Objective To investigate the correlation between seasonal blood pressure （BP） variability and total burden score of cerebral small vessel disease （CSVD） with different severities. Methods The patients with CSVD who were consecutively admitted were enrolled， and according to the total burden score based on head MRI， they were divided into control group （CSVD 0 points）， mild group （CSVD 1‒2 points）， and moderate-to-severe group （CSVD 3‒4 points）.General information was collected from all patients， as well as 24-hour ambulatory blood pressure monitoring （ABPM） during warm and cold seasons. The correlation between ABPM parameters in different seasons and the imaging burden of different severities of CSVD was analyzed. Results A total of 145 patients were enrolled， with 29 patients in the control group，64 in the mild group， and 52 in the moderate-to-severe group.Compared with the control group， the mild group and the moderate-to-severe group had significantly higher age（F=9.721，P=0.001）， 24-hour systolic blood pressure （SBP） in hot season（F=6.572，P=0.002）， daytime SBP in hot season（F=6.460，P=0.002）， daytime diastolic blood pressure （DBP） in hot season（F=5.802，P=0.004）， nighttime SBP in hot season（F=8.508，P<0.001）. Compared with the control group， the moderate-to-severe group had significantly higher levels of 24-hour DBP in hot season（F=4.564，P=0.012）， nighttime DBP in hot season（F=6.294，P=0.002），24-hour SBP in cold season（F=7.012，P=0.001）， 24-hour DBP in cold season（F=4.527，P=0.012），daytime SBP in cold season（F=5.708，P=0.004），daytime DBP in cold season（F=3.138，P=0.046），nighttime SBP in cold season（F=9.154，P<0.001）， and nighttime DBP in cold season（F=8.006，P=0.001）. Compared with the control group， the mild group and the moderate-to-severe group had a significantly higher proportion of patients with abnormal BP circadian rhythm in hot season （χ²=13.059，P=0.001） and cold season （χ²=10.091，P=0.006）.The ordinal logistic regression analysis showed that age （OR=1.147， 95%CI 1.084‒1.214） was an independent risk factor for CSVD， and compared with the patients with dipper-type blood pressure in hot season， the patients with non-dipper blood pressure pattern had a risk of CSVD increased by 13.282 times （OR=13.282， 95% CI 2.379‒74.159）， while those with reverse-dipper blood pressure pattern had a risk of CSVD increased by 25.569 times（OR=25.569，95%CI 3.061‒213.551）. Conclusion The imaging burden score of CSVD increases with the increase in age and the proportion of abnormal circadian blood pressure pattern in hot season， and both age and abnormal circadian blood pressure pattern in hot season are independent risk factors for the imaging burden of CSVD.

Objective To investigate the value of total cerebral small vessel disease （CSVD） score combined with three-dimensional arterial spin labeling （3D-ASL） in predicting the prognosis of patients with acute ischemic stroke （AIS） after 90 days of intravenous thrombolysis. Methods A total of 189 AIS patients who were consecutively admitted to Department of Neurology， Changshu Hospital Affiliated to Nantong University， from January 2021 to June 2023 and underwent intravenous thrombolysis with alteplase were enrolled， and multimodal brain MRI was performed to assess total CSVD load and cerebral blood flow in the area of responsibility. A multivariate logistic regression analysis was used to identify the independent influencing factors for poor 90-day prognosis in AIS patients undergoing intravenous thrombolysis. The receiver operating characteristic （ROC） curve was used to investigate the value of total CSVD score and 3D-ASL used alone or in combination in predicting the prognosis of AIS. Results The multivariate regression analysis showed that diabetes （OR=3.601，95%CI 1.448‒8.954，P=0.006）， total CSVD score ≥3 points （OR=4.077， 95%CI 1.785‒9.313，P=0.001）， and baseline NIHSS score （for every 1-point increase：OR=1.167， 95%CI 1.061‒1.283， P=0.001） were independent risk factors for poor prognosis in AIS patients on day 90 after intravenous thrombolysis，while ASL hyperperfusion was an independent protective factor against poor prognosis （OR=0.16， 95%CI 0.050‒0.356，P=0.014）.The ROC curve analysis showed that the predictive model based on CSVD score and ASL perfusion had a C-value of 0.844 （95%CI 0.786‒0.902， P<0.05） and thus had the best predictive efficacy. Conclusion Total CSVD score combined with 3D-ASL can more comprehensively reflect the whole brain circulation network and has a better effect than each indicator alone in predicting the 90-day prognosis of AIS patients undergoing intravenous thrombolysis.

