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A case of IgG4-related hypertrophic pachymeningitis was reported. The patient was an elderly female, with the course of disease more than 8 years. Clinical manifestations included recurrent headache, vision and hearing loss, exophthalmos and thyroid dysfunction. Finally, she was diagnosed as IgG4-related disease and IgG4-related hypertrophic pachymeningitis by PET-CT and dural biopsy. After treatment with methylprednisolone and mycophenolate mofetil, the patient′s clinical symptoms improved.
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Objective:To evaluate the hemodynamic situation of the patients with moyamoya disease using MR perfusion imaging,and to explore the relationship between compensatory collateral circulation and perfusion. Methods:Seventy-two hospitalized patients with moyamoya disease were selected as typical moyamoya disease group,including 37 males and 35 females,aged 10 - 62 years old,all patients underwent cerebral angiography (DSA)and MR perfusion imaging.And 20 patients with out neurological history were used as control group.With mean transit time (MTT)image as a standard,the abnormal perfusion ranges were classified as region of interest (ROI),and the corresponding perfusion parameter values,including cerebral blood flow (CBF),cerebral blood volume (CBV),MTT and time to peak (TTP)were recorded,respectively.The cerebellum was used as a reference in this study,the perfusion parameters were standardized,and the relative ratios of the perfusion parameters (rMTT,rTTP,rCBF,rCBV)were obtained.Results:Compared with control group,the rMTT and rTTP of the patients in typical moyamoya disease group were prolonged and the rCBF was reduced (P 0.05).②Compared with the contralateral side,the rMTT and rTTP of the suffered side were prolonged,and the rCBF and rCBV were reduced (P 0.05).There were no significant differences in all parameters between hemorrhagic moyamoya disease group and ischemia group (P > 0.05 ). Conclusion:MR perfusion imaging can accurately evaluate the hemodynamic condition of moyamoya disease;MTT and TTP hve higher sensitivities than CBF and CBV.MR perfusion imaging can evaluate the compensation of collateral circulation of moyamoya disease and provide the objective basis for the clinician to select the proper surgical timing and the best operation methods.
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A 40- year-old Male was admitted to the first hospital of Jilin University with the complaint of 4 days of fever and headache and aggravation of weakness in his lower extremities accompanied with dysuria and disturbance of consciousness for one day. He had tachycardia, tachypnea and elevated white blood cell counts. General status of the patient got better day by day, while weakness and pain in his lower extremities had developed and gradually quadriplegia arose. When intensive care unit history, weaning difficulty from mechanical ventilator, clinical manifestations in intensive care unit associated with SIRS, symmetrical paresis pronounced in distal lower extremities, absence of deep tendon reflexes, evidence of distal sensory impairment, presence of electrophysiologic results indicating axonal sensorimotor polyneuropathy and muscle and nerve biopsy results were taken into consideration, he was diagnosed as critical illness polyneuropathy
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Objective To evaluate whether susceptibility weighted imaging (SWI) can be used in definition of penumbra during acute stage of cerebral infarction,compared with perfusion weighted imaging (PWI).Methods Ischemic stroke patients within 3 days after onset were included.They adopted multimodal magnetic resonance imaging examination,including regular magnetic resonance imaging sequence (T1 WI,T2 WI and T2-weight fast fluid-attenuated inversion-recovery),diffusion weighted imaging (DWI),PWI and SWI.Alberta Stroke Programme Early CT Score was done on DWI,SWI and PWI.The mismatch of SWI-DWI (minimal indensity projection (mIP)-DWI) was compared with that of PWI-DWI (mean transit time (MTT)-DWI) and analyzed statistically.The application of prominent vein (PV) on SWI as a sort of alternation of cerebral blood volume (CBV) and direct observation of thrombosis in arteries on SWI were done.Results The SWI-DWI (2.39 ± 1.42) and the MTT-DWI (2.72 ± 1.49) mismatch showed no statistically significant difference (r =0.726,P ＞ 0.05).The grade of PV was positively related with the CBV of the ipsilateral brain tissue on admission (r =0.564,P ＜ 0.05).SWI showed the similar ability with magnetic resonance angiography to judge responsible blood vessels with susceptibility vessel sign.Conclusion SWI-DWI can evaluate the ischemic penumbra.PV may reflect the increased blood volume of the lesion side of the brain tissue.SWI can reveal the thrombosis of the responsible vessels.
