Early detection of intracranial hemorrhage is crucial to saving patients' neurological function and even life, and accurate quantification of hematoma volume will provide an essential basis for clinical decision-making. Non-contrast computed tomography is a standard imaging method for intracranial hemorrhage. With the continuous development of artificial intelligence, an increasing number of studies are applying artificial intelligence to the early detection and segmentation of non-contrast CT images of intracranial hemorrhage. This article reviews the recent research progress of artificial intelligence in the detection, subtype classification, and hematoma segmentation of intracranial hemorrhage, in order to verify whether artificial intelligence can construct an accurate automatic classification system for intracranial hemorrhage to reduce the error rate, and to provide a basis for assisting clinicians in making accurate diagnosis and treatment plans.

Patent foramen ovale (PFO) refers to the gap-like structure left after the septum primum and septum secundum failed to fully fuse, which is closely related to cryptogenic stroke and migraine based on thrombosis and embolism. Gaining a comprehensive understanding of the underlying mechanisms of PFO-associated thrombosis will greatly contribute to the clinical identification of the pathology of PFO and individualized management, benefiting patients fully. This article reviewed the research progress on PFO-related thrombosis mechanisms from paradoxical embolism, in situ thrombosis, left atrial function changes to hypercoagulable state, providing a theoretical basis for the following research on high-risk factors and prevention strategies of PFO-related diseases.

Aortic dissection is the tearing of the intima and media of the aorta due to various causes. The intima of the aorta is separated from the media and then blood flows in, resulting in the division of the aortic lumen into true lumen and false lumen. Aortic dissection is one of the cardiovascular emergencies with the highest mortality risk, and the mortality rate is as high as 50% if no surgical treatment is performed within the first 48 hours. In recent years, with the progress of diagnosis and surgical techniques, the case fatality rate of aortic dissection has decreased significantly. With the improvement of survival rate, relevant studies have found that patients' prognosis is closely related to postoperative complications of dissection, which seriously affect patients' postoperative rehabilitation and reduce patients' postoperative quality of life. Neurological complications, especially ischemic stroke and spinal cord ischemia, are among the most common and severe postoperative complications of aortic dissection. How to prevent and reduce the incidence of postoperative neurological complications has become a hot research topic at present. How to diagnose and treat postoperative neurological complications has also attracted extensive attention from neurologists. In this article, we reported the diagnosis and treatment process of two patients with postoperative neurological complications of aortic dissection and reviewed the literature, to improve the vigilance and attention of neurologists on the postoperative neurological complications of aortic dissection.

Cognitive impairment is a severe and advanced neurological detrimental syndrome that imposes a substantial burden on families and society. Few drugs can treat cognitive impairment, and their efficacy is limited. It is urgent to seek new treatment strategies. In recent years, studies have shown that dl-3-n-Butylphthalide can be used to treat cognitive impairment, while its efficacy and safety still need to be reinforced by more evidence. This review summarizes the pharmacological mechanism, basic researches and clinical studies of dl-3-n-Butylphthalide in cognitive disorders. This paper may provide a new option for treating cognitive conditions.

To report a novel HTRA1 gene mutation and summarize the clinical phenotypes and genetic characteristics of the family with this heterozygous HTRA1 mutation associated with autosomal dominant cerebral small vessel disease (CSVD).

Clinical data of the proband and his family members were collected. The mutation loci were captured by high-throughput sequencing and validated by Sanger sequencing, and the pathogenicity was predicted by in silico tools. The literature was reviewed.

The proband was a 51-year-old male whose clinical manifestations included sudden numbness of left limbs and cognitive impairment at the age of 50, without typical symptoms of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) such as alopecia and spondylosis. Brain MRI revealed right basal ganglia infarction, symmetric lesions in white matter, and microbleeds. Genetic testing revealed a heterozygous missense mutation of HTRA1 gene (c.941T＞G). Function prediction suggested pathogenicity. His mother suffered from cerebral infarction in her sixties, which resulted in cognitive impairment, and died at the age of 70. His brother carries the same heterozygous mutation, and he suffered from cerebral infarction at the age of 32, resulting in right hemiplegia, speech disorder, and cognitive impairment. His neuroimaging findings were consistent with the imaging features of CSVD. His son carried the same heterozygous mutation but is currently asymptomatic, possibly due to his age.

