29 February 2020, Volume 37 Issue 2

    

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Journal of Apoplexy and Nervous Diseases
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  Clinical and imaging characteristics of convexal subarachnoid hemorrhage complicated with acute cerebral infarction

  BI Zhuajing, CAO Yayun, CAO Jie, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 100-103.

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  Objective　To analyze and summarize the clinical and imaging characteristics of the patients with convexal subarachnoid hemorrhage complicated (cSAH) with acute cerebral infarction,and also to discuss the etiology,mechanisms and prognosis of this disease.Methods　Data from eight patients diagnosed as cSAH with acute cerebral infarction were analyzed.The clinical representation,imaging features,therapy and prognosis were observed.Results　Eight patients had a mean age of 58 years (range,43~68 years),and half of them were male.The main cause is large artery atherosclerosis,and this disease also can be observed in amyloid cerebrovascular disease,cardiogenic embolism,cancer radiotherapy,moyamoya disease and unknown cause.Clinical onset of the disease is characterized by conscious disturbance,headache,limb movement and sensation disorder,aphasia and limb convulsion.All patients were presented with continuous or transient limb movement and/or sensation disorder.Six cSAH cases were associated with ipsilateral acute cerebral infarction,and the other two cSAH cases with contralateral acute cerebral infarction.Six cases were presented with internal carotid artery stenosis or occlusion.All patients received timely symptomatic and etiological treatment.Antiplatelet treatments were given for three patients with large artery atherosclerosis stroke and anticoagulation therapy was initiated for patient with cardioembolic stroke.All patients had a favorable outcome (90 days modified Rankin scale score≤2),and no recurrence occurs.Conclusion　cSAH with acute cerebral infarction is characterized by various clinical manifestations and different etiologies.The most common cause is large artery atherosclerosis stenosis or occlusion.cSAH can not only occur at the same side of the infarct territory,but also at the opposite side of infarction.The patients generally can obtain good outcome after the early symptomatic and etiological treatment.
  
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  Correlation between serum Adropin protein and severity and prognosis of patients with hypertensive intracerebral hemorrhage

  QIAO Weidong, JIANG Zhenzhong, YUN Wang, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 104-107.

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  Objective　To investigate the correlation between serum Adropin protein expression and the severity and prognosis of patients with hypertensive intracerebral hemorrhage.Methods　Patients with hypertensive intracerebral hemorrhage who were treated in our hospital from January 2016 to January 2018 were enrolled.One hundred patients were enrolled in the study group.One hundred healthy subjects were included as control group.Serum Adropin protein levels were measured and analyzed.The relationship between the levels of Adropin protein and the disease condition and prognosis in patients with hypertensive intracerebral hemorrhage.Results　The study group finally included in 97 cases.The control group finally included in 99 cases.The expression levels of Adropin protein in the study group were lower than that in the control group (P<0.05).The expression levels of Adropin protein were significantly different in patients with different severity of disease (P<0.05).The expression levels of Adropin protein in patients with hypertensive intracerebral hemorrhage with different prognosis were statistically significant (P<0.05).Univariate analysis showed that age,severity of disease,amount of bleeding,and whether it broke into the ventricle were the prognostic factors of hypertensive cerebral hemorrhage (P<0.05).Multivariate logistic regression analysis showed that Adropin protein,age,severity of disease,and whether bleeding broke into the ventricle were independent factors affecting the prognosis of patients with hypertensive intracerebral hemorrhage (P<0.05).Conclusion　Serum Adropin protein is associated with the severity and prognosis of patients with hypertensive intracerebral hemorrhage.Serum Adropin protein is an independent factor affecting the prognosis of patients with hypertensive intracerebral hemorrhage.
  
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  The mechanism of omega-3 unsaturated fatty acid DHA on β-amyloid-induced memory impairment in mice

  LU Bing, LIU Zhou, ZHENG Xifeng, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 108-111.

