Diagnosis and clinical manifestations of subacute combined degeneration of the spinal cord： Analysis of 21 cases

BACKGROUND： Subacute combined degeneration of the spinal cord is caused by vitamin B12 deficiency and is a kind of degenerative disease owing the characteristics of nervous system diseases. In addition, different patients have variously clinical manifestations and various prognoses after vitamin B12 therapy. OBJECTIVE： To investigate and analyze diagnosis, clinical manifestations and prognosis of subacute combined degeneration of the spinal cord. DESIGN： Case analysis. SETTING： Department of Neurology, the Third Hospital of Peking University. PARTICIPANTS： A total of 21 subacute combined degeneration of the spinal cord patients including 14 males and 7 females aged from 33 to 82 years were selected from Department of Neurology, the Third Hospital of Peking University from January 1999 to December 2005. Duration from onset to final diagnosis lasted for 1.5 - 108 months. All patients had typically clinical manifestations; meanwhile, level of serum vitamin B12 was decreased and/or vitamin B12 therapy was effective. All patients provided the confirmed consent. METHODS： Clinical data of 21 subacute combined degeneration of the spinal cord patients were retrospectively analyzed, while general data and clinical characteristics were recorded at the same time. Levels of blood routine, serum vitamin B12 and homocysteine were measured at the phase of hospitalization. Normal value of serum vitamin B12 was 187 - 1 059 ng/L and normal value of serum homocysteine was 5 - 15μ mol/L. All patients received neuroelectrophysiological examination and 15 patients received MRI examinations of spinal cord. After final diagnosis, patients were given vitamin B12 therapy. And follow-up was performed to investigate the prognosis. MAIN OUTCOME MEASURES： （1） Levels of blood routine, serum vitamin B12 and homocysteine; （2） results of neuroelectrophysiological examination; （3） results of MRI examination of spinal cord; （4） prognosis. RESULTS： Clinical data of 21 patients and follow-up data of 20 patients were involved in the final analysis and 1 patient was lost because of living in the other province. （1） Clinical manifestations： All 21 patients had typically clinical manifestations. The original symptoms included numbness of lower and/or upper limbs （5 cases）, unstable gait （3 cases）, limb asthenia （4 cases）, limb numbness combined with light asthenia （5 cases）, limb numbness combined with unskillful activity （3 cases）, and limb numbness combined with unstable gait （1 case）. （2） Experimental results： Eight subacute combined degeneration of the spinal cord patients accompanied with mild-severe anemia and mean corpuscular volume of 13 patients were increased. Among 13 subacute combined degeneration of the spinal cord patients not administrating vitamin B12 before hospitalization, the levels of serum vitamin B12 of 2 patients were not measured but those of other patients were decreased. After vitamin B12 therapy,the levels of serum vitamin B12 of 8 patients were normal or increased. In addition, the levels of serum homocysteine of 6 patients were not measured but those of 7 patients were increased. While, the levels of homocysteine of 5 following-up patients were normal. The levels of serum vitamin B12 of 8 patients who received with vitamin B12 therapy before hospitalization were normal or increased. Among them,the levels of bomocysteine were not measured in 4 patients, those of 3 patients were increased, and that of 1 patient was normal. （3） Results of neuroelectrophysiological examination： Among all patients, 95% （20/21） patients had abnormal sensory-evoked potential, 89% （8/9） patients had abnormal motor evoked potential, 67% （10/15） patients had abnormal nerve conduction, 13% （2/15） patients had neurogenic muscle injury showed by electromyography （EMG）, 70% （7/10） patients had abnormal brain-stem auditory evoked potential, and 40% （4/10） patients had abnormal visual evoked potential. （4） Results of MRI examination of spinal cord： MRI examination demonstrated that 40% （6/15） patients had spinal cord lesion, but spinal cord lesion disappeared in 2 patients during follow up. In addition, clinical manifestations of patients were improved after standard vitamin B I2 therapy. CONCLUSION： Nervous system lesion caused by vitamin B 12 deficiency is not only involved in spinal cord, also in peripheral nerve, optic nerve, auditory pathway, etc. Diagnosis of the lesion depends on clinical characteristics and level of serum vitamin BI2. Especially, neuroelectrophysiological examination, measurement of homocysteine and MRI examination of spinal cord are beneficial for diagnosis and evaluation of therapeutic effects.     

