Reversible cerebral vasoconstriction syndrome presenting as convexity subarachnoid hemorrhage and posterior reversible encephalopathy syndrome during postpartum: A case report and literature review

@#Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache and reversible cerebral vasoconstriction, with other neurologic signs and symptoms. To the best of our knowledge, there were only a few cases of RCVS presenting both as both convexity subarachnoid hemorrhage (cSAH) and posterior reversible encephalopathy syndrome (PRES). Herein, we report a case of a 32-year-old woman with RCVS who presented with recurrent thunderclap headaches that occurred 50 days after delivery, with cSAH and PRES on magnetic resonance imaging (MRI). She had significant clinical and radiological recovery on 3 months’ follow-up. The clinical coexistence of cSAH and PRES in our case with RCVS is quite rare. This case illustrates the importance of awareness of the diagnosis of RCVS among clinicians even when initial brain and vascular imaging are normal. Early diagnosis and treatment are crucial for better prognosis.

Cerebral small-vessel disease: An update review / 中华老年医学杂志

Cerebral small-vessel disease(CSVD)is a major cause of cognitive decline, dementia, affective disorders, urinary dysfunction and functional disability in the elderly.This review will focus and elaborates on the pathogenic classification, pathogenesis, clinical features and treatment and propose the prospect in the future study, in order to raise the importance of CSVD and provide a certain theoretical basis for clinical diagnosis and treatment.

Quantitative evaluation of blood-brain barrier permeability in patients with ischemic white matter lesions with dynamic contrast-enhanced MRI / 中国医学影像技术

Objective To investigate the changes of blood-brain barrier (BBB) permeability and the correlation with cognitive function in patients with ischemic white matter disease with dynamic contrast-enhanced MRI (DCE-MRI).Methods Totally 71 subjects underwent routine MRI,DCE-MRI,mini-mental state examination (MMSE) and Fazekas scoring,and then were divided into patient group and control group according to the Fazekas scores.The leakage rate (K),area under the leakage curve (AUC) and fractional blood plasma volume (Vp) in cerebral white matter hyperintensities area and normal appearing white matter area were measured and compared between the two groups.The correlation between these parameters and MMSE scores were analyzed.Results K and AUC value of white matter hyperintensities area and normal appearing white matter area in patient group were significantly higher than those in control group (all P＜0.001).Vp value of normal appearing white matter area in patient group was lower than that in control group (P=0.015).K and AUC value of white matter hyperintensities area in patient group had significant negative correlation with MMSE scores (r=-0.440,--0.540,both P＜0.001).Conclusion BBB permeability increased in cerebral white matter hyperintensities and normal appearing white matter area in patients with ischemic white matter lesions,which correlated with cognitive function.

Cerebral small vessel disease and cognitive impairment / 中华行为医学与脑科学杂志

Cerebral small vessel disease (CSVD) gives rise to one in five strokes worldwide,which affect the small arteries,arterioles,capillaries and small veins of the brain.CSVD is associated with recent small subcortical infarct,lacuna of presumed vascular origin,white matter hyperintensity of presumed vascular origin,perivascular space,cerebral microbleeds,and brain atrophy.CSVD constitutes a major source of cognitive decline,affective disorder,urinary disorders,gait disturbances,impaired activities of daily living particularly in the elderly.The review will focus on recent progress on the clinical features of cognition,the neuroimaging,treatment and the prospective in the future study.

Thoracoscopic operation of the third type of esophageal atresia : a single center's experiences / 中华胸心血管外科杂志

