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Objective To investigate the clinical features and neuroimaging features of patients with osmotic demyelination syndrome (ODS).Methods The clinical features and examination results ,including the clinical manifestations,the data of cranial MRI/CT,changes of EEG,treatment and prognosis,were analyzed in 4 patients with ODS.Results All the 4 patients had the history of hyponatraemia.The common clinical manifestations included psychiatric disorder,altered consciousness,dysphasia,dysphagia,quadriplegia and dystonia.Severe transient abnormal EEG was found in these patients,and all the brain CT scanning and CSF were negative.MRI features could only be noted 10 d after the appearing of clinical manifestations and all the first time MRI was negative in these 4 patients.Four patients were diagnosed as having extrapontine myelinolysis,showing symmetrical low T1-weighted signal and high T2-weighted signal within the pons,the basal ganglia,the thalami,the insular cortex and the hippocampal head.Three patients were also diagnosed as having central pontine myelinolysis,showing symmetrical T1 low signal and T2 high signal in the basilar part of pons; much clear imaging could be noted with the help of weighing the abnormal signals.Three patients got improvement with 1 having dystonia sequel.Conclusion ODS is correlated with chronic hyponatraemia,and both hypokalaemia and hypochloremia may be the 2 possible triggers; when they appear,quick correction is not needed.MRI features may be significantly delayed,thus,repeated imaging study is necessary.
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Objective To investigate the hemodynamic changes in patients with intracerebral hemorrhage (ICH) using CT perfusion (CTP) imaging and the relation between cerebral perfusion and the Scandinavian Stroke Scale (SSS) of the patients. Methods Forty-one patients with supratentorial ICH underwent plain CT scanning and CTP imaging at different times after ICH onset (from 5 h to 14 days). The impact of the time after ICH onset, hematoma volume, edema area, mean hlood pressure (MBP) and blood glucose on the hemodynamics of the patients was assessed, and the correlation between the SSS and the hemodynamic changes evaluated. Resnlts The cerebral blood flow in the edema area (CBF1), the peripheral area of the edema (CBF2, within 1 cm to the edema) and the distant cortical area from the hematoma (CBF3) showed significant differences (r=0.027, P=0.870) and fluctuated with time. CBF1 showed a positive linear relation with CBF2 (r=0.334, P=0.035), but neither of them was correlated to CBF3 (r=0.027, P=0.870;r=0.142, P=0.383). CBF1 also showed positive linear relations with relative cerebral blood volume (rCBV1) (r=0.803,P=0.000) and the peak time (PT1) (r=-0.52, P=0.752). The reduction of CBF1 was inversely correlated to the hematoma volume and the edema area (r=-0.501, P=0.001;r=-0.589, P=0.000), but not related with MBP or blood glucose (r=0.141, P=0.386;r=0.014, P=0.930). The area of ischemic injury (the ischemic area defined by CBF parameters-the hematoma area, edema area (r=0.449, P=0.003;r=0.645, P=0.000), but not to the MBP or blood glucose (r=-0.047, P=0.769;r=0.141,P=0.378). SSS was found to correlate to the volume and location of the hematoma and the reduction of CBF and CBV (r=-0.418, P=0.007;r=0.542, P=0.000;r=0.376, P=0.017;r=0.312, P=0.050), but not to the ischemic and edema area (r=-0.283, P=0.073;r=-0.163, P=0.308). Conclusion CBF is reduced in the edema area, peripheral area of the edema and the distant cortical area from the hematoma but showing different patterns of variation. Ischemic injury is present in the edema area around the hemotema, and its scope and severity is related with the hemotoma volume and the size of the edema area and may vary with time. The location and volume of the hematoma as well as the perfusion level in the edema area all affect the SSS of the patients.
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Objective To investigate the relationship between cortical watershed infarction and carotid artery stenosis and evaluate the stent insertion operation.Methods After 23 cortical watershed infarction patients diagnosed by CT or MRI received DSA detection,we performed stent insertion operationon 11 patients according to their requirements,and conservative treatment on the remaining 12 patients.All the patients underwent follow up for 6-12 months post-operatively.Results Among the 23 cortical watershed infarction patients,22 Were detected with carotid artery stenosis.Statistical analysis showed that the degree of carotid artery stenosis was associated With the elinical svmDtoms and the volume of steal phenomenon(P<0.05);further,the artery stenosis improvement was over 90%with the stent inserted;conversely,dizziness and steal phenomenon disappeared.The post procedure follow-up,ranging 6-12 months,showed that the patients with stent insertion got less new symptoms,steal phenomenon and artery stenosis,compared with the patients with conservation treatment(P<0.05).Conclusion Cortical watershed infarction is associated with carotid artery stenosis.The stent insertion iS useful for the treatment ofcarotid artery stenosis and prevention of cortical watershed infarction.
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Objective To explore therapeutic effects and mechanisms of radical scavenger edaravone on experimental cerebral hemorrhage.Methods Two hundred-forty male SD rats were divided randomly into four groups:control group,cerebral hemorrhage group,edaravone treatment group before operation (A) and edaravone treatment group after operation (B).Experimental cerebral hemorrhage model was made according to the method reported by Rosenberg.Water quantity contained in brain and nervous missing sign were observed,meanwhile the levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in brain tissue were measured.Results Compared with cerebral hemorrhage group,nervous missing sign and water quantity contained in brain obviously changed in edaravone treatment group (P