs) in the basal ganglia, enlarged perivascular space (EPVS) in the basal ganglia, deep cerebral microbleeds (CMBs), and cerebral perfusion impairment between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that higher diastolic blood pressure (odds ratio [ OR] 1.070, 95% confidence interval [ CI] 1.003-1.141); P=0.040], deep WMHs ( OR 2.271, 95% CI 1.135-4.544; P=0.020), deep CMBs ( OR 5.047, 95% CI 1.240-20.549; P=0.024), and cerebral perfusion impairment ( OR 6.083, 95% CI 1.318-28.080; P=0.021) were independent risk factors for END in patients with SSI. There were statistically significant differences in hypersensitive C-reactive protein, NIHSS score at END, basal ganglia EPVS, END, and cerebral perfusion impairment between the poor outcome group and the good outcome group ( P<0.05). Multivariate logistic regression analysis showed that NIHSS score at END ( OR 1.485, 95% CI 1.034-2.133; P=0.032), basal ganglia EPVS ( OR 3.005, 95% CI 1.224-7.378; P=0.016), and cerebral perfusion impairment ( OR 9.234, 95% CI 1.994-42.765; P=0.004) were independent risk factors for the poor outcome at 90 d in patients with SSI, while anterior circulation infarction ( OR 0.066, 95% CI 0.013-0.334; P=0.001) was independently negatively correlated with the poor outcomes at 90 d after onset. Conclusion:Cerebral perfusion impairment is an independent risk factor for END and poor outcome at 90 d after onset in patients with SSI.

No case of moyamoya syndrome with bilateral posterior cerebral artery (PCA) occlusion has been reported in China so far as this disease is extremely rare. The case shown in this article is a middle-aged women who has a history of atrial fibrillation, hypertension and type 2 diabetes acutely attacked by this syndrome. The main clinical manifestations included binocular blindness, right limb weakness. Imaging findings showed bilateral acute cerebral infarction in the parietal occipital lobe, bilateral anterior cerebral artery and middle cerebral artery smoke angiogenesis, bilateral PCA occlusion with distal smoke angiogenesis. Considering the medical history of the patient, the cause of the disease was diagnosed as embolic stroke of undetermined source. The patient′s consciousness has been recovered and the limb weakness has been improved after active symptomatic treatment. However, the blindness did not see any improvements. This case report aims to improve clinicians′ understanding of bilateral PCA embolization in patients with moyamoya syndrome so the occurrence of cerebral infarction can be effectively prevented.

Objective　To explore the relevant clinical phenotype of different diseases relating to hot cross bun (HCB) sign and to determine the correlation between neuroimaging and clinical features.Methods　Data of one patient with HCB syndrome in the Department of Neurology of our hospital were collected.The published cases of HCB syndrome were systematically reviewed.According to the etiology,14 cases were analyzed.The clinical symptoms,Magnetic resonance imaging (MRI) features,Laboratory examination treatment and prognosis and so forth were retrospectively analyzed.Results　Published cases through the system references,classify disease and its clinical heterogeneity were reviewed.We found that HCB sign associated with 9 kinds of disease,including nutrition metabolic disease,inflammatory demyelinating disease,nervous system degenerative disease,secondary to suspected vasculitis Parkinson’s syndrome,tumor paraneoplastic disease testicular cancer is caused by the death of infectious diseases,genetic correlation disease related diseases,stroke and poisoning.Conclusion　This study shows that the basic disease spectrum of HCB syndrome may be more extensive than before.According to different clinical phenotypes,imaging features and basic diseases,the occurrence of HCB may be involved in different pathogenesis.