Objective Conclusion thoracoscope surgery clinical data and correcting Ⅲ esophageal atresia(EA) and discuss the feasibility and clinical effect.Methods 24 cases confirmed the third type of esophageal atresia were retrospectively analyzed.There were 12 male and 12 female.9 cases were type Ⅲa EA and 15 cases were type Ⅲb EA.The weights were from 1.9 kg to 3.6 kg,mean weight was 2.56 kg.The age were from born to 8 days,the mean age was 2.5 days.Before operation esophageal contrast study was carried out,also ultrasonography was routinely used to evaluate heart and abdominal viscera.Results The diagnosis of third type EA was confirmed by esophageal contrast study with a blind proximal end of the esophagus and air inflation in the gut.There were 3 cases with proximal blind pouch at the 2nd vertebrate level and the other 21 cases at the 3rd to 4th vertebrate level.All the cases except one just beginning transferred to open operation because hypo-SpO2 was corrected by thoracoscopic operation.The operation time was from 110 min to 280 min,and the mean time was 120 min.The azygos vein in the former 14 cases divided and was preserved in the latter 10 cases.So the stump of the tracheoesophageal fistula (TEF) of the latter 10 cases were covered by the preserved azygos vein or plus the parietal pleura.One Ⅲa type EA could not be repaired by the radical operation and abandoned.5 cases with anastomotic leakage were cured by conserved tactics.2 cases with early TEF recurrence were initially supported by enteral nutrition by putting nasogastric jejunal tube and corrected by the 2nd stage operation.5 cases with anastomotic stricture were dilated by two times.Conclusion It is feasible to correct the Ⅲ type EA by thoracoscopic operation with good results and nice appearances.The preserved azygos vein to cover the stump of the TEF may contribute to reduce the recurrence of TEF.

Characteristics and risk factors analysis of cognitive decline in elderly patients with cerebral infarction / 中国脑血管病杂志

Objective To investigate the characteristics and risk factors for cognitive decline in elderly patients with cerebral infarction.Methods A cross-sectional study was performed to investigate the population of Jiang'an Town,Rugao,Jiangsu Province from November 13,2014 to December 21,2014.The samples from the Rugao longitudinal study of aging included 1 788 individuals from 31 villages aged from 70 to 84 years.They were all Han nationality,including 830 males and 958 females.History of cerebral infarction was identified according to the neurological diagnosis confirmed by the secondary hospital and above or brain CT.The modified Kyohko Hasegawa dementia scale was used to evaluate the cognitive function.Five dimensions (orientation,memory,near memory,computing power,and common sense) of this population were assessed.The total score >21.5 was non-cognitive impairment and ≤21.5 was cognitive impairment.Multivariate logistic regression was used to analyze the risk factors for cognitive decline in elderly patients with cerebral infarction.Results (1) In the 1 788 subjects,133 had cerebral infarction (7.4%),and 1 655 did not have cerebral infarction.The proportion of hypertension in patients with cerebral infarction was higher than that without cerebral infarction (63.9% [n=85] vs.41.7% [n=690]).The high-density lipoprotein cholesterol level was lower than that of the non-cerebral infarction group (1.40±0.29 mmol/L vs.1.47±0.33 mmol/L).There was statistically significant difference (all P<0.05).(2) The patients with cerebral infarction were partially impaired in orientation and computational power,and the overall cognitive function score was 20±7,which was significantly lower than patients with non-cerebral infarction (21±6).The difference between the two groups was statistically significant (P<0.05).(3) In 133 patients with cerebral infarction,76 had cognitive impairment,the incidence was 57.1%,and 59 of them were women.The average value of serum creatinine in patients with cognitive impairment was 59±15 μmol/L,which was significantly lower than those with non-cognitive impairment (66±14 μmol/L).There was significant difference (P<0.05).(4) Multivariate logistic regression analysis showed that the education level below primary school (OR,2.86,95%CI 2.19-3.72) and female (OR,1.85,95%CI 1.50-2.28) were the independent risk factors for cognitive decline in elderly patients with cerebral infarction.High serum creatinine concentration (OR,0.96,95%CI 0.95-0.97) was a protective factor for it.Conclusion The cognitive function of the elderly was decreased after cerebral infarction,especially in the aspect of orientation and calculation.The education level below primary school and women were the independent risk factors for cognitive impairment,and high serum creatinine concentration had a certain protective effect.

The research progress of cerebral microbleeds / 中华行为医学与脑科学杂志

Cerebral microbleeds (CMBs),as an important imaging marker of cerebral small vessel disease (CSVD),is a subclinical damage caused by small hemosiderin deposits indicative of prior cerebral microscopic hemorrhage.In recent years,CMBs have become an important research issue in the field of neuroimaging with the development of newer magnetic resonance imaging (MRI) methods for the higher detection rate of the CMBs.It must to be mentioned that CMBs plays a crucial role in the formatting process of vascular cognitive impairment (VCI),which caused researcher's attention.This review focuses on the research progress in epidemiological status,pathological mechanisms,risk factors,imaging manifestations,clinical features and treatment therapies of CMBs,in order to provide theoretical references for the early detection,prevention and treatment of CSVD and VCI.

