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@#Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache and reversible cerebral vasoconstriction, with other neurologic signs and symptoms. To the best of our knowledge, there were only a few cases of RCVS presenting both as both convexity subarachnoid hemorrhage (cSAH) and posterior reversible encephalopathy syndrome (PRES). Herein, we report a case of a 32-year-old woman with RCVS who presented with recurrent thunderclap headaches that occurred 50 days after delivery, with cSAH and PRES on magnetic resonance imaging (MRI). She had significant clinical and radiological recovery on 3 months’ follow-up. The clinical coexistence of cSAH and PRES in our case with RCVS is quite rare. This case illustrates the importance of awareness of the diagnosis of RCVS among clinicians even when initial brain and vascular imaging are normal. Early diagnosis and treatment are crucial for better prognosis.
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Cerebral small-vessel disease(CSVD)is a major cause of cognitive decline, dementia, affective disorders, urinary dysfunction and functional disability in the elderly.This review will focus and elaborates on the pathogenic classification, pathogenesis, clinical features and treatment and propose the prospect in the future study, in order to raise the importance of CSVD and provide a certain theoretical basis for clinical diagnosis and treatment.
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Cerebral small vessel disease (CSVD) gives rise to one in five strokes worldwide,which affect the small arteries,arterioles,capillaries and small veins of the brain.CSVD is associated with recent small subcortical infarct,lacuna of presumed vascular origin,white matter hyperintensity of presumed vascular origin,perivascular space,cerebral microbleeds,and brain atrophy.CSVD constitutes a major source of cognitive decline,affective disorder,urinary disorders,gait disturbances,impaired activities of daily living particularly in the elderly.The review will focus on recent progress on the clinical features of cognition,the neuroimaging,treatment and the prospective in the future study.
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Objective To explore the clinical characteristics of the cognitive disorder in patients with small vessel disease(SVD).Methods A total of 60 patients with SVD and 50 age,gender-matched healthy subjects were recruited consecutively from the Department of Neurology,Beijing Chaoyang Hospital. All the participants were performed by a battery of neuropsychological tests.The Fazekas scale was used to as-sess the severity of white matter lesions,and the scale of medial temporal lobe atrophy(MTA)was used to e-valuate the severity of medial temporal lobe.Results Patients with SVD were associated with global cogni-tive function deficits,including the general tests of MMSE((25.9±2.4)vs(28.1±1.7))and MoCA((23.0 ±3.7)vs(26.2±3.0)),and also with performances of AVLD-I((5.0±1.0)vs(8.2±2.0)),AVLT-D((3.7± 1.0)vs(9.3±1.9)),AVLT-R((7.6±1.5)vs(11.7±1.6)),TMT-B,Stroop B,Stroop C and DST(P<0.05). The score of MOCA was related negatively with Fazekas scale(r=-0.361,P=0.04).The severity of Fazekas had a positive relationship with the scores of MTA(r=0.449,P=0.032).Conclusion Patients with SVD are closely correlated to general cognitive impairment,especially with memory decline,attention and executive function,which may be attributed to the impairment of frontal-subcortical circle.
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Objective Vascular mild cognitive impairment(VaMCI) refers to mild cognitive impairment caused by or associated with vascular causes.This study aims to investigate the characteristics of the cognitive impairment in patients with vascular mild cognitive impairment (VaMCI).Methods Seventy-five patients with VaMCI(VaMCI group) and 38 healthy old subjects whose age, sex and education level match the VaMCI group patients(control group) were recruited from the department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between Jan 2016 and June 2016.The neuropsychological examinations were used to evaluate the severity of cognitive impairment, specifically including the Minimum Mental State Examination(MMSE), Montreal cognitive assessment scale(MoCA), Clinical Dementia Rating(CDR), Activity of Daily Living Scale(ADL), Hachinski ischemic score table, Hamilton Depression Scale(HAMD) and Auditory Verbal Learning Test(AVLT).The Fazekas scale was used to assess the severity of white matter lesions, and the medial temporal lobe atrophy rating scale(MTA) was used to evaluate the atrophic severity of medial temporal lobe.Results The overall cognitive function score in VaMCI group was significantly lower than the control group [MMSE [25.7±2.3 vs 28.4±2.0] MoCA [22.8±3.9 vs 26.3±3.7]], the differences was statistically significant(P<0.05);as well as the AVLT-I [5.1±1.0 vs 8.9±1.9], AVLT-D [3.7±1.0 vs 9.8±1.5] and AVLT-R [7.6±1.9 vs 12±1.5] scores in VaMCI group was significantly lower than the control group, the differences was statistically significant(P<0.05), which suggested patients with VaMCI have overall cognitive impairment, especially memory impairment.But Fazekas and MTA scores in VaMCI groups were higher than the control group, the differences was statistically significant(P<0.05).Correlation analysis showed that the scale of medial temporal lobe atrophy had a negative relationship with the performance of MoCA (r=-0.434,P=0.002).Conclusion Our findings demonstrate patients with VaMCI have significant cognitive impairment, especially memory impairment, which may be correlated to the severity of the white matter lesions and the medial temporal lobe atrophy.