Lower and upper motor neuron involvement and their impact on disease prognosis in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis is a fatal neurodegenerative disease characterized by progressive muscle wasting,breathing and swallowing difficulties resulting in patient’s death in two to five years after disease onset.In amyotrophic lateral sclerosis,both upper and lower motor neurons of the corticospinal tracts are involved in the process of neurodegeneration,accounting for great clinical heterogeneity of the disease.Clinical phenotype has great impact on the pattern and rate of amyotrophic lateral sclerosis progression and overall survival prognosis.Creating more homogenous patient groups in order to study the effects of drug agents on specific manifestations of the disease is a challenging issue in amyotrophic lateral sclerosis clinical trials.Since amyotrophic lateral sclerosis has low incidence rates,conduction of multicenter trials requires certain standardized approaches to disease diagnosis and staging.This review focuses on the current approaches in amyotrophic lateral sclerosis classification and staging system based on clinical examination and additional instrumental methods,highlighting the role of upper and lower motor neuron involvement in different phenotypes of the disease.We demonstrate that both clinical and instrumental findings can be useful in evaluating severity of upper motor neuron and lower motor neuron involvement and predicting the following course of the disease.Addressing disease heterogeneity in amyotrophic lateral sclerosis clinical trials could lead to study designs that will assess drug efficacy in specific patient groups,based on the disease pathophysiology and spatiotemporal pattern.Although clinical evaluation can be a sufficient screening method for dividing amyotrophic lateral sclerosis patients into clinical subgroups,we provide proof that instrumental studies could provide valuable insights in the disease pathology.     

重型、特重型颅脑外伤性脑梗死相关危险因素分析

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case - fatality. Methods Gender, age, Glasgow coma scale ( GCS), the presence or absence of basicranial fracture, cerebral hernia or infection, surgical modality, hypotension, and the use of diuretics and hemorheologic agents were recorded and analyzed in 62 PTCI patients ( study group)and 680 patients without PTCI (control group) following severe and extremely severe head injuries.Results GCS, the presence or absence of cerebral hernia and/or infection, hypotension, the use of diuretics and hemorheologic agents were closely correlated with the occurrence of PTCI ( P ＜ 0. 05 ).Conclusion GCS, the presence of cerebral hernia and infection, hypotension, and over - dosage of diuretics are common risk factors for PTCI, and the use of hemorheologic agents is a protective factor of PTCI in patients with severe and extremely severe head injuries.     

银杏叶提取物治疗阿尔茨海默病的Meta分析

OBJECTIVE:To evaluate the effect of Ginkgo biloba extract on Alzheimer’s disease using meta-analysis.DATA SOURCES:The following sources were used for articles concerning Ginkgo biloba extract for the treatment of Alzheimer’s disease:Western biomedical journal literature databases,Chinese Biomedical Literature Database,Chinese Journal Full-text Database,Chinese Science and Technology Journal Full-text database.DATA SELECTION:Randomized controlled trials addressing Ginkgo biloba extract for the treatment of Alzheimer’s disease were selected.The pathway and method of information collection were identical between treatment and control groups.Mild and moderate Alzheimer’s disease patients scoring ≤ 26 points on the mini-mental state examination were included.Subjects met the diagnostic criteria for dementia by the American Psychiatric Association’s "Diagnostic and Statistical Manual of Mental Disorders" Fourth revised edition.The quality of included literature was assessed by two authors.Meta-analysis was performed by RevMan4.2 software which was provided by the Cochrane Collaboration.Heterogeneity,sensitivity analysis,and bias evaluation were conducted.MAIN OUTCOME MEASURES:Scores of mini-mental state examination,ADAS-cog,and Syndrom-Kurztest.RESULTS:The five included randomized controlled trials contained 819 patients.Meta-analysis showed that the Syndrom-Kurztest score was significantly decreased(weighted mean difference =-2.32;95%CI =-3.12,-1.52;P < 0.01) compared with the control group.No significant difference was found in the mini-mental state examination and ADAS-cog score(P > 0.05).However,there was a tendency to elevate mini-mental state examination score and to reduce the ADAS-cog score.CONCLUSION:Ginkgo biloba extract shows good therapeutic effects for mild and moderate Alzheimer’s disease.However,high-quality,randomized,double-blind,and controlled trials are needed to further confirm its therapeutic effects.     

