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We report here a case of myelitis of the cervical spinal cord in a 59-year-old woman presented with right arm weakness and numbness. Cervical myelitis developed three weeks after the eruption of zoster rash from the C2 to C5 dermatomes. The serum aquaporin-4 antibody was detected using the cell based transfection immunofluorescence assay. MRI of the cervical spine revealed abnormal cord signal. Cerebrospinal fluid analysis demonstrated varicella-zoster virus DNA was not detected. The patient was diagnosed with neuromyelitis optica spectrum disorder, supporting the hypothesis that the pathogenesis of neuromyelitis optica spectrum disorders is triggered by infection.
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To describe a rare case of moyamoya syndrome associated with systemic lupus erythematosus [SLE]. A 22-year-old woman presented with left-sided hemiparesis in addition to fever, fatigue and malar rash. Brain magnetic resonance imaging revealed acute infarction in the right middle cerebral artery territory. Cerebral angiography showed features of moyamoya syndrome. Brain biopsy showed evidence of vasculitis. She responded well to steroid therapy. This case represented a rare co-occurrence of SLE-related vasculitis and moyamoya syndrome. Early vascular imaging is critical in patients with SLE and suspected ischemic stroke
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Objective To investigate the sensitivity and specificity of transcranial Doppler (TCD) diagnosis for intracranial posterior circulation artery stenosis or occlusion.Methods Seventy-two cases of patients treated for posterior circulation intracranial artery stenosis or occlusion were chosen,TCD and CT angiography (CTA) tests were carried out and the results were compared and analyzed.Results Compared with CTA,the sensitivity for period of posterior circulation intracranial arteries by TCD was 82.50％,while specificity reached 94.64％.Positive predictive value attained 91.67％,while negative predictive value reached 88.33％ and the accuracy was 89.58％.Conclusions TCD diagnosis for period of posterior circulation intracranial arterial has high specificity,normal sensitivity,and the highest diagnosis accuracy for intracranial segment of vertebral artery.TCD can serve as early inspecting method for intracranial artery.
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Objective To investigate the correlation between plasma fibronectin (Fn) level and the hemorrhagic transformation (HT) in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke,symptom onset within 72 hours,no bleeding at baseline MRI (including gradient echo sequences) and without thrombolytic therapy were recruited prospectively.At 7 - 10 days after symptom onset reexamined MRI.The patients were divided into HT and non-HT groups according to whether they had a hemorrhage or not.The plasma Fn levels in both groups were compared.Logistic regression analysis was used to investigate the predictors of HT.Results A total of 78 patients were included,and among them 11 patients (14.10％ ) showed HT.The proportions of atrial fibrillation (36.4％ vs.9.0％,P =0.012) and cardioembolism (36.4％ vs.6.0％,P =0.021) in the HT group were significantly higher than those in the non-HT group.The baseline mean systolic blood pressure (182.09 ±20.73 mm Hg [ 1 mm Hg=0.133 kPa]vs.161.25 ±26.40)mm Hg,P =0.015),mean diastolic blood pressure (98.00 ± 11.26 mm Hg vs.86.60 ± 15.21 rnm Hg,P =0.020),and plasma Fn level (4 835.04 ± 756.30 μg/L vs.3 849.44 ± 1 289.18 μg/L,P =0.016) were all significantly higher than those in the non-HT group.Multivariate logistic regression analysis showed that plasma Fn level (odds ratio [ OR],1.001,95％ confidence interval [ CI] 1.000 - 1.001,P =0.017) and atrial fibrillation (OR,13.408,95％ CI 1.963 -91.592,P =0.008) were the independent predictors of HT in patients with acute ischemic stroke.Conclusions The plasma Fn level in patients with HT increased significantly.The plasma Fn level can be used as an independent predictor of non-thrombolytic HT after the onset of acute ischemic stroke.
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Objective To study the reliability and validity of the clinical neurologic deficit scale in evaluating stroke patients. Methods A total of 222 inpatients with acute stroke onset were included in the study. They were assessed when admitted, at the 14th and 90th day of hospitalization by different physicians using the clinical neurologic deficit scale. Intrarater and interrater reliability were determined using Kappa correlation. The split-half rehability and internal consistency were evaluated using Cranbach's a coefficient. Concurrent validity and the predictive validity were determined by spearman rank correlation coefficients. Construct validity was assessed by the factor analysis and the construct validity of the scale was measured according to the classifications of the Oxfordshire Community Stroke Project ischemic stroke subtypes in the patients with cerebral infarction. Results The scores of intrarater reliability in all items were higher than 0.6, the score of interrater reliability in the item "walking" was 0.542, the split-half reliability and the internal consistency were good as demonstrated by the score of 0.911 and 0.886 respectively, and assessment of reliability of different methods showed that "strength in upper limb" and "strength in hand", were poor as shown by the score of 0.393 and 0.386 respectively. The scale is highly correlated with the NIHSS ( both P=0.000) in both total and subtypes of stroke patients according to the classifications of the Oxfordshire Community Stroke Project by concurrent validity analysis. There was a high correlation between the scores of the scale and Barthel Index and the modified Rankin scales at the 90th day of hospitalization (both P=0.000). Conclusions The clinical neurologic deficit scale has a good internal consistency. There is concurrent validity between the scale and the NIHSS and could predict stroke outcome. Factor analysis of the scale displays the best construct validity in the patients with partial anterior circulation infarction, and could be used to evaluate the focus of vertebrobasilar artery despite its insensitivity.
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Objective: To investigate the impact of stroke unit (SU) on the compliance of secondary prevention in patients with stroke at 12 months after stroke. Methods: Research subjects were stroke patients who were treated in SU (n = 500) and in general ward (GW) (n =445) using a design of retrospective study. The patients in the SU group were followed up by hospital, telephone and home interviews for 12 months, and the patients in the GW group were followed up by telephone interview for 12 months. The main outcome measures were the rate of using antithrombotics, the rate of smoking cessation, and the rates of awareness of early stroke symptom and stroke risk factors of patients. Results: he rate of using antithrombotics was 92.76% in the SU group, and it was significantly higher than 51.49% in the GW group (P ＜0.01); the rate of smoking cessation, and the rates of awareness of early stroke symptom and stroke risk factors of patients were 82.33%, 91.04%, and 94.03% respectively in the SU group, and they were significantly higher than 54.75%, 6.53%, and 70.37% in the GW group(P all ＜ 0.01 ). Conclusions: SU attaches importance to the secondary stroke prevention and emphasizes standardized treatment, and the compliance of the secondary stroke prevention in patient with stroke is improved significantly.