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Coronavirus-NL63 is a common respiratory virus, which often causes severe respiratory symptoms such as fever, cough, expectoration, pneumonia and so on. The damage of central nervous system is rare. A case of acute necrotizing encephalitis caused by respiratory coronavirus-NL63 infection with cognitive impairment as the first symptom is reported, finding of CT/magnetic resonance imaging scanning indicating necrosis combined with a striated encephalomalacia of the corpus callosum and bilateral cerebral hemispheres.
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Objective:To examine whether the combination of quantitative regional apparent diffusion coefficient (ADC) and amplitude-integrated electroencephalogram (aEEG) can predict the outcome of comatose patients with severe traumatic brain injury (sTBI).Methods:A prospective study was conducted. The patients with coma caused by sTBI [Glasgow coma scale (GCS) < 8] admitted to Suqian First Hospital from January 2016 to June 2019 were enrolled. All patients underwent aEEG examination and magnetic resonance imaging (MRI) scan within 1 week after emergency treatment. The ADC values of 9 regions of interest (frontal gray matter and white matter, parietal gray matter and white matter, temporal gray matter and white matter, caudate nucleus of basal ganglia, lenticular nucleus and thalamus) were measured by head MRI, and the mean ADC values of frontal lobe, parietal lobe, temporal lobe and basal ganglia were calculated respectively. According to the follow-up results after 12 months, the differences of each index between patients with poor prognosis [Glasgow outcome score (GOS) 1-2] and patients with good prognosis (GOS 3-5) were compared; the receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive ability of aEEG and ADC for the good prognosis of patients with sTBI, and the predictive value of the combination of aEEG and ADC.Results:A total of 52 patients with sTBI were enrolled, with mean age of (36.7±13.9) years old, 35 of whom were male. Within 12 months follow-up, 29 patients had achieved favorable outcomes and 23 patients had unfavorable outcome. There were 21, 17 and 14 patients with aEEG , and grade, respectively, and 19, 10 and 0 patients had good prognosis respectively. ADC values of 9 regions of interest in patients with good prognosis were significantly higher than those in patients with poor prognosis (×10 -6 mm 2/s: 924±107 vs. 531±87 in frontal gray matter, 804±95 vs. 481±74 in frontal white matter, 831±93 vs. 683±72 in temporal gray matter, 726±87 vs. 654±63 in temporal white matter, 767±79 vs. 690±75 in parietal gray matter, 716±84 vs. 642±62 in parietal white matter, 689±70 vs. 465±68 in caudate nucleus, 723±84 vs. 587±71 in lenticular nucleus, 807±79 vs. 497±67 in thalamus, all P < 0.01). ROC curve analysis showed that the area under ROC curve (AUC) of aEEG for predicting good prognosis of sTBI patients was 0.826, when the cut-off value of aEEG was < 1.5, the sensitivity was 94.7% and the specificity was 72.8%. Among the ADC value prediction abilities in the interested areas, the prediction of ADC value in frontal lobe and basal ganglia area were better than that in sTBI patients. AUC was 0.817 and 0.903 respectively. The best cut-off values were > 726×10 -6 mm 2/s and > 624×10 -6 mm 2/s respectively, the sensitivity of predicting prognosis were both 100%, and the specificity was 63.4% and 61.8%. A model combining frontal ADC and basal ganglia ADC with aEEG was 91.0% sensitive and 93.7% specific for favorable outcome of sTBI patients. Conclusion:Combination of the quantitative measurement of regional ADC and aEEG may be useful for predicting the outcome of the patients with sTBI.
