Sheehan syndrome requires life-long hormone replacement therapy, and discontinuation of medication can lead to a pituitary crisis. We report a case of a patient with Sheehan syndrome who developed loss of consciousness and severe hyponatremia after abruptly discontinuing medication due to coronavirus disease 2019(COVID-19) infection. After resuscitation, the patient gradually regained consciousness but developed slurred speech, unresponsiveness, and muscle weakness five days later. Brain magnetic resonance imaging(MRI) revealed extrapontine myelinolysis. Treatment with gamma globulin and glucocorticoids led to gradual recovery of consciousness, speech function, and muscle strength. The patient regained independent living abilities after six months of rehabilitation. This case underscores the necessity of continuous hormone therapy and highlights the potential risks of abrupt medication cessation in Sheehan syndrome. Additionally, in patients with severe hyponatremia and pituitary crisis, attention should be paid to the speed of serum sodium recovery. Timely recognition and management of neurological complications, such as myelinolysis, are essential for improving outcomes.

Sheehan syndrome requires life-long hormone replacement therapy, and discontinuation of medication can lead to a pituitary crisis. We report a case of a patient with Sheehan syndrome who developed loss of consciousness and severe hyponatremia after abruptly discontinuing medication due to coronavirus disease 2019(COVID-19) infection. After resuscitation, the patient gradually regained consciousness but developed slurred speech, unresponsiveness, and muscle weakness five days later. Brain magnetic resonance imaging(MRI) revealed extrapontine myelinolysis. Treatment with gamma globulin and glucocorticoids led to gradual recovery of consciousness, speech function, and muscle strength. The patient regained independent living abilities after six months of rehabilitation. This case underscores the necessity of continuous hormone therapy and highlights the potential risks of abrupt medication cessation in Sheehan syndrome. Additionally, in patients with severe hyponatremia and pituitary crisis, attention should be paid to the speed of serum sodium recovery. Timely recognition and management of neurological complications, such as myelinolysis, are essential for improving outcomes.

Objective:To investigate the correlation between serum uric acid level and heart rate variability (HRV) in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke admitted to the Department of Neurology, the First Affiliated Hospital of Nanjing Medical University from July 2017 to July 2019 were enrolled retrospectively. They were divided into 4 groups (Q1, Q2, Q3, and Q4) according to the sex-specific serum uric acid quartiles. The demographic data, baseline clinical data, laboratory indicators and HRV recorded by 24-h dynamic electrocardiogram in each group were compared. The independent correlation between HRV time domain parameters RR (normal-to-normal, NN) interval standard deviation (standard deviation of the NN intervals, SDNN), RR interval mean standard deviation (standard deviation of the average NN intervals, SDANN) and serum uric acid level was analyzed through multiple linear regression model.Results:A total of 141 patients were enrolled in the study, including 100 males (70.92%), aged 61.55±12.92 years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 2 (interquartile range: 1-4), and the serum uric acid level was 302.87±73.48 μmol/L. There were significant differences in the NIHSS score ( P<0.034), the proportion of patients with hypertension ( P=0.015), the estimated glomerular filtration rate ( P<0.001), and the HRV time domain parameters (all P<0.001) between each quartile group. The proportion of patients with low HRV (SDNN <100 ms) in the lowest serum uric acid level quartile group was significantly higher than that in other quartile groups ( P<0.05). Multiple linear regression analysis showed that serum uric acid levels were significantly and positively correlated with SDNN (standardized β=0.321, P<0.001) and SDANN (standardized β=0.266, P=0.001). Conclusions:The low level of serum uric acid in patients with acute ischemic stroke indicates that HRV is low, which may suggest that the mechanism of oxidative stress is involved in the decrease of HRV in patients with acute ischemic stroke.

