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Relationship between reduction of regional cerebral blood flow in normal appearing white matter and the extent of age-related white matter lesions

Jie TANG ; Qiuyi WU ; Jianhui FU ; Qiuqiong DENG ; Qiang DONG ; Zhen HONG ; Chuanzhen LYU

Chinese Journal of Neurology.2014;47(11):758-762. doi:10.3760/cma.j.issn.1006-7876.2014.11.004

Objective To explore the relationship between reduction of regional cerebral blood flow in the normal appearing white matter (NAWM) and the extent of age-related white matter lesions (WML).Methods We used Fazekas scale to divide all participants into four groups (normal,mild,moderate,severe) according to the extent of the lesions showed on MRI.Regional cerebral blood flow (rCBF) in the area of WML and NAWM was measured by xenon contrast CT examination.Results A total of 56 cases were selected.The average rCBF (ml · 100 g-1 · min-1) in the lesions (WML) around ventricle,in right centrum ovale and in left centrum ovale respectively was 20.33 ± 2.52,21.27 ± 1.02,21.03 ± 1.83 for mild; 16.33 ±2.03,15.55 ±1.71,15.91 ±0.98 for moderate; 14.05 ±2.63,14.46 ±2.17,14.23 ± 1.95 for severe.The average rCBF (ml · 100 g-1 · min-1) in the NAWM around ventricle,in right centrum ovale and in left centrum ovale respectively was 20.79 ± 2.78,22.26 ± 1.9,22.15 ± 2.4 for normal; 21.12 ± 2.95,22.17 ± 1.50,22.25 ± 2.13 for mild,18.02 ± 2.41,19.45 ± 1.94,19.62 ± 1.54for moderate; 16.38 ± 3.22,18.18 ± 2.84,16.74 ± 2.97 for severe.The decrease of rCBF in the severe and moderate lesion areas was more serious than that in the mild lesion areas and reached statistic significance (P ＜ 0.05) ; The decrease of rCBF in the severe and moderate lesion areas was more serious than that in the area of NAWM in the same grade and reached statistic significance (P ＜ 0.05).The decrease of rCBF in the area of NAWM around severe and moderate lesion areas was more serious compared with that around mild lesion areas or normal areas (P ＜ 0.05) ; But the difference of rCBF in the area of NAWM around mild lesion areas and normal areas did not show any statistic significance.Conclusions Chronic ischemia was found to be existed not only in the lesions (WML) but also in the area of NAWM around the lesions,and was related to the extent of the lesions.Chronic ischemia may play a key role in the mechanism of aged-related WML.

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Multi-factor analysis of the central nervous system infection after invasive intracranial pressure monitoring

Haiyan LI ; Jingping ZHANG ; Guofeng WU

Chinese Journal of Neurology.2014;47(11):763-766. doi:10.3760/cma.j.issn.1006-7876.2014.11.005

Objective To investigate the related factors of central nervous system infection in patients who received invasive intracranial pressure monitoring.Methods The clinical data of 63 patients who received invasive intracranial pressure monitoring were retrospectively analyzed.Possible related factors including gender,age,disease,Glasgow coma scale score,emergency operation or selective operation,duration of the operation,drainage tube placement site,drainage tube lifetime,sensor insertion site,sensor indwelling duration,electrolytes,glucose and other complications were studied and compared retrospectively between patients with and without central nervous system infection.All data were analyzed with univariate analysis and multivariate Logistic regression analysis to identify the related factors and independent risk factors associated with central nervous system infection.Results In univariate analysis,drainage tube placement site (x2 =12.345,P =0.002),drainage tube lifetime ((2.5 ± 0.9) d and (6.3 ± 5.7) d in patients without and with central nervous system infection,respectively,t =-4.434,P =0.000),sensor insertion site (x2 =4.701,P =0.030),sensor indwelling duration ((6.5 ± 3.0) d and (8.9 ± 4.6) d in patients without and with central nervous system infection,respectively,t =-2.420,P =0.019) and other complications (x2 =13.086,P =0.000) were the relevant factors of central nervous system infection (P ＜0.05).In multivariate Logistic regression analysis,the sensor insertion site (OR =0.047,P =0.000) and other complications (OR =10.953,P =0.019) were the independent risk factors for the central nervous system infection.Conclusions There are a variety of factors related to central nervous system infection in patients with placement of intracranial pressure monitoring.The sensor insertion site and other complications were the independent risk factors for the central nervous system infection.

