Cobb syndrome, or cutaneomeningospinal angiomatosis, is a clinically rare manifestation of angiomatosis or arteriovenous malformations of the skin, spine, spinal cord, and viscera in the same spinal segment. A 48 years old female patient with Cobb syndrome treated ecently is reported as follow. The patient was admitted to hospital due to lower limbs weakness for three days. Left lumbar and abdominal pain occurred before onset without obvious causes, and then lower limbs weakness occurred. In this case, clinical manifestations were acute onset and development rapidly. Imaging showsed myeleterosis from C 1 to T 11, consistent with vertebral segments of hemangiomas in the left parotid gland, the left axillary, the left subclavian, the right femoribus internus, and the right lobe of the liver, etc. Her symptoms and imaging manifestations all meet the diagnostic criteria of Cobb syndrome. Cobb syndrome is easy to be missed diagnosis and misdiagnozed clinically with poor prognosis. This paper discussed and analyzed the rare case in combination with relevant literature, in order to improve clinicians′ understanding of Cobb syndrome, so as to achieve early diagnosis and treatment, thus to reduce permanent neurological complications.

Stroke canlead to hemiplegia,aphasia,and cognitive impairment,and also complicate with seizure and epilepsy.In recent years,there are more and more studies about post-stroke seizure and post-stroke epilepsy,but the main focus is on risk factors.This article reviews the risk factors,pathogenesis,and treatment of post-stroke seizure and post-stroke epilepsy.

Objective To investigate the correlations of serum cystatin C level with severity of stroke and short-term outcome in patients with acute ischemic stroke.Methods Patients with first-ever acute ischemic stroke aged ≥50 years who did not receive thrombolysis and took a visit within 3 d after onset were selected prospectively.The serum cystatin C level was detected within 24 h after admission and various clinical data were collected.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological deficits on the day of admission.The NIHSS score ＜8 was defined as mild stroke and ≥8 was defined as moderate to severe stroke.The modified Rankin Scale (mRS) was used to evaluate the short-term outcome at discharge or 14 d after onset,0-2 was defined as good outcome and ＞2 was defined as poor outcome.Results A total of 188 patients were enrolled,including 93 (49.5％) females and 95 (50.5％) males,their mean age was 65.4 ±9.2 years old (range 50-87).There were 120 patients with mild stroke (63.8％),68 with moderate to severe stroke (36.2％);106 patients (56.4％) had good outcome and 82 (43.6％) had poor outcome.Univariate analysis showed that serum cystatin C level in the moderate to severe stroke group was significantly higher than that in the mild stroke group (1.36 ± 0.29 mg/L vs.1.21 ±0.23 mg/L;t =3.902,P ＜ 0.001),the serum cystatin C level in the poor outcome group was significantly higher than that in the good outcome group (1.38 ± 0.25 mg/L vs.1.22 ± 0.25 mg/L;t =4.101,P =0.001).Multivariate logistic regression analysis showed that the serum cystatin C level was an independent risk factor for stroke severity (odds ratio 12.182,95％ confidence interval 11.163-13.202;P ＜ 0.001) and short-term poor outcome (odds ratio 9.025,95 ％ confidence interval 8.202-9.848;P ＜ 0.001).Conclusion The serum cystatin C level is significantly correlated with the severity of stroke and the short-term outcome in patients with acute ischemic stroke.

Objective To investigate the relationship betw een the serum bilirubin level and the severity of disease and short-term outcome in patient w ith acute ischemic stroke. Methods A total of 120 consecutive inpatients w ith acute ischemic stroke w ere enroled and 105 healthy subjects at the same time w ere used as a control group. The biochemical indicators, such as serum total bilirubin, direct bilirubin, indirect bilirubin, blood lipid, and blood glucose w ere measured w ithin 24 h after admission. The National Institutes of Health Stroke Scale ( NIHSS ) w as used to assess the neurological deficits on the day of admission. The NIHSS score <8 w as defined as mild stroke and ≥8 w as defined as moderate to severe stroke. At discharge or 14 d after onset, the modified Rankin Scale (mRS) w as used to evaluate the clinical outcomes, 0-2 w as defined as good outcome and > 2 w as defined as poor outcome. The levels of serum total bilirubin, direct bilirubin, and indirect bilirubin w ere measured again. Results The levels of serum total bilirubin, direct bilirubin, and indirect bilirubin in the moderate to severe stroke group w ere significantly higher than those in the mild stroke group ( P <0.01) and the control group ( P <0.01). Multivariate logistic regression analysis show ed that the increased levels of serum total bilirubin (odds ratio [OR] 1.855,95%confidence interval [CI] 1.390-2.475; P <0.01), indirect bilirubin ( OR 3.380, 95%CI 1.271-11.901; P <0.05), and direct bilirubin ( OR 3.51, 95%CI 1.062-11.473; P <0.01) had significantly independent correlation w ith baseline disease severity. Univariate analysis show ed that the increased serum total bilirubin level on admission w as associated w ith the short-term poor outcome ( P <0.05), but after adjustment for other confounding factors, there w as no statistical significance ( OR 2.411, 95%CI 0.803-7.243, P >0.05). Conclusions The serum bilirubin level show ed stress increase in patients w ith cerebral infarction in acute phase; and it w as significantly associated w ith the degree of neurological deficit, but it w as not associated w ith short-term outcome. It might be a defense response to the body for stroke events.