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Cerebral microbleeds (CMBs),as an important imaging marker of cerebral small vessel disease (CSVD),is a subclinical damage caused by small hemosiderin deposits indicative of prior cerebral microscopic hemorrhage.In recent years,CMBs have become an important research issue in the field of neuroimaging with the development of newer magnetic resonance imaging (MRI) methods for the higher detection rate of the CMBs.It must to be mentioned that CMBs plays a crucial role in the formatting process of vascular cognitive impairment (VCI),which caused researcher's attention.This review focuses on the research progress in epidemiological status,pathological mechanisms,risk factors,imaging manifestations,clinical features and treatment therapies of CMBs,in order to provide theoretical references for the early detection,prevention and treatment of CSVD and VCI.
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<p><b>OBJECTIVE</b>To observe the impacts of eye acupuncture on neurological deficit and Barthel index in the patients of infarction hemiplegia and explore its function mechanism.</p><p><b>METHODS</b>Ninety-six patients of infarction hemiplegia were randomized into an observation group and a control group, 48 cases in each one. In the control group, the routine western medicines such as thrombolysis and antiplatelet aggregation were used. In the observation group, on the basis of the treatment as the control group, eye acupuncture was added atandareas bilaterally, once a day, 5 times a week. Separately, before treatment and after 2 weeks' treatment the score changes of the modified Edinburgh Scandinavia stroke scale (MESSS) and the activity of daily life scale (ADL, Barthel index, BI) were observed and the efficacy was compared between the two groups. The plasma endothelin was determined and compared before and after treatment in the two groups.</p><p><b>RESULTS</b>After treatment, the effective rate was 93.8% (45/48) in the observation group and was 79.2% (38/48) in the control group. The effective rate in the observation group was higher apparently than that in the control group (<0.05). The scores of neurological deficit were (13.29±1.45) and (18.24±1.33) in the observation group and control group respectively after treatment, which all lower apparently than (28.44±1.45) and (28.14±1.89) before treatment (both<0.05). Additionally, the difference was significant between the two groups after treatment (<0.05). The scores of Barthel index were (82.33±1.56) and (63.34±2.14) in the observation group and control group respectively, which all higher apparently than (38.53±1.54) and (38.14±2.56) before treatment (both<0.05), and the difference was significant between the two groups after treatment (<0.05). The levels of plasma endothelin were (54.55±11.48)ng/L and (62.44±9.88)ng/L in the observation group and the control group after treatment respectively, which were all lower apparently than (78.24±9.25)ng/L and (78.14±10.78)ng/L before treatment (both<0.05). Additionally, the difference was significant between the two groups after treatment (<0.05).</p><p><b>CONCLUSIONS</b>Eye acupuncture effectively improves the neurological deficit and Brathel index in the patients of infarction hemiplegia and comprehensively improves the efficacy. The effect mechanism is possibly relevant with reducing plasma endothelin.</p>
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Objective To determine the relationship between characteristic damages in white matter and its executive dysfunction by magnetic resonance diffusion tensor imaging (DTI) in the patients with leukoaraiosis (LA). Methods A total of 23 patients with LA and 19 age,sex and education-matched healthy people as control were enrolled.Montreal cognitive assessment (MoCA),Stroop test,trail making test (TMT),digit-symbol test(DST),verbal fluence (VF) were applied to assess cognitive and executive functions.Fractional anisotropy (FA),apparent diffusion coefficient (ADC) and mean diffusivity (MD) in white matter lesion (WML) and normal appearing white matter (NAWM) were measured in LA group,the bilateral centrum semiovale,anterior and posterior periventricular white matter in control group were measured by DTI. The white matter DTI parameters were compared between the groups, the relationship between DTI parameters and executive function was investigated in LA group. Results In LA patients,distinct executive dysfunction were found.The scores of Stroop B [(69.4± 13.4) vs.