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Diagnosis value of CTA on posterior inferior cerebellar artery aneurysm(report of 2 cases)

Journal of Clinical Neurology.2014;(3):219-221.

Objective To explore the diagnosis value of CTA on posterior inferior cerebellar artery ( PICA ) aneurysm.Methods The clinical data of 2 patients with PICA aneurysms were analyzed retrospectively .Results Two patients were elderly,acute onset,CT confirmed subarachnoid hemorrhage ,CTA of the first time were negative within 3 h after the onset .After the treatments of preventing cerebral vasospasm , increasing blood volume , protecting brain cells and etc for 3-7 d, one case improved ,one case were invalid .Given CTA examination again then found 3 aneurysms, one case with 2 aneurysms located on the left side of the PICA , accompanying with hydrocephalus ,and the other case with 1 aneurysm located on the left side of the PICA .Two patients obtained a good image evaluation and rich information .Conclusions In view of the particularity of the PICA aneurysms , CTA can be used as the preferred method of examination , which can provide comprehensive imaging data .When CTA examination of the first time is negative , giving CTA again remains an ideal choice after short-term treatment .

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Clinical effects of botulinium toxin A local injection treatment for hemifacial spasm

Jiudong XING ; Lijun HAN ; Limei WEI

Journal of Clinical Neurology.2014;(3):228-229.

Objective To investigate the clinical effects of botulinum toxin A ( BTX-A) local injection treatment for hemifacial spasm .Methods Seventeen sites were used to inject BTX-A in 46 patients with hemifacial spasm . Before and after treatment , the grades of facial spasm were evaluated .Clinical efficacy was evaluated based on hemifacial spasm rating 4 weeks after treatment .The recurrence of symptoms in patients given repeated BTX-A injection.Results After BTX-A injection, 15 cases of completely relieved , obviously relieved in 29 cases, partial remission in 2 cases;the efficiency was 95.6%.The onset time was (2.6 ±1.1) d;sustained efficacy was (19.1 ± 2.3)weeks.Injection times was 1 in 5 cases, 2 in 23 cases, 3 in 11 cases and 4 or more in 7 cases.The onset time of repeated injection was(2.61 ±1.03) d, the duration was(19.24 ±2.12) weeks and the efficiency was 100%, They had no significant differences between initial and repeated injection .Six cases occurred local facial mild paralysis, and complete recovery after 2-4 weeks.Conclusion BTX-A local injection for hemifacial spasm is a safe and effective treatment , has no significant adverse reaction;and the effect of repeated injection is not decreased .

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Effect of early tracheal intubation on hypoxemia and level of blood lactate, C-reactive protein in patients with severe intracerebral hemorrhage

Tao WANG ; Lixin LIU ; Yuanhui WEI

Journal of Clinical Neurology.2014;(3):225-227.

Objective To explore the effect of early tracheal intubation on hypoxemia and level of blood lactate, C-reactive protein(CRP) in patients with severe intracerebral hemorrhage .Methods Fifty-four patients with severe intracerebral hemorrhage were divided into routine tracheal intubation (routine intubation group,n=25) and early tracheal intubation group(early intubation group,n=29) radomly.In routine tracheal intubation group, tracheal intubation was performed only when respiratory failure occurred .In early intubation group , tracheal intubation was performed as long as hypoxemia which can not be fixed by inspiring oxygen , tongue retropulsion or vomit occurred . Levels of artery blood gas analysis , lactate and CRP were tested before and after 2 h ( lactate ) or 24 h ( CRP ) of tracheal intubation .Heart rate and respiratory frequency were also monitored .Results PaO2 , PaCO2 , SaO2 and heart rate were markedly improved after intubation in both groups , levels of lactate and CRP were evidently reduced after intubation in both groups(all P<0.05).After intubation, the PaO2 of early intubation group was significantly higner and the CRP of early intubation group was significantly lower than that of routine intubation group ( all P<0.05);Before intubation, the PaO2 and SaO2 of early intubation group were significantly higher and levels of lactate and CRP were significantly lower than those of routine intubation group ( P<0.05 ) .Conclusion Early tracheal intubation can improve hypoxemia and reduce the level of lactate and CRP in patients with severe intracerebral hemorrhage .

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Influence factors of new diagnosed abnormal glucose metabolism in patients with acute cerebral ischemic strokes

Rong SHAO ; Bojun HAN ; Yu KONG

Journal of Clinical Neurology.2014;(3):216-218.