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  Objective　To analyze the effects of omega-3 unsaturated fatty acid DHA on memory in mice model with Alzheimer’s disease (AD).Methods　 Thirty-six mice were randomly divided into sham operation group (sodium carboxymethyl cellulose gavage),Aβ model group (sodium carboxymethyl cellulose gavage) and Aβ+DHA group (DHA gavage).AD mice model were established by injecting oligomeric Aβ1-42 into the hippocampus of 36 mice by Aβ-intrahippocampal injection method.The memory function of mice were observed by Morris water maze test and the changes in hippocampal neurons of AD rats were determined by Nissl’s staining;In the hippocampus,the content of TNF-α and IL-16 were measured by ELISA and the expression of BDNF,IFN-γ and NF-κB protein were detected by Western blot.Results　Compared with sham operation group,prolongation of latency prolonged,the number of crossing platform and the expression of BDNF protein decreased,while TNF-α content,IL-16 content,IFN-γ protein expression and NF-κB protein expression increased in Aβ model group and Aβ+DHA group.Compared with the Aβ model group,the latency shortened,the number of crossing platform and BDNF protein expression increased,while the TNF-α content,IL-16 content,IFN-γ protein expression and NF-κB protein expression decreased in Aβ+DHA group,the differences were all statistically significant (P<0.05).Conclusion　DHA can improve memory impairment in AD mice induced by Aβ1-42,and its mechanism may be related to decreasing the content of TNF-α and IL-16,inhibiting the expression of IFN-γ and NF-κB,and promoting the expression of BDNF protein in hippocampus.
  
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  A systematic analysis of endovascular treatment for symptomatic non-acute intracranial artery occlusion

  TONG Xu, MA Ning, GAO Feng, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 112-117.

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  Objective　We aimed to systematically review the clinical research status of endovascular recanalization for symptomatic non-acute intracranial artery occlusion.Methods　Literature search was carried out in PubMed database up to October 2019 for the case series published in English on endovascular treatment for symptomatic non-acute intracranial artery occlusion.Two reviewers independently screened literature according to inclusion and exclusion criteria,extracted and pooled data of included studies.Then univariate and multivariate logistic regression models were used to explore the risk factors of successful recanalization,intraoperative complications,postoperative restenosis/reocclusion and clinical adverse events.Results　A total of 15 case series were finally included involving 190 patients.The results of pooled-analysis demonstrated that the frequencies of successful recanalization,intraoperative complications,postoperative restenosis/reocclusion and clinical adverse events were 87.9%,20.7%,15.8% and 16.3%,respectively.The successful recanalization rate of patients with occlusion time ≥ 1 month was lower than that of patients with occlusion time <1 month (75.0% vs 95.9%,OR=0.13,95% CI=0.04~0.45,P<0.01).As compared with the low-volume center,the high-volume center had a lower risk of clinical adverse events (8.6% vs 25.0%,OR=0.28,95% CI=0.10~0.77,P=0.01).Conclusion　Our study suggests that the successful endovascular recanalization rate of symptomatic non-acute intracranial artery occlusion is relatively high,but intraoperative complications,postoperative restenosis/reocclusion and clinical adverse events cannot be ignored.Moreover,occlusion time and operator’s experience may the success or failure of treatment.However,owing to limited quality and quantity of the included literatures,our findings still need to be verified by conducting more high quality studies.
  
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  Meta-analysis of butylphthalide soft capsules combined with aspirin in treatment of acute cerebral infarction

  KONG Jingmin, LIU Changying, ZHU Shanshan, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 118-122.