Objective To investigate the association of the total burden of cerebral small vessel disease （CSVD） with the level of tumor necrosis factor-α（TNF-α） and prognosis in patients with ischemic stroke （AIS）. Methods A total of 120 patients with AIS who were admitted to our hospital from January 2022 to December 2023 were enrolled as subjects， and all patients underwent cranial MRI scanning. Baseline data and TNF-α level were compared between the patients with different total burden scores of CSVD， and the correlation between TNF-α level and CSVD total burden score was analyzed. TNF-α level and CSVD total burden score were compared between the AIS patients with different prognoses to investigate the influence of TNF-α and CSVD total burden score on the short-term prognosis of AIS， as well as their value in predicting the short-term prognosis of AIS. Results There were significant differences in age， the proportion of patients with hyperlipidemia， the proportion of patients with smoking， and the levels of TNF-α and Hcy between the patients with different CSVD total burden scores （P<0.05）. The level of TNF-α was positively correlated with the number of lacunar cerebral infarcts， Fazekas score of white matter lesions， and EPV score （r=0.654， 0.775， 0.820， P<0.05）， but it had no linear correlation with the number of cerebral microbleeds （r=-0.035，P>0.05）. The logistic regression analysis showed that before correction， age， hyperlipidemia， smoking， TNF-α，and Hcy were significantly correlated with lacunar infarction， white matter lesions， EPV severity， cerebral microbleeds，and CSVD total burden score （P<0.05）， and after correction， TNF-α was still significantly correlated with lacunar infarction， white matter lesions，cerebral microbleeds， EPV severity， and CSVD total burden scores （P<0.05）. There were significant differences in CSVD total burden score and TNF-α between the patients with a good prognosis and those with a poor prognosis（P<0.05）.TNF-α combined with CSVD total burden score had the largest area under the receiver operating characteristic curve（AUC） of 0.912 in predicting the short-term prognosis of AIS，which was significantly higher than the AUC of TNF-α or CSVD total burden score used alone（P<0.05）. Conclusion The increase in TNF-α level has a certain relationship with CSVD total burden score and short-term prognosis in AIS patients， and the combination of TNF-α level and CSVD total burden score has a relatively high clinical application value in predicting the short-term prognosis of AIS patients.

Objective To systematically evaluate the association between obstructive sleep apnea （OSA） and the radiological features of cerebral small vessel disease （CSVD）， to investigate the potential mechanism of OSA in the development and progression of cerebrovascular diseases， and to provide a new scientific basis for optimizing clinical management strategies. Methods The patients with first-episode ischemic stroke and CSVD who were admitted from May 2021 to October 2023 were enrolled according to the inclusion and exclusion criteria. Cranial MRI was performed to evaluate the radiological features of CSVD， and sleep respiration testing was conducted to calculate hypoxic burden （HB）， a specific indicator for OSA， which was compared with traditional indicators. The multivariate logistic regression analysis was used to investigate the association between these hypoxic indicators and CSVD， and the receiver operating characteristic （ROC） curve was plotted to compare the correlation between hypoxic indicators and outcome measures. Results A total of 243 patients with first-episode acute ischemic stroke were enrolled in this study， among whom there were 155 male patients （63.8%） and 88 female patients. The multivariate logistic regression analysis showed that both HB OR=1.037， 95%CI 1.020-1.055， P<0.001） and apnea-hypopnea index （AHI）（OR=1.044， 95% CI 1.020-1.070， P<0.001） were significantly positively correlated with white matter hyperintensities （WMH）.The ROC curve analysis showed that the correlation between HB and WMH （AUC=0.722） was better than that between HB and AHI（AUC=0.670）. However， sleep time with oxygen saturation below 90% and oxygen desaturation index were not associated with WMH. OSA was not associated with enlarged perivascular spaces， cerebral microbleeds， or lacunar infarction. Conclusion Compared with traditional indicators， HB has a stronger correlation with WMH and can be used as a more effective indicator for risk assessment in OSA patients， thereby providing a precise basis for individualized intervention.

