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Objective To investigate whether routine laboratory findings should be awaited before intravenous thrombolytic therapy for ischemic stroke.Methods Emergency patients (including ischemic and non-ischemic stroke cases) treated at the Department of Neurology,Beijing Tsinghua Changgung Hospital between January 1st 2016 and October 1st 2017 were analyzed retrospectively.The platelet count,prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR) in the first test were used as the main indicators.The proportion of patients with abnormalities between the overall population and the ischemic stroke subgroup was analyzed,and the above indicators between all patients with ischemic stroke and those receiving intravenous thrombolytic therapy were compared.The specific causes of failure to receive intravenous thrombolytic therapy in patients with ischemic stroke were analyzed descriptively.Results A total of 3 348 patients were enrolled.The emergency blood routine data were available in all patients.The emergency blood biochemical data were available in 3 278 patients (97.9％),and the emergency coagulation function data were available 1 742 patients (52.0％).There were no significant differences in the proportion of platelet count ＜ 100 × 109/L (1.3％ vs.1.5％;x2=0.29,P=0.586),APTT＞36.5s (3.8％ vs.3.6％;x2=0.06,P=0.809),PT ＞15s (2.6％ vs.2.8％;x2 =0.03,P=0.866),and INR ＞ 1.5 (2.0％ vs.2.0％;x2 =0.01,P=0.970) between the general population and the ischemic stroke subgroup.In a total of 687 patients with ischemic stroke,57 (8.3％) received intravenous thrombolysis.There were no significant difference in mean platelet count,APTT,PT,and INR between the thrombolytic group and the entire ischemic stroke group.Forty-nine patients (5.1％) with ischemic stroke had abnormal main indicators,of which 57.1％ (28/49) had a history of related diseases at the same time,while only 6.1％ (3/49) had abnormal laboratory indicators as the main factor of contraindication for intravenous thrombolysis.Conclusions Patients with acute ischemic stroke (especially in the absence of a history of related disease) have a low proportion of abnormal blood test findings and are less likely to be the main contributor of contraindication for intravenous thrombolysis.Therefore,when there is no reason to suspect that the test findings are abnormal,intravenous thrombolytic therapy should not be delayed because of waiting for the test findings.
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Objective To analyze the improvement of clinical symptoms,relapse and neurological functional recovery and the prognostic factors of anti-N-methyl-D-aspatate receptor (NMDAR) encephalitis.Methods Follow-up was conducted for 51 hospitalized patients with anti-NMDAR encephalitis at the Department of Neurology,Xuanwu Hospital,Capital Medical University from June 2012 to April 2015.The neurological functional recovery was evaluated through modified Ranking Scale (mRS),and the prognostic factors were analyzed.Results Among the 51 patients with anti-NMDAR encephalitis,89％ (45/51) were completely recovered or remained mild neurological dysfunction (mRS score ≤ 2).The prognosis of main clinical symptoms was as follows:78％ (35/44) of the mental and behavior disorders were fully recovered,94％ (32/34) of the seizures were controlled and 65％ (21/31) of the cognitive deficiency were completely recovered;25％ (13/51) of the patients relapsed.Comparison of clinical data of initial on-set among complete recovery patients group (mRS score =0),partial recovery patients group (mRS score =1 or 2) and poor prognosis patients group (mRS score ≥ 3) showed that initial clinical manifestation with memory deficiency (17,9,6 cases respectively;x2 =6.664,P=0.036),involuntary movements(19,4,5 cases respectively;x2 =7.976,P =0.019) and central hypoventilation (5,0,2 cases respectively;x2 =6.124,P =0.047) had statistically significant difference.Conclusions The majority of anti-NMDAR patients have favorable prognosis,but some of the patients may remain various degrees of neurological deficiency,including mental and behavior disorders,cognitive deficiency and seizures.Initial clinical manifestation with memory deficiency,involuntary movements and central hypoventilation may indicate a poorer prognosis.
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Objective To analyze the clinical characteristics of leucine-rich glioma-inactivated protein 1 antibody-associated encephalitis.Methods Fourteen patients diagnosed as leucine-rich gliomainactivated protein 1 antibody-associated encephalitis in Capital Medical University Xuanwu Hospital from January 2012 to January 2015 were recruited.The clinical manifestation,brain magnetic resonance imaging,cerebrospinal fluid findings and biochemical examination of these patients were analyzed.Results The case series of 14 patients had an average age of (48.93 ± 15.60) years (range 27-67 years) with a male to female ratio of 2.5∶ 1.All patients presented with short-term memory loss.Nine patients experienced dementia.Additionally,among the 14 patients,12 experienced seizures,8 experienced faciobrachial dystonic seizures,10 had psychiatric symptoms,and 8 showed sleep dysfunction.Two patients were transferred into intensive care unit because of deteriorating symptoms and were provided operated mechanical ventilation.Thirteen of 14 patients exhibited abnormalities in their brain magnetic resonance imaging,with lesions in temporal lobe and hippocampus.Six patients had abnormal cerebrospinal fluid findings,8 patients showed hyponatremia (serum Na+ ＜ 135 mmol/L),while 5 patients co-existed with other autoantibodies.Screening for malignant tumors revealed normal findings.During 2 years follow-up,3 patients relapsed.Conclusions Leucine-rich glioma-inactivated protein 1 antibody-associated encephalitis is an autoimmune encephalitis characterized by short-term memory loss,faciobrachial dystonic seizures and hyponatremia.Lesions in brain MRI always involve in temporal lobe and hippocampus.This disease can relapse and is seldom associated with tumor.