Intracranial artery stenosis (ICAS) in youth is an under-explored condition. ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence, leading to a poor prognosis for individuals and a great burden to society. The etiology and risk factors of ICAS in youth differ from those of older patients, thus resulting in a difference in the progression and prognosis of the disease. Even though the diagnosis of ICAS is lumen-based, it is sometimes difficult to identify in young patients based on imaging alone. Notably, novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence. Moreover, pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients. Thus, considering the poor prognosis, there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.

Early or ultra-early pharmacological thrombolysis together with mechanical thrombectomy are key treatments for ischemic stroke, and both are aimed at vascular recanalization and improved collateral circulation. While these methods enhance tissue perfusion in the ischemic penumbra, they also trigger complex neurotoxic reactions, including apoptosis, acidosis, ion imbalance, oxidative stress, and pyroptosis, exacerbating cerebral ischemia-reperfusion injury (CIRI). Pyroptosis, a recently discovered form of programmed cell death driven by inflammation, plays a significant role in neuronal death during CIRI. This study reviews the regulatory mechanisms of pyroptosis in CIRI.

Objective: To evaluate the basic appearance and variation of the venous sinuses and veins in healthy individuals. Methods: Prospectively-recruited healthy volunteers completed a questionnaire and underwent magnetic resonance imaging plus contrast-enhanced magnetic resonance venography (CE-MRV) to measure their sinus diameters. Anatomical variations of cerebral venous sinuses were evaluated. Results: Fifty-eight individuals were included. The mean diameter of the left transverse sinus (LTS) (5.37±1.35 mm) was significantly smaller than that of the right transverse sinus (RTS) (6.65±1.57 mm) (P<0.001), and the average discrepancy was 19.2%. RTS dominance was noted in 55.1% of cases. Four superior sagittal sinus (SSS) anatomical variations were found. Type A was the most common and was present in 43 participants (74.1%). The SSS preferentially drained into the RTS in 32 patients (55.2%), and arach-noid granulation was observed in the transverse sinus (TS) and SSS in patients. According to our reclassification combined with Osborn’s previous research, we found that the SSS commonly drained into the RTS and that the straight sinus (StS) branched into both TSs. Conclusions: A 19% difference between the LTS and RTS provides a threshold for TS lateral dominance instead of a TS abnormality. Clinicians and radiologists should not ignore the influence of acquired pathology when the SSS drains in a non-RTS-dominant manner. Anatomical variations of the torcular herophili are frequent; the most commonly observed was the StS branching into both TSs, with the SSS draining into the RTS.

Objective: To explore the clinical and pathological characteristics of cerebral venous sinus thrombosis (CVST) with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), and to investigate the diagnosis, radiographic changes, and prognosis over the course of treatment. Methods: The clinical data and radiographic findings of a young male CVST patient, who presented with initial symptoms of SAH and ICH, were collected and analyzed. The relevant literature was also reviewed. Results: The patient had no specific clinical symptoms except for headache. The brain computed tomography (CT) scan revealed SAH, a high-density shadow in the right posterior fossa and cerebellar hemisphere, and ICH in the left frontal lobe. Magnetic resonance venography (MRV) further revealed bilateral thrombosis in the transverse and sigmoid sinuses. Conclusion: CVST with SAH and ICH is rare and difficult to diagnose. Careful radiological study and clinical analysis are important for the correct and early diagnosis of this condition. Anticoagulation therapy is considered the primary treatment for CVST.

Objective: To summarize the clinical features, imaging manifestations, therapeutic options, and prognosis of the primary angiitis of the central nervous system (PACNS) and to explore the role of high-resolution magnetic resonance imaging (HR-MRI) in the PACNS diagnosis and treatment. Methods: One patient with PACNS treated by HR-MRI was retrospectively analyzed and summarized by combining relevant literature. Results: The patient was a young female who was hospitalized with progressive cerebral infarction and multiple intracranial arterial stenosis. HR-MRI indicated vasculitic changes. After excluding other diseases, hormone shock combined with immunosuppression was given, followed by long-term rehabilitation treatment. The patient’s condition tended to stabilize, and the prognosis was satisfactory. Conclusion: PACNS is challenging to diagnose and is characterized by poor prognosis and easy recurrence. HR-MRI plays an important role in the clinical diagnosis and treatment adjustment for PACNS.