Objective To investigate the application value of occupational therapy in cognitive impairment in patients with cerebral small vessel disease. Methods A total of 84 patients with cerebral small vessel disease who were admitted to our hospital from April 2021 to September 2022 and were found to have cognitive impairment were enrolled as subjects， and they were randomly divided into observation group and control group using a random number table， with 42 patients in each group. The patients in the control group received conventional Western medicine treatment， while those in the observation group received occupational therapy in addition to the treatment in the control group. After 8 weeks of continuous treatment， the two groups were compared in terms of treatment outcome， Mini-Mental State Examination （MMSE） score， Montreal Cognitive Assessment （MoCA） score， brain-derived neurotrophic factor （BDNF）， high-sensitivity C reactive protein （hs-CRP）， homocysteine （Hcy）， and cerebral blood perfusion parameters. Results The treatment group had a higher overall response rate than the control group （95.24% vs 73.81%， P<0.05）. After treatment， the observation group had significantly higher MMSE， MoCA， and MBI scores than the control group （P<0.05）. Compared with the control group， the observation group had a significantly lower MTT and significantly higher CBV and CBF （P<0.05）. Compared with the control group， the observation group had a significantly higher level of BDNF and significantly lower levels of hs-CRP and Hcy （P<0.05）. Conclusion Occupational therapy has a marked clinical effect in patients with cerebral small vessel disease and cognitive impairment and can effectively improve cognitive function and cerebral blood perfusion， upregulate the level of BDNF， and reduce the expression of hs-CRP and Hcy. It is of great significance for improving the quality of life and prognosis of patients.

Objective To investigate the association between motoric cognitive risk syndrome （MCR） and neuroimaging markers in patients with cerebral small vessel disease （CSVD）， to assess the imaging markers associated with MCR， and to compare the differences in imaging markers between MCR and mild cognitive impairment （MCI）. Methods A retrospective study was conducted among 187 patients with CSVD who were admitted to Department of Neurology， Hebei Medical University Third Hospital， from April 2023 to November 2024， and they were divided into groups based on whether they were diagnosed with MCR or MCI. Clinical and imaging data were collected， and the univariate and multivariate logistic regression analyses were used to investigate the imaging features of CSVD patients with MCR. Results Compared with the MCR-negative group， the MCR-positive group had significantly higher BMI， proportion of male patients，and proportion of patients with hypertension， lacunar infarcts， severe white matter hyperintensity （WMH）， severe enlarged perivascular space （EPVS） in the basal ganglia， and high CSVD total burden （P<0.05）. The multivariate logistic regression analysis showed that the total volume of WMH was an independent risk factor for MCR in CSVD patients（OR=1.038，95%CI 1.003‒1.075，P=0.033）. Stratification by MCI，MCR showed that compared with the other groups， the MCI+/MCR+ group had a significantly higher proportion of patients with hypertension （the MCI-/MCR+ group had a higher proportion of patients with hypertension than the MCI+/MCR- group）， a significantly higher total volume of WMH， a significantly higher proportion of patients with severe deep brain and paraventricular WMH， and a significantly higher proportion of patients with severe EPVS（P<0.05）.Compared with the MCI+/MCR-group， the MCI-/MCR+ group had significantly higher grades （a significantly higher proportion of patients with grade 2 or 3 WMH than the MCI+/MCR- group） and total volume of periventricular and deep WMH（P<0.05）. There was no significant difference in CSVD total burden between groups（P>0.05）. Conclusion WMH is an independent risk factor for MCR in patients with CSVD. MCR is associated with a larger volume of WMH.This study highlights white matter abnormalities in MCR and the potential of motor function assessment in early risk stratification for dementia.