Impacts of eye acupuncture on neurological deficit and Barthel index in patients of infarction hemiplegia / 中国针灸

<p><b>OBJECTIVE</b>To observe the impacts of eye acupuncture on neurological deficit and Barthel index in the patients of infarction hemiplegia and explore its function mechanism.</p><p><b>METHODS</b>Ninety-six patients of infarction hemiplegia were randomized into an observation group and a control group, 48 cases in each one. In the control group, the routine western medicines such as thrombolysis and antiplatelet aggregation were used. In the observation group, on the basis of the treatment as the control group, eye acupuncture was added atandareas bilaterally, once a day, 5 times a week. Separately, before treatment and after 2 weeks' treatment the score changes of the modified Edinburgh Scandinavia stroke scale (MESSS) and the activity of daily life scale (ADL, Barthel index, BI) were observed and the efficacy was compared between the two groups. The plasma endothelin was determined and compared before and after treatment in the two groups.</p><p><b>RESULTS</b>After treatment, the effective rate was 93.8% (45/48) in the observation group and was 79.2% (38/48) in the control group. The effective rate in the observation group was higher apparently than that in the control group (<0.05). The scores of neurological deficit were (13.29±1.45) and (18.24±1.33) in the observation group and control group respectively after treatment, which all lower apparently than (28.44±1.45) and (28.14±1.89) before treatment (both<0.05). Additionally, the difference was significant between the two groups after treatment (<0.05). The scores of Barthel index were (82.33±1.56) and (63.34±2.14) in the observation group and control group respectively, which all higher apparently than (38.53±1.54) and (38.14±2.56) before treatment (both<0.05), and the difference was significant between the two groups after treatment (<0.05). The levels of plasma endothelin were (54.55±11.48)ng/L and (62.44±9.88)ng/L in the observation group and the control group after treatment respectively, which were all lower apparently than (78.24±9.25)ng/L and (78.14±10.78)ng/L before treatment (both<0.05). Additionally, the difference was significant between the two groups after treatment (<0.05).</p><p><b>CONCLUSIONS</b>Eye acupuncture effectively improves the neurological deficit and Brathel index in the patients of infarction hemiplegia and comprehensively improves the efficacy. The effect mechanism is possibly relevant with reducing plasma endothelin.</p>

Relationship between serum 25-hydroxyvitamin D level and post-stroke depression in the elderly with acute stroke / 中华老年医学杂志

Objective To investigate the correlation between serum 25 hydroxyvitamin D[25 (OH) D] level and post-stroke depression in elderly patients with acute stroke.Methods Depression was assessed by Beck Depression Inventory (BDI),Burns Depression Checklist (BDC),and the Diagnostic and Statistical Manual of Mental Disorders Ⅳ in 231 elderly inpatients at 2-4 weeks after onset of acute cerebral infarction.According to the depression assessment,the patients were classified into four groups:normal group),depressive symptoms group,with mild depression group,and severe depression group.The cut-off point of 25 (OH) D level for post stroke depression was analyzed by receiver operating characteristic (ROC).Results The serum level of 25(OH)D was (23.0±1.6) nmol/L in all subjects,(25.0±1.7) nmol/L in normal group,(23.7± 1.6) nmol/L in depressive symptoms group,(22.4±1.5) nmol/L in mild depression group,(16.3± 1.5) nmol/L in severe depression group.Serum 25(OH) D level had significant differences between major depression groups and other three groups,while no significant differences were found between mild depression group,depressive symptoms group and normal group.Pearson correlation analysis showed that scores of BDI and BDC were inversely related to 25 (OH)D level (r=0.24 and-0.25,both P＜0.01).ROC curve analysis showed that the cut off point of serum 25 (OH) D level for severe post-stroke depression was 21.6 nmol/L.Conclusions Serum 25 (OH)D level is inversely related to depression.Serum 25(OH) D level is reduced in patients with severe post stroke depression.

