Stroke is one of the most common and serious neurological complications associated with extracorporeal membrane oxygenation （ECMO） therapy， and close monitoring， early recognition， and timely intervention can reduce the incidence rate of stroke and the mortality rate of patients. Transcranial Doppler （TCD） and transcranial color Doppler ultrasonography （TCCD） have emerged as the preferred modalities for monitoring cerebral blood flow in ECMO patients due to their bedside applicability， ability to provide real-time dynamic assessments， and noninvasive safety. This article summarizes the spectral characteristics of cerebral blood flow in patients undergoing various ECMO modalities and elaborates on the latest research advances and clinical significance of TCD/TCCD in predicting stroke events， monitoring cerebral microembolic signals， reflecting the change in intracranial pressure， confirming brain death， and providing prognostic evaluation.
Objective To investigate the safety and efficacy of remote ischemic conditioning （RIC） in the treatment of patients with acute ischemic stroke undergoing mechanical thrombectomy. Methods This was a single-center randomized parallel-controlled clinical study. A total of 40 patients with anterior circulation large-vessel occlusive ischemic stroke who were admitted to Baoji High-Tech Hospital within 24 hours after onset and underwent emergency mechanical thrombectomy from July 2023 to July 2024 were enrolled and randomly assigned to the experimental group and the control group at a ratio of 1∶1. The patients in the experimental group received standardized RIC treatment （cuff pressure 200 mmHg）， while those in the control group received sham RIC intervention （cuff pressure 60 mmHg）， and the course of treatment was 7 days for both groups. The two groups were compared in terms of baseline information， safety assessment indicators （including hemorrhagic transformation， symptomatic intracranial hemorrhage， and adverse events）， and efficacy evaluation indicators [including NIHSS score， Barthel index， and mRS score after 7 days of treatment， as well as the proportion of patients with good prognosis （an mRS score of 0-2） and excellent prognosis （an mRS score of 0-1） at follow-up on day 90]. Results A total of 39 patients were finally included in the analysis， with 19 in the experimental group and 20 in the control group. At follow-up on day 90， 3 patients were lost to follow-up， and 18 patients in each group were included in the analysis. There were no significant differences between the two groups in all baseline data （P0.05） except sex （P=0.048）. The safety analysis showed that during hospitalization， there were no deaths in either group， and there were no significant differences in hemorrhagic transformation， symptomatic intracranial hemorrhage， and adverse events between the two groups （P0.05）. One patient in the control group and 2 patients in the experimental group died at follow-up on day 90， with no significant difference between the two groups（P0.999）. The efficacy analysis showed that after 7 days of treatment， there were no significant differences in NIHSS score， Barthel index， and mRS score between the two groups （P0.05）. At follow-up on day 90 after surgery， 10 patients in the experimental group and 9 patients in the control group had a good prognosis （55.6% vs 50.0%， P0.99）， and 10 patients in the experimental group and 6 patients in the control group had an excellent prognosis （55.6% vs 33.3%， P=0.315）. Conclusion RIC has good safety and efficacy in the treatment of patients with acute ischemic stroke after mechanical thrombectomy， with a tendency to improve 90-day functional prognosis.
Objective To investigate the practical efficacy of precise pulmonary rehabilitation strategy based on lung ultrasound（LUS） in patients with stroke-associated pneumonia （SAP）. Methods A total of 86 SAP patients who attended Xiangtan Central Hospital from January 2023 to January 2025 were enrolled and randomly divided into control group and experimental group， with 43 patients in each group. The patients in the control group received conventional SAP rehabilitation regimen， while those in the experimental group received LUS-based precise pulmonary rehabilitation strategy； the course of intervention was 14 days for both groups. The two groups were compared in terms of pulmonary function， pulmonary infection， inflammatory factors， and quality of life before intervention and after 7 and 14 days of intervention， and adverse reactions were recorded for both groups. Results Significant time， group， and interaction effects were observed in pulmonary function between the two groups， indicating that the experimental group had a significantly better improvement in pulmonary function than the control group， which became more significant over time （P0.001）. Compared with the control group， the experimental group had significantly lower rate of pulmonary infection and levels of inflammatory factors （P0.001）， a significantly higher quality of life （P0.001）， and a significantly lower overall incidence rate of adverse reactions （P0.05）. Conclusion For patients with SAP， the precise pulmonary rehabilitation strategy based on LUS can improve lung function and inflammatory indicators， alleviate pulmonary infection， enhance quality of life， and reduce the risk of adverse reactions. Therefore， it holds promise for clinical application.