Objective:To study the clinical characteristics and risk factors of carotid artery plaques in patients with type 2 dia-betes mellitus(T2DM ) and ischemic stroke .Methods :A total of 185 patients with ischemic stroke from Jul 2013 to Dec 2013 were divided into T2DM group(n=72) and non-T2DM group(n=113) .All the patients underwent ultrasonic examination to confirm the incidence of carotid artery plaques .And 22 patients received computed tomographic arteriography (CTA) for further diagnosis of carotid artery plaques .The relationships of glucose metabolism and lipid metabolism with the size of carotid artery plaquewereanalyzed.Results:Theincidencerate,natureandsizeofcarotidarteryplaque,intima-mediathickness(IMT)ofca-rotid artery in T2DM group were significantly different from those in non-T2DM group(P<0 .05) .The main factors affecting the sizes of carotid artery plaques were T 2DM ,2 h postprandial blood glucose(2 h PBG) ,homeostatic model assessment for in-sulin resistance(HOMA-IR) ,fasting blood glucose(FBG) ,low density lipoprotein-cholesterol(LDL-C) , P<0 .05 .There was significant difference in the degree of lumen stenosis detected by ultrasound and CTA in the 22 patients(P<0 .05) .Conclu-sions:The size of carotid artery plaque in patients with ischemic stroke are influenced by T 2DM ,2 h PBG ,HOMA-IR ,FBG and LDL-C .The incidences of plaques as well as vulnerable plaques increases when patients suffer with T 2DM simultaneously .Ul-trasound can be applied as the preferred method for carotid artery plaque screening .CTA manifests as a more promising manner to demonstrate the characteristics of the plaques and the severity of lumen stenosis .

YKL-40 (human cartilage glycoprotein 39) is a newly discovered inflammatory cytokine, which belongs to the member of 18 glycosyl hydrolase of mammal family. Previous studies have indicated that YKL-40 is associated with the acute or chronic inflammatory diseases and tumors. Studies in recent years have suggested that YKL-40 may be involved in the occurrence and development of atherosclerotic plaques, and it is correlated with the plaque instability. The physiological function and the mechanisms of YKL-40 are not fully understood. It may have the roes of promoting vascular smooth muscle migration and proliferation, promoting cell adhesion and proliferation, as well as regulating extracellular matrix remodeling The detection of YKL-40 may have some significance in the aided diagnosis, predicting prognosis, prevention of cardiocerebrovascular diseases, and even the establishment of new therapeutic strategies.

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) can be induced in ischemia and other pathological states and mediate neuronal apoptosis after cerebral ischemia.Understanding the upregulation mechanism of TRAIL in ischemic brain tissue is promising to develop new treatment for stroke.

Control of hypertension is essential for stroke prevention. For most patients, the monotherapy often fails to lower blood pressure to normal levels, while the combination therapy can increase the effect of lowering blood pressure, however, not all the antihypertensive drugs have good efficacy. The early data analysis of the Chinese Hypertension Intervention Efficacy Study and the subgroup analysis of the KYOTO HEART study have showed that dihydropyridine calcium channel blocker amlodipine and angiotensin receptor blocker valsartan are both the most effective antihypertensive drugs in the prevention of stroke.

Cerebral artery atherosclerosis is the main reason leading to cerebral infarction. CD40/CD40L overexpression will stimulate the immune and inflammatory responses,leading to local inflammatory cell infiltration within the atherosclerotic plaque, triggering plaque rupture, and thus causing cerebral infarction. Studies have suggested that that CD40L is associated with the severity of cerebral infarction, Therefore, clinical detection of CD40L can be used as an indicator for identifying the severity of cerebral infarction to guide clinical treatment.

In addition to lipid-lowering,statins also have a wide range of pleiotropy.This article synthesizes and induces the pleiotropy of statins in the prevention and treatment of ischemic cerebrovascular diseases.