Clinical features of long segmental myelopathy caused by nitrous oxide / 北京大学学报(医学版)

OBJECTIVE@#To analyze the clinical and imaging characteristics of the neurological damage caused by nitrous oxide (N2O).@*METHODS@#In the study, 10 patients in the Department of Neurology of China-Japan Friendship Hospital from October 2015 to February 2018 were retrospectively analyzed for the demographic data, the history of inhaled N2O, clinical features, blood examination, electrophysiological examination, spinal magnetic resonance imaging and therapeutic efficacy profiles.@*RESULTS@#The male-to-female ratio was 4:6 and it presented with an age-of-onset 17-26 years [the average age: (20.80±3.12) years]. The time from inhaled N2O to onset was 1 month to 1 year [the average time: (6.95±4.19) months]. Paralysis in all the patients and numbness in 9 patients were the main clinical features, while positive Lhermitte's sign in 3 patients, urinary and defecation disturbance in 4 patients were also found. Blood examination indicated anemia in 2 patients, giant cell anemia in 1 case and small cell hypochromic anemia in 1 case. 3 cases had been treated with vitamin B12 in an external hospital, and the other 7 cases had abnormal increase in homocysteine levels. Electrophysiological examinations showed sensory and motor nerve involvement in 9 patients, and motor nerve involvement in 1 patient. The severity of lower extremity lesion was significantly heavier than that of upper extremity. Spinal magnetic resonance imagings showed that long segmental lesions were present in the cervical spinal cord of all the patients, 3 cases with long segmental lesions of the thoracic cord and 2 cases with spinal cord swelling. In 6 cases, the horizontal axis had an "inverted V-type" T2 high signal, 1 case was classified as "crescent", and 3 cases were "eight-shaped". The symptoms in these 10 cases were alleviated in varying degrees after stopping the inhalation of nitrous oxide, actively supplementing high doses of vitamin B12 and doing early rehabilitation exercises.@*CONCLUSION@#Myelopathy with nitrous oxide presents as paralysis and numbness in limb extremities. In imaging, cervical spinal cord damage is common, accompanied by thoracic spinal cord damage. The horizontal axis is more common in the "inverted V-type". Treatment with high doses of vitamin B12 is effective.

Clinical and Radiological Features of Wallerian Degeneration of the Middle Cerebellar Peduncles Secondary to Pontine Infarction / 中华医学杂志(英文版)

<p><b>Background</b>Wallerian degeneration (WD) of bilateral middle cerebellar peduncles (MCPs) can occur following pontine infarction, but its characteristics have not yet been clarified because of the low incidence. Thus, the present study discussed the clinical and radiological features to improve the awareness of this disease.</p><p><b>Methods</b>Clinical and radiological information from consecutive individuals diagnosed with WD of bilateral MCPs following pontine infarction in three hospitals over the past 4 years between October 2012 and October 2016 were retrospectively investigated and compared with a control group (patients with pontine infarction had no secondary WD).</p><p><b>Results:</b>This study involved 30 patients with WD of MCPs, with a detection rate of only 4.9%. The primary infarctions (χ =24.791, P = 0.001, vs. control group) were located in the paramedian pons in 21 cases (70.0%), and ventrolateral pons in nine cases (30.0%). WD of the MCPs was detected 8-24 weeks after pons infarction using conventional magnetic resonance imaging (MRI); all secondary WDs were asymptomatic and detected incidentally. All WD lesions exhibited bilateral, symmetrical, and boundary blurring on MRI. The signal features were hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging and fluid-attenuated inversion recovery, and slightly hyperintense or isointense on diffusion-weighted imaging and apparent diffusion coefficient maps. Secondary brainstem atrophy was found in six (20.0%) cases. A Modified Rankin Scale score 0-2 was found in 10 (33.3%) cases and score >2 in 20 (66.7%) cases at 90 days after discharge, and the short-term prognosis was worse than that in control group (χ =12.814, P = 0.001).</p><p><b>Conclusions</b>Despite the rarity of bilateral and symmetrical lesions of MCPs, secondary WD should be highly suspected if these lesions occur within 6 months after pontine infarction, particularly paramedian pons. Conventional MRI appears to be a relatively sensitive method for detecting WD of MCPs, which might affect the short-term prognosis.</p>