Clinical manifestation, imageological and pathological characteristics of Wernicke encephalopathy

BACKGROUND: The clinical manifestations of Wernicke encephalopathy(WE) are atypical and short of effective auxiliary examination means. The effects of magnetic resonance imaging (MRI) in the diagnosis of WE have been reported successively. But its imageological detection needs to be further investigated. OBJECTIVE: To analyze the characteristics of clinical manifestations, skull MRI examination and pathological results in patients with WE. DESIGN: Retrospective analysis. SETTING: The General Hospital of Chinese PLA. PARTICIPANTS: Ten patients of WE admitted to the Department of Neurology, General Hospital of Chinese PLA were recruited. Among them, five patients were diagnosed pathologically after death. Their pathological changes accorded with the pathological characteristics of WE. The other 5 patients were diagnosed clinically before death. Their pathological changes accorded with clinical and imageological manifestations and had definite reaction to the treatment of thiamine. Ten patients, 7 males and 3 females, were aged (47±13) years ranging from 33 to 73 years. Their disease courses averaged 6 weeks ranging from 3 to 10 weeks. They all were non-alcoholics. Four patients developed WE after acute pancreatitis, two patients after the recurrence of gastric cancer, two patients after cholecystectomy, one patient after hepatitis medicamentosa, one patient after Alzheimer disease. Informed consents were obtained from all the patients and their relatives. METHODS: After admission, clinical manifestations of patients were observed and recorded. Five patients underwent skull MRI examination and their detected results were recorded. Five dead patients underwent autopsy and brain pathological examinations. Neuropathological examination involved cerebrum, cerebellum and brain stem. MAIN OUTCOME MEASURES: Clinical manifestations, MRI examination results, pathological analysis results and prognosis of all the patients. RESULTS: Ten patients with WE were involved in the final analysis. ①Nine patients presented various degrees of mental and conscious disturbance. Six patients initially presented vertigo, nausea, and vomiting. Five patients showed opthalmoplegia. Three patients presented hypotension (BP < 120/60 mm Hg, 1 mm Hg= 0.133 kPa). Two patients showed ataxia. One patient showed severe polyneuropathy. Both lower extremities were more severe. EMG showed axonal degeneration. ②Five patients accepted skull MRI examination. Three patients showed typical high signals in periaqueductal regions and circumference of third and fourth ventriculus in T2 -weighted and flair-weighted images, two of them showed high signals in fornixes in T2 -weighted and flair-weighted images, and one of them showed high signals in optic chiasma, both mammillary bodies, and subcortical white matter. No abnormality was found in the other two patients. Two patients who accepted the supplements of thiamine showed obviously improvements in the second MRI examination. ③Macroscopically, the border between gray and white matters was clear in the coronal section of cerebrum. Congestions, edema and multiple petechial hemorrhages were found in periaqueductal regions, circumference of third and fourth ventriculus, and both mammillary bodies. Microscopically, various degrees of necrosis of parenchymal structures, loss of nerve cells and ischemic changes were found. Myelinated fibers were more affected than neurons. There were focal capillary proliferation and multiple petechial hemorrhages. Prominent astrocytic proliferations were found in gelatinous fiber staining. And demyelinations were found in myelin staining. These pathological findings were all in accord with the diagnostic criteria of WE. ④In the diagnosis before death, 4 of 5 patients who were supplemented with thiamine had obvious improvement 2 weeks later and 1 of them abandoned therapy due to progressive aggravation of jaundice caused by recurrence of stomach cancer. The other 5 patients who were not diagnosed definitely before death and not supplemented with thiamine died. Final diagnosis was performed in autopsy examination. CONCLUSION: The clinical manifestations of this group of WE patients are atypical. MRI and pathological examination results are corresponding, and both have the characteristic manifestations of WE..     

