Objective To study the clinical significance of routine MRI and 3 dimensional time of flight magnetic resonance angiography (3D-TOF-MRA) for the pathogenesis of Trigeminal neuralgia (TN) Methods 32 patients with TN and 32 controls were observed by MRI and 3D-TOF-MRA by the enhancement of DTPA Diagnosis of the presence of compressions in the root exit zone (REZ) of the Trigeminal nerves were carried out by two radiologist on an independent console Results (1) In patients studied, compressions of the REZ of the nerves were detected with 29 on symptomatic sides (90 63%), neurovascular on 25 sides and tumor on 4 sides, and 2 on the asymptomatic sides(6 25%, all neurovascular) In the controls, 3 sides (4 26%, all neurovascular) were involved in the compressions of the REZ of the Trigeminal nerves (2) In 25 cases with TN of neurovascular etiology, the offending vessels were the superior cerebellar arteries in 17 cases (68%), anterior inferior cerebellar arteries in 2 cases, vertebral artery (VA) in 1 cases, difficultly identified vessels in 2 cases, vein in 2 cases, vascular malformation in 1 case (3) The RR of microvascular and tumor compressions which cause TN were 36 74 (4) The real microvascular compression and entrapping were only detected on the symptomatic sides of TN in 13 patients (52%) Conclusion MRI and 3D-TOF-MRA appeared to be the best imaging test for the pathogenesis of TN now The major causes of TN might be different neurovascular and tumor compressions in the REZ of the fifth cranial nerve, with real compression, entrapping or tight contact

Objective To investigate the pathological and electro-physiological process of terminal sprouting after muscle injection of Botulinum toxin type A(BTXA) in rats. Methods Sprague-Dawley rats were randomly divided into a BTXA group and a control group. Five unit of BTXA was injected into the right gastrocnemius of the rats in BTXA group, instead of 0.9% saline in the control group. The morphologic axon analysis and SFEMG (mean consecutive difference and fiber density) were measured at 1,4,8,12 week after injection. Results The mean consecutive difference was prolonged in 1-4 week, and got better at 8 week, recovered at 12 week. It was revealed of the recovery of neuromuscular junction at 12 week after BTXA injection. The results of fiber density and morphologic axon analysis demonstrated terminal sprouting after injection of BTXA. Conclusion Motor nerve terminal sprouting could appear after BTXA injection and the function of neuromuscular junction could become recovered at 12 week.

Objective To study the clinical significance of 3 dimensional time of flight magnetic resonance angiography(3D-TOF-MRA) for the pathogenesis of hemifacial spasm (HFS) and trigeminal neuralgia(TN).Methods 48 patients with HFS and 46 patients without HFS and 42 patients with TN and 40 patients without TN were examined by MRI and 3D-TOF-MRA by the enhancement of DTPA. Diagnosis of the presence of compressions in the root exit zone(REZ) of facial nerves and trigeminal nerves were done by two radiologists on an independent console. Results (1)In the patients, compression of the REZ of the facial nerves and trigeminal nerves were detected on 45 spastic sides (93.8%,neurovascular on 44 sides and tumor on 1 side) and 36 spastic sides ( 85.7%,neurovascular on 32 sides and tumor on 4 sides ), 8 and 4 on the asymptomatic sides (16.7% and 9.5%, all neurovascular ). In the controls, 4 and 5 sides ( 4.4% and 6.3% ) were found in the compression of the REZ of the facial nerves and trigeminal nerves. ( 2 ) The offending vessels of compression of the REZ of the facial nerves were the anterior inferior cerebellar artery (AICA) in 17 cases ( 38.6% ), the posterior inferior cerebellar artery (PICA) in 12 cases (27.3%), the vertebral artery (VA) in 6 cases (13.6%). The offending vessels of compression of the REZ of the trigeminal nerves were the superior cerebellar artery ( SCA ) in 18 cases ( 56.3% ), the anterior inferior cerebellar artery in 5 cases (15.6%), the difficult identified vessels (DIV) in 4 cases (12.5%). (3)The relative risks of microvascular compressions which cause HFS and TN were 26.6 and 9.84. (4) The compressions of the REZ of the facial nerves and trigeminal nerves were proved in 4 cases (neurovascular 3 cases and tumor 1 case) and 10 cases (neurovascular 6 cases and tumor 4 casee) in the operation.Conclusion MRI and enhanced 3D-TOF-MRA appeare to be the best imaging technology for the pathogenesis of HFS and TN now. The major causes of HFS and TN may be different neurovascular compressions in the REZ of the facial nerves and trigeminal nerves, some cases are caused by tumor compression.