Objective To investigate the hemodynamic features of left innominate vein （LIV） compression and their association with clinical manifestations， and to assess the diagnostic value of ultrasound. Methods A total of 32 patients with LIV compression and 67 healthy controls （HCs） were enrolled， and according to the symmetry of the diameters of bilateral transverse sinuses， sigmoid sinuses， and internal jugular veins （IJV）， the HCs were divided into symmetric group with 32 individuals and asymmetric group with 35 individuals. All subjects underwent CTV/MRV and ultrasound examination to measure the diameter， velocity， and flow volume of IJV and vertebral vein， and the differences between groups were analyzed. The receiver operating characteristic （ROC） curve was plotted to assess diagnostic efficacy. Results The patients with LIV compression mainly had the neurological symptoms such as cerebral tinnitus， dizziness， and tinnitus. Compared with the HCs， the patients with LIV compression had a significantly lower total flow volume of IJV and vertebral vein on the ipsilateral side [（406.42±177.05）ml/min vs （742.55±276.41）ml/min， P0.001）]， and the parameters of the ipsilateral side were lower than those of the contralateral side. There was no significant difference in the flow volume of IJV between the contralateral side of patients with LIV compression and the dominant side of the HCs in the asymmetric group. Total flow volume had an area under the ROC curve of 0.849 in predicting LIV compression， with a sensitivity of 77.60%， a specificity of 78.10%， and a cut-off value of 525.73 ml/min. Conclusion This study systematically reveals the blood flow characteristics of the bilateral IJV-vertebral vein system in patients with LIV compression，i.e.，LIV compression leads to a reduction in flow on the ipsilateral side and a compensatory increase on the contralateral side，and the asymmetry of bilateral blood flow may be the cause of the symptoms such as cerebral tinnitus and tinnitus.Ultrasound can be used to measure the total flow volume of IJV and vertebral vein， and it can effectively identify this disease and thus has a good value in screening.
Objective To systematically evaluate the efficacy and safety of Xingnaojing Injection （XNJ） in the treatment of post-stroke disorders of consciousness （PSDOC）. Methods PubMed， Embase， the Cochrane Library， Web of Science， VIP， CNKI， Wanfang Data， and SinoMed were searched for related randomized controlled trials （RCT） published up to July 2025. RevMan 5.4 and Stata 16.0 were used for data extraction and analysis. Results A total of 48 RCT were included， with 4 570 patients in total. The RCT included had relatively low overall risk of bias. The meta-analysis showed that compared with conventional treatment alone， XNJ combined with conventional treatment significantly improved the Glasgow Coma Scale （GCS） score of patients with PSDOC （mean difference=2.62， 95% confidence interval： 2.37-2.86， I²=66%， P0.000 01）. The subgroup analyses showed that XNJ administered at three dosages （20 ml， 30 ml， 40 ml） and for different treatment durations （1 week， 2 weeks， 4 weeks） could effectively improve the GCS score of patients， and it also showed efficacy in patients with hemorrhagic/ischemic stroke and disorders of consciousness. Nine RCT reported the adverse reactions including nausea， rash， and mild dizziness during the trial， which were resolved after the infusion rate was slowed down. Conclusion XNJ is a safe and effective therapy for improving consciousness in patients with PSDOC.
Acute cerebral infarction predominantly occurs in middle-aged and elderly individuals with multiple underlying diseases， and it is often accompanied by atherosclerosis or heart diseases. It has a low incidence rate in children and adolescents， who tend to have atypical symptoms in the early stage， leading to misdiagnosis or missed diagnosis. With the continuous development of imaging technology， the diagnosis of cerebral infarction has become more precise， which helps to further clarify the etiology of cerebral infarction and identify an increasing number of patients with different subtypes of cerebral infarction in clinical practice. This article reports a rare case of a pediatric patient with acute cerebral infarction caused by primary central nervous system vasculitis， which led to neurological dysfunction， in order to improve the awareness of cerebral infarction in children among clinicians.