Objective To explore the changes in serum lactate dehydrogenase （LDH）， monocyte chemoattractant protein-1 （MCP-1）， and transcription factor 4 （TCF4） levels in patients with cerebral small vessel disease complicated by depression and their clinical significance. Methods According to the inclusion and exclusion criteria， 90 patients admitted to the Kailuan General Hospital between January 2022 and August 2024 were selected as the study subjects， including 27 patients diagnosed with cerebral small vessel disease complicated by depression and 63 patients with cerebral small vessel disease uncomplicated by depression. An additional 45 healthy individuals with normal head MRI findings and no mental disorders during the same period at the hospital were selected as the control group. General information was collected from the three groups， including age， body mass index， systolic blood pressure， and diastolic blood pressure.The general information and the levels of serum LDH，MCP-1，and TCF4 in the three groups were compared. The correlations of serum LDH，MCP-1，and TCF4 levels with HAMD score in patients with cerebral small vessel disease and depression were analyzed. Logistic regression was applied to analyze possible factors leading to depression in patients with cerebral small vessel disease.The receiver operating characteristic curve was applied to analyze the efficacy of serum LDH， MCP-1， and TCF4 levels in diagnosing depression in patients with cerebral small vessel disease. Results The levels of serum LDH， MCP-1，and TCF4 were significantly higher in the cerebral small vessel disease complicated by depression group than in cerebral small vessel disease uncomplicated with depression group and the control group （P<0.05）， and these levels were significantly higher in the cerebral small vessel disease uncomplicated with depression group than in the control group （P<0.05）.The serum LDH，MCP-1 and TCF4 were positively correlated with HAMD score in patients with cerebral small vessel disease complicated with depression（r=0.606，0.798，0.672，all P<0.001）.Serum LDH， MCP-1， and TCF4 were influencing factors for depression in cerebral small vessel disease（P<0.05）.The area under the receiver operating characteristic curve of LDH， MCP-1，and TCF4 in combination in the diagnosis of depression in cerebral small vessel disease was 0.917， which was superior to serum LDH， MCP-1， and TCF4 alone （Z_{LDH-combination}=2.457，P=0.014；Z_{MCP-1-combination}=2.384， P=0.017； Z_{TCF4-combination}=2.317， P=0.021）. Conclusion Serum LDH， MCP-1， and TCF4 levels increased in patients with cerebral small vessel disease complicated with depression. Their combination is valuable in the diagnosis of cerebral small vessel disease complicated with depression.

Objective To investigate the association between fibrinogen-to-albumin ratio （FAR） and the overall burden of cerebral small vessel disease （CSVD）， as well as their value in predicting early neurological deterioration （END） in patients with acute ischemic stroke （AIS）. Methods A total of 103 AIS patients who were admitted to our hospital from January 2023 to March 2025 were enrolled. According to the CSVD total burden score， the patients were divided into low burden group （0-2 points） with 58 patients and high burden group （3-4 points） with 45 patients； According to the presence or absence of END， they were divided into END group with 21 patients and non-END group with 82 patients. The weighted generalized additive model combined with smooth curve fitting was used to investigate the correlation between FAR and CSVD total burden score. A logistic regression analysis was used to explore the association of FAR and CSVD total burden score with the prognosis of END in AIS patients. The receiver operating characteristic （ROC） curve was used to assess the value of FAR and CSVD total burden score in predicting END in AIS patients. The restricted cubic spline method was used to analyze the dose-response relationship between FAR and END in AIS patients. The Bootstrap method was used to investigate the mediating effect of CSVD total burden score in the relationship between FAR and END in AIS patients. Results The high burden group had a significantly higher FAR than the low burden group （P<0.05）， and there was a U-shaped relationship between FAR and CSVD total burden score， with an inflection point of 8.14%. Compared with the non-END group， the END group had a significantly higher proportion of patients with a CSVD total burden score of 3-4 points and a significantly higher FAR （P<0.05）. After adjustment for the covariates such as age and sex， FAR （OR=1.918， 95%CI 1.825‒2.157，P<0.05） and CSVD global burden score （OR=2.167，95%CI 2.051‒2.249， P<0.05） were still independently associated with the risk of END in AIS patients. FAR combined with CSVD total load score had a significantly higher predictive value than either indicator alone， with an area under the ROC curve of 0.951. The mediating effect analysis showed that CSVD total burden score played a mediating effect between FAR and AIS patient prognosis END （P<0.05）. Conclusion There is a significant association between FAR and the overall burden of CSVD， and combined measurement of FAR and CSVD total burden score can significantly enhance the performance in predicting END， thereby providing an important basis for developing individualized treatment strategies in clinical practice.