Objective To study the contribution of enhanced 3D time-of-flight MRA in the diagnosis of neurovascular compression in the patients with trigeminal neuralgia.Methods Enhanced 3D time-of-flight MRA and MRI in 37 patients clinical suspected trigeminal neuralgia were analyzed retrospectively.Results We found 27 sides trigeminal nerve in 24 patients were compressed by vascular in the enhanced 3D time-of flight MRA.In 24 patients neurovascular compression was ipsilateral with trigeminal neuralgia,and the side without trigeminal neuralgia, vascular compression in 3 cases were found.There was statistics correlation between neurovascular compression and trigeminal neuralgia.The other 13 patients with trigeminal neuralgia were non-neurovascular compression.The trigeminal nerve was compressed by superior cerebellar artery in 14 patients,anterior inferior cerebellar artery in 5 patients,tortuous vertebral artery in 1 patient,malformation of vascular in 1 patient,other microvascular in 5 patients.Conclusion Enhanced 3D time-of-flight MRA,which is super than MRI,can clearly display trigeminal nerve and neighboring vascular.Int is the optimum technology of radiology to diagnose the neuroveascular trigeminal neuralgia and helpful for diagnosis and treatment.

Objective To evaluate the application of CT myelography (CTM) in detecting the site of spontaneous cerebrospinal fluid (CSF) leaks and analyze it's imaging features.Methods Six patients (3 women and 3 men) with spontaneous intracranial hypotension (SIH) were included, who met the criteria of the International Headache Classification (2nd edition, 2004). Five patients subsequently underwent whole spine MRI and all 6 patients underwent CTM. Autologous blood mixed with omnipaque (300 mg/ml) was injected followed by selective puncture at the leak site indicated by CTM. Results MRI was failed to find leak site in the 5 patients, whereas CTM successfully found leak sites in all 6 patients. There were 1 to 7 leak sites respectively with an average of 4.2 sites (totally 25 points). Leak sites at cervical (12 sites) and thoracic (12 sites) were more frequent than at lumbar (1 site). CTM was featured by linear leakage of the contrast medium along the spinal nerve roots, paraspinal collections of hyper-density contrast medium and beak-like enlargement of the nerve sleeves. All patients responded well to the treatment, with complete resolution of symptoms. Conclusion CTM has been shown to be a study of choice to accurately define the location and extent of a CSF leak.

Objective In this study,functional magnetic resonance imaging(fMRI)is performed to visualize what type of brain activity correlates with writer's cramp.Methods Ten patients with writer's cramp and ten age-and gender-matched control subjects participated in this study.fMRI block design is used.Subjects were scanned while performing three visually instructive tasks with MR Vision 2000:(1)suppositional writing;(2)writing with finger;(3)writing with a pencil.Data were analyzed with Analysis of Functional Neuroimaging(AFNI)software for groups of patients versus controls.Results Compared with controls,patients with writer's cramp showed greater activation of contralateral basal ganglion(especially the putamen,864 activated voxels in patients versus 54 in controls),ipsilateral cerebellar hemisphere,and contralateral sensorimotor,supplementary motor,premoter,primary sensory cortex in the task of writing with a pencil.There is no obvious difference in the task of writing compared with finger writing.Furthermore,these differences existed in the subtractive activated maps for “writing with pencil” minus “writing with finger”,while the activation of subcortical area and insula in controls disappeared.Conclusion These results indicate that the dysfunction of basal ganglion and subcortical-cortical loop might play a pathophysiologic role in the writer's cramp.

