Progress in clinical diagnosis and drug treatment of chronic insomnia / 中国临床药理学与治疗学

The clinical symptoms of chronic insomnia are various, the clinical diagnosis process needs to be combined with sleep parameters, daytime symptoms and psychological status of patients. Recently, the neuroimaging research suggests that chronic insomnia patients have certain structural changes and functional changes, which leads a new direction for the following research. The new drugs for the treatment of chronic insomnia, improving receptor specificity or increasing intervention targets, will provides more choices for patients.

Pathophysiology and cognitive behavioral therapy of chronic insomnia / 中国临床药理学与治疗学

The occurrence and development of chronic insomnia involves subjective and objective factors, which can be classified as predisposing factors, precipitating factors and perpetuating factors. Cognitive behavioral therapy for insomnia (CBT-I) evolves from the pathopsychological analysis of chronic insomnia patients, and selectively combines the sleep hygiene, cognitive therapy and behavioral therapy to improve the symptoms of patients. With the popularity of internet, the digital cognitive behavioral therapy for insomnia has an convenient advantage over the traditional therapy, and has become the focus of research. Researchers have proposed multiple therapies for chronic insomnia, including drug therapy and non-drug therapy, which improve the treatment effect of chronic insomnia from different perspectives.

Clinical value of Aβ1-42, tau protein and thyroid hormone levels in predicting cognitive impairment after ischemic stroke / 中国神经精神疾病杂志

Objective To investigate the relationship between serum markers β amyloid (Aβ), tau and thyroid hormone levels and post-stroke cognitive impairment (PSCI) in the acute phase of cerebral infarction. Methods A total of 214 patients with acute cerebral infarction were enrolled. The baseline data and serological indicators were collected and the cognitive function of patients was evaluated. All patients were divided into cognitive impairment group and normal group based on follow-up results. The differences of Aβ1-42, tau protein and thyroxine levels between the two groups and their relationship with disease progression were analyzed. The Cox regression analysis and ROC curve were used to compare the above parameters to predict the development of PSCI. Results The total protein level of Tau (210.6 ±98.9 pg/mL) was higher and Aβ1-42 (426.1 ±123.5 pg/mL) and triiodothyronine (T3) (1.43 ±0.57 nmol/L), free thyroxine (FT4) (13.15±2.23 pmol/L) was significantly lower in the cognitive impairment group than in the normal group (P<0.05). Tau protein (r=-0.457), Aβ1-42 (r=0.348), T3 (r=0.211), and FT4 (r=0.306) were all associated with disease progression (P<0.05). Cox regression analysis showed that Aβ1-42 and T3 were important influencing factors in the occurrence of PSCI. The area under the curve of Aβ1-42 combined with T3 was 0.841. The specificity and the sensitivity were 74.8% and 85.3%, respectively, with a diagnostic cutoff value of 0.572. Conclusion Aβ1-42 and T3 levels in the acute phase of cerebral infarction may predict the progression of PSCI.

Difference of cervical vestibular evoked myogenic potentials in different audition stage of Ménière disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Our goal was to find whether inreversible function damage of saccule was exist and correlated in Meniere's patients with different audition.@*METHOD@#Senenty-nine patients with unilateral Meniere's disease, who visited the Dizziness Diagnosis and Treatment Centre of the Second Military Medical University from January to July in 2015 were included. They were grouped as slightly audition damage group (41 cases), mildly-severely audition damage group(38 cases). Meanwhile 20 normal controls underwent the research. The cervical vestibular evoked myogenic potentials were conducted in symptom free period.@*RESULT@#There was no significant difference of the C-VEMP inducing rate between slightly audition damage group and normal control group. While a statistically difference showed between mildly-severely audition damage group and normal control group or slightly audition damage group. P1, N1 latency had no statistically difference between three groups. The P1-N1 amplitude and asymmetric ratio had no difference between slightly audition damage group and normal control group, but had a statistically difference between mildly-severely audition damage group and slightly audition damage group, normal control group.@*CONCLUSION@#The function of saccule in Meniere's patients decreased with the aggravation of audition damage.

