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Anti-contactin associated protein-like 2 (CASPR2) antibody encephalitis is a rare autoimmune encephalitis with variable clinical symptoms and atypical imaging manifestations. The prognosis of the patients with severe disease is poor. Reversible posterior leukoencephalopathy syndrome is rarely reported in autoimmune encephalitis. The clinical data, diagnosis and treatment of a patient with anti-CASPR2 antibody encephalitis complicated with reversible posterior encephalopathy syndrome were reported, in order to improve the understanding of clinicians on the rare disease complicated with atypical imaging manifestations.
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Objective:To explore the use of internet-based continuous visual recognition task (MemTrax test, MTX) as a rapid screening tool for amnestic mild cognitive impairment (aMCI).Methods:Sixty-four patients with aMCI and 64 individuals with normal cognition as healthy controls were enrolled respectively from Department of Neurology and Health Examination Center of the First Affiliated Hospital of Kunming Medical University from August 2018 to December 2019. Montreal Cognitive Assessment (MoCA) scale and MTX were adopted to assess the cognitive function of all subjects. The total adjusted MoCA scale score, correct rate of MTX, reaction time of MTX and MTX score were obtained and statistically analyzed.Results:The adjusted MoCA scale scores of aMCI patients and healthy controls were 19 (14, 24) and 26 (24, 27; Z=6.795), the correct rate of MTX of aMCI patients and healthy controls were 74% (60%, 80%) and 88% (84%, 94%; Z=8.359), and the MTX score of aMCI patients and healthy controls were 51.11±14.07 and 70.56±14.91 ( t=7.590), respectively, all with statistically significant difference ( P<0.001). Reaction time of MTX of aMCI patients and healthy controls was 1.401 (1.253, 1.590) s and 1.277 (1.163, 1.410) s, respectively ( Z=3.083, P<0.01). After adjustment for age, physical or mental occupation, exercise, hypertension, hyperlipidemia, stroke, sleep time, as well as smoke, the linear regression showed that the aMCI patients had a significant decrease of adjusted MoCA score, correct rate of MTX and MTX score ( P<0.001), and an extension of reaction time of MTX ( P=0.071), compared with the controls. By MTX and MoCA scale assessment, the best cutoff value was 81% for correct rate of MTX and 23 for adjusted MoCA scale score respectively for the prediction of aMCI (with sensitivity of 79.7%, 93.8% respectively, and specificity of 68.8%, 82.8% respectively). The area under the curve (AUC) of correct rate of MTX was 0.93 (95% CI 0.89-0.97, P<0.001), and the AUC of adjusted MoCA score was 0.85 (95% CI 0.78-0.91, P<0.001). There was a statistically significant difference in paired comparison of the two AUCs (χ2=4.620, P<0.05). Conclusion:MTX acts better for the detection of aMCI than MoCA scale, and correct rate of MTX<81% can be considered as the existence of MCI.
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Myasthenia gravis (MG) is an acquired autoimmune disease involving neuromuscular junctions transmit dysfunction. The main clinical manifestations are partial or systemic skeletal muscle weakness and extreme fatigue, increased symptoms after activity, relieved after rest and treatment with cholinesterase inhibitors. However, recent studies have found that patients of MG are not only accompanied by motor symptoms such as muscle weakness and dysphagia, but also with non-motor symptoms. This article reviews the clinical research progress of non-motor symptoms in MG.
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Myasthenia gravis (MG) is an acquired autoimmune disease involving neuromuscular junctions transmit dysfunction. The main clinical manifestations are partial or systemic skeletal muscle weakness and extreme fatigue, increased symptoms after activity, relieved after rest and treatment with cholinesterase inhibitors. However, recent studies have found that patients of MG are not only accompanied by motor symptoms such as muscle weakness and dysphagia, but also with non?motor symptoms. This article reviews the clinical research progress of non?motor symptoms in MG.
