Reversible posterior leukoencephalopathy syndrome (RPLS) is a cliniconeuroradiological entity mainly characterized by the rapidly progressive increase in blood pressure, headache, vomiting, conscious disturbance and seizure. Neuroimaging showed symmetrical reversible white matter edema in bilateral cerebral hemispheres, particularly in posterior brain.Clinical symptoms and neuroimaging changes can be recovered completely with timely and correct treatment. The two major hypotheses about the pathogenesis of RPLS-cerebral vasospasm and cerebrovascular hyperperfusion-have been in dispute. At preseut, most researchers still agree that the latter is the main cause of cerebral edema. This article expounds the new viewpoints of its pathogenesis and the above two major hypotheses in recent years from the characterizations of etiology, pathology and imaging of RPLS.

The diagnostic core of multiple sclerosis(MS) always requires dissemination in space and time since the publication of the first criteria over 40 years ago.Though several modified clinical criterias have been proposed to diagnosis MS,no paitents must meet such condition in diagnostic criteria because of the reticular clinical manifestation of this disease.The diagnosis of MS is still based on clinical parameters including detailed history and a careful examination to exclude alternative disease.The effects of some disease modifying agents to MS have been confirmed by evidence-based medicine.But the intact treatment plan must contain aspects of acute attacks,prevention of relapses and progression,management of symptoms,and rehabilitation.The individualized treatment is needed according to the medical insurance,payment ability and other influencing factors in China.

Objective To explore the value of blink reflex (BR) and brainstem auditory evoked potential (BAEP) in the diagnosis of multiple sclerosis (MS). Methods Totally 20 normal persons and 32 MS patients were examined with BR and BAEP respectively.Results 32 MS patients were divided into two groups according to the abnormalities localized to the brainstem: the symptomatic group and the asymptomatic group. The abnormal rates of BR in two groups were 85.7% and 50.0% respectively. The abnormal rates of BAEP in the two groups were 71.4% and 44.4% respectively. The abnormal rates of BR in Ⅴand Ⅶ cranial nerves were both 21.9%. The abnormal rates of BR,BAEP,BR and BAEP in finding out lesions of brainstem were 65.6%,56.3% and 75.0% respectively.Conclusions Subclinical lesions in brainstem, Ⅴand Ⅶ cranial nerves were demonstrated by BR. The combined abnormal rate of BR and BAEP was higher than either test alone.

Objective To study the clinical features of cryptococcosis. Method The clinical manifestations of 101 patients with cryptococcosis were comprehensively analyzed using clinical statistical method. Results Among the 101 patients, 68 were male and 33 were female, 94.1% cases were chronic or sub chronic in onset. Headache and fever were the most common symptoms, over 85.0% patients got headache and(or) fever, vomiting (71.3%) was the second common, and the confusion, convulsion, seizure, visual and hearing damage are also relatively common. Nearly 70.0% patients had intracranial hypertention. Among the 58 patients who received brain CT scaning, 40 showed abnormal changes. All of 8 patients who received brain magnetic resonance imaging(MRI) showed abnormal changes. And 97 cases were positive in cerebrospinal fluid ink stain, 2 cases were negative in ink stain but positive in cerebrospinal fluid culture, and 2 were diagnosed after brain biopsy or brain surgery. Most cases had been falsely diagnosed as many other diseases. Conclusions Most patients with cryptococcosis should be chronic or sub chronic in onset, and their clinical features, cerebrospinal fluid routine and biochemical test, or CT and MRI are lack of specificity. The finding of Cryptococcus in cerebrospinal fluid culture and brain biopsy should be the golden standard of diagnosis.

Objective To investigate the change of the concentration of IL-2?IL-6?IL-10 in peripheral blood and cerebral spinal fluid (CSF) in monkey's experimental allergic encephalomyelitis (EAE),as to explaining it's function in mechanism and prognosis of the disease. Methods First set up animal models of monkey's EAE. Then separate the animals by their onset symptoms according to the level and the different stages of disease. At the same time survey the blood and CSF concentrations of IL-2?IL-6?IL-10, finally process the findings statistically. Results IL-2 in the first or the third week in the acute stage of EAE (5.0?0.8 and 5.3?1.2,respectively) was obviously higher than that (0.7?0.3) before the onset,P=0.045,0.041 respectively,both IL-6 and IL-10 in recuperation or chronic stage were higher significantly than before the onset,P=0.004 3,0.006 5 respectively. The findings were significant statistically. Conclusion IL-2 up-regulates immunologically,which accelerates the disease. IL-6 and IL-10 down-regulate immunologically,which reduce the disease. The findings may play an important role in studying immunological mechanism of EAE or MS in the future.