High-resolution Magnetic Resonance Vessel Wall Imaging for Intracranial Arterial Stenosis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging (HRMR VWI) for intracranial arterial stenosis.</p><p><b>DATE SOURCES</b>We retrieved information from PubMed database up to December 2015, using various search terms including vessel wall imaging (VWI), high-resolution magnetic resonance imaging, intracranial arterial stenosis, black blood, and intracranial atherosclerosis.</p><p><b>STUDY SELECTION</b>We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI. We organized this data to explain the value of VWI in clinical application.</p><p><b>RESULTS</b>VWI with black blood technique could provide high-quality images with submillimeter voxel size, and display both the vessel wall and lumen of intracranial artery simultaneously. Various intracranial vasculopathies (atherosclerotic or nonatherosclerotic) had differentiating features including pattern of wall thickening, enhancement, and vessel remodeling on VWI. This technique could be used for determining causes of stenosis, identification of stroke mechanism, risk-stratifying patients, and directing therapeutic management in clinical practice. In addition, a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy.</p><p><b>CONCLUSIONS</b>This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.</p>

Plaques of Nonstenotic Basilar Arteries with Isolated Pontine Infarction on Three-dimensional High Isotropic Resolution Magnetic Resonance Imaging / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few studies for evaluating plaque characteristics of nonstenotic basilar arteries (BA). Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo acquisition (VISTA) and investigate the differences between the patients with and without isolated pontine infarction (IPI).</p><p><b>METHODS</b>Twenty-four consecutive symptomatic patients with nonstenotic BA on time of flight magnetic resonance angiography (TOF MRA) were enrolled from China-Japan Friendship Hospital between January 2014 and December 2014. BA was classified as "normal" or "irregular" based on TOF MRA, and "normal wall", "slight wall-thickening", and "plaque" based on three-dimensional VISTA images. Outcomes from MRA and VISTA were compared. Patients were categorized as IPI and non-IPI groups based on the diffusion-weighted imaging. Clinical and plaque characteristics were compared between the two groups.</p><p><b>RESULTS</b>A total of 1024 image slices including 311 (30.37%) plaque slices, 427 (41.70%) slight wall-thickening slices, and 286 (27.93%) normal wall slices for the entire BA from 23 patients were finally included for analysis. VISTA images detected plaques in all the 9 (100%) irregular MRA patients and 7 of 14 (50%) normal MRA patients. IPI was found in 11 (47.83%) patients. Compared to non-IPI group, the IPI group had a higher percentage of plaque slices (P = 0.001) and lower percentage of normal wall slices (P = 0.014) than non-IPI group.</p><p><b>CONCLUSIONS</b>Three-dimensional VISTA images enable detection of BA plaques not visualized by MRA. BA plaques could be found in both the IPI and non-IPI group. However, IPI group showed plaques more extensively in BA than the non-IPI group.</p>