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Objective To explo the antioxidant effect and molecular mechanism of gastrodin (Gas) in epilepsy (EP) rats induced by LiCl-pilocarpine (PILO) . Methods Eighty male SD rats were randomly divided into 5 groups: sham group, EP group, therapy groups (pretreated with 60 mg/kg, 90 mg/kg, 120 mg/kg of gastrodin respectively) . The EP model was esteblished by peritoneal injection of LiCl-PILO. Therapy groups were pretreated with various concerntration of Gas. The control group was given the same dosage of normal saline. The alteration of behavior was observed, the concentration of catalase (CAT), glutathion (GSH), superoxide dismutase (SOD), glutathion reductase (GR), total antioxidtion (T-AOC) and malondialdehyde (MDA) in rats brain cortex were detected by chemical colorimetric method, phosphorylation of p38 was determined by western blot. Results There was no EP seizure in sham group,and the EP seizure degree in therapy groups (gas pretreated groups) was significantly decreased,and had statistically significant difference with EP group (P<0.05) . The EP model rats exhibited a significant decrease in the concentration of endogenous antioxidants (CAT, GSH, SOD, GR and T-AOC), while an increase of the concentration of MDA and phosphorylation p38 protein as compared to sham group (P<0.05) . After treatment of the Gas,treatment group rats attenuated the seizure degree,exhibited a significant increase of the concentration of endogenous antioxidants (P<0.05),while a decrease in concentration of MDA and phosphorylation of p38 as compared to model group (P<0.05) . Conclusion Gas may have a neuroprotective role in central nervous system of epileptic rats modle by down-regulateing the seizure degree and the activity of p38 kinase and up-regulateing the content of endogenous antioxidants.
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Objective To study the serum levels of melatonin,tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) in multiple sclerosis (MS) patients and the correlation with disability.Methods Forty patients with multiple sclerosis were collected as MS group and 30 healthy participants were collected as control group.Serum levels of melatonin and cytokines,including IFN-γ and TNF-,were detected in all participants by the enzyme-linked immunosorbent assay (ELISA) method;disability status of patients with MS was evaluated by EDSS scale.The relevant analysis between serum melatonin,TNF-α,IFN-γ levels and EDSS score in patients with MS was conducted.Results The concentration of serum melatonin in MS group was significantly lower than control group (P＜0.01).TNF-α levels were higher than control group (P＜0.05) and the difference was statistically significant between MS patients and control group.Among MS group and control group,no significant correlation with the serum levels of IFN-γ was seen.The serum melatonin level was inversely correlated with EDSS score in MS patients (r =-0.76,P＜0.01),and positively correlated with TNF-α (r =0.83,P＜0.01) and as compared to IFN-γ,no significant correlation was found (r =0.17,P＞0.05).Conclusion The decrease of melatonin and increase of TNF-α can be a factor in the inflammatory reaction in patients with MS,and is closely related with dysfunction occurring in multiple sclerosis.Serum melatonin and TNF-α can be used as laboratory indicators to monitor clinical curative effect and evaluate prognosis of MS.
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Objective To explore the activition and polarization of microglia in the epileptic rats induced by lithium chloride-pilocarpine. Methods One hundred male SD rats were randomly divided into five groups: control group and different time points model groups including 1d,3d,7d and 14d. Epilepsy models were established by lithium chloride-pilocarpine intraperitoneal injection. The control group was given the same dosage of normal saline. The morphology change was detected by immunofluorescence,and the expressions of iNOS and Arg-1 were determined by IHC at respective time points. Results Compared the model groups with control group,microglia was activated,synapsis was shorten,volume got bigger,most of them seemed as amoebocyte,the expression of iNOS increased and Arg-1 decreased,especially at 3d.ConclusionThe results from this study indicated that microglia was activated and polarized in epileptic rats induced by pilocarpine.
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Objective To investigate the neuropsychological and functional neuroimaging features in patients with cerebellar infarction (CI).Methods We analyzed 59 CI patients (27 left CI,32 right CI) and 26 healthy control subjects who received standard and experimental cognitive testing and neuroimaging study.We compared the cognitive manifestations between the groups with Student' s t test.Results Patients with CI(left/right) achieved significantly lower scores in auditory verbal learning test (AVLT) of memory test (12.27 ± 1.37 vs 9.33 ± 1.90/10.25 ±2.20,t =6.46,4.26,P ＜0.05),Associative Learning of Clinical Memory Scale (22.77 ± 3.07 vs 18.67 ± 1.98/16.84 ± 3.55,t =5.74,6.69,P ＜ 0.05),symbol digit modalities test (SDMT) of visuospatial test(42.54 ±6.32 vs 20.85 ±9.57/34.84 ± 16.10,t =9.68,2.47,P ＜ 0.05),and errors responses (RE) of Wisconsin card sorting test for executive function (16.77 ± 2.64vs 52.22 ± 16.29/54.47 ± 16.27,t =11.15,12.89,P ＜ 0.05).Patients with left CI had significantly lower scores in correct responses percentage (RCP; 58.71 ± 10.93 vs 78.43 ± 5.26,t =-8.41,P ＜ 0.05)and significantly higher scores in the trials to compete first category (RF; 23.59 ± 9.79 vs 14.12 ± 3.75,t =4.68,P ＜ 0.05).Those finding suggests left CI would cause impairment on abstract conceptualization and concept formation; The patients with right CI had significantly lower scores in total memory quotient (86.69 ± 7.56 vs 112.02 ± 9.70,t =-11.17,P ＜ 0.05),higher scores in perseverative responses (RP ;44.59 ± 17.50 vs 8.23 ± 3.46,t =11.47,P ＜ 0.05) and nonperseverative responses errors percentage (nRPE; 44.00 ±20.67 vs 10.58 ± 2.35,t =9.07,P ＜ 0.05).It means right CI would cause serious deficits on memory,cognitive shift and attention.The fibers between cerebellum and frontal,parietal lobe were reduced in CI patients,compared with healthy control.Conclusions These results suggest that cerebellum participated in the formation of part of cognitive function by connection with cerebrum.After CI,that the fibers contacted with the prefrontal and parietal reduced is the possible mechanisms for cognitive impairment.