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Objective To assess cognitive impairment and its correlation with power of quantitative electroencephalogram (qEEG) in patients with temporal lobe epilepsy (TLE).Methods Fifty-five patients with TLE seen consecutively in Suqian First Hospital and 40 healthy controls (HC) were assessed by Mini-Mental State Examination (MMSE),Brief Cognitive Battery (BCB) and qEEG.The global interhemispheric and intrahemispheric difference values for power spectral ratios (Dv-PSR) were calculated.Cognitive functions and Dv-PSR of the TLE patients and the HC were compared,and correlation between cognitive impairment and power of qEEG was assessed using Spearman correlation analysis.The significance level was set at P≤0.05.Results Statistical analysis showed that MMSE scores did not have statistically significant difference between the TLE patients and the HC (26.9±2.4 vs 27.3±2.6,t=0.502,P=0.549).However,BCB examination showed that immediate memory,incidental memory,delayed recall,learning test,verbal fluency and recognition differed significantly between the TLE and the HC groups (7.34± 1.33 vs 8.92±1.37,6.05±1.12 vs 7.93±1.20,6.77±1.08 vs 8.19±1.14,11.87±4.47 vs 16.8±4.56,8.52±1.74 vs 9.75 ± 1.36,8.74 ± 1.19 vs 9.87 ± 1.18,respectively;t=2.916,Z=3.204,t=2.549,Z=3.937,t=1.341,t=2.791,P＜ 0.05).Interhemispheric Dv-PSR in frontal,central,temporal and parietal area was higher in the TLE group than in the HC group (0.478±0.043 vs 0.252±0.028,0.441±0.051 vs 0.306±0.039,0.394±0.027 vs 0.247± 0.018,0.511±0.036 vs 0.224±0.021,respectively;t=3.711,2.403,3.144,4.327,P＜0.05),and intrahemispheric Dv-PSR in frontal,central,parietal and occipital area (minus temporal area respectively) was also higher in the TLE group than in the HC group (0.521±0.024 vs 0.221±0.017,0.249±0.012 vs 0.167±0.008,0.187± 0.013 vs 0.104 ± 0.007,0.313 ± 0.021 vs 0.127 ± 0.009,respectively;t=4.208,3.192,2.611,3.737,P＜0.05).Spearman analysis showed positive correlations between intrahemispheric,interhemispheric Dv-PSR and several cognitive domains impairment assessed by BCB (P＜0.05).Conclusion There was mild cognitive impairment in TLE patients,which was significantly associated with Dv-PSR assessed by qEEG,suggesting that Dv-PSR measurement may be used as a marker for cognitive impairment in epilepsy.
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Objective To study the clinical value of amplitude integrated EEG(aEEG),EEG reactivity,EEG patterns,and Glasgow Coma Scale(GCS) scores of predicting the prognosis in comatose patients with severe traumatic brain injury.Methods Sixty-four hospitalized comatose patients with severe traumatic brain injury were evaluated by aEEG,EEG reactivity,EEG patterns and GCS and followed up for one year to observe the prognosis of the patients.Results Accuracy of aEEG,EEG reactivity,EEG patterns and GCS in predicting outcomes of comatose patients with severe traumatic brain injury correctly classified as 73.4％,68.8％,73.4％,64.1％ respectively.The accuracy of GCS in evaluating the prognosis of comatose patients with severe traumatic brain injury was lower than that of the other three methods (P＜0.05).There were positive correlations among aEEG,EEG reactivity,EEG patterns,and GCS (r=0.574-0.843,P＜ 0.05).There were positive correlations between aEEG,EEG reactivity,EEG patterns,GCS and the patients' prognosis(r=0.647,0.609,0.621,0.532,P＜ 0.05).Conclusion As a new electroencephalographic technique,aEEG combined with EEG reactivity,EEG patterns,and GCS can be effectively used to evaluate the prognosis of STBI coma patients,which has a certain clinical value.
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Objective To investigate the clinical and electroencephalogram (EEG) features of patients with idiopathic generalized epilepsy in adults with phantom absences.Methods Six patients were referred to the clinic of epilepsy from April,2007 to December,2011.They all had clinical assessment,EEG,or video EEG confirming absences seizure.Results Six patients showed the following similar clinical-EEG features:(1) mild ictal impairment of consciousness associated with generalized 3.0-3.5 Hz spike and slow wave discharges; (2) late-onset generalized tonic-clonic seizures; (3) absence status epilepticus with or without secondary generalized tonic-clonic seizures; (4) generalized discharges were mostly seen in three types in the awaking stage:fragmented discharge (＜4 s),brief discharge (4-10s) and long-time discharge (＞ 10 s).None of the patients had myoclonic jerks or photosensitivity.One patient' s mother had a history of generalized tonic clonic seizures.One patient had a history of children absence epilepsy and one patient had a history of febrile convulsion in the age of 1-3.Conclusion Idiopathic generalized epilepsy with phantom absences has distinct clinical and EEG features and may become a new idiopathic generalized epilepsy syndrome in adults.
