Objective To accumulate clinical experience and to directe clinical work.Methods A total of 208 patients with psychogenic dizziness from department of neurology of Navy General Hospital of PLA were included in the study.Self-rating anxiety scale (SAS),self-rating depression scale (SDS) and Bech-Rafaelsen mania rating scale (BRMS) were used for the evaluation.Results Among all the patients aged from 17 to 77 (the average age:52),152 were female and 56 were male.There were 3 types according to different clinical features and therapy prognosis:anxiety and depression type (176 cases,84.6％),hysteria type(18 cases,8.7％) and mania type(14 cases,6.7％).The drugs increasing the concentration of excitatory had a good therapeutic efficacy on anxiety and depression type.Alluding cure had notable effect on hysteria type and mood stabilizer had notable effect on mania type.Conclusions Women tended to have psychogenic dizziness.It can be divided into three types:anxiety and depression type,hysteria type and mania type.Clinical symptoms and laboratory examination of each type have their own characteristics,and treatment strategies are also different.

Objective To explore the etiology of patients with chief complaint of vertigo in the department of neurology in order to reduce thc rate of misdiagnosis.MethodsA total of 367 patients with chief complaint of vertigo in our department of neurology were followed up.The associated medical history,symptoms and physical examination were obtained.ResultsThe main diagnoses for the 367 patients were benign paroxysmal positional vertigo (BPPV) ( 219,59.7％ ),posterior circulation ischemia (PCI) ( 65,17.7％ ),migraine ( 31,8.4％ ),hypertension ( 18,4.9％ ) and psychogcnic vertigo ( 17,4.6％ ).Conclusions Presentation of vertigo can be clinically diagnosed in most discases,with the most common causc of BPPV.Combination of the prominent clinical features,physical examinations and especially Dix- Hallpike maneuver may guide the general physicians to a most proper cause of vertigo.

Primary angiitis of the central nervous system is relatively rare. In recent years, research of the disease in neuroimaging, differential diagnosis, treatment and other aspects advanced greatly. This paper provided a systematic review of this disease entity in order to promote neurologists, neurosurgeons and radiologists′ experience in the diagnosis and treatment of the disease.

Objective To investigate the possible role and mechanism of the neurotoxic effect of dexamethasone on adult rats after having focal cerebral ischemia. Methods The rat model of focal cerebral ischemia was established by permanent middle cerebral artery occlusion (MCAO) One hour after ishemia,the experimental groups were treated with dexamethasone (5 mg/kg) while the control groups were treated with saline TUNEL staining and In-suit RT-PCR were used to show the changes of apoptosis and the expression of Fas mRNA at ipsilateral cerebral hemisphere. Results TUNEL positive cells were present in a time from 48 h to 72 h, localizing at peripheral ischemic area The expression of Fas mRNA at peripheral ischemic area in control groups began at 12 h, peaked at 24 h, and decreased to a lower level at 48 h and 72 h, and returned to the baseline at 120 h Treatment with dexamethasone after ischemia made apoptosis present at 24 h and the number of TUNEL positive cells at 48 h exceeded that in the control group at 48 h ( P

Objective To investigate the clinical manifestions ,neuropathology and imaging in the patients with MELAS type of mitochondrial encephalomyopathy for exploring the diagnostic method of the disease. Methods Systemic study was performed on the clinical features,imaging of four MELAS patients. Muscle biopsy and 2 brain biopsies of 3 cases were examined. Results The main clinical features were characterized by intolerance to exercise,recurrent headache and vomit,focal or generalized seizures,dementia,stroke like episodes,sensorineural deafness, hypertrophic cardiomyopathy,endocrine dysfunction,short stature,lactic acidosis and so on. Electromyography showed myopathic damage. CT showed calcification in basal ganglia. CT showed multiple low density lesion primarily in gray matter of occipital,parietal and temporal cortex,which was expressed by the abnormal longer T 1 and T 2 weighted signals on MRI.Muscle biopsy showed red ragged fiber and abnormal mitochondria. Brain biopsy showed laminar necrosis of cortex,astrocytosis,diffused microvascular proliferation and calcification. Four cases were diagnosed as MELAS type.Conclusion According to clinical manifestations and neuroimage features,MELAS is possibly early defined in combination with muscle or/and brain biopsy.

Objective To study the expression of TGF ? 1 protein and the changes of microglia of adult rats' brain treated with dexamethasone following permanent focal cerebral ischemia as to elucidating the neurotoxic effect of dexamethasone. Methods The adult rat's models of permanent focal cerebral ischemia were established by permanent middle cerebral artery occlusion.One hour after ischemia experimental groups were treated with dexamethasone (0.5 mg?kg -1?d -1) where as the control groups were treated with saline. The size of infarct was detected by Q570 image analysis system. Immunohistochemistry and picture analyses were performed to observe the expression of TGF ? 1 protein. The microglia was demonstrated by histochemical staining with isolectin-B4.? Result Dexamethasone treatment after ischemia increases the infarct volume significantly. The expression of TGF ? 1 and the changes of microglia were mainly located at the border zone of the infarct. The accumulation of the isolectin-positive microglia began at 12 h,peaked at 2d, decreased at 5 d. The densities of microglia in the groups treated with dexamethasone after ischemia decreased significantly at 12 h,24 h and 3 d as compared with the control groups, and disappeared at 5 d.The expression time-course of TGF ? 1 protein was two-phase. The first peak of expression was at 6 h; the second was from 24 h to 72h. The significant decrease in expression of TGF? 1 protein in rats treated with dexamethasone was observed at 6 h,24 h and 72h compared with that of control group. Conclusion The exceeding inhibition of the response of microglia and the two-phase expression of TGF ? 1 protein at the border zone of infarct may play a role in the neurotoxic effect of dexamethasone on cerebral ischemia.