HTRA1 c. 941T＞G (p.M314R) heterozygous variant is pathogenic, and its clinical phenotype and genetic characteristics are similar to those of HTRA1 gene heterozygous mutation associated autosomal dominant cerebral small vascular disease previously reported.

To analyze the correlation between the components and characteristics of intracranial atherosclerotic plaques and ischemic stroke by high-resolution MRI vascular wall imaging (HRMR-VWI).

78 patients with intracranial atherosclerotic stenosis in the Department of Neurology of Baotou Central Hospital from December 2020 to September 2021 were scanned by HRMR-VWI. The detected intracranial plaques were divided into responsible plaques (67) and non-responsible plaques (125), and the differences in plaque composition and characteristics between the two groups were compared. According to the history of cerebral infarction, the patients were divided into three groups: acute / subacute cerebral infarction group (34 cases), chronic cerebral infarction group (18 cases), and non-cerebral infarction group (26 cases). The differences in the composition and characteristics of responsible plaque among the three groups were compared. Statistical analysis was conducted using SPSS 21.0 software, and the relationship between plaque composition, characteristics, and ischemic stroke was analyzed through multiple Logistic regression. The correlation with the National Institutes of Health stroke scale (NIHSS) was analyzed through Spearman correlation, and the significance test criteria were used α=0.05.

In the responsible plaque group, the rate of intraplaque hemorrhage (IPH) (P＜0.001), the rate of thrombus (P＜0.001), the rate of significant enhancement (P=0.010), the rate of moderate to severe stenosis (P＜0.001), and the plaque load (P＜0.001) were significantly higher than those in the non-responsible plaque group, and the differences were statistically significant. The rate of IPH (P=0.013), the rate of thrombus (P=0.001), and the plaque load (P＜0.001) of responsible plaques in the acute/subacute cerebral infarction group were significantly higher than those in the non-cerebral infarction group, and the differences were statistically significant. IPH (rs=0.348, P=0.004), thrombus (rs=0.373, P=0.002), and plaque load (rs=0.360, P=0.003) were all positively correlated with NIHSS score.

The presence of IPH and thrombus is closely related to responsible plaque and ipsilateral stroke. A large plaque load can increase the risk of ischemic stroke events, and the severity of stroke may be more severe and the prognosis worse.

【视频简介】血小板在血栓形成过程中发挥了重要作用，内皮损伤、胶原暴露诱导血小板黏附、活化与聚集，介导血栓形成，同时激活凝血通路，共同参与生理性止血。然而，血小板还具有免疫调节功能，一方面，血小板能够直接与免疫细胞作用，介导免疫细胞激活与黏附；另一方面，血小板激活后通过分泌炎症因子，进一步引起免疫炎症。急性缺血性卒中是典型的血栓炎症疾病，血栓形成常伴有血栓炎症。血栓炎症是急性缺血性卒中发生发展的重要机制，通过干预血栓炎症相关靶点治疗急性缺血性卒中具有广阔的临床前景。

To analyze the risk factors related to hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) after intravenous alteplase thrombolytic therapy.

This was a retrospective study. According to the inclusion and exclusion criteria, a total of 195 patients diagnosed with AIS and treated with intravenous thrombolysis were enrolled in the Emergency Center of the First Affiliated Hospital of Xinjiang Medical University from August 2019 to May 2022. According to whether bleeding occurred after intravenous thrombolysis, it was divided into the bleeding group (26 cases) and the non-bleeding group (169 cases). General clinical data (including gender, age, past history, etc.) and relevant laboratory test results (blood routine, biochemical complete items, coagulation routine, etc.) were collected. Univariate analysis was used to compare the group differences in the above data. Binary Logistic regression analysis and ROC curve analysis were performed for the risk factors of HT after AIS intravenous thrombolysis.

