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.

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 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 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.

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 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.

BACKGROUND:Treatment programs for low back pain are of great varieties, but there is stil no a definite treatment. Pressure biofeedback instrument is a tool to measure abdominal muscle activity, and its reliability in the treatment of low back pain is less reported. OBJECTIVE:To explore the reliability and feasibility of the pressure biofeedback instrument for assessment of low back pain. METHODS:Thirty patients with chronic low back pain were enrol ed and subject to four kinds of postures:posture A was prone position;posture B was supine position with flexion of the knee joints, posture C was supine position with unilateral flexion of the hip and knee joint, posture D was prone position with unilateral shoulder flexion. Intra-abdominal pressure values under the different postures were measured twice within a week in the same subject. Intraclass correlation coefficient (ICC) was used to assess the reliability. RESULTS AND CONCLUSION:Posture A had good test-retest reliability, and the value of ICC was 0.853 (95%confidence interval:0.691-0.930);posture B showed moderate test-retest reliability, and the ICC value was 0.751 (95%confidence interval:0.477-0.882);posture C also had moderate test-retest reliability, and the ICC value was 0.789 (95%confidence interval:0.557-0.900), posture D had good test-retest reliability, and the value of ICC was 0.892 (95%confidence interval:0.641-0.919). Therefore, the pressure biofeedback for evaluation of low back pain has good reliability, which can be used for the evaluation of low back pain.

Objective To explore the relationship between plasma homocysteine(Hcy) levels and cerebral infarction.Methods 87 patients with acute cerebral infarction and 80 controls were enrolled in the study. Plasma Hcy levels were measured by high-performance liquid chromatography-fluorescence detection(HPLC-FD) technology using Baseling 810 type high-performance liquid chromatograph.Results Fast plasma Hcy levels were higher in the patient group[(15.28?4.33)?mol/L] compared with those in the control group[(11.32?3.86) ?mol/L]( P

Objective To study the relationship of plasma homocysteine (Hcy), polymorphism in 5,10-methylenetetrahydrofolate reductase (MTHFR) and cystathionine-?-synthase (CBS) genes, and cerebral infarction in the elderly. Methods 61 elderly patients with first-ever acute cerebral infarction and 57 controls were studied. The plasma Hcy levels were measured using high-performance liquid chromatography-fluorescence detection (HPLC-FD). The polymorphism in MTHFR was determined by a polymerase chain reaction (PCR) assay and subsequent restriction enzyme digestion.CBS was determined by amplification refractory mutation system (ARMS). Results The fast plasma Hcy levels were higher in the patient group compared with those in the control group [(13.07?3.96)?mol/L vs (11.51?3.90)?mol/L, P 0.05). There were no differences in the plasma Hcy levels among the different genotypes. Conclusions The MTHFR, CBS gene mutations cannot lead to hyperhomocysteinemia in the elderly patients with acute cerebral infarction. Hyperhomocysteinemia is associated with the independent risk of cerebral infarction, however, mutations only in MTHFR and CBS cannot be ascertained to be independent risk of cerebral infarction in the elderly.