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  Objective　To evaluate the efficacy and safety of butylphthalide combined with aspirin in treatment of acute cerebral infarction.Methods　CNKI,Wanfang,VIP,sinomed,PubMed,Cochrane library databases were searched by computer from the building time to October 2019.According to the inclusion and exclusion criteria,the eligible RCT was selected and Meta-analysis was carried out by Revman 5.3 soft ware.Results　A total of 1375 cases were included in 15 articles.The results from Meta-analysis demonstrated that the cure rate of the treatment group was superior to that of the single drug ［RR=1.56,95% CI (1.16,2.10),Z=2.93 (P=0.003)］,additional other treatments［RR=1.99,95% CI(1.30,3.05),Z=3.16(P=0.002)］;the effective rate of the treatment group was superior to that of the single drug［RR=1.41,95%CI(1.22,1.64),Z=4.52(P<0.00001)］,additional other treatments［RR=1.24,95%CI(1.12,1.38),Z=4.07(P<0.0001)］;the NHISS score of the treatment group was lower than that of the single drug［MD=-2.79,95%CI(-3.72,-1.86),Z=5.86(P<0.00001)］,additional other treatments［MD=-2.70,95%CI(-3.54,-1.85),Z=6.26(P<0.00001)］.There was no significant difference in safety between the two groups.Conclusion　Butylphthalide combined with aspirin is effective and safe in the treatment of acute cerebral infarction.
  
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  Study on the correlation of adrenal immunity in EAMG rat model

  WANG Jing, FANG Lijie, LIU Ying, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 123-128.

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  Objective　To investigate the correlation of adrenal glands in EAMG rats and the treatment mechanism of prednisone,to elucidate the pathogenesis of EAMG.Methods　Thirty-six lewis rats were randomly divided into model group,control group and prednisone group,with 12 rats in each group.Observe Lennon score of EAMG rats in each group,and detect serum AChR-Ab level of EAMG rats by ELISA.Detect expression of IFN-γ mRNA、TGF-β mRNA、TNF-mRNA、IL-2 mRNA、IL-4 mRNA、IL-17 mRNA in adrenal gland by PCR.Results　Compared with the control group,the expressions of IFN-γ mRNA、TGF-β mRNA、IL-4 mRNA in the adrenal glands of the model group were decreased,while the expressions of TNF-α mRNA、IL-17 mRNA were increased in significant differences.Compared with the model group,the expression of IFN-γ mRNA in the adrenal glands of the prednisone group decreased,while the expression of TGF-β mRNA、IL-4 mRNA、TNF-α mRNA、IL-4 mRNA、IL-17 mRNA increased.There was no expression of IL-2 mRNA in the adrenal glands of EAMG rats.Conclusion　Prednisone can effectively improve the Lennon score of EAMG rats,reduce the serum AChR-Ab level of EAMG rats,protect the expression of TGF-β mRNA、IL-4 mRNA in adrenal cells of EAMG rats,and reduce the expression of TNF-α mRNA、IL-17 mRNA、IFN-γ mRNA in adrenal cells of EAMG rats,which may be one of the mechanisms of its treatment for MG.
  
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  Association between methylation of promoter region of ABCG1 gene and acute cerebral infarction

  ZHANG Guangwei, LIU Dan

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 129-133.

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  Objective　To investigate the relationship between methylation of promoter region of ATP binding cassette transporter G1 (ABCG1) gene and acute cerebral infarction.Methods　Eighty-four patients with acute cerebral infarction (case group) and 90 non-cerebral infarction patients (control group) who admitted to our department at the same time were selected.The methylation expression of ABCG1 gene promoter region in peripheral blood of case group and control group was detected,and the correlation between ABCG1 gene promoter region and cerebral infarction was discussed.Results　The positive rate of ABCG1 promoter methylation in case group was significantly higher than that in control group (P<0.01).The positive rate of ABCG1 promoter methylation was positively correlated with acute cerebral infarction (r=0.318,P<0.01),and was an independent risk factor for the onset of acute cerebral infarction (OR=3.047,95%CI=1.439~6.454,P<0.01).Conclusion　 The methylation status of promoter region of ABCG1 gene is correlated with the occurrence of acute cerebral infarction,and may be an independent risk factor for the occurrence of cerebral infarction.By detecting the methylation status of promoter region of ABCG1 gene.We can provide evidence for the early diagnosis of acute cerebral infarction and provide some theory for the gene diagnosis and treatment of cerebral infarction.
  