Diffusion tensor imaging of executive dysfunction in the patients with leukoaraiosis / 中华老年医学杂志

Objective To determine the relationship between characteristic damages in white matter and its executive dysfunction by magnetic resonance diffusion tensor imaging (DTI) in the patients with leukoaraiosis (LA). Methods A total of 23 patients with LA and 19 age,sex and education-matched healthy people as control were enrolled.Montreal cognitive assessment (MoCA),Stroop test,trail making test (TMT),digit-symbol test(DST),verbal fluence (VF) were applied to assess cognitive and executive functions.Fractional anisotropy (FA),apparent diffusion coefficient (ADC) and mean diffusivity (MD) in white matter lesion (WML) and normal appearing white matter (NAWM) were measured in LA group,the bilateral centrum semiovale,anterior and posterior periventricular white matter in control group were measured by DTI. The white matter DTI parameters were compared between the groups, the relationship between DTI parameters and executive function was investigated in LA group. Results In LA patients,distinct executive dysfunction were found.The scores of Stroop B [(69.4± 13.4) vs.(43.3 ± 5.0),t =8.03,P＜0.05)],Stroop C [(141.4±42.1) vs.(65.4±10.3),t=7.66,P＜0.05)]and Stroop C B[ (72.0±41.4) vs.(22.1±9.6),t=5.13,P＜0.05)],TMT-A[(73.2±15.3)vs.(31.2±7.2),t 10.97,P＜0.05) ],TMTB[(125.6±18.0) vs.(81.6±5.9),t=10.22,P＜0.05) ] andDST[ (24.8±5.6 )vs.(36.8±5.1),t=7.19,P＜0.05) ] were inferior in LA group to control group.The values of FA in centrum semiovale [(0.2±0.1) vs.(0.4±0.1) and (0.4±0.1),F =45.08,P＜0.05)],anterior periventricular white matter [(0.2±0.0) vs.(0.4±0.1) and (0.4±0.1),F =70.11,P＜0.05)] and posterior perivcntricular white matter[ (0.3±0.1) vs.(0.4±0.1) and (0.4±0.1),F=8.54,P＜0.05) ]of WML were reduced as compared with those of NAWM and control group.The values of ADC(×10- 3mm2/s) in the above three regions of WML [(1.2±0.2) vs.(0.8±0.1) and (0.8±0.1),F=46.77,P＜0.05)],[(1.2±0.3) vs.(0.8±0.0) and (0.8±0.1),F=68.22,P＜0.05)]and [(1.4±0.3) vs.(0.8±0.0) and (0.9±0.1),F=17.08,P＜0.05) ] were elevated,as compared with those of NAWM and control group,and the values of MD ( × 10-5 mm2/s) in the three regions of WML[ (127.8±14.5) vs. (95.3±26.4) and (100.8±9.4),F 19.72,P＜0.05) ],[(127.4±16.0) vs.(101.8±13.9) and (93.4±5.6),F=39.26,P＜0.05) ] and [(134.4±21.2)vs.(114.8=14.5) and (114.4±11.7),F=10.66,P＜0.05) ]were also increased,as compared with those of NAWM and control group.There was negative correlation of FA with Stroop C-B (r=-0.46,P＜0.05),TMT-A (r=-0.48,P＜0.05) and TMT-B (r=0.46,P＜0.05),while FA was positively related with DST test (r=0.42,P＜0.05) in anterior periventricular white matter.Conclusions DTI can detect the characteristic damages of white matter,which is strongly related with executive function impairments possibly induced by the damage of prefrontal-subcortical loop in the patients with LA.

Serum uric acid level and related clinical features in high risk syndrome of neuromyelitis optica / 中华神经科杂志

