ABSTRACT
Combined central and peripheral demyelination (CCPD) is a rare autoimmune disease and its action mechanism remains unknown. This article described a case of CCPD with anti-neurofascin 155 IgG4 antibodies after varicella-zoster virus (VZV) infection who was recovered after steroids and intravenous immunoglobulin treatments. The clinical characteristics of this patient were summarized and the possible pathogenesis was discussed, so as to provide information of CCPD after VZV infection for clinicians.
ABSTRACT
Cerebral amyloid angiopathy (CAA) is a common cerebral small vessel disease, mainly caused by β-amyloid deposition on the small vessels less than 200 μm in diameter in cortex and leptomeninges. CAA is a major cause of spontaneous intracerebral hemorrhage in the elderly, especially lobar location. Early symptoms are insidious, and as the disease progress, they manifest as cerebral hemorrhage, cognitive decline, transient focal neurological episodes, cerebral infarction, epilepsy, headache, etc. MRI revealed that CAA is a disease in which bleeding and ischemia coexist, and even inflammation and immune responses are involved. MRI findings of CAA include cerebral hemorrhage, cerebral microbleeds, convexity subarachnoid hemorrhage and cortical superficial siderosis, cortical microinfarcts, CAA-associated inflammation, white matter hyperintensities, enlarged perivascular spaces, cerebral atrophy and lacune, etc. The same patient often has several of the above manifestations, and each manifestation has different specificity for the diagnosis of CAA. The rapid development of MRI technology has led to the improvement of the diagnostic level of CAA, and it is of great clinical significance to understand these imaging findings. This article reviews the MRI findings of sporadic CAA.
ABSTRACT
Rickettsia felis is a Gram-negative prokaryotic organism that is obligatorically parasitic in cells. Cat fleas are the main vector of Rickettsia felis. Clinical symptoms of human infection with Rickettsia felis include fever, fatigue, headache, macular papules, and eschar. There are few reports of serious complications or deaths due to infection of Rickettsia felis. A confirmed case of severe encephalitis caused by Rickettsia felis infection was admitted to neurology department of Affiliated Hospital of Jining Medical University on January 29, 2020. After comprehensive treatment of antiviral by acyclovir, mannitol dehydration to reduce intracranial pressure, human immunoglobulin to regulateimmunity, minocycline hydrochloride capsule, levofloxacin mesylate and sodium chloride against Rickettsia felis infection, control of seizure and pulmonary infection, the patient's condition was improved and then discharged. By summarizing the experience and lessons in the treatment of this patient, we hope to remind everyone to strengthen the understanding of Rickettsia felis infection.
ABSTRACT
Guillain-Barré syndrome (GBS) is an autoimmune-mediated peripheral neuropathy. The main therapeutic strategies for GBS are intravenous immunoglobulin and plasma exchange; however, a part of patients respond not well to current strategies. The definite mechanism of GBS remains not clear and animal models are powerful tools to investigate the pathogenesis of GBS and explore new treatments. Till now, a series of animal models have been established. This paper is aimed to review these models with focus on their characteristics, advantages and disadvantages, which will be helpful for the further experimental studies of GBS.
ABSTRACT
Objective To evaluate the clinical significance of cortical laminar necrosis (CLN) on diffusion-weighted imaging at acute stage of cerebral infarction.Methods 41 patients were retrospectively investigated who were diagnosed acute cerebral infarction in area of middle cerebral artery,and they got diffusion weighted imaging ( DWI ),magnetic resonance angiography ( MRA ) and colored ultrasonic inspection of cervical arteries within 48 hours after onset,with exclusion of cardioembolism,and 5 patients also had digital subtraction angiography (DSA).The patients were classified into CLN positive group or negative group.The stenosis or occlusion of ipsolateral MCA,intracranial and extracranial ICA were compared between the two groups.Results 9 patients'DWI had CLN,among whom 7 patients present moderate or more severe stenosis of feeding artery,and 5 patients who only had CLN signal presented severe stenosis or occlusion.32 patients'DWI had not CLN,among whom 12 patients present moderate or more severe stenosis of feeding artery.The CLN positive group had a high incidence of ipsilateral intracranial ICA and(or) MCA moderate or severe stenosis or occlusion(55.6％ vs 21.9％,x2 =3.85,P ＜ 0.05 ).The 5 patients who only had CLN signal had ipsilateral feeding artery severe stenosis.A positive correlation was found between CLN and moderate or severe stenosis or occlusion of ipsilateral intracranial ICA and(or) MCA(OR:4.5,95％ CI:1.0 ～ 20.2).Conclusion Patients with acute cerebral infarction and CLN on DWI were more likely to suffer from moderate or severe stenosis or occlusion of feeding large artery,and these patients should be evaluated vessel condition.