Objective　To investigate the etiology,clinical manifestations and neuroimaging features of the lesions of the middle cerebellar foot caused by different diseases.Methods　The general clinical data of 9 patients with bilateral middle cerebellar peduncle lesions admitted to our hospital from May 2016 to October 2021 were retrospectively analyzed,and the clinical manifestations and imaging characteristics of different diseases were analyzed.Results　Abnormal lesions were seen in 9 patients with middle cerebellar feet,including case 1:Speech slurred,left limb weakness for 3 months,dizziness,walking instability for 10 days previous pontine infarction,diagnosed as Walle’s degeneration.Case 2:Dizziness and unstable walking for 1 year after pontine hemorrhage,diagnosed as pontine hemorrhage and Waller’s degeneration of the bridge arm.Case 3:Presented with dizziness and walking instability for 2 years and was diagnosed with mu-ltiple system atrophy.Case 4:Memory loss for 2 months,aggravation for 10 days,previous rheumatoid arthritis,diagnosed as lupus encephalopathy.Case 5:Seizures of limbs,loss of consciousness for 3 days,chronic renal insufficiency in the past,diagnosed as renal encephalopathy.Case 6:Left lower limb weakness for 4 months,dizziness,seppch impairment for 2 days,diagnosed as neuromyelitis optic specturum disease.Case 7:Dizziness,walking instability for 15 days,HIV positive,diagnosed as HIV encephalopathy.Case 8:Clumsy handholding for 4 years,involuntary shaking for 2 days,diagnosis of Wilsonl’s disease.Case 9:Dizziness,unstable walking for 3 months,previous history of Hodgkin’s lymphoma,diagnosed as Hodgkin’s lymphoma with central nervous system damage.Conclusion　The etiology of the lesions of middle cerebellar foot is complex,attentions are needed in order to reduce clinical misdiagnosis and missed diagnosis.

Objective:To investigate the correlation between white matter hyperintensities (WMHs) and collateral circulation in patients with stroke caused by anterior circulation large vessel occlusion (aLVO).Methods:Patients with stroke caused by aLVO treated with endovascular mechanical thrombectomy in the Department of Neurology, Zhengzhou People's Hospital from December 2017 to April 2021 were retrospectively enrolled. Their demography, vascular risk factors, baseline clinical data and Fazekas scale score were collected. Multivariate logistic regression analysis was used to determine the independent correlation between WMHs and the collateral circulation status in patients with aLVO. Results:During the study, 166 patients with aLVO were included (77 males, 46.39%; aged 69.62±5.91 years). Their baseline National Institutes of Health Stroke Scale (NIHSS) score was 9.33±4.42. There were 120 patients (72.29%) in the good collateral circulation group and 46 (27.71%) in the poor collateral circulation group. Univariate analysis showed that there were significant differences in baseline NIHSS score, total Fazekas score and periventricular Fazekas score between the good collateral circulation group and the poor collateral circulation group (all P<0.05). Multivariate logistic regression analysis showed that total Fazekas score (odds ratio 2.583, 95% confidence interval 1.445-4.619; P=0.001) and periventricular Fazekas score (odds ratio 2.190, 95% confidence interval 1.022-4.692; P=0.044) were the independent risk factors for the poor collateral circulation. Conclusion:The severity of WMHs is associated with the poor collateral circulation in patients with aLVO.

Objective　To investigate the difference in collateral circulation and clinical prognosis between cervical carotid atherosclerosis and cardioembolism.Methods　We enrolled 318 adult endovascular patients with acute ischemic stroke due to anterior circulation occlusion between January 2014 and November 2020.132 patients with cervical carotid atherosclerosis and 186 with cardioembolism were included.The collateral score,the modified Rankin Scale (mRS) score,mortality at 90 days between patients with carotid artery stenosis and patients with cardiogenic embolism was compared.Results　Compared with stroke due to cardiac embolism,stroke due to carotid atherosclerosis had a higher incidence of the internal carotid artery end occlusion（P＜0.001）and a higher collateral-circulation score（OR=1.63）,a lower mRS scores before stroke（P＜0.001）,and a lower 90-day median MRS score（OR=1.93）.Conclusion　Compared with cardiogenic embolic stroke patients,carotid atherosclerotic stroke patients have better collateral circulation and slightly better median MRS at 90 days.