重型、特重型颅脑外伤性脑梗死相关危险因素分析

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case - fatality. Methods Gender, age, Glasgow coma scale ( GCS), the presence or absence of basicranial fracture, cerebral hernia or infection, surgical modality, hypotension, and the use of diuretics and hemorheologic agents were recorded and analyzed in 62 PTCI patients ( study group)and 680 patients without PTCI (control group) following severe and extremely severe head injuries.Results GCS, the presence or absence of cerebral hernia and/or infection, hypotension, the use of diuretics and hemorheologic agents were closely correlated with the occurrence of PTCI ( P ＜ 0. 05 ).Conclusion GCS, the presence of cerebral hernia and infection, hypotension, and over - dosage of diuretics are common risk factors for PTCI, and the use of hemorheologic agents is a protective factor of PTCI in patients with severe and extremely severe head injuries.     

Serum anti-aquaporin 4 antibody in neuromyelitis patients is not correlated with the length of injured spinal cord segments

Clinical information and serum samples of 20 neuromyelitis patients and 30 patients with multiple sclerosis were collected in this study. The expression of anti-aquaporin 4 antibody in the serum of all patients was detected with an indirect immunofluorescence assay, using human embryonic kidney 293 cell line that stably express human-derived aquaporin 4 as a substrate. The characteristics of head and spinal magnetic resonance imaging were also observed in patients who had neuromyelitis and were positive for anti-aquaporin 4 antibody. Results showed that the expression of anti-aquaporin 4 antibody was significantly different between multiple sclerosis patients and neuromyelitis patients. There were 13 out of 20 neuromyelitis patients (including high-risk syndrome) that were positive for anti-aquaporin 4 antibody. The magnetic resonance imaging examinations of the head and spinal cord found that among the 13 positive patients, nine cases showed normal cerebral hemisphere and optic nerve, two cases had optic nerve changes, and one case had an atypical lesion in the brain. All 30 multiple sclerosis patients were negative for this antibody. The experimental findings indicate that patients with neuromyelitis optica had more than three lesioned segments in the spinal cord by magnetic resonance imaging, and the segment length of the injured spinal cord was not associated with the titer of aquaporin 4 antibody in neuromyelitis patients.     

Five-year follow-up of 23 asymmetrical Parkinson’s disease patients treated with unilateral subthalamic nucleus stimulation

In this study, 23 asymmetrical Parkinson’s disease patients were treated with unilateral deep brain stimulation of the subthalamic nucleus and followed up for 5 years. At 5 years after stimulation treatment, Unified Parkinson’s Disease Rating Scale II, III and axial symptom scores in the off-drug condition were significantly increased compared those at baseline. However, total Unified Parkinson’s Disease Rating Scale II, III and axial symptom scores were significantly lower with stimulation-on compared with the synchronous stimulation-off state in off-drug condition, and the motor symptoms of contralateral side limbs were effectively controlled. Only low Hoehn-Yahr stage was correlated with good long-term postoperative improvement in motor symptoms. The mean levodopa-equivalent daily dose after stimulation treatment was significantly lower than that before treatment, but dyskinesias became worse. Our experimental findings indicate that unilateral deep brain stimulation of the subthalamic nucleus is an effective treatment for improving motor symptoms in well selected asymmetrical Parkinson’s disease patients presenting no severe axial symptoms and dyskinesias.     

Gamma-knife for treating pituitary adenomas in 501 cases： Retrospective case analysis

