A survey of 37 cases with basal ganglia calcification (BGC): CT-scan findings of BGC and its relationship to underlying diseases and epilepsy

Thirty-seven cases that showed bilateral basal ganglia calcification (BGC) were found in 5987 patients. These cases (0.6%) were studied in relation to their CT findings, underlying diseases and epilepsy. CT findings of BGC were divided into "localized" type (33 cases) and "diffuse" type (4 cases). The number of patients with the "localized" type clearly seemed to increase with age. The M:F ratio of the "localized" type was 1:2. The "localized" type was seen in both idiopathic BGC and familial BGC. The "diffuse" type was seen in hypoparathyroidism only. The specific relationship of these two types of BGC to underlying diseases, however, does not fully agree with results so far reported. We experienced a case with familial BGC during this study that appears to be only the 15th so far reported. Partial epilepsy occurred in 75% of epilepsy with BGC, but there seemed to be no direct relationship between BGC and epileptogenicity.     

基底核钙化与节段性颅颈肌张力障碍关系的初步探讨:附90例报告

目的初步探讨基底核钙化(BGC)与节段性颅颈肌张力障碍(SCCD)的关系以及存在BGC的SCCD患者的临床特征。方法回顾性分析2015年3月至2018年9月中日友好医院神经外科收治的90例SCCD患者(试验组)的临床资料。将同期门诊就诊的70例神经科疾病患者(包括30例缺血性脑血管病患者、18例痴呆患者、22例脑出血患者)以及20名健康人作为对照组。采用卡方检验比较两组患者BGC的发生率,并分析存在BGC的SCCD患者的临床特征。结果试验组中BGC的发生率为38.9%(35/90),高于对照组的18.9%(17/90),两组的差异具有统计学意义(χ²=8.762,P=0.003)。存在BGC的SCCD患者中的女性患者所占比例(31/35)较无BGC的SCCD患者(30/55)更高,差异有统计学意义(χ²=11.353,P=0.001)。BGC在具有不同临床表现的SCCD患者中的比率(例)为:以单纯眼睑痉挛为主要表现的患者中占30.3%(10/33),眼睑痉挛合并口-下颌肌张力障碍的患者中占33.3%(13/39),除上述表现外同时合并颈部症状的患者中占12/18,三组间的差异具有统计学意义(χ²=7.374,P=0.025)。通过对比影像学结果发现,以单纯眼睑痉挛为主要表现的患者基底核区的钙化相对较轻,而同时合并眼睑痉挛、口-下颌肌张力障碍、颈部症状的患者其基底核区钙化程度较重,眼睑痉挛合并口-下颌肌张力障碍的患者基底核区的钙化程度介于上述两类型患者之间。结论BGC与SCCD的发病可能有关;存在BGC的SCCD患者中,女性患者占大多数;受累部位越多,临床表现越复杂的SCCD患者BGC的阳性率越高,且钙化程度相对较重。     

Calcification of the basal ganglia in Down's syndrome and Alzheimer's disease

Summary The prevalance and severity of calcification in the basal ganglia (BGC) has been examined histopathologically in 194 patients divided into ten diagnostic categories. The prevalence and severity of BGC was greater (for age) in Down's syndrome and in patients under 75 years of age with Alzheimer's disease. The severity, but not the prevalance, of BGC was greater in Down's syndrome than in patients of similar age with Alzheimer's disease. Both the prevalence and the severity of BGC in patients over 75 years of age with Alzheimer's disease were as expected for age alone. The increased prevalence and severity of BGC in Down's syndrome and in younger patients with Alzheimer's disease appeared not to be related to the presence of dementia or degenerative disease per se, nor was it affected by the presence of cerebral infarction. BGC may result from an age-related disturbance of the structure of arteries within the globus pallidus, which is accelerated (or occurs prematurely) in Down's syndrome and in younger patients with Alzheimer's disease, but probably does not form part of that spectrum of changes that constitutes the pathological basis of Alzheimer's disease.     