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The phenomenon of secondary ischemic brain injury after intracerebral hemorrhage is more common in clinical practice.In recent years,a growing number of studies are trying to find an effective therapy to avoid the occurrence of ischemic brain injury and improve the prognosis in patients with intracerebral hemorrhage.This article reviews the incidence and mechanisms of ischemic brain injury after intracerebral hemorrhage.
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Objective To investigate the correlation between fatigue and cognitive impairment and depression after lacunar stroke.Methods A total of 103 patients with lacunar infarction admitted from September 2009 to November 2010 were enrolled.Post-stroke fatigue was evaluated with the Fatigue Scale (FS-14) and the Fatigue Severity Scale (FSS-9); cognitive function was evaluated with the mini-mental state examination (MMSE) and the Montreal cognitive assessment (MoCA); and depression was evaluated with the self-rating depression scale (SDS) and the Hamilton Depression Rating Scale (HAMD).Results There were 34 patients (33.01％) (FSS-9) and 45 patients (43.69％) (FS-14) had fatigue.Of the 34 fatigue patients determined with FSS-9 scores,20 had cognitive impairment,26 had depression,and 16 had both cognitive impairment and depression.The Pearson correlation analysis showed that the FS-14 scores were siguificantly negatively correlated with the scores of MMSE (r =-0.307,P =0.002) and MoCA (r =-0.457,P=0.000),and significantly positively correlated with the scores of SDS (r =0.368,P =0.000) and HAMD (r =0.526,P =0.000); the FSS-9 scores were significantly negatively correlated with the scores of MMSE (r =-0.292,P=0.003) and MoCA (r=-0.340,P=0.000),and significantly positively correlated with the scores of SDS (r =0.403,P =0.000) and HAMD (r =0.564,P =0.000).Conclusions The incidence of fatigue,cognitive impairment and depression was higher.There was a certain correlation between fatigue and cognitive impairment and depression.
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Apathy is a common neuropsychiatric complication after stroke,the identification of apathy after stroke and its related factors and providing an effective intervention on it may contribute to the rehabilitation in patients with stroke.This article reviews the incidence of apathy after stroke,pathophysiological mechanisms,diagnostic evaluation and treatment.
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Early diagnosis and early intervention for cognitive impairment after ischemic stroke can delay disease progression and prevent the occurrence of dementia.This article reviews the advances in research on ischemic stroke caused each risk factor for cognitive impairment.
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Ischemic stroke is a catastrophic event in young adults. It may cause death,disability, incapacity and decline in the quality of life. When the neurologists are facing the suspected ischemic stroke in young adults, the greatest challenge of diagnosis is to identify the causes. This article reviews the risk factors, etiological diagnosis as well as its associated disorders and dysfunction in young adults.
