Cerebral small vessel disease (CSVD) refers to a group of clinical, imaging, and pathological syndromes resulting from various etiologies affecting intracranial small vessels. Gait and balance disturbances, commonly observed in the elderly, represent the second most frequent clinical manifestations of CSVD. An increasing number of studies have investigated the potential mechanisms underlying CSVD-induced gait and balance disturbances. However, no consensus has been reached, and considerable debate persists regarding their relationship. This review summarizes the current findings the association between CSVD and gait and balance disturbances, aiming to enhance understanding and provide a foundation for future investigations.

Lactate serves not only an important energy metabolite in the nervous system but also participates in the regulation of cellular functions. Under conditions of hypoxia or increased neuronal activity, astrocytes generate lactate through glycolysis, providing energy support to neurons via the lactate shuttle mechanism. Stroke-induced ischemia and hypoxia significantly elevate lactate levels. Lactate not only contributes to energy metabolism but also influences lactylation modifications and functions as a signaling molecule in cellular regulation. This article reviews the alterations in lactate metabolism and lactylation during ischemic stroke and their impacts on neuroprotection and recovery, offering new insights and strategies for clinical treatment of stroke.

Cerebral amyloid angiopathy (CAA) is an age-related cerebral small vessel disease characterized by the deposition of β-amyloid in the walls of small arteries, arterioles, and capillaries within the leptomeninges, cortex, and cerebellum. It is the leading cause of spontaneous lobar intracerebral hemorrhage in the elderly and a major etiological factor in age-related cognitive decline. The current diagnostic standard, the Boston criteria, integrates pathological, clinical, and neuroimaging features and is widely used in both clinical and research settings. However, awareness of CAA remains suboptimal in China, and existing diagnostic criteria do not fully align with the needs of routine clinical practice. Additionally, there has been a lack of nationwide guidelines or expert consensus on the diagnosis, prevention, and treatment of CAA in China. To bridge this gap, the Chinese Society of Neurology and its Cerebrovascular Disease Study Group convened a panel of experts to develop the Chinese Consensus on the Diagnosis and Management of Cerebral Amyloid Angiopathy (2023 edition) (hereinafter referred to as the Consensus). Adhering to internationally recognized methodological standards, the Consensus systematically reviewed the latest global evidence and provided evidence-based recommendations addressing 14 key clinical issues in CAA diagnosis and management. These recommendations aim to standardize clinical practice and serve as a practical guide for Chinese neurologists. This article delves into the Consensus's core recommendations to enhance their comprehension and clinical implementation.

To investigate the distribution patterns of cerebral iron deposition in cerebral amyloid angiopathy (CAA) and to examine the correlation between iron deposition levels and cognitive impairment in CAA.

Patients diagnosed with CAA at the Neurology Department of Peking Union Medical College Hospital between May and November 2024 were enrolled. Quantitative susceptibility mapping (QSM) was used to noninvasively assess cerebral iron deposition. Cognitive function was evaluated using the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). An imaging processing workstation automatically segmented the whole brain into 106 regions of interest (ROIs), and the magnetic susceptibility values of each ROI were calculated. A univariate linear regression model was employed to analyze the correlation between magnetic susceptibility values in each brain region and cognitive scores.

A total of 13 CAA patients were included, of whom 11 (84.6%) were male, with a median age of 70.0 (59.0, 74.5) years. The median MMSE score was 25 (22, 28), and the median MoCA score was 19 (14, 22). In CAA patients, magnetic susceptibility values were significantly higher in the globus pallidus [48.15 (40.50, 81.08)], putamen [36.15 (23.98, 48.98)], and caudate nucleus [27.20 (10.07, 39.85)] compared to other nuclei and cortical regions. The left putamen (β=-0.229, P=0.036) and right precuneus (β=-0.618, P= 0.045) showed significant negative correlations with MMSE scores. No significant correlation was found between regional magnetic susceptibility and MoCA scores. 

In CAA patients, iron deposition is predominantly localized in the basal ganglia. Elevated iron deposition in the putamen and parietal lobe (precuneus) may be associated with cognitive decline in CAA.

To investigate the association between body composition (specifically body fat and muscle mass) and neuroimaging markers in patients with cerebral small vessel disease (CSVD).