Objective To evaluate the value of united nerve electrophysiological tests in the diagnosis of diabetic peripheral neuropathy (DNP).Methods The quantitative temperature threshold (QTT), including the cold sensation threshold (CST) , thermal sensation threshold (WST), cold pain threshold (CPT) and thermal pain threshold (HPT), sympathetic skin response (SSR) and nerve conduction velocity (NCV) were measured for 85 diabetic patients.Results The abnormal rate of QTT was 84.71％ , significantly higher than that of SSR and NCV (56.47％ and 31.76％ respectively).However, no significant difference was found in the abnormal rate of QTT between the DPN asymptomatic group and DPN symptomatic group (78.85％ and 93.94％ respectively).There was significant difference in the abnormal rate of SSR (48.08％ and 69.70％ respectively) and the abnormal rate of NCV (19.23％ and 51.52％ respectively) between the above two groups(P ＜ 0.05).There was no difference in the abnormal rate of QTT for patients with short or long course of disease (77.77％ and 89.80％ respectively), but significant difference in the abnormal rate of SSR (44.44％ and 65.31％ respectively) and the abnormal rate of NCV (19.44％ and 40.82％ respectively) Conclusion The abnormal rate of QTT was highest in detecting the diabetic patients, and it is not related to clinical symptoms or disease course.However, the abnormal rates of SSR and NCV were related to clinical symptoms and course.It is more sensitive to diagnose DPN using united electrophysiological tests of QTT, SSR and NCV.

OBJECTIVETo investigate the mechanisms of Wuling mycelia powder on memory retrieval impairment in rats with chronic epilepsy.

METHODSD rats were randomly divided into four groups: the pentylenetetrazole-kindling group (the model control group), the low dose of Wuling mycelia powder (0.3 g x kg(-1), ig) group, the high dose of Wuling mycelia powder (0.6 g x kg(-1), ig) group and the blank control group. After being successfully trained in the 8-arm (4-arm baited) radial maze, the rats were intraperitoneally injected with a subconvulsive dose (35 mg x kg(-1)) of pentylenetetrazole (saline in control group) every 48 h for 12 times. Wuling mycelia powder were orally administered 30 min before every pentylenetetrazole injection. Memory retrieval was tested at the same maze. Phosphorylated CREB were analyzed by Western blot. Brain pathological sections were stained using HE, hippocampal nerve cells were observed under optical microscopes.

RESULTBoth of reference and working memory abilities of these chronic epilepsy rats were impaired as expressed in the 8-arm radial maze but reversed by Wuling mycelia powder to some extent. Chronic epilepsy caused a decreasing p-CREB in hippocampal nerve cells and injury in hippocampal CA1 region and CA3 region among rats. Wuling mycelia powder inhibited hippocampal p-CREB from decreasing and protected hippocampal nerve cells.

CONCLUSIONWuling mycelia powder could ameliorate memory impairment induced by epilepsia. Its mechanism may be related to the increase in p-CREB expression in brain and the protective effect on hippocampal nerve cells.

