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China reports more patients with stroke than anywhere else in the world. While there is still a great deal of unknown information, stroke research has been making great progress in recent years. This study will review and discuss a variety of factors such as clinical research, population and genetic epidemiology, brain ischemia/reperfusion exploring, leukoencephalopathy (CADASIL), neural stem cell and stroke, neuroprotective treatment for stroke, clinical therapy test in stroke, rehabilitation and prevention. Cities and towns in China have good integrated systems for registering and investigating strokes. Chinese researchers have followed closely the international level of stroke treatment with a forward position in neural stem cell. Traditional Chinese drugs have featured effects on neuroprotective treatment for stroke which has also been investigated. Chinese scientists suggested a new way of dividing neuroprotectors in stroke. The clinical therapy test with urokinase and defibrase for cerebral infarction in China is effective and relatively safe, yet the original papers published by Chinese researchers and clinical effects for patient treatment still need to be improved and updated.

A 39-year-old man was admitted for complaints of worsening gait difficulty, weakness and dysarthria. His symptoms had developed 17 months earlier with unsteadiness of gait. Subsequently, he gradually developed difficulties in handwriting, weakness and dysarthria. His symptoms were considered as spinocerebellar ataxia in a local hospital and treated with CoQ10, and vitamins B1 and B12. No improvement was observed. His disability accelerated 2 weeks prior to admission. There is no family history of cerebellar symptoms. Physical examination revealed palpable thyroid gland. Neurological examination showed normal mental status, right central facial weakness, lingual fasciculations, brisk jaw jerk, hyperactive gag reflex and scanning dysarthria. Strength of left upper and right limbs was 4/5 with bilateral palmomental reflexes and right Babinski signs. Focal dystonia was observed in the right hand. He was only able to walk several steps, with broad-based, ataxic gait. Marked slowing and dysmetria of rapid alternating movements were noted. Pinprick and position sensations were preserved. There was no orthostatic hypotension. Magnetic resonance imaging (MRI) of the brain disclosed slight atrophy of the cerebellum without gadolinium enhancement (Fig. 1a). The electroencephalogram, Montreal Cognitive Assessment test and electromyography were normal. Cerebrospinal fluid (CSF) showed 126 mg/dl protein (normal 15–45 mg/dl) and normal IgG index. There were no oligoclonal bands (OB). Anti-GM1, GQ1b and GD1b antibodies were negative in both serum and CSF. Screenings of connective tissue disease, heavy metal and antibodies against viruses were negative. Angiotensin converting enzyme, vitamin B12, vitamin E, folate and rapid plasma reagin tests were unremarkable. Paraneoplastic antibodies were not detected in the serum. The chest CT was normal. Positron emission tomography (PET) only demonstrated a slightly decreased FDG uptake in the right thalamus (Fig. 1b). Genetic testing of SCA1-7, SCA12, SCA17 and DRPLA was negative. The patient was euthyroid with increased thyroglobulin antibody (TG-Ab) and thyroperoxidase antibody (TPO-Ab) concentrations at 83.2 U/ml (normal 0–60 U/ml) and [1,300 U/ml (normal 0–60 U/ml), respectively. Both TGAb and TPO-Ab were present in the CSF at 17.4 and 87.5 U/ml respectively. Thyroid ultrasound and scan revealed slightly enlarged thyroid gland with several hypoechoic areas and normal tracer uptake. Although antigliadin antibodies were not tested, neurological manifestations of gluten sensitivity are mainly ataxia, peripheral neuropathy, epilepsy and headache [6], which are not typical in this case. We diagnosed the condition as Hashimoto’s encephalopathy (HE) and initiated intravenous methylprednisolone 1 g/day for 5 days followed by oral prednisone tapering. Y. Tang and C. Chu contributed equally to this work.

BACKGROUND AND OBJECTIVES:: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke. RESULTS:: A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak. CONCLUSION:: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.

BACKGROUND AND OBJECTIVES:: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. PROTOCOL DESIGN:: The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3×2 factorial design comparing: three different SBP targets (1