Comparison of caloric responses between vestibular migraine and Ménière disease patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the features of caloric tests in vestibular migraine (VM) and Menière's disease (MD) patients, and provide objective evidence for differentiating the 2 groups of patients.@*METHOD@#This case-control study included 11 MD patients with left ear involved and mild to moderate impaired hearing, and 18 matched cases with VM. All participants received caloric tests. Maximum slow phase velocities (SPVmax) were used to describe horizontal and vertical nystagmus respectively and were compared between the 2 groups. Horizontal and vertical canal parasis(CP) were calculated according to respective SPVmax. Unilateral (UW-VR) or bilateral (BW-VR) weakness of vestibular response, and positive unilateral (UVR) or bilateral (BVR) vertical response or negative bilateral vertical response (NBVR) were judged by the boundary point of SPVmax of 5°/s respectively. Total left (LV) or right (RV) Vertical reactions were calculated accoeding to vertical SPVmax,and inter ears difference of vertical responses (IED-VR) calculated from LV minus RV.@*RESULT@#There were no significant differences in age and gender between the 2 groups. Horizontal SPVmax of all of caloric tests of VM group,except the left cold (LC), were statistically larger than that of MD group (P < 0.05) and the maximum responses of right warm (RW) caloric test in VM group (34.50 ± 17.77) were significantly greater than that in MD group (12.82 ± 6.69) (P < 0.01). Only the vertical SPVmax of RW of all caloric tests has statistically difference between the 2 groups (P < 0.01), and the maximum responses of RW caloric test in VM group (6.00 ± 4.45) were significantly stronger than that of LC in MD group (1.27 ± 2.00) (P < 0.01). Horizontal CP ≥ 25% of the 2 groups(VM: 72.22%, MD: 54.55%) were not statistically different, while the proportions of UW-VR and BW-VR in VM group (5.56%, 0) were significantly lower than that in MD group (27.27%, 18.18%) (P < 0.05). Vertical CP ≥ 25% of the 2 groups (VM: 94.44%, MD: 27.27%) were significantly different (P < 0.01), and the proportions of positive UVR (left: 5.56%, right: 77.78%) and BVR (0) and NBVR (16.67%) in VM group were significantly different from that in MD group (UVR (left: 9.09%, right: 0), BVR (0), NBVR (90.91%)) (P < 0.01). There was statistically difference between LV and RV in VM group (P < 0.01, LV < RV), while no difference were showed in MD group. IED-VR in VM group (left intenser: 16.67%, right intenser: 83.33%) was statistically different from that in MD group (left intenser: 36.36%, right intenser: 9.09%, both no difference: 54.55%) (P < 0.01).@*CONCLUSION@#Vestibular responses of caloric test are more sensitive, and vertical reactions are more easily induced in VM patients than in MD. Caloric test can be used to differentiate the 2 groups of diseases.

Effects of aging on vestibular evoked myogenic potential / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose of this study is to assess the effects of aging on air-conducted sound elicited cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential(oVEMP) in normal people.@*METHOD@#Sixty normal subjects were recruited for the vestibular evoked myogenic potential examination. Among them, 20-40 year-old group was setted as the first group, 41-60 year-old group was setted as the second group, > 60-year-old group was setted as the third group. Each group included 20 normal subjects. SPSS 16.0 software was used to analyze the data.@*RESULT@#As the age growing, P1 latency prolonged, N1-P1 amplitude decreased, and amplitude asymmetric ratio increased in cVEMP; N1 latency prolonged, P1-N1 amplitude decreased, and amplitude asymmetric ratio increased in oVEMP.@*CONCLUSION@#With the age growing, the time of otolithic organ input pathways prolonged, the function of otolithic organ decreased and the decrease level may be asymeetrical on both sides.

The features of high and low-frequency function of horizontal, semicircular canal in Meniere's disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the feature of horizontal semicircular canal function at high and low-frequencies in Meniere's disease.@*METHOD@#Thirty patients suffering from unilateral Meniere's disease were included in the research from 2013 June to 2014 June. Caloric test and video head impulse test were performed to evaluate the high low-frequency function of horizontal semicircular canal.@*RESULT@#these patients were devided by the severity of unilateral weakness in caloric test. The gain value in video head impulse test, which reflects the high-frequency function of semicircular canal, were not different between the normal and mild abnormal group (P > 0.05), but were obviously different between the normal and mild-severe abnormal group, slight abnormal and mild-severe abnormal group (P 0.05).@*CONCLUSION@#A part of Meniere's disease may have normal high, low-frequency function of horizontal semicircular canal. As patient suffering slight injury of low-frequency function, the high-frequency function keeps normal. As the injury of low-frequency function become mildly to severely, the damage of high-frequency function appears, but the symmetry still keeps balance.