Objective To explore the MRI features of brain and spinal cord in patients with multiple sclerosis(MS).Methods The data of MRI of 110 patients with clinic definite MS were analyzed retrospectively.Results The lesions on brain MRI were usually seen in the white matter surround the ventricle(55.8%),deep frontal lobe white matter(54.7%),deep parietal lobe white matter(44.2%)and brainstem(25.6%).Basal ganglia(23.3%)and thalamus opticus(11.6%)were also affected.The size of the brain lesions was varied,the appearances were punctiform,mottling,patching,ellipse and so on.The lesions of the spinal cord were usually on the cervical cord(75.0%)and thoracic cord(68.8%).There were string lesions which parallel spinal cord long axial and mottled lesions.The spinal cord lesions existed in both white matter and gray matter.10.0% of the patients had spinal cord atrophy or spinal cord swelling.The signal intensity of lesions was equal T1,long T2 or long T1,long T2,which was related with the clinical course.Conclusion Different size and appearance lesions in the white matter of brain and spinal cord are the main MRI features of MS.

Objective To establish a method to detect neuromyelitis optiea (NMO)-IgG in patients serum using indirect immunofluorescence assay (IFA). Methods The normal tissues (cerebellum/ midbrain, kidney and stomach) from C57 mice were cryosectioned onto microscope slides as detective substrate. For NMO-IgG detection, isolated serum from patient with NMO, multiple sclerosis (MS), optic neuritis or myelitis was incubated with the tissue sections on the slide at 4℃ overnight and subsequently incubated with a fluorochrome-cojugated lgG specific for human. For double immunostaining with aquaporius-4 (AQP4), the slides were incubated with primary antibody of AQP4 and secondary antibody of IgG-TRITC. Detection of NMO-IgG and its co-localization with AQP4 was analyzed using fluorescence microscope. Results All 182 serum samples from patients were tested using IFA. Some samples revealed a characteristic immunohistochemical staining of NMO-IgG in mouse CNS tissues, predominately in pia and subpia, and capillaries in white and grey matter in the cerebellum, midbrain, and spinal cord. Double immunostaining with AQP4 demonstrated the co-localization of NMO-IgG with AQP4. Conclusions We established an IFA using a substrate from C57 mouse cerebellum/midbrain, kidney and stomach tissue to detect NMO-IgG in patient serum. This method is specific and efficient in detection and may be useful in diagnosis and differential diagnosis of neuromyelitis optica.

0.05).No significant difference was shown among the four groups for the proportions of brainstem involved(P=0.335).Significant differences were found for the proportions of bilateral hemicerebrum and spinal cord involved(P

Objective To summarize the features of multiple sclerosis (MS) in China. Methods The clinical manifestations and inducements of 413 MS patients are comprehensively analyzed using clinical statistical method. Other parameters are also analyzed by electromyography and brainstem auditory evoked potential. Results MS in China mainly invades young and middle-aged people, with a higher ratio in female than in male. MS was found mostly acute or subacute in onset and usually due to an inducement mainly consisting of common cold, fever, cyesis and fatigue. The first seen symptoms were various and complicated, but mainly showed different types of visual disturbance such as the acuity of vision decrease, constriction of visual field and diplopia. Limb paralysis, sensory abnormality and visual disturbance were found the commonest symptoms. Lhermitte’s sign was common. Paroxysmal symptoms as algospasm and seizure were relatively common. Electromyography and brainstem evoked potential showed that peripheral nervous system damage might occur in MS. Spinal cord and visual nerve were found the mostly invaded according to the clinical data. Conclusion The features of MS in China should be different from those in the western countries.

Objective:To study demyelinating mechanism of the central nervous system in acute experimental allergic encephalomyelitis(EAE).Methods:EAE in cynomolgus monkeys was induced successfully by homologous brain white matter homogenate. Lymphocyte subset in blood and cerebrospinal fluid was monitored by flow cytometer. Pathological changes in brains of acute EAE monkeys were investigated by immunohistochemistry and electron microscopy. Results:In the CSF of acute EAE, CD4 + lymphocytes increased significantly, and CD8 + lymphocytes and B lymphocytes increased slightly whereas the control was normal. A lot of CD4 + lymphocytes and a few CD8 + lymphocytes infiltrated into temporal deep white matter of acute EAE, whereas the control was normal. Inner laminae of myelin sheath were loose and axon was separated, whereas outer laminae were normal. Although axon was preserved well, oligodendrocyte had a severe edema in cytoplasm with mitochondria swollen, crista blurred or broken, and nucleus lysised partly.Conclusion:It is oligodendrocyte rather than myelin sheath itself which is firstly attacked in the demyelination in EAE.