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  Technology of intraoperative ultrasound in peripheral intracranial aneurysm clipping

  ZHANG Hua, LEI Binsong, XU Liqin, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 134-137.

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  Objective　To evaluate the clinical significance of intraoperative ultrasound assisted clipping of peripheral intracranial aneurysms.Methods　The clinical data of 14 patients with distal intracranial aneurysms treated by craniotomy and clipping with intraoperative ultrasound-assisted technique were retrospectively analyzed as experimental group.The clinical data of 13 patients with distal intracranial aneurysms (without intraoperative ultrasound-assisted technique) treated by craniotomy and clipping were compared between the two groups.Results　The average operation time and hospitalization days of 14 patients in the experimental group were shorter than those of 13 patients in the control group;the incidence of complications of 14 patients in the experimental group was lower than that of 13 patients in the control group;the average GOS prognosis score of 14 patients in the experimental group was higher than that of 13 patients in the control group,the statistics were all P<0.05.Conclusion　Intraoperative ultrasound-assisted clipping of distal intracranial aneurysms can guide the accurate localization of lesions,shorten the operation time and hospitalization days,reduce injury and postoperative complications,and improve the prognosis of patients.
  
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  Correlation between cognitive impairment in Alzheimer’s disease and uric acid and homocysteine

  PAN Ting, TANG Qiqiang

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 138-141.

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  Objective　To investigate the relationship between cognitive impairment of Alzheimer’s disease and serum Uric acid (UA) and Homocysteine (Hcy) concentrations in the patients.Method　We collected 39 cases of geriatric cognitive impairment hospitalized in the department of neurology of anhui provincial hospital from September 2018 to May 2019,and 22 normal control cases with no significant differences in age,gender and education level，the levels of serum uric acid and homocysteine were measured in both groups,and neuropsychological tests including MMSE and MoCA were conducted.Results　The MMSE score (17.54±4.71) and MoCA score (11.41±4.48) of the case group were lower than that of the control group MMSE score (27.82±1.84) and MoCA score (23.27±3.23),the difference between the two groups was statistically significant (t=9.801,P<0.05,t=10.895,P<0.05) in the case group,UA was 325.16±80.19,Hcy was 14.37±7.37,in the control group,UA was 258.47±71.06,and Hcy was 8.91±2.61.The differences between the two groups were statistically significant (t=-3.246,P<0.05,Z=4.316,P<0.05);Hcy level was negatively correlated with MMSE and MoCA(R=-0.490,P<0.05).The UA value in the case group was positively correlated with MMSE and MoCA (R=0.573,P<0.05,R=0.624,P<0.05).Conclusion　Hyperhomocysteine is a risk factor for cognitive impairment,which is positively correlated with cognitive function.UA is positively correlated with patients cognitive function,especially with visual space and executive ability,and uric acid level may be related to the disease process of cognitive impairment.
  
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  Analysis of clinicopathological characteristics and curative effect in lipid storage myopathy

  KANG Juan, DRNG Yanchun, XU Yuqiao, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 142-146.

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  Objective　To explore the clinical manifestations,pathological characteristics and therapeutic responses of lipid storage myopathy (LSM).Methods　The clinical information of 22 LSM patients were collected and analyzed retrospectively.Results　Proximal limb muscle weakness and motor intolerance were observed in all patients.The concentrations of creatine kinase in blood were found increased to various degrees in 20 cases.EMG examinations showed myogenic damage in 18 cases.Muscle pathology examination of 22 cases showed increased lipid droplets in the muscle fibers.Follow-up data was available for 20 of all the patients after treatment.Nineteen cases were treated with low-doses prednisone,18 cases with riboflavin and 6 cases with L-Carnitine.All patients showed distinct degree of improvement of clinical symptoms within a month.After treatment for 3 months,8/22 patients were recovered except for 2 patients who were relapsed.And repeated treatment was effective.Conclusions　LSM is a curable disease.It is recommended to avoid fever,fatigue and other triggering factors.In the absence of genetic testing,riboflavin,L-carnitine,and prednisone should be used empirically.In the presence of genetic testing,targeted therapy should be performed based on gene mutations.
  