Objective Excessive cerebral microbleeds（CMB）are a critical risk factor for cognitive impairment in cerebral small vessel disease（CSVD），yet their neuroimaging mechanisms remain unclear. By using multivariate divergence among multi-contrast MRI features， this study constructs a morphometric inverse divergence （MIND） networks to reveal the pattern of CMB-related structural disruption at the network level and investigate the potential imaging mechanisms of cognitive impairment. Methods A total of 69 CSVD patients with CMB were enrolled as CSVD-c group， 61 patients without CMB were enrolled as CSVD-n group， and 66 healthy controls （HC） were enrolled as HC group. MIND network topology was compared between the three groups， and the correlation between network abnormalities and neuropsychological parameters was analyzed. Results At the cognitive domain level， CSVD patients showed global cognitive decline， significantly affecting multiple domains including memory，visuospatial ability， executive function， and language. Compared with the HCs， CSVD patients had reductions in MIND strength in the frontal lobe （left area 9a and right p32） and the right temporal lobe （Mβ and Pβ），as well as increases in the extent and severity of CMB. For global topology， the patients with CSVD showed significant reductions in global and local efficiency and a significant increase in shortest-path length， with significantly greater changes in the CSVD-c group； for regional topology， there was a significant reduction in nodal efficiency in right Mβ. The correlation analysis showed that global and local efficiency and shortest-path length were significantly correlated with the scores of global cognition and multiple cognitive domains. Network-based statistic further revealed diminished connectivity within the default-mode network （DMN） and between DMN and visual/sensorimotor networks in the CSVD-c group. Conclusion CMB not only exacerbate global cognitive decline in CSVD patients，but also significantly affect multiple cognitive domains including memory， visuospatial ability， executive function， and language.Characteristic network alterations， including reduced synchrony in fronto-temporal regions， impaired global network efficiency and local temporal lobe efficiency， and weakened DMN-related connectivity，may be the potential mechanisms by which CMB aggravate cognitive impairment in CSVD.

Objective White matter hyperintensity（WMH） is the core imaging marker for cerebral small vessel disease， and gait disturbance induced by WMH is a major cause of functional disability in middle-aged and elderly populations. Existing studies mostly focus on the static association between WMH and gait disturbance， while time-varying characteristics are observed in the functional connectivity of brain networks. The dynamic functional connectivity（dFC） technique can capture the real-time interaction characteristics of brain networks， providing a new perspective for analyzing the neural mechanism of WMH-related gait disturbance. This study aims to investigate the neuroimaging mechanism of patients with WMH and gait disturbance using the dFC technique and clarify the association of dynamic brain network imbalance with motor function and cognitive function. Methods Subjects were recruited in Nanjing Drum Tower Hospital from 2023 to 2025， and after screening based on inclusion and exclusion criteria， 93 subjects were enrolled in the group of WMH with gait disturbance （WMH-GD group）， 86 subjects were enrolled in the group of WMH without gait disturbance （WMH-nGD group）， and 92 subjects were enrolled in the normal control group （NC group）. Background data collection， neuropsychological assessment， gait testing， and cranial magnetic resonance imaging （MRI） scanning were performed for all subjects. The DynamicBC toolbox was used to perform the dFC analysis and extract the dynamic indicators including fractional windows（F）， mean dwell time （MDT）， number of transitions（NT）， and transition probability （TP）； network-based statistics（NBS） were used to identify differential connectivity between brain regions across groups； the correlation analysis was used to investigate the correlation between dynamic indicators and clinical parameters. Results The cluster analysis identified two brain functional connectivity states， i.e.， State Ⅰ （sparse and weak connectivity， accounting for 61.29%） and State Ⅱ （dense and strong connectivity， accounting for 38.71%）. Inter-group comparisons showed that compared with the WMH-nGD group， the WMH-GD group had significantly higher F value （72.48% vs 57.38%， P<0.05） and MDT （95.47 windows vs 54.46 windows， P<0.05） of State Ⅰ and a significantly lower value of NT （2.44 times vs 3.83 times）， as well as a significantly lower value of TP from State Ⅱ to State Ⅰ （TP Ⅱ→Ⅰ： 2.61% vs 5.84%， P<0.05） and a significantly higher value of TP from State Ⅱ to State Ⅱ （TP Ⅱ→Ⅱ：97.39% vs 94.16%， P<0.05）. The NBS analysis showed that compared with the WMH-nGD group， the WMH-GD group had a significant reduction in inter-regional connectivity between the occipital lobe， the parietal lobe， and the frontal lobe in State Ⅰ and a significant increase in connectivity within subcortical brain regions and between the limbic lobe and the subcortical region. The correlation analysis showed that in the WMH-GD group， Mini-Mental State Examination score was negatively correlated with MDT of State Ⅰ and TP Ⅱ→Ⅱ and was positively correlated with TP Ⅱ→Ⅰ and NT， and gait speed was positively correlated with NT. Conclusion Dynamic brain network imbalance is observed in patients with WMH and gait disturbance， which manifests as rigidity of the sparse and weak connectivity state， a reduction in transition flexibility， and reorganization of cortex-subcortex connectivity. These abnormalities are closely associated with cognitive and gait functions， suggesting that disruption of brain network metastability may be one of the core neural mechanisms underlying WMH-related gait disturbance.