Wall Imaging for Unilateral Intracranial Vertebral Artery Hypoplasia with Three-dimensional High-isotropic Resolution Magnetic Resonance Images / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few studies for evaluating wall characteristics of intracranial vertebral artery hypoplasia (VAH). The aim of this study was to determine wall characteristics of VAH with three-dimensional volumetric isotropic turbo spin echo acquisition (3D VISTA) images and differentiate between acquired atherosclerotic stenosis and VAH.</p><p><b>METHODS</b>Thirty patients with suspicious VAH by luminograms were retrospectively enrolled between January 2014 and February 2015. The patients were classified as "acquired atherosclerotic stenosis" or "VAH" based on 3D VISTA images. The wall characteristics of VAH were assessed to determine the presence of atherosclerotic lesions, and the patients were classified into two subgroups (VAH with atherosclerosis and VAH with normal wall). Wall characteristics of basilar arteries and vertebral arteries were also assessed. The clinical and wall characteristics were compared between the two groups.</p><p><b>RESULTS</b>Five of 30 patients with suspicious VAH were finally diagnosed as acquired atherosclerotic stenosis by 3D VISTA images. 25 patients were finally diagnosed as VAH including 16 (64.00%) patients with atherosclerosis and 9 (36.00%) patients with normal wall. In the 16 patients with atherosclerosis, plaque was found in 9 patients, slight wall thickening in 6 patients, and thrombus and wall thickening in 1 patient. Compared with VAH patients with normal wall, VAH patients with atherosclerosis showed atherosclerotic basilar arteries and dominant vertebral arteries more frequently (P = 0.000).</p><p><b>CONCLUSIONS</b>Three-dimensional VISTA images enable differentiation between the acquired atherosclerotic stenosis and VAH. VAH was also prone to atherosclerotic processes.</p>

Clinical and pathologic features of melanocytic lesion of the central nervous system / 中南大学学报(医学版)

OBJECTIVE@#To investigate the clinical and pathologic features of melanocytic lesion of the central nervous system.@*METHODS@#We analyzed the clinical features, neuroimages, and operational and neuropathological findings of 2 patients of neurocutaneous melanosis and 4 patients of primary leptomeningeal melanoma.@*RESULTS@#All the 6 patients had the common clinical features of intracranial hypertension and epilepsy. Brain CT and MRI showed abnormal signals. More melanin pigment nevi were found on the skin of the 2 patients subjected to neurocutaneous melanosis. The other 4 patients subjected to primary leptomeningeal melanoma had no melanin pigment nevus on the skin, but the brain section displayed positive meningeal melanoma.@*CONCLUSION@#Intracranial hypertension and epilepsy are the main clinical manifestations of melanocytic lesion of the central nervous system, and cutaneous lesion and radiological findings are very important for the diagnosis.

Evaluation on a cohort based population intervention project regarding risk factors for cerebrovascular diseases / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the changes of risk factors in cerebrovascular diseases in cohort-based population after intervention and evaluating the intervention effect.</p><p><b>METHODS</b>In 1987, an intervention cohort and a control cohort were selected randomly in urban areas of Changsha. Risk factors in cerebrovascular diseases were investigated in two cohort populations aged over 35 years as baseline indication. Then comprehensive prevention of cerebrovascular diseases was carried out in intervention cohort during 1987 - 2000. After intervention for 14 years, a reexamination was taken in the two groups noted above.</p><p><b>RESULTS</b>After 14 years, the prevalence of diabetes mellitus, hypertension, mean systolic and diastolic pressure, weight increased from 33.8% to 35.7%, 30 to 129 per 10,000, 128.41 mm Hg to 134.49 mm Hg, 77.78 mm Hg to 78.54 mm Hg, 54.80 kg to 57.78 kg in the intervention group, respectively while the baseline indication increased from 35.9% to 56.8%, 30 to 228 per 10,000, 127.70 mm Hg to 141.80 mm Hg, 78.27 mm Hg to 82.89 mm Hg, 54.92 kg to 59.69 kg in the control one. The changes were of statistical significance in each group except diastolic pressure and the prevalence of hypertension in intervention group, but all the parameters increased significantly in the control group; rate of alcohol intake decreased significantly in two groups, but rate of cigarette smoking decreased with no significance. The changes between two groups were not significant either; the cumulative incidence of stroke was significantly lower in intervention cohort (3.4%) than in control cohort (4.7%).</p><p><b>CONCLUSION</b>The risk factors for cerebrovascular diseases (such as hypertension, diabetes mellitus etc.) were increasing along with by aging. Intervention programs can delay the increase of risk factors and down-regulate the incidence of stroke.</p>