Objective To investigate the research hotspots， development trends， and potential challenges in the field of stroke and exosomes based on bibliometric and visual analyses， and to provide scientific evidence for basic research and clinical translation. Methods The Web of Science database was used to obtain related articles published up to 2024， and CiteSpace and other tools were used to perform visual analyses from various aspects such as publication trends， collaboration networks， co-occurrence and clustering of keywords， and literature burst analysis. Results A total of 1 153 articles were included. The analysis showed an overall increasing trend in the number of publications per year. The institution with the highest number of publications was Henry Ford Health System， the author with the highest number of publications was Professor Chopp， and the journal with the highest number of articles Int J Mol Sci. High-frequency keywords included "extracellular vesicles" "ischemic stroke" and "stroke"， forming 12 research clusters， with neural repair and barrier protection as the key research directions. Conclusion The research on stroke and exosomes has been increasing year by year， with rapid development in recent years and the formation of an interdisciplinary pattern. Future studies should focus on the molecular mechanisms mediated by exosomes and their clinical application in stroke treatment， so as to promote the development of precision medicine and provide new therapeutic approaches.
Objective To investigate the effect of stellate ganglion block （SGB） on postoperative recovery quality， serum inflammatory factors， and neuron-specific enolase （NSE） in patients undergoing carotid endarterectomy. Methods A total of 92 male or female patients who underwent elective carotid endarterectomy in The Affiliated Suzhou Hospital of Nanjing Medical University were enrolled， with an age of 40-75 years and an ASA grade of Ⅱ-Ⅲ. The patients were randomly divided into SGB group with 46 patients and control group with 46 patients. The patients in the SGB group received SGB treatment before carotid endarterectomy， while those in the control group did not undergo SGB. ELISA was used to measure the serum levels of interleukin-1β （IL-1β）， interleukin-6 （IL-6）， interleukin-10 （IL-10）， and NSE immediately after anesthesia intubation， before blocking， after vessel opening， at the end of surgery， and at 6 and 24 hours after surgery. Major adverse cardiac events during the perioperative period and the rate of use of vasoactive agents were recorded for both groups， as well as Mini-Mental State Examination （MMSE） score， Montreal Cognitive Assessment （MoCA） score， and Quality of Recovery-15 （QoR-15） score on day 1 before surgery and on days 3 and 7 after surgery. Results Compared with the control group， the SGB group had significantly lower serum levels of IL-1β， IL-6， and NSE and a significantly higher serum level of IL-10 （P0.05）. During the perioperative period， compared with the control group， the SGB group had significantly lower incidence rates of hypertension， nausea and vomiting， and hypoxemia and a significantly rate of use of vasoactive agents （P0.05）. The SGB group had significantly higher MMSE， MoCA， and QoR-15 scores than the control group on day 7 after surgery （P0.05）. Conclusion For patients undergoing carotid endarterectomy， SGB can effectively alleviate perioperative inflammatory response， reduce the serum level of NSE， improve the quality of short-term postoperative recovery， and reduce adverse events.
