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Objective:To investigate the clinical characteristics of cerebral hemorrhage caused by tentorial dural arteriovenous fistula (TDAVF).Methods:An unusual TDAVF case admitted to the Department of Neurology, Qilu Hospital, Shandong University in March 2020, complicated with hypertension with successive bilateral basal ganglia hemorrhage in short term was reported. The characteristics of cerebral hemorrhage caused by TDAVF reported in the literature were summarized and analyzed.Results:Digital subtraction angiography (DSA) revealed that there was arteriovenous fistula in the tentorial foramen area of this patient (male, 33 years old), and the TDAVF was fed by the right meningohypophyseal trunk, bilateral middle meningeal artery and posterior cerebral artery. A shunted pouch was present in the tentorial foramen area, and retrograde reflux drainage was seen in the deep venous system, from the meningeal vein to superior sagittal sinus or sigmoid sinus. Transarterial embolization was performed and subsequently DSA showed obliteration of the fistula. This patient experienced no clinical decline or rehemorrhage during the 12 months follow-up period. Forty-one cases of TDAVF with hemorrhage of cerebral parenchyma which were reported before March 30, 2021 with detailed clinical and imaging data were summarized. The average age of onset of this group of patients was 57.2 years, and the ratio of male to female was about 3∶1. The hemorrhage was located in superior of the tentorium in 17 cases (41%), while in inferior of the tentorium in 24 cases (59%). Supratentorial intracerebral hemorrhage mainly occurred in occipital lobe and thalamus. DSA showed that the arteriovenous fistula was classified as Borden type Ⅲ or Cognard type Ⅳ in 36 cases (88%). Twenty-nine patients (71%) underwent a single surgical procedure, while 12 cases (29%) underwent combined surgical or other treatments. Overall, 37 patients (90%) achieved angiographically documented obliteration of the fistula and 39 patients (95%) experienced good or excellent outcomes.Conclusions:TDAVF often presents as cerebral parenchymal hemorrhage which is common in supratentorial region, but rare in basal ganglia region. The cause of cerebral hemorrhage in patients with hypertension may not be attributed to hypertension. Early diagnosis and intervention are of great significance to improve the prognosis of patients.
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Autoimmune cerebellar ataxia (ACA) is a cerebellar syndrome mediated by autoimmune mechanisms, and ACA with positive anti-Homer3 antibody is very rare. This article reports a 55-year-old male patient admitted to Qilu Hospital, Shandong University, due to dizziness and walking instability for 22 days. The serum and cerebrospinal fluid showed positive results for anti-Homer3 antibody, and the symptoms improved after intravenous immunoglobulin combined with hormone therapy. Based on the review of the case data and relevant literature reports, the pathogenesis, clinical manifestations, auxiliary examination, treatment and prognosis of ACA with positive anti-Homer3 antibody are analyzed, so as to deepen the understanding of clinicians and improve the diagnosis and treatment level.
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Objective:To summarize the clinical, pathological and molecular biological characteristics of one patient of paranodal disease with anti-contactin-associated protein 1 (Caspr 1) antibodies.Methods:The patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) admitted to Qilu Hospital of Shandong University from August 2018 to December 2020 were retrospectively studied. The clinical data of one acute onset CIDP patient with anti-Caspr 1 antibodies were collected and retrospectively analyzed with literature review. Anti-nodal/paranodal IgG and their subclasses in serum and cerebrospinal fluid (CSF) were investigated by immuno?uorescence assays. Pathological characteristics were explored by sural nerve biopsy further.Results:The patient presented with tremor, ataxia and neuropathological pain besides symmetrical limb muscle weakness and hypaesthesia. The CSF protein was elevated significantly. The brachial plexus and lumbosacral plexus magnetic resonance imaging showed enlarged nerve roots. The patient was responsive well to intravenous immunoglobulin and steroids in acute phase, while the symptoms improved significantly with rituximab in chronic phase. Autoantibodies against Caspr 1 were detectable in serum and CSF, with IgG4 predominant. Sural nerve biopsy revealed segmental demyelination and myelin digestion chamber. Dispersed lamellae of myelin sheath and axonal degeneration were confirmed by electron microscopy.Conclusions:Tremor, ataxia, neuropathic pain, significantly elevated CSF protein and enlarged nerve roots are suggestive of paranodal diseases with anti-Caspr 1 antibodies. For patients with suspected Guillain-Barre syndrome/CIDP and above phenotypes, nodal/paranodal antibodies and antibody subtypes should be detected to optimize the treatment.