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Analysis of the causes of micturition and defecation dysfunction in motor neuron disease patients

Lei ZHAO ; Liying CUI ; Hua DU ; Benhong LI ; Shuang WU

Chinese Journal of Neurology.2014;47(11):767-771. doi:10.3760/cma.j.issn.1006-7876.2014.11.006

Objective To investigate the clinical features and causes of micturition and defecation dysfunction in motor neuron disease (MND) patients.Methods The micturition and defecation function was evaluated by a questionnaire covering storage and voiding of urine and feces respectively in 50 MND patients.The clinical features and external anal sphincter electromyography (EAS-EMG) were analyzed to explore the causes of micturition and defecation dysfunction in MND patients.Results Micturition and defecation dysfunction was detected in 9 of 50 (18.0％) MND patients.The main types of micturition and defecation dysfunction were constipation (4/9),urinary frequency,urgency with or without incontinence,fecal urgency (4/9),powerlessness for micturition and defecation (2/9),hesitancy for micturition (1/9).EAS-EMG was normal in 9 MND patients accompanied with micturition and defecation dysfunction.Conclusions MND patients accompanied with micturition and defecation dysfunction were not very rare.Constipation,urgency and powerlessness were the main types of micturition and defecation dysfunction and they were not related to the function of external anal sphincter.Gastrointestinal dysfunction from abnormal autonomic nerve involvement,muscle weakness and the resulted reduced activity,severe upper motor neuron damage and respiratory muscle weakness may be the main causes of micturition and defecation dysfunction in MND patients.

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Expression of myostatin gene mRNA in the muscle tissue from 75 patients with muscular weakness

Xiaoping ZHAO ; Chuanqiang PU

Chinese Journal of Neurology.2014;47(11):772-775. doi:10.3760/cma.j.issn.1006-7876.2014.11.007

Objective To investigate myostatin gene mRNA expression in the muscle tissue from patients with muscle weakness suffering from different illness.Methods The clinical data of our patients were all from the Muscular Disease Center,Department of Neurology,People' s Liberation Army General Hospital.A total of 75 patients suffered from muscular weakness were included consecutively.Skeletal muscle biopsies were obtained with informed consent from all 75 patients.The diagnosis was confirmed by two senior doctors for muscular disease according to the clinical feature,the results of electromyography,serum creatine kinase activity and histopathological examination.Among of them,21 cases were diagnosed as polymyositis,15 cases progressive muscular dystrophy,5 cases neurogenic amyotrophy,4 cases chronic muscle fiber damage,4 cases mitochondrial myopathy,4 cases lipid storage myopathy,4 cases myotonic dystrophy,3 cases muscular dystrophy in adults,2 cases dermatomyositis,and 2 cases inclusion body myositis.There were 2 cases characterized by pure high activity of creatine kinase.And the other 9 cases were diagnosed as non-neuromuscular disease.The expression of myostatin gene mRNA in muscle tissue was evaluated by reverse transcription polymerase chain reaction method,with glyceraldehyde-3-phosphate dehydrogenase as internal reference.Results The expression of myostatin gene mRNA was detected in 63 patients,but not in other 12 cases,and the percentage of positive expression was 84％.The expression index was with great variation,from 0 to 3.52.In positive cohort,the index was correlated positively with the duration of disease (r =0.236,P =0.041).The activities of creatine kinase in positive expression cohort were higher than that of negative one,but nonsignificantly.Conclusion The expression of myostatin gene mRNA in muscle tissue may not correlate to the entity of atrophic muscular disease because of its great variation.

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Characteristics and clinical value of MRI/1H-magnetic resonance spectroscopy in tumor-like inflammatory demyelinating diseases

Yan HUANG ; Xiuhua MA ; Zhibo XIAO ; Peng XUE ; Sijia ZHANG ; Yong CHEN ; Qiong ZHANG

Chinese Journal of Neurology.2014;47(10):687-690. doi:10.3760/cma.j.issn.1006-7876.2014.10.004

Objective To summarize the magnetic resonance imaging/ 1 H-magnetic resonance spectroscopy (MRI/1 H-MRS) features of tumor-like inflammatory demyelinating diseases (TIDD),and investigate the clinical value of MRI/1 H-MRS.Methods MRI features of 10 cases of TIDD in brain confirmed by pathology were retrospectively analyzed and compared with pathology.Results The lesions mainly located in the white matter with mild mass effect.MRI scan all showed low T1 high T2 signal,and 7 cases showed high signal,3 cases showed slightly high or mixed signals on DWI.Enhanced MRI showed 5 cases with significant enhancement withopen loop sign,4 cases with significant patchy or nodular enhancement,1 case with mild flakes or linear enhancement.Three cases showed expanded blood vessels and plumbed to the lateral wall inside the edge of the lesions.1H-MRS performance showed 4 cases all with significantly increased Lac and Lip; 3 cases with rised glutamate and glutamine complex β,γ-Glx peaks,reduced N-acetylaspartate acid (NAA),increased Cho to varying degrees.All pathological changes were demyelination,perivascular inflammatory infiltration and reactive gliosis,hypertrophy and abnormal mitotic figure.Seven cases could be seen obesity glial cells.Conclusions TIDD had its salient MRI features:lesion had obvious edema and mild mass effect,MRI enhancement showed open loop sign and small veins expansed,on perfusion-weighted imaging it showed low perfusion.1H-MRS showed β,γ-Glx peaks,Lac and Lip peaks significantly increased,NAA slightly reduced,Cho mildly elevated.Comprehensively analyzing the MRI and 1H-MRS features,combined with clinical manifestations,contribute to the diagnosis of the disease.