BACKGROUND: Gamma-knife is characterized by low risk and low death rate, without trauma, bleeding or infection. MRI has replaced CT as a method of location, and provides a good choice for treating pituitary tumors. OBJECTIVE: To analyze the effectiveness and complications of 501 cases with pituitary adenoma by using gamma-knife retrospectively. DESIGN: Case-analysis. SETTING: Gamma-knife Center, the 363 Hospital of Chinese PLA. PARTICIPANTS: A total of 501 cases were selected from Gamma-knife Center, the 363 Hospital of Chinese PLA from January 1997 to December 2002. All patients were certainly diagnosed with CT and MRI scanning. There were 186 males and 315 females. Their ages ranged from 15 to 84 years with the mean age of 39 years. All patients provided confirmed consent. METHODS: All 501 cases with pituitary adenomas were treated by gamma-knife or combined with operations. The average iso-dose curve was 50% (30%–65%), peri-dose was 14 Gy and the average target number was 5.17. ① At 35 months after treatment, patients received follow-up including clinical symptoms, imaging symptoms and endocrine symptoms. ② Patients who received second gamma-knife treatment were analyzed and their complications were observed after operation. MAIN OUTCOME MEASURES: ① Follow-up results of clinical symptoms, image and endocrine indexes; ② second gamma-knife treatment; ③ postoperative complications. RESULTS: Among 501 accepted patients, 275 cases were involved in the follow up of clinical symptoms, 154 in image symptoms and 98 in endocrine symptoms. ① Follow-up results of clinical symptoms, image and endocrine indexes: Follow up of clinical symptoms demonstrated that clinical symptoms of 169 cases were relieved, of 68 disappeared, and of 38 deteriorated. Follow-up of image symptoms indicated that pituitary tumor of 25 cases disappeared, of 84 shortened, of 42 not changed, and of 3 enlarged. Follow-up of endocrine symptoms suggested that endocrine of 50 cases was abnormal, of 29 recovery to normal value, and of 19 not changed obviously. ② Second gamma-knife treatment: At 6–24 months after gamma-knife treatment, 15 patients with pituitary tumor received second gamma-knife treatment; especially, one patient received for the three times. The conditions in details were recorded as follows: The peri-dose for the first treatment ranged from 8 to 12 Gy; in addition, that for the second one ranged from 6 to 12 Gy. ③ Postoperative complications: The complications were as follow: hypopituitarism occurred in 2 patients (0.7%); tumor apoplexy in 2 patients (0.7%); weakened eyesight in 5 patients (1.8%); 3 of which recovered with dehydration and hormone treatment; 2 patients received tumor resection and optical nerve decompression operation with dehydration and hormone treatment ineffectively. CONCLUSION: Gamma-knife is effective and safe for pituitary adenoma.     

Combined therapy of telbivudine and pegylated interferon α-2a induced sensory neuropathy:2 case reports

Objective To report the clinical and pathological features of the sensory neuropathy caused by a combined therapy of telbivudine and pegylated interferon α-2a in 2 patients with hepatitis B virus infection Methods Two male patients aged 48(case 1)and 20(case 2),who suffered from hepatitis B virus infection.were given telbivudine and pegylated interferon α-2a.After 4 months treatment,both patients developed numbness and pain in the lower limbs.The physical examination showed decreased pain sensation in distal extremities.Hypahidrosis appeared in distal extremities.The nails were pale changed in fingers and toes in cage 1.Case 2 presented mild weakness in the proximal muscle of lower limbs and the tendon reflex was decreased in both lower limbs.His 8erunl creatine kinase level was mild elevated.The electromyography examination and sural nerve biopsies were performed on both patients.Results Electromyography examination showed significant decrease of amplitude of sensory nerve action potentials and mild decrease of sensory nerve conduction velocities in both patients.The amplitude of motor nerve action potentials was also decreased in case 2.Light microscope examination revealed middle reduction of myelinated fibers,wallerian degeneration of myelinated fibers and small clusbers of regenerated fibers in sural nerve.Electro microscopy examination revealed the loss of unmyehnated nerve fibers.After the combined therapy was stopped and vitamin B,CoQ10 and L-camitine were administered,the patients recovered gradually.Conclusions Combined therapy of telbivudine and pegylated interferon α-2a may cause sensory neuropathy with electrophsiological and pathological abnormalities of axonal lesions.The sensory neuropathy induced by the combined therapy may be reversible.     