(43.3 ± 5.0),t =8.03,P＜0.05)],Stroop C [(141.4±42.1) vs.(65.4±10.3),t=7.66,P＜0.05)]and Stroop C B[ (72.0±41.4) vs.(22.1±9.6),t=5.13,P＜0.05)],TMT-A[(73.2±15.3)vs.(31.2±7.2),t 10.97,P＜0.05) ],TMTB[(125.6±18.0) vs.(81.6±5.9),t=10.22,P＜0.05) ] andDST[ (24.8±5.6 )vs.(36.8±5.1),t=7.19,P＜0.05) ] were inferior in LA group to control group.The values of FA in centrum semiovale [(0.2±0.1) vs.(0.4±0.1) and (0.4±0.1),F =45.08,P＜0.05)],anterior periventricular white matter [(0.2±0.0) vs.(0.4±0.1) and (0.4±0.1),F =70.11,P＜0.05)] and posterior perivcntricular white matter[ (0.3±0.1) vs.(0.4±0.1) and (0.4±0.1),F=8.54,P＜0.05) ]of WML were reduced as compared with those of NAWM and control group.The values of ADC(×10- 3mm2/s) in the above three regions of WML [(1.2±0.2) vs.(0.8±0.1) and (0.8±0.1),F=46.77,P＜0.05)],[(1.2±0.3) vs.(0.8±0.0) and (0.8±0.1),F=68.22,P＜0.05)]and [(1.4±0.3) vs.(0.8±0.0) and (0.9±0.1),F=17.08,P＜0.05) ] were elevated,as compared with those of NAWM and control group,and the values of MD ( × 10-5 mm2/s) in the three regions of WML[ (127.8±14.5) vs. (95.3±26.4) and (100.8±9.4),F 19.72,P＜0.05) ],[(127.4±16.0) vs.(101.8±13.9) and (93.4±5.6),F=39.26,P＜0.05) ] and [(134.4±21.2)vs.(114.8=14.5) and (114.4±11.7),F=10.66,P＜0.05) ]were also increased,as compared with those of NAWM and control group.There was negative correlation of FA with Stroop C-B (r=-0.46,P＜0.05),TMT-A (r=-0.48,P＜0.05) and TMT-B (r=0.46,P＜0.05),while FA was positively related with DST test (r=0.42,P＜0.05) in anterior periventricular white matter.Conclusions DTI can detect the characteristic damages of white matter,which is strongly related with executive function impairments possibly induced by the damage of prefrontal-subcortical loop in the patients with LA.
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Objective To investigate the neural circuit of inhibitory control in late-onset depressed patients(LOD) by functional magnetic resonance imaging(fMRI). Methods Fourteen late-onset depressed patients (LOD group) and thirteen elderly healthy subjects( control group) were recruited. The two groups were age, gender, and education matched. All the subjects performed a visual Go/Nogo task during the fMRI scan. Erect or inverted isosceles triangular figures were used for stimuli. The two groups were instructed to press a button as quickly and correctly as possible when the erect triangular figures(Go) were presented, but not to response when the inverted triangular figures(Nogo) were presented. The differences of brain activation between the two groups were compared. Results ( 1 ) During Go trials, there were no significant differences in reaction time and hit rate between the two groups (P ＞ 0.05 ). During Nogo trials, however, the late-onset depressed patients showed much higher false alarm rate(0.09 ±0.06) compared with control group(0.04 ±0.02) (P＜0.05＝. (2) During Go trials , LOD group showed significantly greater activity in left postcentral gyrus, left inferior parietal lobule, right precentral gyrus, left paracentral lobule, right inferior parietal lobule, right anterior cingulate cortex, left middle frontal gyrus, right middle frontal gyrus, right superior frontal gyrus compared with the control group. Whereas during Nogo trials, LOD group exhibited greater activity in left inferior parietal lobule and left middle frontal gyrus compared with the control group. Conclusion This study suggests that inhibitory control dysfunction in late-onset depressed patients may be closely related to frontostriatal circuit impairment. Over activation in left middle frontal gyrus, right middle frontal gyrus and right anterior cingulate cortex may contribute to the pathogenesis of late-onset depression.