Objective To investigate serum uric acid (UA) levels and related clinical features in patients with high risk syndrome of neuromyelitis optica. Methods UA levels were measured in 51 patients with high risk syndrome of neuromyelitis optica including 34 with longitudinally extensive transverse myelitis (LETM) and 17 with optic neuritis (ON), 48 with neuromyelitis optica (NMO), 45 with other neurological diseases (OND) and 65 with healthy controls (HC). The disability severity was assessed by the expanded disability status scale (EDSS). Spinal lesions were viewed by MRI. Serum aquaporin-4(AQP4) antibody was tested in cell based immunofluorescence assay. Results Serum UA levels in LETM ( ( 189. 84 ±85. 65) μmol/L) and ON patients ( (222. 12 ±61.68) μmol/L) were significantly lower than that in OND ((315.90±71.36) μ mol/L) and HC ((291.05 ±76.64) μ mol/L) subjects (P＜0.01). No difference was found between LETM, ON and NMO groups. UA levels were significantly lower in females ( ( 158.24 ±55.92), (187.00±47.52), (198.21 ±62.62), (274.51 ±70.66)and (243.26±60.65) μmol/L)than in males ( ( 262. 09 ± 101.63 ), ( 262. 45 ± 62. 13 ), ( 298.90 ± 74. 14 ), ( 355.37 ± 50. 30 ) and (340. 34 ±58. 23) μmol/L) in all groups (t=3. 183, 2.578, 4.356, 4.365 and 6.579, all P＜0.05).UA levels in patients with high risk syndrome of NMO were not correlated with mono or relapse course,duration or status of serum AQP4 antibody. UA were negatively correlated with EDSS in patients with LETM (r= -0.714, P＜0.01). Conclusion Lower serum UA levels were found in patients with high risk syndrome of NMO and related to more severe symptoms in LETM group.

Serum uric acid level and related clinical features in neuromyelitis optica / 中华内科杂志

Objective To investigate serum uric acid (UA) levels and related clinical characteristics of neuromyelitis optica (NMO). Methods The serum uric acid levels were measured in 65 patients with NMO, compared to control groups which were 76 cases with multiple sclerosis ( MS), 126 cases with cerebral vascular diseases (CVD) and 130 healthy controls(HC). The disability severity in NMO was assessed by the Expanded Disability Status Scale (EDSS). Magnetic resonance imaging ( MRI ) was performed to strengthen assessment the involved lesions. Serum AQP4 antibody was tested in a cell based immunofluorescence assay. Results In male groups, serum UA levels in NMO patients [ (298.90±74.14) μmol/L] were significantly lower than that in CVD [ (355.37 ±50. 30) μmol/L] and HC subjects [ (340.33 ± 58.23 ) μmol/L, P ＜ 0.05 ]. No difference was found between NMO and MS [ ( 292.36 ±92.95) μmol/L] groups. In female groups, serum UA levels in NMO patients [(198.21 ± 62.62)μmol/L] were significantly lower than that in CVD [(274.51 ± 70.66) μmol/L] and HC subjects [(243.26 ±60.65) μmol/L,P ＜0.05]. No difference was found between NMO and MS [(232.29 ±71.95 ) μmol/L ] groups. UA levels were significantly lower in females [ ( 198.21 ± 62. 62) μ mol/L] than in males [ (298.90 ±74.14) μmol/L]. UA levels were significantly lower in patients with EDSS≥5 [ ( 195.48 ± 83.70 )μmol/L] than EDSS ＜ 5 [ (241.00 ± 63.20)μmol/L] NMO patients. In our study UA levels were not correlated with longitude of spinal lesions, activity revealed by MRI and AQP4 antibody tires.Conclusion Lower serum UA levels were found in patients with NMO and related to more severe symptoms.

Relationship between carotid artery stenosis severity and 3-vessel coronary artery disease / 中国组织工程研究