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Objective@#To investigate the stroke burden (prevalence, incidence, and mortality) and its risk factors for men and women, urban and rural residents at the provincial level in Shandong province.@*Methods@#This study formed part of the National Epidemiological Survey of Stroke in China (NESS-China). This population-based study included 25 190 adults living in Shandong province and was conducted in 2013. The data were derived from eight disease surveillance points (DSPs). They were located in Qingdao Shibei district, Zaozhuang Xuecheng district, Yantai Zhifu district, Laiwu Laicheng district, Yantai Penglai, Weifang Gaomi, Zaozhuang Yiyuan, Linyi Junan. All living subjects who had suffered a stroke by August 31, 2013 were considered as having a prevalent stroke. Incident stroke was defined as a first-ever stroke (both fatal and non-fatal) between September 1, 2012 and August 31, 2013. Fatal cases of incident strokes were used to estimate stroke mortality rate. Stroke cases were subcategorized as follows: ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Stroke cases with no brain imaging within the first week of stroke onset or cases where the results of imaging were not available were classified as stroke of undetermined pathological type (UND).@*Results@#Of the 25 190 participants, 449 had experienced a prevalent stroke, 118 participants were diagnosed as having an incident stroke, 33 fatal cases were identified over the 12-month period. The crude rate of prevalence, incidence and mortality were 1 782.5 per 100 000 people, 468.4 per 100 000 person-years and 131.0 per 100 000 person-years. The age-standard rate of prevalence, incidence and mortality were 1 059.0 per 100 000 people, 279.7 per 100 000 person-years, and 76.0 per 100 000 person-years. Compared to women, the prevalence of stroke was markedly higher among men (1 463.3 per 100 000 people vs 2 265.0 per 100 000 people). Compared to urban residents, the prevalence of stroke was markedly higher among rural residents (563.7 per 100 000 people vs 2 203.6 per 100 000 people). Among all prevalent cases, there were 348 people suffering from IS, 75 cases suffering from ICH, 6 cases suffering from SAH, and 20 cases of UND. The prevalece rates of IS, ICH, SAH and UND were 1 385.5 per 100 000 people, 301.7 per 100 000 people, 23.8 per 100 000 people and 79.4 per 100 000 people, respectively. The three most prevalent risk factors in stroke cases were hypertension (66.4%), current smoking (26.1%), and alcohol drinking (24.9%).@*Conclusions@#Stroke was highly prevalent in Shandong province, China. The prevalence and incidence rates of stroke were significantly greater for men than women. Large geographical variations in the stroke burden were also observed in Shandong province, with a greater stroke burden observed in rural areas.
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Objective To investigate the stroke burden (prevalence, incidence, and mortality) and its risk factors for men and women, urban and rural residents at the provincial level in Shandong province. Methods This study formed part of the National Epidemiological Survey of Stroke in China (NESS?China). This population?based study included 25 190 adults living in Shandong province and was conducted in 2013. The data were derived from eight disease surveillance points (DSPs). They were located in Qingdao Shibei district, Zaozhuang Xuecheng district, Yantai Zhifu district, Laiwu Laicheng district, Yantai Penglai, Weifang Gaomi, Zaozhuang Yiyuan, Linyi Junan. All living subjects who had suffered a stroke by August 31, 2013 were considered as having a prevalent stroke. Incident stroke was defined as a first?ever stroke (both fatal and non?fatal) between September 1, 2012 and August 31, 2013. Fatal cases of incident strokes were used to estimate stroke mortality rate. Stroke cases were subcategorized as follows:ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Stroke cases with no brain imaging within the first week of stroke onset or cases where the results of imaging were not available were classified as stroke of undetermined pathological type (UND). Results Of the 25 190 participants, 449 had experienced a prevalent stroke, 118 participants were diagnosed as having an incident stroke, 33 fatal cases were identified over the 12?month period. The crude rate of prevalence, incidence and mortality were 1 782.5 per 100 000 people, 468.4 per 100 000 person?years and 131.0 per 100 000 person?years. The age?standard rate of prevalence, incidence and mortality were 1 059.0 per 100 000 people, 279.7 per 100 000 person?years, and 76.0 per 100 000 person?years. Compared to women, the prevalence of stroke was markedly higher among men (1 463.3 per 100 000 people vs 2 265.0 per 100 000 people). Compared to urban residents, the prevalence of stroke was markedly higher among rural residents (563.7 per 100 000 people vs 2 203.6 per 100 000 people). Among all prevalent cases, there were 348 people suffering from IS, 75 cases suffering from ICH, 6 cases suffering from SAH, and 20 cases of UND. The prevalece rates of IS, ICH, SAH and UND were 1 385.5 per 100 000 people, 301.7 per 100 000 people, 23.8 per 100 000 people and 79.4 per 100 000 people, respectively. The three most prevalent risk factors in stroke cases were hypertension (66.4%), current smoking (26.1%), and alcohol drinking (24.9%). Conclusions Stroke was highly prevalent in Shandong province, China. The prevalence and incidence rates of stroke were significantly greater for men than women. Large geographical variations in the stroke burden were also observed in Shandong province, with a greater stroke burden observed in rural areas.
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Objective To investigate the function and clinical significance of platelet-derived microparticles (PMP), glycoprotein(GP)Ⅱb-Ⅲa, PagT and blood-lipid in whole blood of patients with cerebro-thrombotic diseases before and after treatment. Methods The quantity of PMPs, activation ratio of GPⅡb-Ⅲa and PAgT were measured before and after treatment of cerebro-thrombotic patients by using flow cytometry and platelet adhesion instrument. Blood-lipid concentration was measured by automatic-biochemical analyzer. Results PMP, GPⅡb-Ⅲa , PAgT, TC, TG, and LDL were (223?54)/10 4 Plt, (77.98?14.22)%, (69.78?16.93) %, (5.12?0.85) mmol/L, (1.78?0.28) mmol/L, and (3.49?0.66) mmol/L respectively before treatment; and were (136?18)10 4Plt, (40.71?11.64) %, (58.12?12.51)%, (4.84?0.73) mmol/L, (1.43?0.33) mmol/L, and (3.03?0.62) mmol/L,respectively in the treatment group. These parameters were significantly decreased than that before treatment (P