Objective To investigate the clinical features and etiology of bilateral middle cerebellar peduncle lesion. Methods A retrospective analysis was performed for the clinical and imaging data of 59 patients who underwent cranial magnetic resonance imaging （MRI） in Central Hospital Affiliated to Dalian University of Technology and Yellow River Sanmenxia Hospital and were found to have abnormal signals of bilateral middle cerebellar peduncles， and a descriptive analysis was performed. Results As for clinical manifestations， among the 59 patients， there were 23 patients with unilateral limb weakness， 21 patients with dizziness， 12 patients with slurred speech， 8 patients with walking instability and limb numbness， 2 patients with drinking cough， dysphagia， double vision， and weakness of both lower limbs， 1 patient with limb tremor and bradykinesia， and 3 patients without symptoms. As for clinical diagnosis， among the 59 patients， there were 42 with Wallerian degeneration， 4 with acute cerebral infarction， 3 with demyelinating diseases of the central nervous system， 3 with hypertensive encephalopathy， 2 with multiple system atrophy， 1 with parkinsonism， 1 with the possibility of neuronal intranuclear inclusion disease， 1 with hypoparathyroidism and intracranial calcification， 1 with central nervous system lymphoma， and 1 with the possibility of ischemic or metabolic encephalopathy. Conclusion There are complex and diverse etiologies for bilateral middle cerebellar peduncle lesion， with Wallerian degeneration as the most common clinical diagnosis. Other diseases， such as acute cerebrovascular disease， inflammatory demyelinating diseases， neurodegenerative diseases， neoplastic diseases， and inherited metabolic diseases， can also be comorbid with bilateral middle cerebellar peduncle lesion.
Objective To investigate the effect of stellate ganglion block （SGB） on cognitive function， nerve microcirculation， and P2X2/3 receptor expression in rats with trigeminal neuralgia. Methods A total of 45 rats were divided into normal group， model group， and SGB group using a random number table， with 15 rats in each group. All rats except those in the normal group were used to establish an animal model of trigeminal neuralgia， and 2 rats in the model group and 1 in the SGB group died during modeling. After modeling， the rats in the SGB group received SGB with 5 mg of 0.5% ropivacaine injected between the C6 and C7 transverse processes， while those in the other two groups were injected with an equal volume of normal saline. Von Frey filaments were used to measure pain thresholds for each group； the water maze test was used to assess cognitive function； gelatin-ink perfusion and transparent specimen preparation were used for focus stacking of infraorbital nerve tissue； HE staining was used to observe nerve pathomorphology； Western blotting and qRT-PCR were used to measure the expression levels of P2X2 and P2X3. Results Compared with the normal group， both the model group and the SGB group had a significant reduction in pain threshold （P0.05）； compared with the normal group on days 1， 3， and 7 after injection， the model group had a significant reduction in pain threshold （P0.05）； compared with the model group， the SGB group had a significant increase in pain threshold （P0.05）. Compared with the normal group， the model group had a significant increase in escape latency and a significant reduction in the number of platform crossings on days 1，2，3，4， 5， 6， and 7 after intervention （P0.05）， and compared with the model group， the SGB group had a significant reduction in escape latency and a significant increase in the number of platform crossings on days 1， 2， 3， 4， 5， 6， and 7 after intervention （P0.05）； infraorbital nerve tissue was collected after gelatin-ink perfusion， and a microscope was used to take photos continuously under 12-fold magnification； focus stacking with Zerene Stacke showed that in the normal group， infraorbital nerves and vessels grew along the nerve axis with the presence of larger capillaries， and branches penetrated into the nerve tracts and formed a capillary network； the model group had no large vessels and showed reductions in the number and density of horizontal vessel branches while the SGB group showed certain improvements. HE staining showed that the normal group had regular morphology of ganglion cells without disruption， intact cell membrane， and clear cell nucleoli， and the model group had irregular morphology and rupture of ganglion cells， while the SGB group had clearer nucleoli and an increase in microvascular density. Compared with the normal group， the model group had significant increases in the expression levels of P2X2 and P2X3 （P0.05）， while compared with the model group， the SGB group had significant reductions in the expression levels of P2X2 and P2X3 （P0.05）. Conclusion SGB can increase pain thresholds， improve cognitive function， and enhance nerve microcirculation in rats with trigeminal neuralgia， possibly by inhibiting the expression of P2X2/3 receptors.