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The characteristics of clinical manifestations, brain MRI and cerebrospinal fluid findings in patients with anti-N-methyl-D-aspartate receptor encephalitis

Feifei HE ; Jing YE ; Kai DONG ; Xiaoling ZHAO

Chinese Journal of Neurology.2014;47(10):691-694. doi:10.3760/cma.j.issn.1006-7876.2014.10.005

Objective To analyze the clinical manifestations and the features of brain MRI and cerebrospinal fluid (CSF) findings in adult Chinese patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Methods We reviewed the clinical manifestations,brain MRI and CSF examinations of 29 patients who were diagnosed as anti-NMDAR encephalitis.Results The major clinical features of anti-NMDAR encephalitis patients included psychiatric symptoms (86％,25/29),seizures (83％,24/29),decreased consciousness (55％,16/29),involuntary movements (55％,16/29),central hypoventilation (34％,10/29),and hypersalivation (17％,5/29).Some patients also experienced autonomic instability,hemiplegia and aphasia.Underlying ovarian teratoma was identified in 14％ of affected patients(4/29).Brain MRI was found abnormal in up to 62％ patients (18/29),located in the temporal lobes,hippocampus,thalamus,brain stem,cingulate gyrus,frontal and parietal cortex,corpus callosum,internal capsule,basal ganglia and periventricular area.CSF findings were abnormal in 83％ of patients with anti-NMDAR encephalitis.Oligoclonal banding in CSF was positive in 95％ patients (19/20).The recurrence rate during 3 years was 31％ (9/29).Conclusions Anti-NMDAR encephalitis is a treatable disease,yet with high recurrence rate.Its predominant clinical features are psychiatric symptoms and seizures,while involuntary movements,central hypoventilation and hypersalivation are its characteristic manifestations.Lesions in MRI are widespread,not only restricted to limbic lobe.

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Clinical and magnetic resonance imaging analysis of 13 patients with hypertrophic cranial pachymeningitis

Junjun SHEN ; Changming GENG ; Wenhua ZHU ; Langfeng SHI ; Xiang HAN ; Qiang DONG

Chinese Journal of Neurology.2014;47(10):695-700. doi:10.3760/cma.j.issn.1006-7876.2014.10.006

Objective To investigate clinical presentations,laboratory examinations,magnetic resonance imaging (MRI) appearances and treatment of hypertrophic cranial pachymeningitis (HCP).Methods The clinical data of 13 patients with HCP receiving comprehensive therapy in Huashan Hospital from January 2007 to January 2013 were analyzed retrospectively.Results The onset of HCP was mostly chronic with an average duration of 26.7 months.The main clinical manifestations of the 13 patients were chronic headaches (12/13) and cranial nerve paralysis (12/13).Inflammation markers and cerebro-spinal fluid (CSF) protein levels increased in patients with HCP and gradually became normal after the treatment.The MRI demonstrated local or diffused thickened dura located in tentorium (10/13),falx cerebrum (5/13),frontal lobe (4/13),temporal lobe (7/13) and parietal lobe (4/13).The signal intensity was isointense on T1-weighted MR images and hypointense on T2-weighted MR images.Enhanced MR images showed conspicuous enhancement of the dural edges.Corticosteroid therapy improved the clinical symptoms in 12 of 13 patients.Conclusions HCP typically causes headache and paralysis of multiple cranial nerves.Enhanced MRI shows characteristic manifestations.At present corticosteroid therapy is the treatment of choice followed by immunosuppressive agent and radiotherapy.