Management of bilateral benign paroxysmal positional vertigo with Dix-Hallpike test / 中华内科杂志

Objective To explore the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) with bilateral positive Dix-Hallpike test.Methods This is a retrospective study based on the clinical data of BPPV patients diagnosed in the Dizziness Clinic of Changzheng Hospital from January 2012 to December 2012.Totally 490 patients with vertigo and nystagmus provoked by Dix-Hallpike maneuver were included in the present analysis.Results Among all the patients,55 (11.2％) of them presented with bilateral nystagmus by the provocative test.According to the type of nystagmus provoked by DixHallpike maneuver,the 55 patients can be divided into the following four categories.(1) Bilateral geotropic (n =16) and apogeotropic nystagmus (n =5):all these patients were diagnosed with horizontal canal BPPV and free of vertigo after head side-shaking exercise in supine position and Barbecue maneuver.(2) Bilateral predominant down-beating nystagmus (n =2):patients in this group were diagnosed with anterior canal BPPV,and got recovered after Kim maneuver.(3) Bilateral torsional up-beating geotropic nystagmus (n =20):after a lying-down test,6 of the patients manifested as vertical up-beating nystagmus and 14 patientsremained torsional up-beating nystagmus.The formerwere diagnosed with bilateral posterior canal BPPV,and were cured after bilateral PRM therapy,and the latter were diagnosed with horizontal canal BPPV,who were cured after Barbecue maneuver.(4) Torsional up-beating geotropic nystagmus on one side and down-beating nystagmus on the other side (n =12).The down-beating nystagrnus on the other side disappeared when the patients was firstly seated up with head down in 30 degrees for half an hour before second Dix-Hallpike maneuver.These patients were diagnosed with unilateral posterior canal BPPV and cured by PRM therapy.Conclusions It is common for vertigo patients with bilateral nystagmus induced by Dix-Hallpike test.The diagnoses should be made by the types of nystagmus provoked step by step before maneuver therapy.

Clinical features of 51 patients with vestibular paroxysmia / 中华神经科杂志

Objective To explore the clinical features of vestibular paroxysmia (VP).Methods The clinical features of 51 patients with VP from January 2009 to April 2011 were analyzed retrospectively.The treatment effectiveness of antiepileptics was evaluated.Results The ratio of male to female was 1 ∶ 1.55 in the 51 patients with VP and the course of disease was 10 days to 20 years.In 46 patients (90.2％) the attacks occurred at rest,whereas 37 patients (72.5％) were precipitated by a head turn or a body turn.Three minutes hyperventilation-induced vertigo was found in 13 patients (25.5％) and Fukuda test was positive in 15 patients (29.4％).Forty patients (78.4％) were abnormal in brainstem auditory evoked potentials (BAEP) and the interpeak latency of wave Ⅰ-Ⅲ was prolonged than 2.2 ms in 26 patients (51.0％).There were 47 ears had neurovascular cross-compression (NVCC),which were unilateral in 37 patients and bilateral in 5 patients,with type Ⅰ in 23 ears(48.9％),type Ⅱ in 5 ears(10.6％),type Ⅲ in 17 ears(36.2％) and type Ⅳ in 2 ears(4.3％).Three month-treatment led to a significant reduction in the attack frequency(3 (2,7) per month vs 15 (9,30) per month,Z =-6.156,P ＜ 0.01),in the attack duration(2(1,4) s vs 12(6,20) s,Z =-6.066,P ＜0.01),and a reduction in the visual analogue scale of vertigo (1.86 ±0.57 vs 5.83 ± 1.12,t =1.984,P ＜ 0.01).Conclusions Briefvertigoattacksatrestis the character of VP.Three minutes hyperventilation-induced vertigo is helpful for the diagnosis of VP.The prolongation of the interpeak latency of wave Ⅰ-Ⅲ in BAEP is the character of VP.NVCC widely existed in the patients with VP and types Ⅰ and type Ⅲ was more common.Using antiepileptics,a better treatment effectiveness can be obtained.