Objective To investigate the change in morphometric similarity gradient in patients with white matter hyperintensity （WMH）-related cognitive impairment and its influence on cognitive function. Methods Baseline and neuroimaging data were collected from 141 healthy controls （HC group）， 66 patients with WMH and normal cognition （WMH-NC group）， and 134 patients with WMH and cognitive impairment （WMH-CI group）. The difference in gradient was compared between groups based on the morphometric similarity gradient analysis. The mediating effect model was used to investigate the association between WMH volume，plasma biomarkers for nerve injury， gradient， and cognitive function. Results The research findings showed significant aberrant alternations in morphometric similarity gradient， with a significant increase in variability in the second gradient （P=0.036， not surviving FDR correction）. There was a significant negative correlation between the second gradient and geodesic distance （P_spin<0.001）. In addition，visual cortex gradient played a key mediating role in the association between p-tau₁₈₁/WMH volume and visuospatial function. Conclusion Patients with WMH-related cognitive impairment have aberrant macroscopic connectivity patterns of the cortex. The aberrant pattern of regional cortex mediates the process in which p-tau₁₈₁ and WMH volume affect cognitive function， which provides a new perspective for understanding the potential structural mechanism of WMH-related cognitive impairment.

Cerebral small vessel disease （CSVD） has a high incidence rate， an insidious onset， a heterogeneous etiology， and serious damage. At present， there are still various critical issues in the clinical diagnosis and treatment of CSVD， including the difficulty in early warning， difficult etiological typing， and limited treatment methods. This article summarizes the clinical studies on the diagnosis and treatment of CSVD in recent years， in order to provide a reference for solving problems in diagnosis and treatment.

Obstructive sleep apnea-hypopnea syndrome（OSAHS） is a prevalent sleep-related breathing disorder characterized by recurrent pharyngeal collapse during sleep，and it is recognized as an important risk factor for cardiovascular and cerebrovascular events. Cerebral small vessel disease（CSVD） refers to a series of clinical， imaging， and pathological syndromes that arise from pathological alterations in the small arteries， arterioles， capillaries， venules， and small veins within the brain. There is a close association between OSAHS and CSVD，and OSAHS is significantly associated with various neuroimaging biomarkers for CSVD.This article reviews the current status of research on the association between the imaging features of OSAHS and CSVD and related mechanisms， in order to provide a reference for future research.

Cerebral small vessel disease （CSVD） is an important etiology of vascular cognitive impairment and stroke， and there are still many challenges in its early diagnosis and pathological mechanisms. As a type of extracellular vesicles that exist stably in body fluids and can cross the blood-brain barrier， exosomes have attracted wide attention in recent years. Studies have shown that various exosomal proteins have a potential value in the diagnosis and treatment of CSVD and related cognitive impairment， providing new research directions for the noninvasive management of these diseases. This article systematically reviews the latest advances in exosomal proteins for the diagnosis and treatment of CSVD and related cognitive impairment， in order to provide new perspectives for the application of exosomal proteins in the precise treatment of CSVD.

Objective To investigate the application value of ultrasound measurement of optic nerve sheath diameter （ONSD） in the assessment of brain death. Methods A total of 124 subjects were enrolled and divided into brain death group with 34 patients， deep coma group with 28 patients， and healthy control group with 62 individuals， and ultrasound measurement of ONSD was performed for all three groups. A Spearman correlation analysis was used to investigate the correlation of brain death with ONSD and baseline characteristics. Univariate and multivariate Logistic regression analyses were used to identify the independent predictive value of ONSD for brain death. The receiver operating characteristic （ROC） curve was plotted to determine the optimal cut-off value of ONSD and evaluate its diagnostic efficacy. Results The Spearman correlation analysis showed a significant positive correlation between brain death and ONSD （r=0.825，P<0.001）. The multivariate Logistic regression analysis confirmed that ONSD was an independent predictive factor for brain death （odds ratio=70.874， P<0.05，Nagelkerke R²=0.739， Hosmer-Lemeshow test P=0.786）.ONSD had an area under the ROC curve （AUC） of 0.939（95%CI 88.3‒99.4） in the brain death group and the deep coma group， with an optimal cut-off value of 6.005 mm， a sensitivity of 97.1%，a specificity of 78.6%， a positive predictive value of 84.6%， and a negative predictive value of 95.7%. Conclusion Ultrasound measurement of ONSD has an important clinical application value in the assessment of brain death.

