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.

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.

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 clinical,neuroimaging and electrophysiology features of 62 patients with multiple system atrophy(MSA).Methods Sixty-two cases with diagnosis of probable MSA were recruited in a retrospective studied.Clinical,neuroimage and external anal sphincter electromyography (EAS-EMG)data was retrospectively analyzed.Results In 62 cases(44 male and 18 female),the onset age was between 37 and 76.Among them,29 cases(46.8 % )were MSA-A,with orthostatie hypotension as the main clinical manifestation;24 cases(38.7 % )were MSA-C,with cerebellar ataxia ag the main chnical manifestation;9 cases(14.5 % )were MSA-P,with extrapyramidal symptoms as the main clinical manifestation.MRI showed that main lesion of MSA-A was in the cerebellum:that of MSA-C was in the cerebellum,pons and medulla;and that of MSA-P was in the putamen.Fifty-one cases did EAS-EMG and 46 cases showed neurogenie impairments.Nineteen cases were initially misdiagnosed with other diseases.Conclusions MSA is easy to be omitted or misdiagnosed at early stage.The diagnostie rate of MSA can be increased by the combination of clinical expressions,neuroimage,EAS-EMG and other necessary examinations.

Objective To improve the recognization of long term interval between optic neuropathy and spinal cord injury of neuromyelitis optica. Methods One 51-year old male patient with 37 years'interval between optic neuropathy and spinal cord injury of neuromyelitis optica underwent the examination of plasma and cerebrospinal fluid and head and spinal MRI examinations, who was also followed up. His clinical data were analyzed and related literature was reviewed. Results The myelin basic protein and IgG index in his cerebrospinal fluid was high, his oligoclonal band of cerebrospinal fluid was positive, and abnormal finding in visual evoked potential. Abnormal intramedullary long T2 signals was showed in spinal cord MRI at T1-7 segment. When dignosed as neuromyelitis optica, the clinical symptom and signs was improved with corticosteroid and gamma globulin therapy. The patient was in stable condition at present.Conclusions There could be a long term interval between optic neuritis and myelitis. One should pay attention to clinical features and imaging examination of subclinical lesion in spinal cord and brain and conoide the possibility of developing neuromyelitis optica or multiple sclerosis.

Objective To explore the clinical features, imaging and their diagnosis vaule of Baló's concentric sclerosis (BCS). Methods The clinical manifestation, laboratory examination, neuroimaging characteristics, pathology and follow-up of 12 (2 outpatients and 10 inpatients) cases of BCS were analyzed retrospectively. Results The onset age of 12 patients (male 4, female 8) ranged from 8 to 54 years old (mean 36.8 years). Unconcerned and slowness response were common in the disease onset (7 cases).Other symptoms and signs such as hypophrenia ( 10 cases), limitation of limb or hand movement (8 cases),urinary and fecal incontinence (7 cases), hypo-myodynamia (7 cases), positive pyramidal sign (6 cases)were not rare in course of disease. Eight cases underwent the examination of cerebrospinal fluid myelin basic protein, which increased in 7 cases. Demyelinating change and perivascular inflammatory infiltration were shown in 6 brain biopsies. The involvements of multi-lesions were found in 11 cases. Four patients underwent CT scanning and all the cases showed with hypodense lesions and couldn' t be enhanced. On MRI, all cases appeared round or round-like in shape. Enhanced lesions showed ring-like or half-ting-like shape (8 cases) and concentric ring (3 cases). It's easy to be misdiagnosed as brain tumor (8 cases).Conclusions BCS is a kind of demyelinating disease of subacute or chronic onset accompanied with cognitive disorder being the most common initiating symptoms. It's prone to be misdiagnosed. Diagnosis depends on MRI and corticosteroid treatment is effective. BCS has a good prognosis and presents with benign clinical course.