Effects of sleep inertia on cognitive performance following different time course naps after 30 hours sleep deprivation in healthy men / 中华神经科杂志

Objective To study the effects of sleep inertia (SI) of different time course sleeps on sleep stages and cognitions in healthy men after 30 h sleep deprivation,and also to investigate the mechanism of cognitive functions impairment in sleep inertia stages and the influential factors of sleep inertia.Methods Ten healthy men (age,(20.8 ±2.1) years) participated in the program.The program was divided into 2 stages.First,participants attended a series of tests after 20 min nap(20 min nap group)after 30 h sleep deprivation.The testing series included 3 parts:the continuous performance task,the Stroop Tests,and the Addition Tests.The series of tests were done 3 times immediately after the volunteers were awoken and each lasted about 15 minutes with an interval of 10 minutes between each test.The polysomnogram (PSG) was recorded during the nap.The following 7 days was set as washing-out period to ensure a complete recovery.Participants repeated the similar processes with 2 h nap(2 h nap group) instead of 20 min nap.The cognitive performance of each group was compared with each other along with the best cognitive performance in awakening to estimate whether or not the cognitive abilities regained the normal condition.Results ( 1 ) Sleep latency became shortened in both groups after 30 h sleep deprivation.There were no slow wave sleep (SWS) and rapid eye movement sleep (REM) sleep stages in the 20 min naps,while the percentage of SWS was increased and percentage of REM declined in 2 h naps.(2)In the early of SI (5 min after awaking),cognitive tasks showed that the abilities of continuous attention,selected attention and addition ability were all impaired (continuous performance task:(371.8 ± 21.3 ) times/3 min vs (334.4 ± 22.4) times/3 min,( 373.2 ± 19.0) times/3 min vs ( 323.7 ± 23.8) times/3 min,t =10.443,7.774,both P＜0.01; Stroop tests:(20.3 ±1.5) points vs(17.3 ± 1.0) points,(21.5 ±0.8)points vs( 16.1 ± 1.4 ) points,t =8.478,4.934,both P ＜ 0.05 ; Addition Tests:( 222.2 ± 13.2 ) s vs ( 266.6 ±23.7 ) s,( 226.3 ± 10.9) s vs ( 267.6 ± 23.4 ) s,t =5.748,6.685,both P ＜ 0.01 ).The cognitive functions impairments of 2 h nap group were more severe at the initiation of sleep inertia,but regained the normal condition more quickly.Different cognitive tasks recovered at different speeds.The dispersion of SI needed 30 min.Conclusions ( 1 ) There are difference in the sleep construction and awaked sleep stage between 20 min nap and 2 h nap groups.(2) SI exerts negative influences on cognitive performances of continuous attention,selected attention and addition after sleep deprivation.Many factors may influence the dispersion of SI,including sleep debt,compensation of sleep debt and others.(3) Fragments of sleep are unfavorable to the recovery of body.

Clinical features of 326 patients with benign paroxysmal positional vertigo / 中华神经科杂志

Objective To explore the clinical features and repositioning maneuver effects of benign paroxysmal positional vertigo ( BPPV ).Method The clinical features of 326 patients with BPPV from August 2009 to July 2011 were analyzed retrospectively.Different types of BPPV were compared.Results BPPV was more common in female and the peak period of onset was between the ages of 50 and 60.The average latency of vertigo attack was ( 1.52 ± 1.22) s and 43 patients ( 13.2％ ) had no obvious latency.The median duration of vertigo attack was 10 s,with less than 60 s in 312 patients (95.7％) and between 60—180 s in 13 patients (4.0％).The latency of vertigo attack of posterior semicircular canal-BPPV ( ( 1.74 ± 1.21 ) s) was longer than that of horizontal semicircular canal-BPPV ( ( 0.96 ± 1.06 ) s,t =5.546,P ＜0.01 ).But there were no differences in the gender,the course of disease and the duration of vertigo attack.The patients with posterior semicircular canal-cupulolithiasis were younger than those with posterior semicircular canal-canalithiasis.The duration of vertigo attack of posterior semicircular canalcupulolithiasis was longer than that of posterior semicircular canal-canalithiasis.The latency and the duration of vertigo attack of horizontal semicircular canal-cupulolithiasis were longer than that of horizontal semicircular canal-canalithiasis and the age was older.Conclusions The posterior semicircular canal is more involved in BPPV.The latency of vertigo attack of posterior semicircular canal-BPPV is longer than that of horizontal semicircular canal-BPPV.The latency and the duration of vertigo attack of horizontal semicircular canal-cupulolithiasis are longer than that of horizontal semicircular canal-canalithiasis and the age is older.