中重型颅脑损伤合并颈椎损伤的临床诊断

目的探讨中重型颅脑损伤合并颈椎损伤的临床诊断。方法回顾性分析16例中重型颅脑损伤合并颈椎损伤的临床诊断和影像学检查资料。结果所有患者均行头颅CT和颈椎CT检查,除因伤情严重放弃治疗3例外,余均行颈髓MR检查。头颅CT均有异常发现,颈椎CT发现异常14例;颈椎CT正常,但颈髓MR异常,即无放射影像异常颈髓损伤有2例。结论中重型颅脑损伤患者易合并颈椎损伤,可在头颅CT扫描的同时行颈椎CT扫描,及时行颈髓MR检查可避免漏诊无放射影像异常颈髓损伤。     

重型颅脑损伤术中急性脑膨出原因及处理

目的总结重型颅脑损伤开颅术中发生急性脑膨出的原因及处理。方法对近年我科收治的重型颅脑损伤开颅术中发生急性脑膨出的原因及疗效进行回顾性分析。结果几年来共收治310例GCS3～8分手术的重型颅脑损伤病人，开颅术中发生急性脑膨出29例（9．4％），因急性脑肿胀引起10例（34．5％），因迟发性血肿引起18例（62．1％），其他原因1例（3．4％）；其中急性脑肿胀者死亡10例（34．5％），迟发性血肿者死亡6例（20．7％），总死亡16例（55．2％），植物生存2例（6．9％），重残3例（10．3％），轻残5例（17．2％），恢复正常生活者3例（10．3％）。结论急性脑肿胀与迟发性血肿引起的脑膨出预后不同，前者死亡率几乎达100％，而远隔部位迟发性血肿只要处理及时，预后良好。     

MRI of the brain is safe in patients implanted with the vagus nerve stimulator.

Metallic devices generally represent a contra-indication for MRI scanning. Based on laboratory testing, the neuro cybernetic prosthesis (NCP) is labelled MRI compatible when used with a send and receive head coil. However, there are no published clinical data to support the safety of brain MRI in patients with the NCP. Our objective was to report clinical experience with such a population.We questioned 40 centres that had implanted the NCP system as of 10/1/99. If MRI had been performed on any vagus nerve stimulator patients, we collected information on these patients, the MRI technique used, any events noted during the scan, including both subjective reports (by the patient ), and observable (objective) changes noted by the staff.Twelve centres (30%) responded. Over a time period of 3 years, there were a total of 27 MRI scans performed in 25 patients. All scanners were 1.5 T. A head coil was used in 26 scans, and a body coil in one. The indications for the scans were diverse. Seven were related to the epilepsy, including aetiology or pre-surgical evaluation. Others were unrelated, including brain tumours, cerebral haematoma, vasculitis, headaches, and head trauma. Three scans were performed with the stimulator on, while 24 were performed with the stimulator off. One patient had a mild objective voice change for several minutes. No other objective changes were noted in any of the patients. One 11-year old reported chest pain while experiencing severe claustrophobia. Twenty-five patients denied any discomfort around the lead or the generator.We conclude that this clinical series supports the safety of routine brain MRI using a send and receive head coil in patients implanted with the NCP System.     

Post-traumatic hydrocephalus after ventricular shunt placement in a Singaporean neurosurgical unit

Ventricular enlargement is a common finding after severe head injury and has a poor prognosis if associated with post-traumatic hydrocephalus (PTH). We retrospectively reviewed our head injury database and identified patients who suffered from severe head injury and subsequently had shunt insertion after a diagnosis of PTH. A total of 871 patients with severe head injury were admitted from April 1999 to December 2006. Twenty-three patients (2.6%) were diagnosed with post-traumatic hydrocephalus and had a shunt inserted. Multiple logistic regression analysis showed that age, and unilateral and bilateral decompressive craniectomy, were significant predictors of PTH. The timing of shunt placement was between 2 weeks and 5 months post–head injury with a mean interval of 70 days. Three patients developed complications after shunt insertion. Seventeen patients (74%) achieved improvement after shunt insertion while the remainder had no significant change in neurological status. Eleven patients (48%) had improvements in their Glasgow Coma Scale (GCS) score of ?2 points, while six patients (26%) had a single-point improvement in their GCS score. At 1 year after shunting, 35% of patients had Glasgow Outcome Scale scores of 3 to 4. PTH is a condition that has an insidious onset with varying clinical and radiological presentations. The incidence is low but there is a significant benefit from ventricular shunt insertion. The use of cerebrospinal fluid dynamic studies, in addition to clinical and radiological findings, has the potential for better diagnosis and management of these patients.     