BACKGROUND: Previous studies showed that the prevalence and extent of carotid artery stenosis increased with thedevelopment of coronary artery disease. There was a higher incidence of intracranial small-vessel disease, but lower of carotid artery disease in the Chinese stroke patients as compared with the white.OBJ ECTIVE: To observe the distribution of carotid and intracranial artery stenosis in patients with 3-vessel coronary artery disease.DESIGN: An observational study.SETTING: Department of Neurology; Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University.PARTICIPANTS: From August 2003 to August 2004, The coronary angiography was performed in the outpatients and inpatients suspected to be coronary arteriosclerotic cardiopathy in the Department of Neurology, Beijing Chaoyang Hospital affiliated to Capital Medical University, and 126 patients of them with 3-vessel diseases were examined with carotid arteriography, including 56 males and 70 females, 47-76 years of age. Informed contents were obtained from all the participants.METHODS: Digital substraction angiography (DSA) was performed immediately after coronary angiography in the 126patients. All catheterizations were performed through a transfemoral approach using the Seldinger technique, and thenan appropriate amount of nonionic Ominipaque was injected. The angiography of bilateral carotid arteries, subclavian artery, or vertebral artery was taken from different angles. The percentage of stenosis was calculated directly from DSAmachine. Evaluative standards: Based on the stenosis degree from carotid angiography results, the patients were divided into 5 categories as normal, mild stenosis, moderate stenosis, severe stenosis and complete occlusion.MAIN OUTCOME MEASURES: Severity of carotid stenosis.RESULTS: All the 126 patients were involved in the final analysis of results. There were 13 (10.32%), 18 (14.29%), 12(9.5%), or 10 (7.9%) patients found to have mild, moderate, severe carotid stenosis, or complete occlusion, and the incidences of these changes were fairly similar. However, the incidence of angiographic carotid stenosis coupled with 3-vessel carotid artery disease was 42.06%.CONCLUSION: The prevalence of carotid stenosis in patients with 3-vessel carotid artery disease was as high in the Chinese population as that in Westem countries. In patients with 3-vessel disease, the prevalence of carotid stenosis was higher than that of intracranial artery stenosis, thus they may require both coronary and carotid interventions.

The Clinical use of Large Dose Ambroxol in COPD Patient Undergoing Abdominal Operation / 医学研究杂志

0.05).The subgroup patients of the oxygenation index

A Study on the Changes of Protein C and Fibrinolytic System in Patients with Cerebrovasculer Disease and Intervened Treatment / 医学研究杂志

Objective To investigate the changes of protein C and fibrinolytic system in patients with acute cerebrovasculer disease and the influence of intervened treatments on acute cerebral infarction(ACI).Methods Determinations of protein C(PC),protein S (PS),thrombomodulin(TM),Tissue-type plasminogen activater(t-PA),plasminogen activator inhabitor(PAI) were performed in patiens with acute cerebrovasculer disease and normal control(NC),then redeterminated these items after treatments in patients with ACI.Results PC,PS:The levels in patients with ACI were significantly lower than that in other groups.After dreatments,the levels in patients with ACI increased.There were no significantly discrepancy in acute cerebral hemorrhage(ACH) and lacunar cerebral infarct(LCI) compared with NC;TM:The levels in patients with ACH,ACI were significantly higher than that with LCI and NC.After dreatments,the levels in patients with ACI decreased;t-PA:The levels in patients with ACI were lower than NC,whereas the levels in patients with ACH increased.After dreatments,the levels in patients with ACI increased;PAI:The levels in patients with ACI were significantly higher than NC,and also found that the levels in patients with ACH and LCH were higher compared with NC.The levels in patients with ACI decreased after dreatments.Conclusions There are obviously abnormalities in plasma coagulative and fibrinlytic parameters in acute cerebrovasculer disease;To check the levels of PC,PS,TM,t-PA,PAI are important to predict the type of stroke,the seriousness of disease,the effect of treatment,prognosis of the cases and suggest that earlier treatments be important.

Relationship between expression of the apoptosic genes Bcl-2 and Fas of thymus and clinic in patients with myasthenia gravis / 临床神经病学杂志

0.05). There was no correlation between Bcl-2 and Fas positive cells and acetylcholine receptor antibody serum titre, disease grouping, age and sex in patients with or without hyperplastic thymic and thymoma.Conclusions In MG patients, the expression of Bcl-2 in hyperplastic thymus is upregulated. There is no correlation between the expression of apoptotic genes Bcl-2 and Fas and clinic relative factors.

Thearpeutic effect observation of intra-arterial thrombolysis for treatment of acute cerebral infarction / 临床神经病学杂志

Objective To investigate the therapeutic effect of intra-arterial thrombolysis (IATT) in acute cerebral infarction(ACI). Methods 15 patients with ACI were treated with IATT using Urokinase(UK). All patients were assessed by DSA before and after IATT. The stroke scale(ESS and NIHSS) and Barthel Index(BI) were used before and 2 h,48 h,15 d ,30 d after treatment for appraising thearpeutic effect . Results After IATT, the sides of obliterated middle cerebral artery in 12 patients were completely re-circulated. Compared with before IATT, the scores of ESS, NIHSS and BI were significantly improvement at 2 h,48 h,15 d and 30 d after IATT(P