Effects of rapid eye movement sleep deprivation and GABAergic drug intervention on cognition in rats / 中华神经科杂志

Objective To establish an animal model of rapid eye movement (REM) sleep deprivation (SD) and an animal model for perifornical nucleus microdialysis and investigate the change of cognition, hypocretinergic system and GABAergic system in rats' hypothalamus after various degrees of REM sleep deprivation and sleep revival and two GABAergic drugs intervention. Methods The modified multiple platform method (MMPM)was used to establish sleep deprivation model and the cognitive function was assessed by Morris' water maze. Immunofluorescence technique was used to analyze the number of Hypocretin (Hcrt) immunoreactive neurons, total Fos immunoreactive neurons, Hcrt and Fos colabeled neurons, and the integrated optical density ( IA ) of GABAA Rαl immunoreactive area in rats' hypothalamus.High performance liquid chromatograph (HPLC) was used to quantitatively analyze the level of GABA and Gluin in the rats' hypothalamus. Two GABAergic drugs, a selective GABAA R antagonist, SR-95531, and a selective blocker of type 1 GABA transporter (uptake blocker), NO-711, were used for perifornical nucleus microdialysis. Results There was no statistically significant difference in tests between CC and TC ( Define CC and TC). There was a significant decrease (P ＜ 0. 05 ) of cognitive function measured by Morris maze test in SD 3 d, SD 5 d and RS 6 h of SD groups compared with CC and TC groups. Number of Fos immunoreactive, F+ &H+ immunoreactive neuronsand IA of GABAA Rαl immunoreactive area were all significantly increased ( P ＜ 0. 05 ). Content of GABA measured by HPLC was also increased ( P ＜ 0. 05 ). However, all these changes were partly reversed by sleep revival SR-95531 and NO-711 had different effect on these changes. Conclusions Sleep deprivation, no matter mild or severe, has adverse effects on cognitive function. Activities of both GABAergic and Hcrtergic system are increased during REMSD. These two neurons system could be regulated by each other and the relationship between them is positive correlation. GABAergic system also had self-regulation during REMSD, but microdialysision of either SR-95531 or NO-711 acquired adverse effects on cognitive function of rats. So GABAergic system is not an optimal therapeutic target. Because GABAergic and Hcrtergic system has inhibitory effect on each other,suppressing activity of Hcrtergic system might be a promising therapeutic target.

Functional magnetic resonance imaging study of working memory changes in healthy male volunteers after 36 hours sleep deprivation / 中华神经科杂志

Objective To observe changes in the working memory and brain functional imaging on functional magnetic resonance imaging(fMRI) after 36 hours sleep deprivation (SD) in healthy volunteers and to explore the possible mechanism of the changes.Methods FMRI scannings were performed in ten male healthy young volunteers before and after 36 hours SD and results were analyzed using SPM2 software.Subjects were also tested LTR and PLUS task to measure the persistence and operation of working memory before and after 36 hours SD.Results The reaction time of LTR task after 36 hours SD ( (866 ± 102) ms)was significantly longer than that before SD ( (754 ± 91 ) ms, t = 2.59, P < 0.01 ).The reaction time of PLUS task after SD ( (848 ± 94) ms) was significantly longer ( t = 2.37, P < 0.05 ) than that before SD ( (756 ± 79) ms).The error rate of LTR task after SD (95.3% ± 3.56% ) was significantly higher (t=3.52,P < 0.01 ) than that before SD (84.8% ± 8.71% ).The error rate of PLUS task after SD (95.7% ±4.72% ) was significantly higher (t =3.38 ,P <0.01 ) than that before SD (84.2% ±9.66% ).There were no significant differences between the two tasks.The frontal and parietal lobes, anterior cingulate gyrus and thalamus were activated during memory tasks testing before SD.Brain activation was broader and stronger in PLUS task than in LTR task.After SD, activation in parietal lobe was decreased and activation in prefrontal and thalamus was increased significantly.Conclusions The working memory performance decreased after SD.Both LTR and PLUS tasks of working memory activate frontal and parietal lobes, anterior cingulate gyrus and thalamus.The activation of parietal lobe decreased and the activation of prefrontal lobe and thalamus increased after 36 hours SD.This is the possible mechanism of SD to causes the cognition decline.