Objective To investigate the influnce factors of new diagnosed abnormal glucose metabolism in patients with acute cerebral ischemic stroke .Methods One hundres and twenty stroke patients without history of diabetes were divide into large artery atherosclerotic stroke (LAA), small arterial occlusive stroke(SAO), cardiac embolic stroke(CES), undeterminined etiology stroke (UND) subgroups according to the Trial of ORG 10172 in Acute Stroke Treatment(TOAST) classfication.The patients were tested oral glucose tolerance test (OGTT) one week later after stroke. The impaired glucose regulation ( IGR ) and diabetes patients called the abnormal glucose metabolism group ,compare related indicators and make multivariate Logistic regression analysis .Results There were 68 patients(56.7%) with normal metabolism, 52 patients (43.3%) with abnormal glucose metabolism.Among them, 38 cases were IGR (31.7%), 14 cases were diabetes (11.7%).The rate of abnormality of impaired glucose metabolism in LAA subgroup(63.8%) was significantly higher than the other subgroups (27.3%-31.4%)(all P<0.05).There was no statistically significant difference between the other subgroups .Compared with normal glucose metabolism group, age, the rate of hyperlipidemian and family history of diabetes were significant higher in abnormal glucose metabolism group (P<0.05 -0.01).Multivariate logistic regression analysis showed that hyperlipidemia ( OR=1.671,95%CI:1.208 -2.311,P=0.012), family history of diabetes (OR =1.421,95%CI:1.114 -1.813,P=0.042) and LAA(OR=2.825,95%CI:1.706-4.674,P=0.023) were independent risk factors of new diagnosed abnormal glucose metabolism in ischemic stroke .Conclusion There is a high prevalence of new diagnosed abnormal glucose metabolism in ischemic stroke .Hyperlipidemia , family history of diabetes and LAA are independent risk factors of it .

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Effects of repetitive transcranial magnetic stimulation on cognitive function in patients with mild cognitive impairmen

Liyong ZHANG ; Liangjin YUAN ; Yu WANG

Journal of Clinical Neurology.2014;(3):203-206.

Objective To explore the effects of repetitive transcranial magnetic stimulation ( rTMS ) on cognitive function in patients with mild cognitive impairmen ( MCI).Methods Fifty patients with MCI were randomly divided into rTMS treatment group ( rTMS group ) and piracetam treatment group ( control group ) , 25 patients in each group .The stimulated point of rTMS treatment were in the bilateral prefrontal area , for one time a day, continuous treatment for 6 d as a courses in rTMS group patients .Two courses of treatment was interval of 3 weeks, a total of 4 courses.The patients of control group were treated with piracetam 0.8 g, 3 times a day, for taking 16 weeks.Before and after treatment, the event-related potentials P300 and Montreal Cognitive Assessment (MoCA) scale examination were taken in two group respectively .Results Compared with before treatment , the P300 latency significant was significantly shortened and amplitude increased , scores of MoCA scale and delay memory were significantly increased (P<0.05-0.01) after treatment in the rTMS group.Compared with the control group, the difference of those had statistical significance ( all P<0.05 ) .The difference of those had no statistical significance before and after treatment in control group .Conclusion rTMS treatment can improve memory and cognitive in patients with MCI .It can delay the progress of dementia to some extent .

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Clinical features of Kennedy desease(Report of 3 cases)

Faying QI ; Naiyong GAO ; Fengyuan CHE

Journal of Clinical Neurology.2014;(3):179-181.

Objective To explore the clinical features of Kennedy disease .Methods The clinical data of 3 patients with Kennedy disease was respectively analyzed .Results All three patients were middle-aged male and had a chronic onset .Patients were mainly presented with the muscle weakness and fasciculation in the proximal limb and bulbar , and the symptoms grow progressively .Two patients were hyperplasia of mammary glands , 3 patients had high levels of serum creatine kinase , and 2 patients'serum testosterone level was increased .EMG detected a widespread neuronal damage in all three cases , and the sensory conductions were abnormal in 2 patients.Repeat numbers of CAG in exon 1 of androgen receptor gene of 2 patients were tested, and they were 57, 47 respectively.Conclusions The clinical features of Kennedy disease are muscle weakness and androgen insensitivity syndrome in male patient and EMG presented with motor neuron damaged .Repeat number of CAG in exon 1 of androgen receptor gene is increased.

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Change of synaptophysin in rat model hippocampal formation after pentylenetetrazol kindling

Yabo FENG ; Hong YAO ; Zhaofu CHI

Journal of Clinical Neurology.2001;14(1):30-32.

Objective　To study the plasticity of hippocampal formation in epilepsy.Methods　The optical density (OD)of synaptophysin positive immunoreactive product was examined by image pattern analysis instrument in hippocampus of pentylenetetrazol induced kindling epileptic rats. The examined areas included CA1,CA3 and the dentate gyrus.Results　The OD of synaptophysin positive immunoreactive product in hippocampal formation of kindling group was higher than the controls,especially in the mossy fiber layer of the area CA3 and the inner molecular layer in the dentate gyrus. Conclusion　The change of synaptophysin resulted from kindling, it also could result in the molecular elements of kindling maintenance.

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Study on the clinic,neuro-electrophysiology and molecular biology of Machado-Joseph disease

Liansheng ZHOU ; Guoxiang WANG ; Yongxing ZHOU

Journal of Clinical Neurology.2001;14(1):16-18.