Basal ganglia calcification and psychotic symptoms in the very old

BACKGROUND: Basal ganglia calcification (BGC) is associated with psychotic symptoms in young and middle-aged patient samples. METHODS: We studied the cross-sectional relationship between psychotic symptoms and BGC in a population sample of non-demented 85-year-olds, of whom 86 were mentally healthy, 11 had hallucinations or delusions, 21 had mood disorders and 20 had anxiety disorders. BGC was measured using computerized tomography (CT). Mental disorders were diagnosed using DSM-III-R criteria and psychotic symptoms were evaluated using information from psychiatric examinations, key-informant interviews and review medical records. RESULTS: BGC on CT was observed in 19% of mentally healthy and 64% of non-demented individuals with hallucinations or delusions [Odds Ratio (OR) 7.7, 95% Confidence Intervals (CI) 2.9-29.7, p=0.003]. There were no associations between BGC and mood or anxiety disorders. CONCLUSIONS: BGC is strongly associated with psychotic symptoms in very old age, possibly due to a disturbance in the basal ganglia dopaminergic system.     

The high rate of prevalence of CT-detected basal ganglia calcification in neuropsychiatric (CNS) brucellosis

Abstract Of 65 cases presenting with neuropsychiatric manifestations of brucellosis (CNS-brucellosis), 9(13.8%) had CT-detected basal ganglia calcification (BGC). Of these, 5 had meningitis and 4 had psychiatric manifestations as presenting features. The diagnosis of brucellosis was made by the finding of consistent history and physical findings and the presence of significantly elevated antibody litres and/or positive culture in the blood and/or CSF. In all the cases, BGC was in the form of punctate hyperdense non-enhancing shadows with average density 44.5–58.4 and maximum density 49–64HU The calcification was unilateral in 3 cases, bilateral and symmetrical in 4 and bilateral but assymmetrical in 2. None of the cases had other predisposing conditions to BGC and in none of the cases did specific anvtibrucella treatment effect a detectable change in the BGC. The finding of CT-detected BGC in patients coming from areas endemic for brucellosis should alert physicians to the possibility of underlying brucellar infection.     

Basal ganglia calcification and psychosis in 22q11.2 deletion syndrome

Intracerebral calcifications are a facultative symptom of hypoparathyreoidism in 22q11.2 deletion syndrome (22qDS). We describe a patient with 22qDS, basal ganglia calcification (BGC) and psychotic symptoms and discuss the etiological connection of BGC with psychiatric symptoms. Future work needs to determine the prevalence of BGC in 22qDS and psychiatric disorders.     

Short-term plasticity of Bergmann glial cell extrasynaptic currents during parallel fiber stimulation in rat cerebellum

Bergmann glial cells (BGC) enclose the synapses of Purkinje neurons (PN) and interneurons in the molecular layer of the cerebellar cortex. During synaptic transmission, glutamate evokes inward currents in the glia by activation of Ca2+-permeable aminohydroxymethylisoxazole propionic acid receptors (AMPAR) and electrogenic transporters. We describe the plasticity of BGC currents during paired-pulse and repetitive stimulation of parallel fibers in cerebellar slices. Paired-pulse facilitation (PPF) of BGC AMPAR currents was 4-fold, twice that of PN PPF. Experiments with a low-affinity AMPAR antagonist showed an increase in extrasynaptic glutamate concentration during the second pulse of the pair. PPF of glial transporter currents was 1.8-fold, similar to synaptic PPF. Tetanic stimulation revealed that facilitation of BGC AMPAR currents is not sustained during high-frequency stimulation, and substantial depression is observed after a few pulses. Consequently, Ca2+ influx through glial AMPARs would initially be facilitated but subsequently depressed, generating a transient Ca2+ influx in response to a sustained tetanus. This pattern of plasticity may be important in enabling Bergmann glial cell processes to detect and support synapses with high-frequency input. Finally, a new current was observed in BGC during repetitive stimulation. It was blocked by NBQX and intracellular GDP-beta-S, increased by glutamate uptake inhibition, had PPF similar to synaptic PPF, and was unaffected by an inhibitor of fast glial AMPAR currents. The evidence suggests that activation of neuronal AMPARs causes the release of a paracrine messenger to activate a G-protein coupled receptor in the BGC.     

Basal ganglia calcification in BB/E rats with diabetes.