Animals ; Chronic Disease ; Cyclic AMP Response Element-Binding Protein ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Epilepsy ; complications ; Hippocampus ; drug effects ; pathology ; Male ; Memory Disorders ; drug therapy ; Phosphorylation ; Rats ; Rats, Sprague-Dawley

Objective To investigate the features of variation of sympathetic skin response(SSR)in depression patients and to clarify the correlation between SSR and the effect of antidepressant therapy in first episode depression.Methods The sample comprised 50 first visit patients,who fulfilled the ICD-10 criteria in a structured interview for depressive disorder.These 50 patients received antidepressant therapy for 6 weeks.Clinical response was defined as ≥50%reduction in total 17-item Hamilton depression rating scale(HAMD).Remission was defined as HAMD score ≤7 at week 6.SSR waveforms were classified into three patterns based on the amplitudes of positive and negative components:P pattern,N pattern and M pattern.Another 50 healthy subjects were involved in this study as controls.Results (1)SSR could be obtained in all normal subjects but couldn't be recorded in 5 of 50 patients whose HAMD scores>28.SSR waveforul patterns were analyzed in these 45 patients P pattern in 7 cases,N pattern 21,M pattern 17.(2)Depression patients had longer latency and lower amplitude than the controls(P<0.01).P pattern had shorter latency and higher amplitude than N pattern.There were no difference in age,course and HAMD scores among the patients with 3 different SSR patterns.(3)Nine of 21 patients of N pattern treated with fluoxetine were remitters.6 patients were clinical responders.These 15 patients had shorter latency and higher amplitude after treatment than that at the initial stage,but there were still differences in latency and amplitude compared with the controls.Conclusion There were significant damages on sympathetic function of depression patients.N pattern was the most SSR pattern among 45 patients recorded SSR.P pattern had shorter latency and higher amplitude than N pattern.SSR is a sensitive and feasible measure inder for neurocardiac electrophysiologic autonomic regulation examination,which could be used to measure clinical therapeutic efficacy for antideppressant in depression patients.

Objective To determine the utility of musculoskeletal ultrasound imaging to support physical findings in different stages of recovery and in recommending treatment regimens.Methods Forty-three hemiplegic stroke survivors with shoulder pain were enrolled.Physical examinations were performed 3 and 6 months after the stroke using a visual analogue scale (VAS),a modified Ashworth scale,measurements of passive range of motion and Brunnstrom staging.This was coupled with sonography of the long head of the biceps,the subscapularis tendon,the supraspinatus tendon,the infraspinatus tendon,the acromioclavicular joint and the subacromial-subdeltoid bursa.Results Three months after the stroke the average VAS score correlated negatively with the average Brunnstrom stage of the shoulders (r=-0.39,P≤0.01),with the range of passive abduction (r=-0.56,P≤ 0.01),the range of passive external rotation (r=-0.36,P≤ 0.02),and the range of passive flexion (r=-0.37,P≤ 0.02).It was positively correlated with abnormal sonographic findings of the long head tendon of the biceps (r=0.32,P≤ 0.04),the subscapularis tendons (r=0.31,P≤0.04) and the supraspinatus tendons (r=0.53,P≤0.01).However,3 months later the VAS results were negatively correlated with Brunnstrom stage (r=-0.45,P ≤ 0.01),range of passive shoulder abduction (r=-0.60,P≤0.01),range of passive external rotation (r=-0.41,P≤0.01),and passive range of flexion (r=-0.52,P≤ 0.01),but positively correlated with spasticity (r=0.34,P≤ 0.03),biceps tendinopathy (r=0.45,P≤0.01),subscapularis tendinopathy (r=0.33,P≤ 0.03) and supraspinatus tendinopathy (r=0.56,P≤ 0.01).Rotator cuff injury was significantly more severe 6 months after stroke than at 3 months.The incidence of pain in the hemiplegic shoulder and abnormal sonographic findings of the biceps tendon and subscapularis tendon were significantly higher at 6 months than at 3 months after the stroke.Supraspinatus tendon problems were notable both at 3 and 6 months.Conclusions Pain in a hemiplegic shoulder is positively correlated with abnormal sonographic findings but negatively correlated with Brunnstrom stages and passive range of motion 3 and 6 months after stroke.Six months after stroke,pain is positively correlated with muscle tone.The tendon at the long head of the biceps and the rotator cuff are vulnerable to injury,especially at 6 months after stroke.