Objective　To study the clinic, neuro-electrophysiology and molecular biology of Machado-Joseph disease (MJD).Methods　Family visiting, physical examination and the blood samples were analysed on molecular biology in 44 members of a family with MJD.The cases of inpatients were examined on cerebrospinal fluid and neuro-electrophysiology.Results　10 patients of the family attacked,which were consisted with autosomal dominant inheritance type. Age of the onset was 8～38 years old. The clinical characteristic was progressive severe spinocerebellar of ataxia,faciolingual myokymia,bulging eyes.Change of denervated muscle was revealed by neuro-etectrophysiological examination. Light atrophy was observed in cerebellar,brain stem, spinal cord.The genetic defect of MJD was located the long arm of chromosome 14 between D14S280 and D14S81, their distance was 3.0 cm.All tested patients had their CAG repeated expansion from 72 to 84 in the MJD gene.Conclusion　MJD is a neuro-degenerative disorder of autosomal dominant inheritance. The disease was clinically characterized by progressive severe spinocerebellar ataxia, no obvious changes of cerebrospinal fluid,neuro-electrophysiology, CT and MRI.The genetic defect of MJD was located the long arm of chromosome 14.The number of CAG repeated expansion mutation was associated with the age of the onset.

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Clinical features of Kennedy disease with secondary mitochondrial dysfunction and glutaric aciduria typeⅡ(report of 1 case)

Jing BAI ; He Lü

Journal of Clinical Neurology.2015;28(5):377-379.

Objective To investigate the clinical characteristics of Kennedy disease with secondary mitochondrial dysfunction and glutaric aciduria typeⅡ.Methods The clinical data of 1 case Kennedy disease with secondary mitochondrial dysfunction and glutaric aciduria typeⅡwas retrospectively analyzed.Results The patient presented muscle weakness in proximal limbs, fasciculation, bulbar palsy, amyotrophy, postural tremor, sensory disturbance, gynaecomastia, impotency.The level of serum creatine kinase and urinary glutaric acid were elevated. Electromyogram and nerve and muscle biopsy supported mixed damage in peripheral nerves, as well as neurogenic and secondary myogenic pathologic changes in muscles.Gene sequencing indicated trinucleotide CAG repeated amplification for 47 times in chromosome X.Diabetes was diagnosed at 7 years after onset.Conclusions The pathogenesis of Kennedy disease is very complex, which may involve myogenic factor.The treatment to the secondary mitochondrial and lipid metabolic disturbance in muscle can improve the muscle weakness to a certain extent.

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Imaging features and treatments of ischemic cerebrovascular disease with unruptured intracranial aneurysms

Lingfeng WU ; Wenfeng CAO ; Xiaomu WU

Journal of Clinical Neurology.2015;28(5):353-355.

Objective To investigate the imaging features and the treatments of ischemic cerebrovascular disease with unruptured intracranial aneurysms.Methods The clinical data of 23 patients of ischemic cerebrovascular disease with unruptured intracranial aneurysms ( unruptured group) and 147 patients of hemorrhagic cerebrovascular with ruptured intracranial aneurysms ( ruptured group) were retrospectively analyzed.Results There were no statistical significances between the two groups baselines such as age, gender, hypertension, diabetes, hyperlipidemia, heart disease, smoking, drinking alcohol (all P>0.05).There were 16 patients (69.6%) with single intracranial aneurysm and 7 patients (30.4%) with multi-intracranial aneurysms in the unruptured group, and the number of intracranial aneurysms were 34.There were 125 patients (85%) with single intracranial aneurysm and 22 patients ( 15%) with multi-intracranial aneurysms in the ruptured group, and the number of intracranial aneurysms were 170.There was no statistical significance of single aneurysm and multi-aneurysms percentage between the two groups (P>0.05).The maximum aneurysm diameter and the percentage of large aneurysms, dissecting aneurysms of the unruptured group were significantly greater than the ruptured group; and the percentage of small-middle aneurysms and saccular aneurysms were significantly smaller than the ruptured group ( all P<0.05 ) .In the unruptured group, 5 cases were treated with intervention treatment and 1 case was treated with aneurysm clip surgery, all of which recovered well after surgery;6 cases were treated with Plavix antiplatelet therapy, 5 cases were treated with Aspirin antiplatelet therapy, cerebrovascular disease events were not found of which followed-up for 6 months;6 cases were not taken antiplatelet therapy, and 1 case of which followed-up and occurred cerebral infarction.In the ruptured group, 46 cases were treated with intervention treatment, 2 cases of which were died;101 cases were treated with aneurysm clip surgery, 6 cases of which were died.Conclusions Small-middle aneurysms are more commonly occurred in patients of ischemic cerebrovascular disease with unruptured intracranial aneurysm, however, the maximum aneurysm diameter of which is significantly bigger than patiehts of hemorrhagic cerebrovascular with ruptured intracranial aneurysms.Most of unruptured aneurysms which had duty relationship with cerebral ischemic events are dissecting aneurysms and saccular aneurysms.Intervention treatment of unruptured intracranial aneurysms is relatively safe and effective.

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