Human diabetes is associated with cognitive impairment and structural abnormalities in the brain such as cerebral atrophy. The aetiology of these abnormalities is not known. The BB/E rat is a well-established model of type 1 (insulin dependent) diabetes. A cohort of 34 BB/E rats with diabetes was divided into three sub-groups according to age (and duration of diabetes). Basal ganglia calcification (BGC) was present in the brains of more than 50% of diabetic animals, but not in any of 37 non-diabetic BB/E rats. BGC occurred more commonly in those animals which had the longest duration of diabetes (p=0.001), such that BGC was present in only 8% of animals with diabetes for 20 weeks, but in 100% of animals with diabetes for 60 weeks. There were no other significant light microscopic neuropathologic changes in diabetic animals. It will be important to investigate the mechanism of brain calcification, whether a similar process occurs in humans with diabetes, and its possible relationship to cognitive decline.     

生物玻璃活性陶瓷复合人骨形态发生蛋白2基因修饰骨髓间充质干细胞

摘要 背景：目前已有将体外培养的骨髓来源间充质细胞与支架复合后修复骨缺损的临床报道,但是由于该类复合材料中缺乏骨生长因子作用,其原位的成骨作用并不十分理想。 目的：观察人骨形态发生蛋白2基因修饰的骨髓间充质干细胞与生物活性玻璃陶瓷复合材料在修复兔颅骨缺损中的原位成骨作用。 方法：复苏冻存的人骨形态发生蛋白2基因修饰的骨髓间充质干细胞,与生物活性玻璃陶瓷复合培养获得人工植骨材料;制备兔双侧颅骨全层骨缺损模型,实验组将人工植骨材料植入骨缺损区,并设置空白质粒转染的骨髓间充质干细胞+生物活性玻璃陶瓷、骨髓间充质干细胞+生物活性玻璃陶瓷、空白组作对照,术后第4,8,12周对植骨区进行大体观察、X射线摄片、组织化学检测和生物化学检测。 结果与结论：转染人骨形态发生蛋白2 的骨髓间充质干细胞与生物活性玻璃陶瓷复合培养的人工植骨材料植入后第4周,骨缺损外周骨质与复合材料之间大部分被高密度阴影充填;第12周,完全被高密度阴影充填;第8周,骨小梁大部分相连成片;第12周,骨小梁粗大,骨髓再生。生物化学检测结果与组织化学检测结果一致,并且成骨效果及成骨活性明显优于对照组。说明携带人骨形态发生蛋白2基因的骨髓间充质干细胞与生物活性玻璃陶瓷复合构成的人工植骨材料基本符合骨组织工程学的要求,在骨缺损区原位具有良好的成骨作用。 关键词：骨髓间充质干细胞;基因转染;生物活性玻璃陶瓷;骨缺损;移植;兔;生物材料 doi:10.3969/j.issn.1673-8225.2010.42.005     

人骨形态发生蛋白2基因转染的骨髓基质细胞复合生物活性玻璃陶瓷

背景：目前已有将体外培养的骨髓基质细胞与支架复合修复骨缺损的临床报道。但是由于该类复合材料中缺乏骨生长因子作用，在原位的成骨作用并不十分理想。 目的：探讨携带人骨形态发生蛋白2基因的骨髓基质细胞复合生物活性玻璃陶瓷材料在修复兔颅骨缺损中的原位成骨作用。 设计、时间及地点：随机对照动物实验，于2005-02/2008-11在辽宁医学院解剖学实验室完成。 材料：生物活性玻璃陶瓷由中国科学院四川成都光电研究所提供，转人骨形态发生蛋白2和转pcDNA3载体的骨髓间充质干细胞由辽宁医学院解剖学教研室骨组织工程研究所保存。 方法：制备兔双侧颅骨骨缺损模型，将基因转染的骨髓基质细胞与生物活性玻璃陶瓷复合培养物植入骨缺损区，术后第4,8,12周对植骨区进行大体观察、X射线摄片、组织切片、组织化学检测。 主要观察指标：①复苏后的转染人骨形态发生蛋白2的骨髓基质细胞的生长特性。②从大体、X射线结果和组织学等方面观察复合材料在原位修复骨缺损的作用。 结果：转染的骨髓基质细胞在细胞形态及增殖特性方面与未转染的细胞无明显差异。扫描电镜显示基因转染的骨髓基质细胞在生物活性玻璃陶瓷表面呈星形紧密排列，长入生物活性玻璃陶瓷孔隙中。复合材料植入免颅骨缺损后，X射线观察术后第4周骨缺损外周骨质与复合材料之间大部分被高密度阴影充填，术后第12周骨缺损外周骨质与复合材料之间完全被高密度阴影充填；光镜观察术后第8周骨小梁大部分相连成片，术后第12周骨小梁粗大，骨髓再生。 结论：基因转染的骨髓基质细胞复合生物活性玻璃陶瓷材料基本符合骨组织工程学的要求，在骨缺损区原位具有良好的成骨作用。 关键词：骨髓基质细胞；基因转染；生物活性玻璃陶瓷；骨缺损     