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Objective To observe the effects of velcade on inflammatory reaction and cell apoptosis after ischemia-reperfusion injury, and to explore the neuroprotective mechanism of velcade.Methods The 15 male Wistar rats were randomly divided into sham-operated group, physiological saline control group and velcade-treated group (n= 5, each). The model of temporary middle cerebral artery occlusion (MCAO) was applied and reperfused after 2 hours. Immediately after the reperfusion, all rats were performed intraperitoneal injection with velcade 0. 2 mg/kg in velcadetreated group, and with the same volume of physiological saline in control group. After 24 hours, the rats were decapitated in all groups. The apoptosis cells were found by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and the expressions of nuclear factor-κBp65 (NF-κBp65) and interleukinh-1β (IL-1β) were detected by immunohistochemistry. Results The immunologically positive cells of NF-κBp65, IL-1β and apoptosis cells were occasionally found in shamoperated group [(1.21 ± 0. 16)/400 power, (11.56 ± 0. 99)/400 power and (2. 88 ± 0. 27)/400 power], while a lot of immunologically positive cells of NF-κBp65, IL-1β and apoptosis cells were found in velcade-treated group and control group. The control with compared group, these cells were significantly more in the velcade-treated group [(56.28± 1.95)/400 power vs. (29. 76±2.53)/400 power, (47. 64±2.06)/400 power vs. (29.6±1. 61)/400 power and (51. 05±4. 23)/400 power vs.(33.44±2.06)/400 power, all P＜0. 05]. Conclusions The velcade could decrease the expressions of the NF-κBp65 and IL-1β and diminish the neuronal apoptosis. The neuroprotective mechanism of velcade may lie in decreasing apoptosis through inhibiting inflammation.
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Objective To observe the clinical characteristics of progressive stroke (PS) patients with vascular stenosis and the relationship between PS and cerebral blood flow (CBF). Methods Fifteen patients of PS with anterior circulation vascular stenosis were chosen, their clinical documents and CBF were analyzed with Xenon-CT when they were in progression. Results These patients mostly presented hemiparalysis and language dysfunction at the beginning ( 13/15 ) before the disease developed rapidly into a serious state. The infarction usually happens in the periventricular area (10/15). Upper limbs paralyzed more severely than low limbs(11/15). Cerebral hypoperfusion areas around the infarction in 11 patients ( 10 ml·100 g-1·min-1 < CBF < 20 ml·100 g-1·min-1 ) were found. Conclusions Patients of PS with vascular stenosis present typically clinical characteristics, Low CBF caused by cerebral artery stenosis may be one of the most important factors leading to PS.
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Objective To investigate the potential mechanisms of vascular dementia (VD) by comparing the neuroethological and pathological changes of two VD models, established with spontaneously hypertensive rat (SHR) and the rat, of which the bilateral carotid arteries were ligated. Methods Ten male SHRs were employed and defined as hypertension control group. Thirty male Wistar rats were randomly assigned to operation group (bilateral carotid arteries were ligated), sham group and control group. All rats enrolled in the operation group were undergone a permanent ligation of bilateral carotid artery (2-VO). The memory function of rats was estimated by the mean escape latency of Morris water maze. The morphological changes of neuron cells in the frontal lobe, temporal lobes, hippocampus and thalami were observed with HE staining, while the changes of white matter around cerebral ventricles were checked with LFB staining, and the demyelination of nerve was calculated. Results The memory function of rats in SHR control group and Wistar operation group was decreased compared with that of the rats in sham group and control group (P0.05). Conclusions SHRs without intervention and Wistar rats undergone 2-VO can be used to reproduce the ideal VD model. Both chronic permanent hypoperfusion and hypertension may lead to the loss of neurons and myelin which may result in memory dysfunction. Hypoperfusion is even more harmful than hypertension. The present study suggests that loss of neurons and myelin may play a role in the VD.