Ninety-five hospitalized patients diagnosed with CSVD at the Seventh Medical Center of the Chinese PLA General Hospital between January 1, 2022, and June 1, 2023, were enrolled. Body composition parameters assessed including body weight, protein content, basal metabolic rate, body fat percentage (BF), and appendicular skeletal muscle mass (ASM). CSVD neuroimaging markers included lacunar infarcts (LI), white matter hyperintensities (WMH), and cerebral microbleeds (CMB). A composite CSVD score was calculated by integrating these markers. Sex-stratified binary or ordinal logistic regression analyses were performed to evaluate relationships between body composition and both individual neuroimaging markers and the composite CSVD score.

Among male patients (n=48), higher composite CSVD scores were significantly associated with increased BF (OR=1.117, 95%CI: 1.021–1.222, P=0.016) and decreased ASM (OR=0.185, 95%CI: 0.057–0.602, P=0.005). In female patients (n=47), only BF showed a significant positive correlation with composite scores (OR=1.059, 95%CI: 1.071-1.343, P=0.002). In addition, when analyzing individual neuroimaging markers, ASM was independently associated with WMH in males (OR=0.099, 95%CI: 0.032-0.311, P<0.001), whereas no significant associations were observed in females.

Body fat and muscle mass in CSVD patients exhibit stronger correlations with composite CSVD scores than with individual neuroimaging markers, suggesting that these body composition metrics may as indicators of global CSVD burden rather than specific pathological features.

To evaluate the safety and efficacy of late-window endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion (LVO-AIS) across different etiological subtypes.

A retrospective analysis was conducted involuing 229 LVO-AIS patients who underwent late-window EVT at Linyi People's Hospital from December 2019 to June 2021. Collateral circulation was compared between large-artery atherosclerosis (LAA) and cardioembolism (CE) subtypes. Vascular recanalization status was assessed using the modified thrombolysis in cerebral infarction (mTICI) scale, and 90-day functional outcomes were evaluated with the modified Rankin scale (mRS). Safety endpoints included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Binary Logistic regression was performed to identify independent predictors of 90-day functional outcomes.

(1) No significant differences in efficacy or safety outcomes were observed between LAA and CE groups (all P>0.05). (2) In the LAA group, patients with favorable outcomes exhibited lower platelet distribution width, a reduced incidence of hyperdense vessel sign, lower baseline National Institutes of Health stroke scale (NIHSS) scores, lower Alberta stroke program early CT score (ASPECTS), and fewer sICH or cerebral herniation events compared to those with unfavorable outcomes. Additionally, shorter puncture-to-recanalization time, higher rates of conscious state, and successful recanalization were significantly associated with favorable outcomes (P<0.05). Multivariate analysis identified lower baseline NIHSS (OR=1.104, 95%CI: 1.013-1.202, P=0.024), conscious state (OR=0.054, 95%CI: 0.018-0.162, P<0.001), and shorter puncture-to-recanalization time (OR=1.046, 95%CI: 1.027-1.066, P<0.001) as independent predictors of favorable outcomes. In the CE group, favorable outcomes were associated with conscious state, alcohol use history, lower baseline NIHSS scores, and shorter puncture-to-recanalization time (P<0.05). Conscious state (OR=0.054, 95%CI: 0.003-0.961, P=0.047) and shorter puncture-to-recanalization time (OR=1.107, 95%CI: 1.016-1.207, P=0.021) independently predicted favorable outcomes.

(1) Late-window EVT demonstrates comparable safety and efficacy for both CE and LAA subtypes of LVO-AIS. (2) Conscious state and puncture-to-recanalization time are independent prognostic factors for LAA and CE subtypes, while baseline NIHSS score specifically predicts outcomes in LAA patients.

To investigate risk factors for early neurological deterioration (END) following intravenous thrombolysis in patients with branch atheromatous disease (BAD)-related stroke and to develop and validate a predictive nomogram.

We retrospectively analyzed data from 263 patients with BAD-related stroke who received intravenous thrombolysis at the Department of Neurology, Shengli Oilfield Central Hospital (Dongying, Shandong Province) between January 2016 and December 2024. Patients were divided into END (n=104) and non-END (n=159) groups based on the occurrence of END. LASSO regression was used to identify factors associated with END, which were then used to construct a risk nomogram using the R software.