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Association of chronic kidney disease and cerebral microbleeds in patients with ischemic stroke

Qing PENG ; Yining HUANG ; Wenhong LIU ; Ran LIU ; Wei SUN

Chinese Journal of Neurology.2014;47(11):747-751. doi:10.3760/cma.j.issn.1006-7876.2014.11.002

Objective To investigate the association between the presence of cerebral microbleeds and chronic kidney disease in patients with ischemic stroke.Methods Patients with ischemic stroke within 1-6 months were consecutively recruited.Cranial MRI was taken within two weeks after recruitment.Cerebral microbleeds were assessed using Microbleed Anatomical Rating Scale on gradient echo MRI.Demographics including sex,age and risk factors were obtained.Chronic kidney disease was defined and classified according to National Kidney Fundation-Kidney Disease Outcome Quality Initiative Guideline.Glomerular filtration rate (GFR) was estimated by using the abbreviated Modification of Diet in Renal Disease equation.Results Of the 636 patients included,mean age was (59.8 ± 10.1) years,435 (68.4％) were male.Sixty-six had decreased estimated GFR (eGFR; ＜ 60 ml · min-1 · 1.73 m-2).Two hundred and one (31.6％) patients had cerebral microbleeds,which were most commonly located in deep or infratentorial location (133/201,66.2％).The presence of cerebral microbleeds was much higher in patients with decreased eGFR than the others (48.5％ (32/66) vs 29.6％ (169/570),x2 =9.709,P =0.002).Age,history of hypertension and decreased eGFR were associated with the presence of cerebral microbleeds in univariate analysis.In multivariate analysis,decreased eGFR was independently associated with the presence of cerebral microbleeds in deep or infratentorial location (OR =1.457,95％ CI 1.044-2.034,P =0.027),but not associated with the presence of cerebral microbleeds in pure lobe.Conclusion Impaired kidney function is associated with the presence of cerebral microbleeds in deep or infratentorial regions in patients with ischemic stroke.

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The clinical characteristics of children with splenium of corpus callosum solitary lesions displayed on MRI

Chaoyang LI ; Chunhua LI ; Jie YANG

Chinese Journal of Neurology.2014;47(12):852-856. doi:10.3760/cma.j.issn.1006-7876.2014.12.008

Objective To explore the prominent clinical features and the prognosis of corpus callosum solitary lesions cases in children.Methods There were 16 cases with corpus callosum solitary lesions receiving treatment at our hospital from January to December 2013.All of the clinical features were collected and retrospectively analyzed.Results The 16 cases aged 1 year to 13 years with an average age of (3.44 ± 3.65) years.The causes of the disease included the viral encephalitis,convulsions,and rotavirus infection.The most prevalent disorders were convulsions (10 cases),gastrointestinal symptoms (8 cases),fever (8 cases),positive cervical resistance (6 cases),fatigue (5 cases),altered states of consciousness (2 cases),headache (1 case),and dizziness (1 case).Corpus callosum lesions lasted for 13-50 days,with an average of (28.8 ± 10.2) days.Cranial magnetic resonance showed the splenium of the corpus callosum with isolated oval lesions,low signal on T1 weighted images and apparent diffusion coefficient images,high signal on T2 weighted images and diffusion weighted images.Conclusions The splenium of the corpus callosum lesions of children occur in a lower rate than adults with the etiology including intracranial infection,convulsions and rotavirus infection.Main clinical manifestations include fever,convulsions and gastrointestinal symptoms (nausea,diarrhea,etc).The cases followed-up showed the lesions and symptoms are reversible,and the prognosis is good.

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Reference jitter values in voluntarily activated extensor digitorum communis muscle recorded with concentric needle electrode

Jianwen WANG ; Fang JI ; Benyan LUO

Chinese Journal of Neurology.2014;47(12):857-860. doi:10.3760/cma.j.issn.1006-7876.2014.12.009

Objective To validate the technique and establish the reference jitter values in voluntarily activated extensor digitorum communis using a concentric needle electrode (CNE) in healthy Chinese adults.Methods From January to August 2013,forty-two Chinese subjects from healthy examination center of our hospital were prospectively studied,including 20 males and 22 females.Routine electromyogram was tested and jitter was recorded with CNE in all subjects.The jitter values of action potentials pairs of muscle fibers were expressed as the mean consecutive difference (MCD) after 20 analyzed potential pairs.Results The mean MCD of 42 subjects was (23.0 ± 3.1) μs ranging from 17 to 32 μs.The mean jitter value of all 840 potential pairs was (22.8 ± 7.5) μs ranging from 8 to 54 μs.Upper 95％ confidence limits for mean MCD and individual MCD were 29.2 μs and 37.8 μs,respectively.The mean value of MCD of 20 males and 22 females were (23.2 ± 2.8) μs and (22.8 ± 3.4) μs,respectively.There was no statistic difference between genders in MCD (t =0.44,P =0.66).There was no correlation between age and MCD (r =0.11,P =0.48).The mean value of mean interpotential interval was (802 ± 139) μs ranging from 541 to 1 160 μs.Conclusion The present study confirms the suitability of jitter analysis with CNE,which can serve as an objective and valuable method for testing the function of neuromuscular conjunctions.

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