H型高血压患者脑白质病变和脑血流动力学的特点

目的 探讨H型高血压患者脑白质病变（white matter lesions,WML）和脑血流动力学的特点。 方法 回顾性纳入连云港市第二人民医院神经内科住院的WML伴高血压患者,根据Hcy水平,分成 H型高血压组和单纯高血压组。所有患者行MRI检查并采用Fazekas量表评估WML严重程度,TCD检测 颅内动脉并分析其搏动指数（pulsatility index,PI）、平均血流速度（mean blood flow velocity,Vm）等血 流动力学特点。对比分析两组患者WML严重程度和脑血流动力学特点。以正常PI值（0.65～1.10）为界, 将研究对象分为PI正常组与增高组（＞1.10）,采用Logistic回归分析其影响因素。 结果 最终入组217例WML伴高血压患者,年龄40～85岁,平均66.35±8.08岁,男性150例（69.1%）。 其中H型高血压组患者131例（60.4%）。H型高血压组总体脑白质Fazekas评分高于单纯高血压组 （2.45±0.33 vs 2.16±0.36分,P =0.011）;脑室旁Fazekas评分也高于单纯高血压组（1.48±0.12 vs 1.38±0.15分,P =0.009）;两组患者深部白质Faze kas评分差异无统计学意义。H型高血压组大 脑中动脉PI值（1.21±0.20 vs 1.10±0.17,P =0.016）和大脑前动脉PI值（1.16±0.18 vs 1.07±0.18, P =0.023）均高于单纯高血压组。Logistic回归分析显示,H型高血压是大脑中动脉PI值（OR 2.080, 95%CI 1.073～4.033,P =0.030）、大脑前动脉PI 值（OR 1.951,95%CI 1.015～3.749,P =0.045）的独立 影响因素。 结论 H型高血压与WML的严重程度有关,是大脑中动脉、大脑前动脉PI值的独立影响因素。     

Cortical Thickness and White Matter Hyperintensity Changes Are Associated With Sarcopenia in the Cognitively Normal Older Adults

Objective We aimed to explore the impact of sarcopenia on the cortical thickness, white matter hyperintensity (WMH), and subcortical volumes in the cognitively normal older adults. Methods Sixty cognitively normal older adults with and without sarcopenia were enrolled in the study. They underwent T1 and FLAIR magnetic resonance imaging. Information on muscle mass, muscle strength and muscle function were measured using bioelectrical impedance analysis, handgrip strength and 5 time-chair stand test (CST) respectively. Structural magnetic resonance images were analyzed and processed using Freesurfer v6.0. Results Compared to the control group, the sarcopenia group demonstrated reduced cortical thickness in left superior frontal, precentral, right post central, inferior parietal, rostral middle frontal superior parietal and both lateral occipital and paracentral gyrus. Volumes of left hippocampus, and periventricular WMH were also reduced in the Sarcopenia group. In addition, we found a significant positive correlation between the left precuneus thickness and muscle mass. Periventricular WMH volumes were also positively correlated with the 5CST score. Conclusion Sarcopenia affects cortical and subcortical structures in the cognitively normal older adults. These structural changes might be associated with underlying neurobiological mechanisms of sarcopenia in the cognitively normal older adults.     

White matter integrity alterations in post‐traumatic stress disorder

Post‐traumatic stress disorder (PTSD) is a debilitating condition which can develop after exposure to traumatic stressors. Seventy‐five adults were recruited from the community, 25 diagnosed with PTSD along with 25 healthy and 25 trauma‐exposed age‐ and gender‐matched controls. Participants underwent clinical assessment and magnetic resonance imaging. A previous voxel based morphometry (VBM) study using the same subject cohort identified decreased grey matter (GM) volumes within frontal/subcortical brain regions including the hippocampus, amygdala, and anterior cingulate cortex (ACC). This study examines the microstructural integrity of white matter (WM) tracts connecting the aforementioned regions/structures. Using diffusion tensor imaging, we investigated the integrity of frontal/subcortical WM tracts between all three subject groups. Trauma exposed subjects with and without PTSD diagnosis were identified to have significant disruption in WM integrity as indexed by decreased fractional anisotropy (FA) in the uncinate fasciculus (UF), cingulum cingulate gyrus (CCG), and corpus callosum (CC), when compared with healthy non‐trauma‐exposed controls. Significant negative correlations were found between total Clinician Administered PTSD scale (CAPS) lifetime clinical subscores and FA values of PTSD subjects in the right UF, CCG, CC body, and right superior longitudinal fasciculus (SLF). An analysis between UF and SLF FA values and VBM determined rostral ACC GM values found a negative correlation in PTSD subjects. Findings suggest that compromised WM integrity in important tracts connecting limbic structures such as the amygdala to frontal regions including the ACC (i.e., the UF and CCG) may contribute to impairments in threat/fear processing associated with PTSD.     

Reversible Cerebral Periventricular White Matter Changes with Corpus Callosum Involvement in Acute Toluene‐Poisoning

Substance poisoning, such as toluene intoxication, has seldom been reported in the relevant literature. The documented cerebral neuroimaging has mostly described reversible symmetrical white matter changes in both the cerebral and cerebellar hemispheres. This paper presents 2 patients with toluene poisoning, whose brain magnetic resonance imaging studies showed a similar picture that included extra involvement over the corpus callosum; however, such corpus callosum involvement has never been mentioned and is quite rare in the literature. We discussed the underlying neuropathological pathways in this article. Hopefully, these cases will provide first‐line clinicians with some valuable information with regard to toluene intoxication and clinical neuroimaging presentations.