Significant differences were found between the END and non-END groups in terms of responsible vessels distribution, infarct location, fasting blood glucose level on the following day, pre-thrombolysis National Institute of Health stroke scale (NIHSS) score, and the muscle strength score of the pre-thrombolysis NIHSS score (all P<0.05). Multivariate logistic regression identified infarct location in the pons [OR=10.438, 95%CI: 3.286–38.495, variance inflation factor (VIF) value=1.083], fasting blood glucose level on the following day (OR=1.248, 95%CI: 1.072–1.475, VIF value=1.022), and muscle strength score of the pre-thrombolysis NIHSS score (OR=1.201, 95%CI: 1.014–1.429, VIF value=1.067) as independent risk factors for END (P<0.05). The predictive nomogram based on the independent risk factors and internally validated through bootstrapping showed good calibration, and strong predictive performance, with an area under the ROC curve of 0.896 (95%CI: 0.850–0.943).

Pontine infarction, elevated next-day fasting blood glucose, and muscle strength score of the pre-thrombolysis NIHSS score are independent risk factors for END after intravenous thrombolysis in patients with BAD-related stroke. The constructed nomogram provides a clinically useful tool for predicting END with high accuracy.

To investigate the effect of nutritional intervention by national-level cardio-cerebral health specialists on clinical outcomes in elderly patients with acute ischemic stroke.

In a quasi-experimental design, 76 elderly patients with acute ischemic stroke admitted to Zhaoqing First People's Hospital from January 2023 to April 2024 were enrolled. Based on admission wards, participants were allocated to either an observation group (n=38, Ward 12-1) or a control group (n=38, Ward 13-2). The control group received standard nutritional care, while the observation group underwent a structured nutritional intervention program delivered through multidisciplinary collaboration under the guidance of cardio-cerebral health specialists. After a 3-month of intervention, the changes in nutritional risk screening NRS2002 scores, modified Rankin scale (mRs) scores, and adverse event incidence were compared between the two groups. The differences in NRS2002 scores and mRs scores at baseline, discharge, and 3-month follow-up were analyzed using repeated measures ANOVA and independent t-tests; while adverse event rates were compared using chi-square tests.

Significant main effects of group, time, and group-by-time interaction were observed in NRS2002 and mRS scores (all P<0.001). At 3-month follow-up, the observation group demonstrated superior outcomes, including lower NRS2002 scores (1.87±0.78 vs 3.37±0.54; t=9.764, P<0.001), reduced mRS scores (1.05±1.37 vs 3.08±1.30; t=6.597, P<0.001), a decreased incidence of adverse events such as pulmonary infection (10.52% vs 50.00%; χ²=14.028, P<0.001), abdominal distension (0% vs 13.15%; χ²=5.352, P=0.021), and aspiration (2.63% vs 15.78%; χ²=3.934, P=0.047).

The multidisciplinary nutritional intervention program led by cardio-cerebral health specialists significantly improves nutritional status, reduces adverse events, and enhances neurological recovery in elderly acute ischemic stroke patients.

To evaluate the clinical effects of traditional Chinese medicine (TCM) hot compress therapy on limb function and its impact on serum levels of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in ischemic stroke (IS) patients with hemiplegia.

A total of 122 IS patients with hemiplegia treated at the Acupuncture, Moxibustion, and Rehabilitation Center of the First Affiliated Hospital of Hunan University of Chinese Medicine from May 2022 to May 2024 were enrolled. Patients were divided into an observation group (n=61) and a control group (n=61) based on different treatment protocols. Both groups received routine therapy. The control group underwent Bobath-based limb rehabilitation training, while the observation group received additional TCM hot compress therapy. Treatment duration was 4 weeks for both groups. The χ² test was used to compare clinical efficacy rates, and independent t-tests were applied to assess differences in National Institutes of Health stroke scale (NIHSS) scores, Fugl-Meyer assessment (FMA) scores, and serum NGF/BDNF levels.

After treatment, the observation group demonstrated a significantly higher total efficacy rate (83.61% vs 65.57%, χ²=4.425, P=0.038). Post-treatment NIHSS scores decreased markedly in both groups, with lower scores in the observation group (7.39±0.91 vs 9.72±1.47, t=10.526, P<0.001). Both upper and lower limb FMA scores increased substantially, showing superior improvement in the observation group (upper limb: 39.11±5.41 vs 34.01±4.97; lower limb: 25.12±4.04 vs 20.56±3.61; t=5.442, 6.574, all P<0.001). Serum NGF and BDNF levels were significantly elevated in the observation group [NGF: (9.46±1.36) ng/mL vs (8.27±0.97) ng/mL; BDNF: (5.62±0.73) ng/mL vs (4.41±0.59) ng/mL; t=5.564, 10.068, all P<0.001].