Objective The supine-to-standing transcranial Doppler（TCD） technique is suitable for evaluating cardiovascular autonomic dysfunction， and this study aims to assess its performance in predicting adverse outcomes in diabetic patients with or without orthostatic hypotension （OH）. Methods The patients with type 2 diabetes mellitus who were admitted to Department of Endocrinology and Department of Neurology in The Second Affiliated Hospital of Hainan Medical University from August 2020 to May 2023 were enrolled as subjects. Basic clinical data were collected， and supine-to-standing TCD was performed to monitor and record the changes in blood pressure， heart rate， and cerebral hemodynamics in both supine and standing positions. The patients were followed for 2-4 years to record medication， orthostatic intolerance score， and adverse events. The two-independent-samples t test was used for comparison of normally distributed continuous variables between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous variables between groups； the chi-square test was used for comparison of categorical variables between groups. The binary logistic regression analysis was used to investigate the association between the results of supine-to-standing TCD and adverse outcomes. Results A total of 118 patients （96 male patients and 22 female patients） were enrolled， among whom there were 28 patients with OH （23.7%） and 90 patients without OH（76.3%）. During follow-up， 19 patients （16.1%） experienced adverse outcomes （including syncope， falls， and death）.TCD showed that impaired “W” wave recovery in cerebral blood flow in the standing position was an independent risk factor for adverse outcomes in diabetic patients （OR=3.536， 95% CI 1.136-11.006， P=0.029）. Conclusion Vascular reflex failure and paradoxical cerebral vasoconstriction may be the mechanisms for impaired cerebral blood flow recovery in the standing position. TCD testing has an important role in detecting cerebrovascular abnormalities and cerebral hemodynamic changes， especially in diabetic patients with OH， and it has good performance in predicting adverse outcomes.

Severe carotid artery stenosis is an independent risk factor for stroke， and carotid endarterectomy （CEA） can effectively prevent ischemic stroke by alleviating such stenosis. However， CEA carries certain risks of adverse events， including perioperative death， ischemic stroke， and hyperperfusion injury， and these adverse events not only compromise perioperative safety but also diminish the efficacy of the procedure in preventing cerebral ischemic events. A multimodal imaging-based comprehensive management mode （i.e.， preoperative assessment with carotid ultrasound， transcranial Doppler （TCD）， and CT angiography， intraoperative monitoring with TCD and cerebral oximetry， and standardized postoperative follow-up with carotid ultrasound and TCD） can significantly reduce perioperative mortality and the incidence rate of stroke and avoid hypoperfusion， hyperperfusion syndrome， and arterial restenosis or occlusion， thereby enhancing the perioperative safety of CEA.

Objective To investigate the severity of white matter lesions （WML） in patients with right-to-left shunt （RLS）-positive migraine. Methods A total of 415 patients with RLS-positive migraine who were consecutively admitted to Department of Neurology， The First Affiliated Hospital of Soochow University， from January 2022 to January 2025 were enrolled， and all these patients met the diagnostic criteria in The International Classification of Headache Disorders， 3 rd edition. RLS was diagnosed based on contrast-enhanced transcranial Doppler and contrast-enhanced transesophageal echocardiography， and the type and grade of RLS were assessed. After a series of statistical analyses was conducted， the factors with P<0.05 in the univariate logistic regression analysis were included in the multivariate binary logistic regression analysis to investigate the risk factors for the onset and severity of WML， with P<0.05 indicating statistical significance. Results The analysis of the baseline data of patients with different grades of WML showed that the grade of WML increased with age in the patients with RLS-positive migraine （P<0.05）. Comparison of multimodal ultrasound findings between the patients with different grades of WML showed that there were significant differences between the patients with different grades of WML in the factors such as large RLS， potential RLS， prolonged PFO tunnel， higher PFO at the right atrial side in resting state and after Valsalva maneuver， higher PFO at the left atrial side after Valsalva maneuver， early appearance of shunt， and longer duration of shunt （P<0.05）. For the establishment of a predictive model， large RLS shunt （P=0.037）， higher PFO at the right atrial side after Valsalva maneuver （P=0.018）， and longer duration of shunt （P<0.001） were independent risk factors for the onset of WML in patients with RLS-positive migraine， and further research showed that prolonged PFO tunnel （P<0.001） was a risk factor for the onset of moderate-to-severe WML in patients with RLS-positive migraine. Conclusion The predictive model established based on the ultrasound factors including large RLS shunt and prolonged PFO tunnel can be used as an imaging method to screen for WML， especially moderate-to-severe WML， which provides a theoretical basis for subsequent treatment.