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Objective To analyze retrospectively the risk factors and predictors of post-encephalitic epilepsy (PEE) and refractory epilepsy in patients with encephalitis.Methods In a hospital based study,the patients with encephalitis were reviewed retrospectively between the January of 1995 and December of 2010.Related factors were evaluated including age,sex,seizure types,neuroimaging,electroencephalogram(EEG) in intermittent period,clinical symptoms,consciousness level,initial seizure and steroid hormone therapy,etc.Results 237 patients with encephalitis were enrolled,whose median age was 26.3 (range 15-57) years old.PEE occurred in 103 (43.46％) patients; and 67 of whom had partial seizure.Significant risk factors for PEE included age (OR =3.72,95％ CI 2.70-5.25,P =0.018),disturbance of consciousness level(OR =5.37,95％ CI 2.43-13.03,P =0.012),cortical lesion in imaging (OR =11.42,95％ CI 5.94-31.27,P =0.000),spike discharges in EEG (OR =18.04,95％ CI 7.30-48.38,P =0.000) and initial seizures in acute phase (OR =32.68,95％ CI 9.62-97.59,P =0.000).The refractory epilepsy occurred in 6t patients.The significant risk factors of refractory PEE included focal seizures(OR =4.09,95％ CI 2.14-9.10,P =0.021),status epilepticus (OR =4.48,95％ CI 1.89-8.07,P =0.017) and poor controlled seizure (OR =6.17,95％ CI 3.52-11.34,P =0.001) during acute phase,multifocal spikes discharge in EEG(OR =5.53,95％ CI 2.91-10.07,P =0.006),cortical lesion in neuroimaging(OR =2.33,95％ CI 1.37-7.72,P =O.028),however,early steroid hormone therapy (OR =2.19,95％ CI 1.11-4.87,P =0.037) and longer time to initial seizure (OR =4.40,95％ CI 3.19-11.62,P =0.014) could significantly reduced the incidence of refractory epilepsy in PEE patients.Conclusion Our data indicated that PEE occur in 43.46％ patients especially in younger patients with disturbance of consciousness level,cortical lesion in imaging,spike discharges in EEG and initial seizures in acute phase.And the risk factors for refractory PEE are also discussed.
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@# ObjectiveTo explore the mechanism causing the sex differences in experimental autoimmune encephalomyelitis (EAE).MethodsEAE model was established with PLP 139-151 in SJL/J mice. The sex differences of illness state were evaluated by neurologic score, and that of response of peripheral lymphocytes to autologous antigens were detected by methods of MTT and ELISA.ResultsThe onset time of female SJL mice was 15±2.1 days less than that of male ones (22±4.3 days), and the feature of diseases course of female mice was relapse after recovery, but that of male mice was transient. No significant differences were observed in T cell responses and interferon-γ productions between male and female mice (P>0.05). Male mice secreted more interleukin-4 than female mice (P<0.01).ConclusionThe sex differences of EAE in mice are due to peripheral lymphocytes secreting more interleukin-4 in male mice.