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  Analysis of clinical characteristics of nerve injury caused by the abuse of nitrous oxide (N2O)

  LIU Caixia, CHEN Qiuhui, TIAN Zhimin, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 147-149.

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  Objective　To analyze clinical features of nerve injury caused bythe abuse of nitrous oxide.Methods　We retrospectively analyzed the clinical data of eight patients with nitrous oxide poisoning and summarized their clinical features.Results　Eight patients with nitrous oxide poisoning were all young and middle-aged with a history of exposure to nitrous oxide.Peripheral nervous system was impaired in eight patients,central nervous system was impaired in five patients,autonomic nerve was impaired in two patients,and two patient had neuropsychiatric symptoms.Vitamin B12 deficiency and homocysteine elevation were detected in eight patients.High doses of vitamin B12,methylcobalamin or adenosine cobalamin were effective.Conclusion　Long-term consumption of N2O can lead to megaloblastic anemia,nervous system injury and even fatal.
  
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  Clinical characteristics of 30 patients with gamma-aminobutyric acid-B receptor (GABAB) encephalitis

  ZHANG Qiaoman, WANG Chengze, Ma Congcong, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 150-153.

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  Objective　To explore the characteristics of clinical presentations，cerebrospinal fluid (CSF),magnetic resonance imaging (MRI) and prognosis of the anti-GABA-B receptor encephalitis.Methods　The clinical data of 30 patients with anti-GABA-B receptor encephalitis were collected.To analysis the characteristics of clinical features，CSF,cranial MRI features and prognosis.Results　Among the 30 patients,eighteen were male,and the mean age at presentation were 58 years (range:15~84 years).Seizure was the most common initial symptom.The major clinical features include seizure (26,86.67%),mental and behavioral disorders (26,86.67%),cognitive dysfunction (24,80.00%).CSF cytology test showed that the lymphocytic pleocytosis and the elevated white blood cell counts can be indicative of this disease.Magnetic resonance imaging showed abnormality in the medial temporal lobe and hippocampus in ten patients （35.71%).The disease is closely related to lung cancer (Especially small cell lung cancer,SCLC).During a median follow-up period of 11 months,thirteen patients died.Nine of the patients died with tumors.Conclusions　The major clinical features of anti GABA-B encephalitis was seizures.Inflammatory response signals in the medial temporal lobe and hippocampus are image features of this disease.It is closely related to lung cancer (Especially small cell lung cancer,SCLC).Almost half of the patients had poor outcome.
  
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  MiR-134 expression in peripheral blood in patients with epilepsy

  WANG Xiaoshuang, GUO Qi, ZHU Yafei, et al

  Journal of Apoplexy and Nervous Diseases. 2020, 37(2): 154-157.

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  Objective　To investigate the difference and significance in the expression of miR-134 in peripheral blood of patients with epilepsy.Methods　Trizol was used to extract serum RNAs of patients with epilepsy,NCode TM VILO TM micrornas cDNA short Kit and Express Sybr those TM micrornas qRTPCR Kits was used to reverse transcriptions and real-time fluorescent quantitative PCR to detect the expression of miR-134.All cases were grouped according to the course of disease,seizure frequency,onset time limit,brain electrical activity and special epilepsy syndrome.Results　Compared with control group,the expression of miR-134 in peripheral blood of epilepsy group is significantly increased,it is obviously higher in long course group and acute group.The expression of miR-134 in different seizure frequency group and special epilepsy syndrome group has no difference.Conclusion　The expression of miR-134 in peripheral blood of patients with epilepsy was significantly increased while it was affected by the length of disease and the duration of seizure.In addition,the expression of miR-134 in peripheral blood of patients with epilepsy was positively correlated with the degree of discharge and severity of damage,indicating that miR-134 could be a biomarker for epilepsy.