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Objective To investigate the cognitive function and emotional disorder and their interrelationships in patients with essential tremor(ET).Methods The cognitive function was evaluated by using scales such as mini-mental state examination (MMSE), aphasia buttery of Chinese for oral-test and read-test, Rey-Osterreith complex figure (ROF), digit span (DS), similarties tests, symbols-digital test, Wisconsin card sorting test, trail making test A, verbal fluency test and clock drawing test in fourty cases and fourty healthy controls matched on age, education level and handedness.The Hamilton depression scale was applied to assess the emotional state of the patients with ET.Results Compared with healthy controls, patients had significantly lower scores in Rey-Osterreith complex figure (t=6.66,P<0.001),digit span (positive)(t=3.32,P<0.001),symbols-digital test (t=4.18,P<0.001),Wisconsin card sorting test (P<0.05),trail making test A (t=3.59,P<0.001),verbal fluency test (t=-3.98,P<0.001) and clock drawing test (t=-4.18,P<0.001), but similar scores in aphasia buttery of Chinese for oral-test and read-test and similarties tests(P>0.05).The cognitive function scores were not significantly associated with the intensity and duration of tremor in patients with ET(P>0.05).Depression, mostly mild depression, was observed in 52.5 percent of patients with ET.Depression was significantly associated with the age (X~2=27.03, P<0.001) and was observed more frequently in the patients under the age of 50.There was no significant association between the cognitive impairment and depression in patients with ET (P>0.05).Conclusions The patients with ET have a multiple-domain cognitive deficit, in which executive function, attention and memory are impaired more severely.The patients with ET have a high incidence of depressive symptoms.
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ObjectiveIn order to investigate anti-ageing mechanisms of the notoginsenoside Rg1,we used Aβ_(1-42) and D-galactose to establish aging rat model. Methods Ninety rats were divided into three groups at random: sham group, model group, treatment group. Aging rat models were established by injecting peritoneally D-galactose (100 mg/kg) to the rats for 56 days and after 35 days aggregated Aβ_(1-42)(μg) was injected to the right lateral ventricle of rats. Meantime, rats were treated by intragastric administration the notoginsenoside Rg1. Then spatial memory of experimental rats was examined with the Morris water maze(MWM). The thiol antioxidants including glutathione reductase (GR) and glutathione peroxidase (GSH-Px) activities were examined by colorimetric method. The concentration of the pro-caspase-3 and Bcl-2 were examined by the immunohistochemistry and Western blotting method. Results In aging model rats escape latercies were significantly prolonged (P<0.05), while decreases were seen in the time of staying the third quadrants of platform, the number of crossing over a platform, the concentration of the GR, GSH-Px, and pro-caspase-3 as compared with the sham group(P<0.05). After treatment of the notoginsenoside Rg1, the aging model rats exhibited significant increases in the time of staying the third quadrants of platform, the number of crossing over a platform, the concentration of the GR, GSH-Px, and pro-caspase-3(P<0.05), while a decrease was observed in escape latercies as compared to control group(P<0.05). Moreover there was no significant difference in the expression of the Bcl-2(P>0.05). Conclusion The results from our study indicate that the notoginsenoside Rg1 could improve the oriented learning and memory capacity and prevent the neurodegeneration of central nervous systems in aging model rats by up-regulating the expression of the thiol antioxidants(including GR and GSH-Px) and resisting the cleavage of the pro-caspase-3.
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Lipoprotein-associated phospholipase A2(Lp-PLA2) is a novel biomarker for cardiovascular disease. Its expression in symptomatic carotid plaques is higher than that in asymptomatic ones, and its product lysophosphatidylcholine is associated with tissue oxidative stress and inflammation. In addition, Lp-PLA2 plays a more unique role in the unstable difference of carotid atherosclerotic plaques.
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Stroke is a disease、with high mortality, and its main clinical manifestation is that the activities of daily living (ADL) of patients are impaired to different extents. This article reviews the related factors that influence ADL.
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Anti-phospholipid antibody and lupus anticoagulant appear in the blood of patients with human immunodeficiency virus (HIV)infection,which result in the increased levels of von Willebrand factor and D-dimer,and decreased the levels of protein S,protein C,antithrombin and heparin cofactor,and thus rgsult in hypercoagulation status.In addition,the HIV infection itself and secondary opportunistic infections may also cause endothelial injury.Both hypercoag ulation status and endothelial injury may promote the occurrence of thrombotic diseases.
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Basal ganglion lesions often result in language impairment. Its patterns of manifestation are complicated. Patients may either have oral language disorders or written language disorders, which almost includes all types of aphasia, The article reviews the anatomy, definition, feature and mechanisms of basal ganglia aphasia as well as the effect of lesion sites on language.
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Thunderclap headache is a sudden severe headache. It is an uncommon type of headache. Identifying it in time and accurate diagnosis are very important because this type of headache is often complicating serious cerebral diseases. This article reviews its causes and diagnostic assessments.