Objective There are currently limited studies on the hemodynamics of posterior cerebral artery （PCA） compensation in patients with severe stenosis or occlusion of the internal carotid artery （ICA）， and this study aims to investigate the application value of transcranial Doppler （TCD） in assessing PCA compensation after severe stenosis or occlusion of the unilateral extracranial ICA. Methods A retrospective analysis was performed for 107 patients who were hospitalized in Encephalopathy Center， Guangdong Provincial Hospital of Traditional Chinese Medicine， from January 2022 to February 2025 and met the diagnostic criteria for severe stenosis or occlusion of the unilateral extracranial ICA， and all patients underwent both digital subtraction angiography （DSA） and TCD. The patients were divided into groups based on PCA compensation on DSA， and TCD quantitative parameters were analyzed. The receiver operating characteristic （ROC） curve was plotted to investigate the value of TCD in assessing graded compensation of the PCA. Results Among the 107 patients， there were 75 patients （70.1%） in the compensation group and 32 patients （29.9%） in the non-compensation group. The optimal cut-off value of TCD in assessing PCA compensation was a mean velocity of ≥65 cm/s at the PCA P1 segment， with an area under the ROC curve（AUC） of 0.869（95% CI 0.785‒0.953）， a sensitivity of 78.7%， a specificity of 84.4%， and a Youden index of 0.630. Compared with the non-compensation group， the compensation group had significant increases in peak systolic velocity， end-diastolic velocity， and mean velocity （P<0.01） and a significant reduction in pulsatility index （P<0.05）. As for the graded compensation of the PCA， the patients with posterior communicating artery （PCoA） compensation alone accounted for 57.3% （43/75）， those with leptomeningeal collateral compensation of the PCA alone accounted for 16.0%（12/75）， and those with both patterns of compensation accounted for 36.7% （20/75）.An end-diastolic velocity of ≥48 cm/s at the PCA P1 segment was the optimal cut-off value for assessing PCoA compensation， with an AUC of 0.813 （95%CI 0.726‒0.900）， a sensitivity of 76.2%， a specificity of 79.5%， and a Youden index of 0.557； a mean velocity of ≥60 cm/s at the PCA P2 segment was the optimal cut-off value for assessing leptomeningeal collateral compensation of the PCA， with an AUC of 0.824 （95%CI 0.723‒0.925）， a sensitivity of 71.5%， a specificity of 90.7%， and a Youden index of 0.625. Conclusion This study conducts a hemodynamic stratification analysis on compensation patterns of the PCA in patients with severe stenosis or occlusion of the unilateral extracranial ICA. Quantitative blood flow indicators at the PCA-P1 and PCA-P2 segments are highly consistent with DSA in assessing PCA compensation and can reliably evaluate the compensation status of the PCoA and the leptomeningeal collaterals.

Case-based teaching is a teaching model that integrates theoretical knowledge with clinical practice， and it is widely used in medical education and plays an important role in standardized residency training. Taking preoperative vascular ultrasound evaluation for carotid endarterectomy （CEA） as an example， this article explores the application of the case-based teaching method in cultivating clinical thinking ability among trainees receiving standardized residency training for ultrasound. Through an analysis of typical cases， trainees engage in the whole process of clinical practice under the guidance of instructors， from medical history collection and imaging interpretation to identification of key intraoperative issues. The teaching process emphasizes the characteristics of vascular ultrasound， such as the combination of vascular structure and hemodynamics， integrated cerebrovascular and cervical assessment， and precise evaluation of collateral circulation. The case-based teaching method not only deepens the understanding of diseases among trainees， but also fosters their ability to think independently and solve clinical problems， facilitating the transition from theory to practice and ensuring precise diagnosis and treatment. This article summarizes the implementation steps and effectiveness of the case-based teaching method， in order to provide a reference for ultrasound residency training.