Objective To analyze the causes and manifestations of non-pulmonary embolism induced perfusion defects (PDs) on dual-energy perfusion imaging (DEPI) using dual source CT.Methods Consecutive 208 patients without pulmonary embolism who underwent DEPI were reviewed retrospectively.The causes of PDs were analyzed by two radiologists, the pulmonary segment numbers, the proportion and the perfusion patterns of each case were recorded and analyzed respectively.Results 1 118 of 3 716 pulmonary segments showed the PDs.Among them, 752(67.26%), 36(3.22%), 308(27.55%) and 22(1.97%) pulmonary segments had PDs due to intra-pulmonary lesions, vascular diseases, artifacts and unidentifiable causes, respectively.In PDs resulted from intra-pulmonary lesions, vascular diseases and unidentifiable causes, three patterns (wedge-shaped, heterogeneous and regionally homogeneous) were identified,and most of those PDs were heterogeneous and regionally homogeneous, which were largely in accordance with the lesions showed on non-contrast enhanced scans.Artifacts included the beam hardening artifacts and artifacts caused by heart beat or diaphragmatic movement.The PDs caused by artifacts usually had particular locations and shapes.Conclusion Understanding of the manifestations and causes of PDs in patients without pulmonary embolism can improve the diagnosis accuracy of pulmonary embolism on DEPI.

Objective To discuss the surgical characteristics,safety and perioperative management of carotid stent angioplasty (CSA) for the treatment of severe carotid artery stenosis (＞85％).Methods From December 2011 to May 2016,a total of 25 patients with carotid artery stenosis (＞85％) were treated with CSA.According to the stenotic characteristics of the lesion,distal cerebral protection device was employed in performing CSA.During the operation,attention was paid to individualized and detailed surgical management and perioperative management program;the revascularization and the dropping-off of thrombus in cerebral protection device were under close observation,while effort was made to control the occurrence of complications.The patients were followed up for one year to observe the occurrence of ischemic cerebrovascular events.Results The cerebral protection device was successfully deployed after it passed over the severe carotid artery stenosis.After balloon pre-dilation the stent was deployed,and the stent showed satisfactory shape.North America Symptomatic Carotid Endarterectomy Testing (NASCET) showed that the average degree of carotid artery stenosis was decreased from preoperative (91.0±3.1)％ to postoperative (21.0±5.1)％.The protective umbrella was successfully retrieved in all patients,and deciduous tissue fragments were observed in 6 retrieved protective umbrellas.During the perioperative period no severe complications,such as cerebral hemorrhage,cerebral infarction,hyper-perfusion syndrome or death,were observed.All the 25 patients were followed up for one year,and no transient ischemic attack,stroke or death occurred.Conclusion In treating severe carotid artery stenosis with CSA,in order to ensure a successful surgery and patient's safety the following points are very important:in-operative individualized and detailed management,perioperative preventive measures,and use of appropriate cerebral protection device.

Objective To investigate the clinical efficacy of low molecular weight heparin combined with ginkgo dipyridamole on the patients with acute cardiogenic cerebral embolism .Methods Eighty cases of cardiogenic cerebral embolism admitted into the Department of Neurology of the hospital from July 2015 to July 2016 were recruited as research subjects .With the knowledge of the pa-tients and consent of their dependents , the patients were equally divided into 2 groups: the observation group and the control group , each consisting of 40 patients.After admission into the hospital , the patients of the 2 groups were given the same basic treatment and the treatment for complication prevention .The patients of the observation group received treatment of low molecular weight heparin com -bined with ginkgo dipyridamole for the treatment of acute cardiogenic cerebral embolism , while the patients of the control group were just given low molecular weight heparin .Recovery of neurological insufficiency and clinical efficacy were compared between the 2 groups both before and after treatment , and at the same time, adverse reactions were also observed and compared between the 2 groups.Results After treatment, the neurological function scores of the observation group were significantly higher than those of the control group , and statistical significance could be seen when comparisons were made between them (P<0.05).Total therapeutic efficacy of the observa-tion group was 97.5%, which was significantly higher than that of the control group (67.5%), also with statistical significance (P<0.05).There was no statistical significance in adverse reactions , when comparisons were made between the 2 groups(P>0.05). Conclusion Low molecular weight heparin combined with ginkgo dipyridamole in the treatment of acute cardiogenic cerebral embolism could produce much better effect than single application of low molecular weight heparin .

Objective To investigate and analyze the near and long-term therapeutic effects of intervention therapy on ische-mic cerebrovascular disease ( ICVD) patients and its clinical value .Methods Clinical data of 110 ICVD patients who received treat-ment at our hospital from April 2012 to May 2015 were retrospectively analyzed .In accordance with different regimens , the patients were divided into two groups:the simple drug treatment group (or the control group) (61 cases) and the intervention therapy group (or the observation group) (49 cases).Then, general medical data, comprehensive evaluation scores before and after the treatment and NIHSS scores were compared between the 2 groups.Results There was no statistical significance in the pathologically affected vessels before therapy, when comparisons were made between the two groups (P>0.05).However, statistical significance could all be seen in the damaged vessels, after 3 days and 12 months of treatment (P>0.05).In addition, statistical significance could also be noted in the therapeutic effect of the damaged vessels at day 3 and month 12, when compared with that before treatment(P<0.01).There was no statistical significance in NIHSS scores detected before therapy for the cerebral infarction patients of the groups (P>0.05).Statisti-cal significance could all be noticed in NIHSS scores , after 1, 6 and 12 months of therapy(P <0.01).Conclusion Intervention ther-apy is a safe and effective method for the treatment of ICVD patients , its near and long-term therapeutic effects are superior to those of the pure drug therapy .

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.

Objective To evaluate clinical features,therapeutic effects and outcomes of patients with non-human immunodeficiency virus(HIV)-infected cryptococcal meningitis treated with fluconazole or fluconazole and flucytosine.Methods Twenty-four cases of non-HIV-infected cryptococcal meningitis(fluconazole with or without flucytosine as initial therapy)in Huashan Hospital,Fudan University from 1997 to 2007 were retrospectively reviewed.Clinical manifestations,therapeutic effects and outcomes of the patients were collected.Results Fluconazole was administered with median dosage of 400 mg/d,for a median duration of 20.5 days.After fluconazole initial therapy for 2 weeks,16.7% showed partial response,83.3% showed no response,and the overall response rate was 16.7%.After 10 weeks,33.3% showed partial response,29.2% showed complete response,16.7% showed no response,and the overall response rate was 62.5%.Mortality at week 10 was 20.8%.Twenty-two patients who failed to respond to initial therapy were switched to other antifungal drugs(amphotericin B,amphotericin B colloidal dispersion,itraconazole)or other fluconazole containing combined therapy.Eleven out of the 24 patients died during one-year follow-up,8 of whom died of eryptococcal meningitis,and 3 died of other diseases.Conclusions The initial therapy of fluconazole with or without flucytosine is inefficient,and most of the patients need other antifungal drugs because of initial therapy failure.Therefore,fluconazole might not be appropriate for initial therapy in non-HIV-infected cryptococcal meningitis.

Objective: To investigate the relationship between obstructive sleep apnea hyponea syndrome(OSAHS) and brain vascular diseases in old patients.Methods: Fifty-two old patients with OSAHS were observed by polysomography,dynamic blood pressure measurement and nuclear magnetic resonance.Results: Compared with the healthy controls,the incidence of apoplexy was obviously higher in the severe OSAHS group and the rate of hypertension is significantly higher in both the moderate and severe groups.Conclusion: There are high incidences of hypertension and apoplexy in old patients with OSAHS.