Performance of chronic schizophrenic patients on cognitive neuropsychological measures sensitive to dementia

Although many chronic schizophrenic patients manifest substantial global cognitive impairment, it is not clear as to whether this impairment should be characterized as dementia. Since many degenerative dementias have a characteristic signature of cognitive impairment and a specific pattern of cognitive decline, examination of schizophrenic patients on these measures can provide information about the qualitative similarity of their cognitive impairment to these other conditions. Three hundred and two chronically hospitalized schizophrenic patients ranging in age from 26 to 98 were examined with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery, as well as a more global measure of cognitive impairment, the Mini-Mental State Examination (MMSE). This assessment was repeated twice, with a 1-year follow-up interval. The CERAD battery measures the prototypical cognitive deficits of Alzheimer's disease, including word list learning and delayed recall, naming and praxis. In contrast to Alzheimer's disease, all aspects of cognitive impairment were linearly associated with MMSE scores and there were no qualitatively different patterns of deficits associated with MMSE scores in different ranges of severity. There was no change in performance on any measure across the follow-up period, regardless of the MMSE scores of the patients at baseline. These data suggest that the specific patterns of deficit in chronic schizophrenic patients with severe cognitive deficits differ from Alzheimer's disease in both course and profile of impairment.     

渗透性脱髓鞘综合征的临床和影像学研究(附四例报道)

目的 探讨渗透性脱髓鞘综合征的临床和神经影像特点.方法 对4例渗透性脱髓鞘综合征患者的临床演变过程、CSF、头颅CT和MRI、EEG动态变化特点、治疗及预后进行分析.结果 4例患者均存在低钠血症,纠正后出现精神意识改变、构音和吞咽困难、四肢瘫痪、肌张力障碍等症状,临床过程有双相性.EEG出现一过性的重度异常.头颅CT及CSF均未见异常.MRI特征性影像晚于临床表现10 d以后出现,4例患者首次MRI均为阴性,7～13 d后复查才显示病灶.MRI示4例患者均存在脑桥外髓鞘溶解症病灶,T1WI加权低信号,T2WI加权高信号,对称性地累及双侧尾状核、豆状核、丘脑、脑岛叶皮质、海马头部等部位,其中3例同时存在脑桥中央髓鞘溶解症改变,呈脑桥基底部位对称性T1低、T2高信号的蝶形病灶;Flair加权异常信号更清楚.3例有好转或痊愈,其中1例遗留明显肌张力障碍.结论 渗透性脱髓鞘综合征与慢性低钠血症有关,合并低血钾、低血氯时可能更易发生.治疗时应尽量避免过快纠正,临床病程具有双相性.MRI的特征性改变出现较迟,复查MRI是非常必要的.     

渗透性脱髓鞘综合征的临床和影像学研究(附四例报道)

目的 探讨渗透性脱髓鞘综合征的临床和神经影像特点.方法 对4例渗透性脱髓鞘综合征患者的临床演变过程、CSF、头颅CT和MRI、EEG动态变化特点、治疗及预后进行分析.结果 4例患者均存在低钠血症,纠正后出现精神意识改变、构音和吞咽困难、四肢瘫痪、肌张力障碍等症状,临床过程有双相性.EEG出现一过性的重度异常.头颅CT及CSF均未见异常.MRI特征性影像晚于临床表现10 d以后出现,4例患者首次MRI均为阴性,7～13 d后复查才显示病灶.MRI示4例患者均存在脑桥外髓鞘溶解症病灶,T1WI加权低信号,T2WI加权高信号,对称性地累及双侧尾状核、豆状核、丘脑、脑岛叶皮质、海马头部等部位,其中3例同时存在脑桥中央髓鞘溶解症改变,呈脑桥基底部位对称性T1低、T2高信号的蝶形病灶;Flair加权异常信号更清楚.3例有好转或痊愈,其中1例遗留明显肌张力障碍.结论 渗透性脱髓鞘综合征与慢性低钠血症有关,合并低血钾、低血氯时可能更易发生.治疗时应尽量避免过快纠正,临床病程具有双相性.MRI的特征性改变出现较迟,复查MRI是非常必要的.     