Objective To investigate the clinical features of autonomic seizures in adults， and to improve the awareness， diagnosis， and treatment of this disease. Methods The clinical features of 10 adult patients with autonomic seizures were summarized， including 1 case from our hospital and 9 cases from the PubMed database. Results The age of onset of the 10 patients ranged from 19 to 70 years， and clinical symptoms included tachycardia， gastrointestinal symptoms， sweating， and general discomfort. Of all patients， 3 had autonomic status epilepticus and 7 had recurrent autonomic seizures. The etiology of this disease included cerebral infarction， meningioma， autoimmune encephalitis， and traumatic brain injury. EEG showed the presence of slow wave， sharp wave， θ wave or δ wave. Antiepileptic treatment was effective. Conclusion For adults with autonomic seizures， especially those with status epilepticus， EEG and radiological examination showed be performed actively， and antiepileptic treatment should be given in a timely manner.
Familial hemophagocytic lymphohistiocytosis （FHL） with central nervous system involvement as the initial clinical manifestation is very rare and has atypical clinical manifestations， which often leads to difficulties in early diagnosis and misdiagnosis. This article reports two cases of FHL confirmed by genetic testing in Department of Neurology， Women and Children’s Hospital of Qingdao University. One patient was a boy with 1‒3 years of age， while the other patient was a girl of pre-school age； both patients had the main clinical manifestations of unstable walking and dysarthria. Brain MRI findings of the boy suggested multiple abnormal signals in the bilateral hemispheres and the cerebellum， and brain MRI findings of the girl suggested multiple symmetrical hyperintensities in the bilateral frontal lobes， the periventricular region， and the basal ganglia. Both children were found to have PRF1 gene mutations. This article reviews relevant literature to improve the understanding of this disease among clinicians， and the possibility of this disease should be considered in case of unexplained central nervous system involvement. For suspected cases， it is recommended to conduct comprehensive examinations and genetic testing， so as to achieve early diagnosis， start treatment in a timely manner， and improve prognosis.
This article reports the medical records of a patient with spontaneous internal jugular vein thrombosis manifesting as cough-induced headache who were diagnosed by digital subtraction angiography （DSA） in The Affiliated Hospital of Guizhou Medical University. The patient was a male individual aged 33 years and had the main clinical manifestation of bilateral frontal pain after severe coughing， with no headache during the interictal period. DSA showed occlusion of the left internal jugular vein， which suggested thrombosis； cranial MRI， cerebrospinal fluid examination， and D-dimer test showed no abnormalities； initial lumbar puncture showed an intracranial pressure of 330 mm H2O. Headache was improved after anticoagulant therapy and symptomatic treatment. This case report suggests that for patients presenting with cough-induced headache accompanied by high intracranial pressure， the possibility of jugular vein thrombosis should be considered in addition to the causes such as posterior fossa lesions， obstructive hydrocephalus， subdural hematoma， and jugular valve insufficiency， and jugular vein ultrasound should be performed to assist in diagnosis and facilitate timely anticoagulant therapy.
Anxiety-depressive disorders are closely associated and frequently comorbid with headache （especially primary headache）， which significantly increases the disease burden of patients and the difficulties of treatment. Anxiety-depressive disorders can not only increase the risk of primary headache but also directly cause headache attributed to anxiety-depressive disorders. There are complex mechanisms underlying the comorbidity of anxiety-depressive disorders and headache， and currently， there is still a lack of diagnostic criteria for "headaches attributed to anxiety-depressive disorders"， which requires future research to delve deeper into the comorbidity mechanisms and optimize diagnostic criteria. This article reviews the interrelationship between anxiety-depressive disorders and headache， as well as related advances in diagnosis， underlying mechanisms， and treatment， so as to provide help for clinical diagnosis and management.
Autonomic nervous system dysfunction is one of the most common non-motor symptoms of Parkinson disease（PD）， and orthostatic hypotension（OH） is one of the common features of autonomic nervous system dysfunction. OH and cognitive impairment are the most common non-motor symptoms of PD and can run through the whole course of the disease， and it remains unclear whether there is an association between these two non-motor symptoms. At present， a large number of studies have been conducted on the association between PD-OH and cognitive impairment abroad， but there are few similar studies in China. Therefore， this article summarizes the association between cognitive impairment and OH in PD， in order to provide a reference for the pathogenesis， treatment， and prevention of cognitive impairment in PD and brings new ideas for the treatment of cognitive impairment in PD.
Medical Publishing Centre of The First Hospital of Jilin University