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BACKGROUND: Experimental autoimmune encephalomyelitis has become the most classical animal model for multiple sclerosis. However, the experimental autoimmune encephalomyelitis model of China presented one-way course of disease. By using proteolipid protein 139-151 and proteolipid protein 178-191, relapse remitting experimental autoimmune encephalomyelitis models may be induced in SJL/J mice which were susceptible to immune, which have similar clinical situation, course and histologicallterations to multiple sclerosis.OBJECTIVE: To establish the relapse remitting experimental autoimmune encephalomyelitis mouse model induced by proteolipid protein, which has similar clinical situation, course and histological alterations to multiple sclerosis.DESIGN: Completely randomized controlled study.SETTING: The centre of Neuro-information, and Neurological Institute,General Hospital of Chinese PLA.MATERIALS: The study was carried out at the Laboratory of Neuro-pathology, General Hospital of Chinese PLA, from February to June 2004.Sixty female SJL/J mice with 8-12 weeks old were selected and randomly divided into proteolipid protein 139-151 group and proteolipid protein-178-191 group with 30 in each.INTERVENTIONS: After injected with proteolipid protein-139-151 or proteolipid protein-178-191, the models of relapse remitting experimental autoimmune encephalomyelitis were induced, and the body weight and neurological signs of each female SJL/J mouse were viewed. The tissue morphological changes of models were observed with hematoxylin and eosin and uxol fast blue stain.MAIN OUTCOME MEASURES: The neurological symptoms and signs,features of relapse and remitting and the perivascular inflammatory cell infiltration, demyelinated lesion of the model of experimental autoimmune encephalomyelitis mouse induced by two proteolipid protein peptides.RESULTS: All 60 mice entered the final analysis. ① Significant neurological symptoms, signs and features of relapse and remitting was manifested in the model of experimental autoimmune encephalomyelitis mouse induced by two proteolipid protein peptides. Obvious phenomena of perivascular inflammatory cuffing, satellitism, predominant perivascular inflammatory cell infiltration and demyelinated lesion were found in spinal and cerebral tissue. ②Changes of body mass: Before immunity, the body mass of mice in two groups was( 17. 84 ± 2.59) g and (17. 88 ± 0.52) g respectively. Onset of relapse of the mice in proteolipid protein-178-191 group was earlier and faster, their body mass had no distinctive change after immunization and the mean body mass was(23.52 ± 2.37) g till the 60th day. Meanwhile, Onset of relapse of the mice in proteolipid protein-139-151 group was later and slower. After the immunity, the body mass of mice was little decrease, and the body mass was (16. 70 ±0.46) g on the 60th day. ③ Neural functional scores: The highest functional scores in the two groups were not different(3.86 ± 1.10vs 3.71 ±1.05, t=0.49, P=0.628).CONCLUSION: The two different antigenic peptides of proteolipid protein can all cause the autoimmune response of central nervous system. Both models have the same characters of relapse and remitting and the severity has no significant difference. But compared with proteolipid protein 139- 151 group,onset and recover of the experimental autoimmune encephalomyelitis of the mice in proteolipid protein 178-191 group were earlier, as well as weight variance was larger, which maybe due to the different structure of two peptides.
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Objective To construct the genes expression profile database of experimental autoimmune encephalomyelitis (EAE) mice model and to screen the high candidate genes with microarray analysis. Methods Polymerase chain reaction (PCR) products on behalf of 4 096 genes from mixed mice tissue library were assembled on the modified Oako glass slide. The general RNA from 6 EAE mice model and 6 normal mice head was transcripted into cDNA by RT-PCR and labelled with cy-3 and cy-5.6 groups each consist one EAE mice and a control. These two probes were mixed and hybridized with the above mentioned gene chips. Scan array 4000 was used for scanning the hybridizing signals and GenePixPro 3.0 for date analysis. Results Of the total 4 096 genes monitored, 43 genes in group one showed changes in expression level of the ratio outside 0.5 and 2, 30 genes differed in group two, 176 genes changed in group three, 76 in group four, 294 in group five and 129 in group six. Conclusions The results showed the consistent different genes expression throughout the EAE mice model. The genes related to immune, cell structure, cell cycle, ion channel, signal transduction, protein synthesis and metabolism are involved in EAE pathogenesis. The results provide deeper insights into the mechanism of EAE and multiple sclerosis.
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Objective:To explore the therapeutic potential of preemptive targeting of the epitope spreading cascade by adoptive transfer after EAE onset of immunoregulatory T cells specific for the MBP87-99 spreading determinant.Methods:EAE was induced by PLP139-151 in SWXJ mice, all mice were weighed and examined daily for neurologic signs. On days 6 after EAE onset, mice were injected with IL-2prom→IL-10cDNA-transfected Th2/Tr1-like T cells specific for MBP87-99,PLP104-117,or BSA. Finally demyelination was quantified by analysis of digitized images of PLP immunostained spinal cord sections.Results:Mice received Th2/Tr1-like T cells specific for MBP87-99 had a significantly improved clinical outcome(P=0.02) compared with control mice, reduction in the relapse rate and delay in mean time to onset of first relapse were also observed(P