Effectiveness of Anchoring with Balloon Guide Catheter and Stent Retriever in Difficult Mechanical Thrombectomy for Large Vessel Occlusion

ObjectiveA distal navigation of a large bore aspiration catheter during mechanical thrombectomy (MT) is important. However, delivering a large bore aspiration catheter is difficult to a tortuous or atherosclerotic artery. We report the experience of anchoring with balloon guide catheter (BGC) and stent retriever to facilitate the passage of an aspiration catheter in MT. MethodsWhen navigating an aspiration catheter failed with a conventional co-axial microcatheter delivery, an anchoring technique was used. Two types of anchoring technique were applied to facilitate distal navigation of a large bore aspiration catheter during MT. First, a passage of aspiration catheter was attempted with a proximal BGC anchoring technique. If this technique also failed, another anchoring technique with distal stent retriever was tried. Consecutive patients who underwent MT with an anchoring technique were identified. Details of procedure, radiologic outcomes, and safety variables were evaluated. ResultsA total of 67 patients underwent MT with an anchoring technique. Initial trial of aspiration catheter passage with proximal BGC anchoring technique was successful for 35 patients (52.2%) and the second trial with distal stent retriever anchoring was successful for 32 patients (47.8%). Overall, navigation of a large bore aspiration catheter was successful for all patients (100%) without any procedure related complications. ConclusionOur study showed the usefulness of anchoring technique with proximal BGC and distal stent retriever during MT, especially in those with an unfavorable anatomical structure. This technique could be an alternative option for delivering an of aspiration catheter to a distal location.     

中老年急性脑血管病早期高血糖调治技术 3544例研究

探讨中老年急性脑血管病早期高血糖调治范围及调治方法。方法:年龄40-80岁,发病在48小时之内的急性脑血管病3544例病人被随机分人治疗组和对照组。每组1772例。治疗组依据急性脑血管病早期高血糖调治技术,应激性高血糖恒定在7.00-7.50mmol/L,糖尿病性高血糖稳定在MBGC+1.50-2.00mmol/L.采用8点法和5点法监测血糖,指导胰岛素用量。对照组采用常规治疗方法。观察临床疗效和预后状况。结果:发病后第10、30天,CSS临床疗效评分,治疗组在基本治愈、显效、好转及总有效方面均明显高于对照组(P<0.01),而在无效或恶化以及死亡方面明显低于对照组(P<0.01)。对照组极易发生低血糖,缺血灶扩大,肢体瘫痪加重及混合性卒中,且预后较治疗组差(P<0.01)。结论:中老年急性脑血管病后应激性高血糖者血糖调治在7.00-7.50mmol/L,糖尿病性在MBGC+1.50-2.00mmol/L,可以获得更好的临床疗效。8点法和5点法可以很好地监测血糖水平,指导胰岛素应用。     

具有帕金森样症状患者相关疾病探讨

目的探讨具有帕金森样症状(PLS)患者的相关疾病。方法收集我院近3年来因PLS而住院的78例患者的临床资料(病史、临床表现和辅助检查结果),按中华医学会神经病学分会运动障碍及帕金森病学组制定的诊断标准确定诊断。结果本组78例患者,出院诊断分别为:帕金森病(PD)36例,继发性帕金森综合征(PS)26例(血管性16例、脑外伤后3例、CO中毒后3例、脑炎后2例,杀虫剂中毒后2例),多系统萎缩(MSA)4例,进行性核上性麻痹(PSP)4例,路易体痴呆(DLB)2例,肝豆状核变性(WD)2例,特发性震颤(ET)2例,基底节钙化症(BGC)1例,皮质基底节变性(CBD)1例。结论具备PLS的疾病谱很广,其中PD大约占60%,另有30～40%的非PD患者具有类似表现,称为非典型帕金森综合征(AP),如多系统萎缩(MSA)、进行性核上性麻痹(PSP)、Wilson病(WD)、路易体痴呆(DLB),基底节钙化症(BGC)、皮质基底节变性(CBD)等,容易误诊,应注意鉴别。     