TCM hot compress therapy demonstrates definite efficacy in improving limb function in IS patients with hemiplegia. It effectively enhances motor recovery, reduces neurological impairment, and may exert these benefits through upregulation of serum NGF and BDNF levels.

To investigate the protective effect of L-theanine on nerve function in rats with focal cerebral ischemia.

One hundred male SPF-grade SD rats were randomly divided into a sham-operated group and a model group. Focal cerebral ischemia was induced in the model group using the thread embolism method. The surviving rats were randomly assigned model control group, Edaravone injection group (0.9 mg/kg), low, medium and high doses of L-theanine (50, 100, 200 mg/kg) according to neural function scores. The sham-operated group and the model control group received an equal volume of pure water via intragastric administration, while the other groups received their respective treatments once a day for 14 consecutive days. Neurological function score, grip strength, and bipedal balance were tested at 7 and 14 days after administration, respectively. Gait analysis and cerebral blood flow measurements were performed after the final administration, followed by histopathological examination of brain tissue. One-way ANOVA was used for comparison between multiple groups, and LSD-t test was used for intergroup comparisons.

In the focal cerebral ischemia rat model, significant motor dysfunction was observed. On days 7 and 14, the model group showed significantly higher neurological function scores (3.0±0.0 vs 0.0±0.0 in sham-operated group; t=0.679, 2.208, all P=0.001), increased hindlimb pressure difference [D7: (62.0±40.8) g; D14: (80.3±32.2) g vs sham-operated group: (3.7±2.7) g and (5.0±2.1) g; t=2.707, 2.608, P=0.032, 0.002], and reduced grip strength [D7: (321.9±28.5) g; D14: (424.1±62.6) g vs sham-operated group: (811.6±60.8) g and (988.5±54.9) g; t=20.632, 19.166, all P=0.001]. After 14 days, the model group also exhibited a greater average body rotation angle [(119.2±28.8)° vs (15.5±9.0)°; t=9.127, P=0.005], and reduced left step width (3.0±2.3 vs 336.0±32.5; t=26.580, P=0.001), speed [(234.9±62.0) mm/s vs (986.5±292.6) mm/s; t=2.531, P=0.001], right forelimb swing duration [(0.04±0.02) s vs (0.13±0.02) s; t=6.742, P=0.001], and right hindfoot pressure [(28.6±2.1) g vs (51.2±7.5) g; t=4.031, P=0.001]. Compared to the model control group, all doses of L-theanine significantly reduced neurological scores and hindlimb pressure differences from day 7 to 14 (all P<0.05). The medium and high doses significantly increased grip strength on D14 (all P<0.05). All L-theanine doses improved gait parameters, including increased left step width, speed, right forelimb swing duration, and right hindfoot pressure (all P<0.05). Medium and high doses of L-theanine also enhanced cerebral blood flow and alleviated pathological changes such as mild neural fiber swelling (all P<0.05), interstitial edema, and cellular infiltration.

L-theanine can significantly improve the motor dysfunction after cerebral ischemia, increases cerebral blood flow, reduces brain tissue pathology, and exerts a notable protective effect on neurological function following cerebral ischemia.

Antiphospholipid syndrome (APS) is an acquired thrombotic disorder with major clinical implications in ischemic stroke, particularly among young adults and in case of cryptogenic stroke. Antiphospholipid antibodies (aPLs) substantially increase stroke risk through multiple prothrombotic mechanisms, including vascular endothelial dysfunction, platelet activation, and complement system dysregulation. Thrombotic risk stratification requires comprehensive assessment of antibody profiles (e.g., triple positivity or positivity lupus anticoagulant), coexisting systemic lupus erythematosus (SLE), and traditional cardiovascular risk factors. APS-associated ischemic stroke exhibits complex pathophysiology, mediated by hypercoagulability, cardioembolism, large artery atherosclerosis, or small vessel occlusion. However, the absence of specific clinical or imaging biomarkers, complicates early diagnosis. Additionally, APS-related stroke is associated with a high recurrent rate and poor prognosis. Current evidence supports long-term anticoagulation as the cornerstone of secondary prevention, while high-risk patients (e.g., those with triple-positive antibody profiles) may benefit from combined antiplatelet agents or immunosuppressive therapies. This review emphasizes the urgent need to enhance early recognition and diagnosis of APS-related stroke, refine risk stratification for recurrence, and advance mechanistic research to develop precision secondary prevention strategies that address the underlying pathogenesis, ultimately improving clinical outcomes.