There were statistically significant between the bleeding group and the non-bleeding group of National Institutes of Health Stroke Scale (NIHSS) score[10(5, 16) vs 4(2, 7); Z=-4.133, P＜0.001], baseline prothrombin time [11.90(11.00, 12.90) s vs 11.30(10.90, 12.10) s; Z=-2.158, P=0.031], prothrombin activity [92.19%(76.67%, 112.26%) vs 104.55%(88.88%, 114.93%); Z=-2.201, P=0.028], international standardized ratio [1.03(0.96, 1.12) vs 0.98(0.95, 1.05); Z=-2.200, P=0.028], thrombin time [20.10(19.30, 21.15) s vs 19.40(18.35, 20.30) s; Z=-2.154, P=0.031], creatinine [81.28(62.75, 102.89) μmol/L vs 66.76(55.36, 79.04) μmol/L; Z=-2.818, P=0.005], estimated glomerular filtration rate (eGFR)[72.97(57.73, 103.19)% vs 95.23(82.86, 107.71)%; Z=-3.367, P＜0.001], neutrophil count (NEUT) [5.01(4.26, 6.06)×10⁹/L vs 4.34(3.33, 5.49)×10⁹/L; Z=-1.971, P=0.049], glycosylated hemoglobin [6.61%(6.61%, 6.66%) vs 6.3%(5.70%, 6.61%); Z=-2.513, P=0.012], and history of atrial fibrillation (5/26 vs 12/169; χ²=4.166, P=0.041). Multivariate logistic regression showed that NIHSS score (OR=1.129, 95%CI: 1.037-1.230) and NEUT (OR=1.247, 95%CI: 1.019-1.527) were independent risk factors for HT after intravenous thrombolysis in AIS (P＜0.05), eGFR (OR=0.961, 95%CI: 0.927-0.996), were independent protective factors for HT after AIS intravenous thrombolysis (P＜0.05); The area under ROC curve of NIHSS score, NEUT and eGFR combined to predict HT after intravenous thrombolysis was 0.798 (95%CI: 0.703-0.893).

NIHSS score and NEUT were independent risk factors for HT after intravenous thrombolysis in AIS, and eGFR was an independent protective factor for HT after intravenous thrombolysis in AIS. The combination of NIHSS score, NEUT, and eGFR had better predictive value for HT after intravenous thrombolysis in AIS.

Migraine is a neurological disorder that places a significant burden on humans and can be triggered by a variety of factors, such as diet, hormones, sensory stimulation, stress, sleep disturbances, etc. There are currently several hypotheses that explain the relationship between these triggers and migraines. In addition to drug treatment, identifying the triggers of patients, eliminating and blocking the migraine attack caused by the triggers may become an important way to prevent and treat migraine, which is of great significance to the management of migraine patients.

To observe the safety and effectiveness of drug-eluting stent (DES) in the treatment of acute middle cerebral artery occlusive stroke.

Retrospective analysis on December 5, 2021 to March 1, 2023 in the XD Group Hospital, Xianyang First People's Hospital, Xi'an Central Hospital, Xijing Hospital, Shaanxi Provincial People's Hospital, Xi'an Northern Hospital, and Xi'an DaXing Hospital seven Hospitals acute middle cerebral artery stroke caused by atherosclerotic occlusion underwent emergency treatment of the clinical data of 34 patients with intracranial DES, Clinical baseline characteristics imaging characteristics (CT-Aspects, DWI-Aspects, CTP) were observed. Surgical situation (DPT, TICI, sICH, NIHSS score immediately after surgery, NIHSS score 24 hours after surgery, NIHSS score 30d after surgery, and mRS score 30 d after surgery), clinical prognosis (mRS score 90 d after surgery, stroke recurrence rate and death rate within 90d after surgery) and incidence of in-stent restenosis 90 days after surgery. Differences in the baseline NIHSS, the mRS score, and the postoperative 30 d NIHSS and the mRS score were compared by t-test.