Objective:To investigate the neutrophil to lymphocyte ratio (NLR) and clinical manifestations, imaging manifestations and plasma D-dimer in cerebral venous sinus thrombosis (CVST) patients with headache as the first symptom.Methods:CVST inpatients with headache as the first symptom admitted to the First Affiliated Hospital of Nanjing Medical University from January 2012 to December 2019 were enrolled retrospectively as case group. In the same period, patients with similar headache symptoms and healthy subjects were included consecutively as control group. The differences of demographic data, biochemical indexes, blood routine indexes and plasma D-dimer were compared among the three groups. Multivariate logistic regression analysis was used to identify the independent correlation between NLR and plasma D-dimer and CVST with headache as the first symptom. According to the median NLR, patients with CVST were divided into low NLR group and high NLR group, and the differences in clinical manifestations, imaging manifestations and plasma D-dimer were compared between the two groups. Multiple linear regression analysis was used to determine the independent correlation between the reciprocal of NLR and plasma D-dimer and clinical features. Results:A total of 51 CVST inpatients with headache as the first symptom, 54 headache controls and 53 healthy controls were included in the study. There were significant differences in triglyceride ( P=0.002), fasting blood glucose ( P=0.044), serum albumin ( P=0.013), uric acid ( P=0.010), plasma D-dimer ( P<0.001), proportion of D-dimer negative patients ( P<0.001), mean corpuscular volume ( P=0.015), white blood cell count ( P<0.001), neutrophil count ( P<0.001), lymphocyte count ( P=0.005), monocyte count ( P=0.004), mean platelet volume ( P=0.010), platelet distribution width ( P=0.029), NLR ( P<0.001) and lymphocyte to monocyte ratio ( P<0.001) among the three groups. Post-hoc analysis showed that plasma D-dimer and NLR in the case group were significantly higher than those in the two control groups (all P<0.001). Multivariate logistic regression analysis with the headache control group and the healthy control group as references showed that NLR and plasma D-dimer were significantly and independently correlated with CVST with headache as the first symptom (all P<0.05). According to the median NLR (4.817 6), the case group was divided into low NLR group and high NLR group. The comparison showed that the onset time ( P=0.041), the proportion of patients with headache as the only symptom ( P=0.016) and the proportion of plasma D-dimer negative patients ( P=0.002) in the low NLR group were significantly higher than those of the high NLR group, and the proportion of patients with headache complicated with disturbance of consciousness ( P=0.032), plasma D-dimer ( P<0.001) and fasting blood glucose ( P<0.001) were significantly lower than those in the high NLR group. With the reciprocal of NLR as the dependent variable, multiple linear regression analysis showed that the reciprocal of NLR was independently negatively correlated with plasma D-dimer ( R=-0.521, P<0.001), and independently positively correlated with headache as the only symptom ( R=0.280, P=0.049). Conclusions:NLR was significantly increased in CVST patients with headache as the first symptom. It might help early diagnosis and clinical feature prediction of CVST patients.

Objective To explore the effects of astrocytes in cervical spinal cord posterior horn on allodynia in rat models of migraine.Methods Fifty-four male SD rats were randomly divided into 9 groups (each group n =6): blank group,sham surgery group,new inflammatory soup 3 d group (IS 3 d group),new inflammatory soup 7 d group(IS 7 d group),saline group,fluorocitrate (FCA)prevention group,FCA prevention control group,FCA treatment group,FCA treatment control group.Following the IS stimulation in the rat dual matter,Von-Frey hair was used to monitor the pain threshold of periorbital skin.Immunofluorescence technique was used to observe the expression of specific marker of astrocyte,glial fibrilary acidic protein (GFAP),and neuron activation marker,C-fos.Results ①Von-Frey hair study showed the thresholds of IS 3 d group and IS 7 d group were significantly decreased compared with the control group(3 d:5.3 ±0.3 vs 6.4 ±0.3,F =40.15;7 d:3.0 ±0.3 vs 6.3 ±0.2,F =382.5,both P ＜0.01).The pain thresholds of FCA prevention group and FCA treatment group both began to significantly increase at the day 4 (FCA prevention:5.5 ± 5.1 vs 5.1 ± 0.2,F =16.00 ;FCA treatment:4.3 ± 0.2 vs 3.0 ± 0.2,F =138.0,both P ＜ 0.01).②GFAP immunofluorescence showed that the mean optical density (A) values of IS 3 d group and IS 7 d group were significantly increased compared with the control group(3 d:24.5 ±4.4 vs 14.8 ± 2.5,F =32.54;7 d:38.9 ± 7.1 vs 14.6 ± 1.8,F =63.56,both P ＜ 0.01).()C-fosimmunofluorescence showed that mean A value of IS 3 d group was significantly increased compared with the control group (20.4 ± 2.3 vs 8.4 ± 1.1,F =129.0,P ＜ 0.01).The difference was not significant between the IS 7 d group and the control group.Conclusions Activated astrocytes contribute to the facial allodynia induced by chronic dural inflammation.Its inhibitor FCA could both prevent and treat the allodynia behaviour.All of these suggest that astrocytes may not only contribute to the initiation of mechanical allodynia but also the maintenance.