Objective: To study the effect of Maitork (a sodium chloride injection containing Ginkgo bioba extract and ligustrazine phosphate) on plasma levels of fibrinogen (Fg), platelet granule membrane protein 140 (GMP-140), tissue plasminogen activator (tPA) after focal cerebral ischemia-reperfusion in rats. Methods: Eighty male SD rats were randomly allocated into groups 3-day (n=40) and 7-day (n=40) after operation. Then each group was divided into 4 subgroups: sham-operation, ischemia control, Ginaton and Maitork. The focal cerebral ischemia model was established in rats. The activities of GMP-140 and tPA were measured by chromogenic substrate assay, and the level of Fg was measured by gel plaque assay. Results: The level of Fg in the Ginaton group was significantly higher than that in the ischemia control group, and the 7-day group was also significantly higher than that in the Maitork group (P

Objective To evaluate the safety of thrombolytic treatment using rt-PA at early stage of acute cerebral infarction in Chinese patients, and to analyze the significance of intra - cerebral hemorrhage after therapy. Methods 206 patients within 6 hours after the onset of stroke were divided into 3 groups: group A (thrombolytic treament using rt - PA with dosage of 0.9 mg/kg over 60 minutes) , group B (thrombolytic treatment using rt-PA with dosage of 0.7 mg/kg over 60 minutes) and group C (control group without rt-PA). Group A, group B, group C were divided into two subgroups according to using Clexane or not. Patients in subgroups A1, B1, C1 were treated with Clexane and in subgroups A2, B2, C2 were not. The Chinese Stroke Scale (CSS) and Barthel Index (BI) were used to evaluate the neurological function before and 24 hours, 3 days, 7 days, and 90 days rt-tPA. Results There was significant difference on hemorrhagic rate and cerebral hemorrhagic rate at the 48 hours and 14 days between group A, group B and group C. There was no significant difference on symptomatic cerebral hemorrhage in groups A, B and group C. There were significant differences between thrombolytic groups and group C on the effective and curative rate at 90 days after therapy. The mortality was lower in thrombolytic groups than in group C at 90 days. There was no significant difference between group A and group B , and also between the subgroups. Conclusion Thrombolytic treatment using rt-PA intravenously in patients with acute cerebral infarction within 6 hours was effective and safe. The dosage of 0.7mg/kg was suitable for Chinese patients.

Objective To explore the clinical characteristics of infratentorial primary angiitis in central nervous system (PACNS).Methods A total of 5 cases diagnosed as infratentorial PACNS in the neurology department of Navy General Hospital of PLA in 2015 were enrolled in the study.The clinical,imaging and pathological data were collected and analyzed.Results All the 5 cases were male with the median onset age of thirty-four.Five cases presented with dizziness,two with headache,three with walking unstable,two with facial numbness and one with dysarthria.Rising pressure of cerebrospinal fluid (CSF) (190-245 cmH2O,1 cmH2O =0.098 kPa) was found in 4 cases by the lumbar puncture,mildly increased number of leukocyte in 2 cases [(12-28) × 106/L],increased CSF protein in 3 cases(540-979 mg/L) and increased IgG index in 3 cases (0.84-1.45).Pons lesions were revealed by magnetic resonance imaging(MRI) in 4 cases,brachium pontis lesions in 2 cases,cerebellum lesions in 2 cases,one with midbrain lesion in 1 case,unilateral lesions in 4 cases and bilateral lesion in 1 case.Different degree of edema and mass effect were shown in all lesions by MRI.Patch like enhancement was found by contrast MRI in 5 cases and meningeal enhancement in 2 cases.Elevation of choline (Cho) peak was found by magnetic resonance spectroscopy (MRS) in 4 cases,reduction of N-acetyl aspartate (NAA) peak in 3 cases,appearance of lactate peak in 1 case and lipid peak in another case.Arterial spin labeling (ASL) was performed in 4 cases and no hyperperfusion was found.Susceptibility weighted imaging(SWI) was performed in 3 cases and microhemorrhage in the lesions was found in 2 cases and normal in 1 case.Magnetic resonance arteriography(MRA) was performed in 1 case and no stenosis was found.Digital subtraction arteriography(DSA) was performed in 1 case and multiple stenosis of the intracranial arteries was showed.Two cases had taken the stereotactic brain biopsy and the histopathologic diagnosis was angiitis.Five cases were treated with methylprednisolone and cyclophosphamide was added on in 1 case.Good prognosis was found in all cases.Conclusions Infratentorial PACNS mostly attacks middle-aged males.The lesions tend to locate in unilateral pons,brachium pontis,cerebellum and midbrain.Hemorrhage or microhemorrhage in lesions is often found by SWI and no hyperperfusion is shown by ASL,which would be useful to distinguish PACNS from malignant tumors.Given the limitations of brain biopsy in clinical practice,clinical and imaging features would be helpful to diagnose PACNS.

To explore the clinical characteristics and imaging features of miliary tuberculomas in central nervous system (CNS).A total of 5 cases diagnosed with tuberculosis in CNS first diagnosed by neurologists in Navy General Hospital of PLA were enrolled in the study.All clinical and imaging data were collected and analyzed retrospectively.The main initial symptoms were fever and headache (4/5).Multiple diffused miliary lesions were shown by brain MRI,with maximum diameter ranged from 1-4 mm and ringshape or nodular enhancement after gadolinium injection.As mycobacterium tuberculosis could seldomly be found in serum and cerebrospinal fluid,contrast MRI remains the effective method for detecting miliary tuberculomas in CNS.