CT evidence of high density area in bilateral striatum secondary to anoxia

We recently observed a patient in whom basal ganglia calcification (BGC) was demonstrated on sequential CT scans only 9 days after the anoxic episode. A 58-year-old woman had a history of diabetes mellitus for 23 years for which she was treated with insulin. She had a operation for retinal detachment under local anesthesia. Two days after the operation, she developed dyspnea, and was referred to our department. She was intubated, and respiratory support was begun. On neurological examination, she was semicomatose, and intermittent spontaneous movements involved in all extremities. The pupils were 3 mm in diameter, equal and responsive. Full doll's eye responses were obtained both horizontally and vertically. Deep tendon reflexes were hyperactive bilaterally without ankle jerks and extensor plantar responses. Arterial blood gas levels revealed a PaO2 of 49 mmHg, PaCO2 38 mmHg: pH 7.16. Serum Ca, P, Mg, Al-p and parathyroid hormone levels were normal. The EEG was isoelectric. Although the initial CT scan was normal, the subsequent CT scan 9 days later showed extensive high density change of the striatum, which was assumed to be BGC due to anoxia was briefly discussed.     

Basal ganglia calcification induced by excitotoxicity: an experimental model characterised by electron microscopy and X-ray microanalysis

Activation of glutamate receptors induces an excitotoxic neurodegenerative process characterised in some brain areas by the formation of calcium precipitates. To examine the pathogenesis of basal ganglia calcification (BGC), an improved procedure of X-ray microanalysis was used to study experimental excitotoxic calcification in the rat. Three weeks after injection of ibotenic acid (IBO) in the rat basal forebrain, calcified inclusions within hypertrophied astrocytes were characterised. They appeared to form part of a filamentous structure localised in the cytoplasm in association with normal mitochondria and other organelles. Larger inclusions were surrounded by reactive microglia. The main inorganic components in these deposits were Ca and P, frequently accompanied by S, Al, Si and K. The shape and Ca/P molar ratio of the large deposits (> 10 μm) indicate that they may be biological apatites. Aluminosilicates were detected as small deposits (< 4 μm) free of other mineral constituents. To our knowledge this is the first report showing that IBO lesion induces brain accumulation of aluminosilicates similar to that described in Alzheimer’s or Fahr’s patients. Our data indicate that precipitation of Ca and Al may reduce their IBO-induced increased concentration. In conclusion, the experimental model and the improved efficiency of X-ray analysis described may help us to understand the pathogenesis of BGC. Received: 3 November 1998 / Revised, accepted: 5 February 1999     

Evaluation of the Intracranial Flow Alteration during Manual Syringe and Continuous Pump Aspiration

GoalsWhile mechanical thrombectomy (MT) has been shown to be effective in the treatment of acute large vessel occlusions, adjunctive measures, such as balloon guide catheters (BGC) and aspiration techniques, are utilized heterogeneously. Clarifying the effects of aspiration applied to the anterior cerebral circulation with proximal flow arrest can shed light on embolic protection during MT.Materials and MethodsManual and pump aspiration were applied through a BGC in a synthetic cerebrovascular model with a 60 ml syringe and a Penumbra pump, respectively. Flow direction was observed during the procedure with fluorescent particles and ultraviolet light. Flow rates were monitored at the simulated internal carotid artery and middle cerebral artery (MCA).FindingsBoth aspiration methods produced retrograde flow in all the modeled cerebrovascular segments. In the syringe aspiration methods, an interval phase occurred during the experimental trial in which suction forces paused and MCA flow became anterograde through posterior communication artery collateral circulation.ConclusionFlow patterns vary with different methods of aspiration. With proximal flow arrest, continuous aspiration methods induce constant retrograde flow in all vessels, whereas manual aspiration demonstrates various flow changes, including periods of anterograde flow during the procedure, which may be less effective at distal re-embolization prevention.     

Comparison of mechanical thrombectomy techniques in an in vitro stroke model: How to obtain a first pass recanalization?