Cerebellar atrophy after severe traumatic head injury in children

Object: The purpose of this study was to describe late neuropathological MRI findings in pediatric severe head injury and to explore the relationship between these lesions and cognitive sequelae. Methods: Thirteen infants with severe head trauma (Glasgow 6) were included in this investigation. Clinical examination, a battery of tests designed to assess neurophysiological status, and MRI investigations of the brain were obtained in periods ranging between 8 and 20 months after the accident. Hemosiderin deposits, encephalomalacia, and cerebellar atrophy were the most frequent traumatic sequelae. The lesions were located in frontal lobes, the basal ganglia, and the cerebellum. Six patients had cerebellar atrophy associated with frontal or temporal postraumatic lesions. Cerebellar clinical dysfunction was observed in only 3 of these patients. Performance on tests evaluating frontal lobe functions was depressed in 5 of them. Conclusions: Late MRI after severe head trauma in our pediatric population showed unexpected cerebellar atrophy. Its correlation with prefrontal dysfunction is difficult to confirm because of its association with other parenchymal post-traumatic lesions. Further research involving a larger sample of patients with brain injury of varying severity is in progress, to investigate whether cerebellar atrophy could be a consequence of severe head trauma. Received: 25 May 2000 Revised: 4 July 2000     

渗透性脱髓鞘综合征的临床和影像学研究(附四例报道)

目的 探讨渗透性脱髓鞘综合征的临床和神经影像特点.方法 对4例渗透性脱髓鞘综合征患者的临床演变过程、CSF、头颅CT和MRI、EEG动态变化特点、治疗及预后进行分析.结果 4例患者均存在低钠血症,纠正后出现精神意识改变、构音和吞咽困难、四肢瘫痪、肌张力障碍等症状,临床过程有双相性.EEG出现一过性的重度异常.头颅CT及CSF均未见异常.MRI特征性影像晚于临床表现10 d以后出现,4例患者首次MRI均为阴性,7～13 d后复查才显示病灶.MRI示4例患者均存在脑桥外髓鞘溶解症病灶,T1WI加权低信号,T2WI加权高信号,对称性地累及双侧尾状核、豆状核、丘脑、脑岛叶皮质、海马头部等部位,其中3例同时存在脑桥中央髓鞘溶解症改变,呈脑桥基底部位对称性T1低、T2高信号的蝶形病灶;Flair加权异常信号更清楚.3例有好转或痊愈,其中1例遗留明显肌张力障碍.结论 渗透性脱髓鞘综合征与慢性低钠血症有关,合并低血钾、低血氯时可能更易发生.治疗时应尽量避免过快纠正,临床病程具有双相性.MRI的特征性改变出现较迟,复查MRI是非常必要的.     

头颅移动CT在NICU的临床应用价值

目的 探讨头颅移动CT在神经外科重症监护室（NICU）的应用价值。方法 我院2013年11月至2014年5月收治入住NICU病人388例,其中颅脑损伤75例,脑肿瘤155例,脑血管病119例,其他39例;共完成1 000例次头颅移动CT扫描。结果 从患者离开床位接受CT扫描至回到原先床位并妥善连接监测和支持设备所需的时间为（8.0±2.5）min,实际CT扫描所需时间为（2.5±0.6）min。200例接受1次移动CT扫描,87例接受2次移动CT扫描,34例接受3次移动CT扫描,67例接受3次以上的移动CT扫描,12例超过10次以上的移动CT扫描。每例患者在NICU接受CT扫描检查平均2.57次。移动CT影像学发现:一般术后改变共420例次,颅内出血共170例次,脑梗死共98例次,脑积水共84例次,脑水肿共106例次,颅内占位共95例次,其他发现共27例次。473例次（47.3%）显示阳性影像学发现（指需要立即干预的颅内病变如肿瘤残余、术区出血、迟发血肿、急性脑积水和脑肿胀等）。没有一个病人因移动CT图像质量问题而被重新送到放射科CT室行CT检查。结论 移动CT可为NICU患者提供及时可靠的影像学诊断,为临床干预提供强有力依据,操作便捷,使用安全。