The average age of the 34 patients was (64.6±6.5) years old, including 24 males (70.6%), 27 patients with hypertension (79.4%), 17 patients with diabetes (50.0%), 12 patients with hyperlipidemia (35.3%), 12 patients with high homocysteine (35.3%), 0 patients with atrial fibrillation, and 20 patients with smokers (58.8%). The mean onset time was (8.9±4.6) hours, the baseline NIHSS score was 7.9±1.1, and the baseline mRS score was 2.7±1.1. CT-ASPECTS score was 9.8±0.4, DWI-ASPECTS score was 8.0±1.0. There were 22 cases (64.7%) of right middle cerebral artery occlusion and 12 cases (35.3%) of left middle cerebral artery occlusion. The mean CTP mismatched volume was (96.5±30.1) ml. 34 patients reached mTICI grade 3 immediately after surgery, and the successful replantation rate was 100%. After operation, one patient had asymptomatic intracranial hemorrhage, and the incidence of sICH was 0%. The NIHSS score at 30 days after operation was 3.6±2.3, which was lower than baseline, and the difference was statistically significant (t=3.975, P=0.001). The mRS score at 30 d after operation was 1.6±0.8, lower than baseline, and the difference was statistically significant (t=2.24, P=0.038). 90-day postoperative follow-up showed that 85.7% (29/34) of the patients had a good clinical prognosis (mRS score 0-2), no patients died, no patients with recurrent ischemic stroke, and no intrastent restenosis occurred.

DES treatment is safe and effective in patients with acute mid-cerebral atherosclerotic occlusive stroke, and the restenosis rate is low in short-term follow-up.

To understand the prevalence of metabolic cardiovascular in the elderly in the community and its impact on dementia, so as to provide a reference for for dementia prevention and control.

Data of the demographic, disease and cognitive function of 14 803≥65-year-old elderly people in the China Multicenter Dementia Survey (CMDS) and the Hubei Aging and Memory Cohort Study (HAMCS) from 2018 to 2023 were collected, and the multivariate logistic regression model was used to analyze the impact of metabolic cardiovascular and its comorbidities on the prevalence of dementia.

Among 14 803 participants, 1 119 (7.6%) had dementia, 9 688 (65.4%) had metabolic cardiovascular disease and its comorbidities. Of whom, 788 (6.7%), 981 (8.3%), and 876 (7.4%) had comorbidities of hypertension, heart disease , cerebrovascular disease and hypertension, respectively. There were significant differences in the prevalence of dementia among the elderly in different groups of residence, gender, age, education level, and marital status. Body mass index, smoking, social activities, hypertension, heart disease, cerebrovascular disease, and autonomic nerve dysfunction had an impact on the prevalence of dementia in the elderly. After adjusting for confounding factors, multivariate logistic regression models showed that the risk of dementia in the elderly with 1-4 metabolic cardiovascular diseases was 1.509 times (95% CI: 1.161-1.960), 1.869 times (95% CI: 1.389-2.516), 2.399 times (95% CI: 1.618-3.557) and 2.684 times (95% CI: 1.257-5.730) of that in old persons who were disease-free, respectively. The risk of dementia in participants with hypertension and diabetes was the highest (OR=2.157; 95% CI: 1.377-3.379). After stratified by sex and age, men with both hypertension and cerebrovascular disease had the highest risk of developing dementia (OR=4.400, 95% CI: 2.154-8.989), and the women with hypertension and diabetes had the highest risk (OR=2.022, 95% CI: 1.189-3.442). Persons who were <75-year-old with both hypertension and cerebrovascular disease had the highest risk (OR=2.140, 95% CI: 1.141-4.014), and those who were ≥75-year-old with both hypertension and diabetes had the highest risk (OR=2.530, 95% CI: 1.402-4.563).

The prevalence of metabolic cardiovascular disease in the Chinese elderly is high, and the risk of dementia in patients with metabolic cardiovascular disease is significantly increased.