The clinical study of posterior semicircular canal benign paroxysmal positional vertigo / 中国实用内科杂志

Objective To evaluate the clinical features and treatment of posterior semicircular canal benign paroxysmal positional vertigo(PC-BPPV).Methods To retrospectively analyse the clinical features and therapy results of 120 patients with PC-BPPV from January 2003 to November 2004 in the Chang Zheng Hospital of the Second Military Medical University.Results Vertigo attack of PC-BPPV had such characters as brief period,positioning,latency and fatigability.Geotropic rotatory nystagmus occurred in 108 patients and apogeotropic rotatory nystagmus in 12 patients in the test of Dix-Hallpike,and the former received the repositioning maneuver therapy of Epley and the later received the therapy of Semont maneuver.The symptoms disappeared completely in 88 patients after a single session and 12 patients after twice、6 patients after triple sessions of Epley repositioning maneuver therapy in the former,no effectiveness in 2 patients;the symptoms remitted in 8 patients after once,2 patients after twice and 1 patient after triple sessions therapy of Semont repositioning maneuver in the later,no change in 1 patient.The total success rate was 97.5%(117/120).Fifteen patients had relapse during follow-up and the recurrence rate was 12.5%(15/120).They also responded to repositioning maneuver therapy.Conclusion The diagnosis of PC-BPPV is based on the typical clinical features and the test of Dix-Hallpike.The repositioning maneuver therapy is safe and effective for PC-BPPV and should be used for all patients when the diagnosis is clearly made.

Traumatic benign paroxysmal positional vertigo:clinical features and prognosis / 中华神经科杂志

Objective To evaluate the chnical features and prognosis of traumatic benign paroxysmal positional vertigo (t-BPPV).Methods By retrospectively analyzing the results of clinical features and prognosis in 19 patients with t-BPPV from January 2003 to September 2006,the results were compared with 51 patients with idiopathic benign paroxysmal positional vertigo (i-BPPV).Results The mean ages were (51.3?19.1) years in t-BPPV group and (63.2?16.5) years in i-BPPV group,the difference was significant (t=2.57,P0.05).The one-stage success rates were 62.5% in t-BPPV group and 83.6% in i-BPPV group,the difference was significant (x~2=4.94,P

Clinical study of horizontal canal benign paroxysmal positional vertigo / 临床神经病学杂志

Objective To study the clinical features and treatment of horizontal canal benign paroxysmal positional vertigo (HC-BPPV).Methods The clinical features of 27 patients with HC-BPPV and the treatment results with otolith repositioning maneuver of Barbecue rotation were analyzed retrospectively.Results All the patients with HC-BPPV had vertigo attack and this kind of vertigo attack presented with some characters such as brief, positioning, latency and no fatigability. Geotropic nystagmus was seen in 21 patients and apogeotropic nystagmus was seen in 6 patients when head was turned to either side in supine position. After Barbecue rotation, all symptoms disappeared in patients with geotropic nystagmus and did not change in patients with apogeotropic nystagmus.Conclusions The diagnosis of HC-BPPV is based on typical clinical features and test of turning head to either side in supine position. Geotropic nystagmus is associated with canalithiasis and apogeotropic nystagmus is associated with cupulolithiasis, and the therapy of Barbecue rotation is very effective to HC-BPPV patients with geotropic nystagmus.

Diagnosis value of epithelial membrane antigen immunocytochemistry examination in meningeal carcinomatosis / 临床神经病学杂志

Objective To assess the diagnosis value of epithelial membrane antigen (EMA) immunocytochemistry examination in meningeal carcinomatosis.Methods The routine cerebrospinal fluid cytologic examination and EMA immunocytochemistry examination of 23 cerebrospinal fluid specimens from 14 patients with definitive meningeal carcinomatosis were analyzed,retrospectively.Results The positive rate of routine cerebrospinal fluid cytologic examination and EMA immunocytochemistry examination were 39.13%(9/23)and 86.96%(20/23),respectively. There was a significant difference between two results ( P