BackgroundSince mechanical thrombectomy (MT) has proven to be effective in the treatment of acute ischemic stroke (AIS), significant research has been dedicated to establishing procedural techniques offering best rate of first pass effect (FPE). In this study, we compared the efficacy of different techniques in vitro to achieve the first pass recanalisation (FPR).MethodsIn vitro MT procedures were performed using a realistic silicone model of the human cerebral vasculature. The MT with stent retriever (SR) were performed with manual co-aspiration through the respective access catheter and intermediate catheter (IC), with Solumbra or partial retrieval techniques into the IC. Two SRs (Solitaire and EmboTrap) were selected to retrieve both red blood cells (RBC) rich and fibrin-rich clots. FPR rates were recorded for each case.ResultsOverall, 144 MT were performed. FPR rates using the partial retrieval and Solumbra technique were of 100% and 87%, respectively (p = 0.01). The rate of FPR was of 92% using the balloon-guide catheter (BGC) compared to 64% with the guide catheter (GC) (p = 0.0001). With an IC, no differences were found between using a BGC or a GC (87.9% vs 89,6%, p = 0.75). No significant difference was observed between the Embotrap and the Solitaire device for the rate of FPR (82% and 74%, respectively; p = 0.23).ConclusionsIn this study, FPR rates were higher with the use of an IC associated with the partial retrieval technique, regardless the guide catheter, the SR, or the clot composition. The less effective technique was the association of GC and SR, without an IC.     

Regulation of the Na+-dependent high affinity glutamate/aspartate transporter in cultured Bergmann glia by phorbol esters

The effects of phorbol 12-tetradecanoyl-13-acetate (TPA) and dibutyryl cAMP on the glutamate transport present in chick Bergmann glial cell (BGC) cultures were examined. TPA produced a significant decrease in [³H]-D-aspartate uptake, while dibutyryl cAMP treatment elicited a slight reduction in the transport. This effect was dose and time dependent and sensitive to staurosporine, a Ca²⁺/diacylglycerol-dependent protein kinase C (PKC) inhibitor. Long-term exposure of the culture to TPA results in a dramatic fall of the transporter activity and a decrease in the amount of the transporter protein. These findings suggest that PKC is involved in transport modulation and possibly in the regulation of the transporter gene expression. J. Neurosci. Res. 50:585–590, 1997. © 1997 Wiley-Liss, Inc.     

Cognitive and psychomotor function during hypoglycemia: a comparison between porcine and human insulin

After an overnight euglycemic clamp, blood glucose levels were precisely lowered on two nonconsecutive mornings via a glucose-controlled insulin infusion system (GCIIS, Biostator) using either purified porcine insulin (PPI) or human insulin (HI). Two cognitive and psychomotor tests were significantly different in 8 type-I diabetic subjects and 8 healthy volunteers at four timepoints, when mean blood glucose concentrations (BGCs) were 100, 65, 50, and 40 mg/dl. Also, a significant difference (p = 0.005) could be found between the mean of all reaction time testing (RTT) values under HI as compared with the mean of all RTT values under PPI. Lowering the BGC resulted in a significant increase in the reaction time (p = 0.012). These effects were not dependent on the type of insulin being used nor were they typical of a particular study group.     

Two cases of familial idiopathic basal ganglia calcifications (BCG) with non-symptomatic family members

We reported two families each propositus of which exhibited extrapyramidal signs and dementia with bilateral basal ganglia calcifications (BGC), while some of the other non-symptomatic family members showed BCG on brain CT by further examinations. Family 1) A 49-year-old woman was normal until her mid 40s when her memory began to fail. At age 40, dementia, finger-tremor and rigidity were observed and with brain CT and Magnetic Resonance Imaging, BCG and dentate calcifications were found. Her two daughters (20 years old and 26 years old) were free of any neuropsychiatric symptoms, but with CT examinations disclosed BCG. Family 2) A 40-year-old man. His symptoms started at 33 years old. He noticed gradually increasing finger-tremor, rigidity and dysarthria. At 40 years he showed mild dementia and BCG on Brain CT. His mother (64 years old) was non-symptomatic but CT showed that she had BCG. In the two families the calcium, phosphorous and parathyroid hormone levels, and Ellsworth-Howard test were normal. Other specific etiology including infections and somatic abnormalities was not discovered. Familial idiopathic basal ganglia calcification was considered to be rare. But the main purpose of this report is to point out that we must pay attention to the possibility of BCG of non-symptomatic family members if one showed dementia and extrapyramidal signs, and BCG on Brain CT in middle age.