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25 March 2018, Volume 14 Issue 1
    

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  • ZHANG Ying, GUAN Yangtai
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 1-5. https://doi.org/10.12022/jnnr.2018-0021
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    The 2010 revision of McDonald criteria for the diagnosis of multiple sclerosis (MS) has widely used in research and clinical practice. By combining the progress in scientific research in recent years, the international panel on diagnosis of multiple sclerosis reviewed the 2010 revision of McDonald criteria and recommended new revisions. The following changes have been made: in patients with a typical clinically isolated syndrome (CIS) and clinical or magnetic resonance imaging (MRI) demonstration of dissemination in space, the presence of cerebrospinal fluid (CSF)-specifc oligoclonal bands allows a diagnosis of MS; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial and infratentorial lesions or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. The 2017 revision of McDonald criteria is intended to simplify or clarify components of the 2010 revision of McDonald criteria, so as to facilitate earlier diagnosis. The 2017 revision of McDonald criteria also preserves the specificity of 2010 revesion, and promotes its appropriate application in diverse population to reduce the frequency of misdiagnosis. This paper presents the highlights of 2017 revision of McDonald criteria for the diagnosis of MS and gives some comments.
  • Expert Perspective
  • PAN Weidong
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 6-10. https://doi.org/10.12022/jnnr.2018-0025
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    Central demyelinated disease (CDD) refers to a group of nervous system diseases that occurs in the brain and spinal cord with different causes and different clinical manifestations. Their etiology and clinical manifestations are different, but have the same characteristics. According to modern medicine, the pathological feature of CDD is myelin sheath loss, while neuron cell body and axonal cord remain relatively intact. Due to the absence in description of demyelinated disease in traditional Chinese medicine (TCM), it can be classified according to the different syndromes and different clinical manifestations of CDD. In TCM, it is believed that CDD is closely related to the functions of liver and kidney, and it is also associated with heart and spleen dysfunction. This paper summarizes the essentials and experiences in TCM syndrome differentiation and treatment of CDD, and provides new ideas for the diagnosis and treatment of CDD by TCM and integrated traditional Chinese and western medicine.
  • Expert Comments on Neuroimaging
  • WU Yifan1, WU Hengqu1, LI Jianping1, CHEN Zengai2, GUAN Yangtai1
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 11-17. https://doi.org/10.12022/jnnr.2018-0016
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    Objective: To discuss the clinical and radiological characteristics of multiple glioblastoma multiforme (GBM) and help clinicians to diagnose GBM in early stage.

    Methods: The process of clinical diagnosis and treatment of a patient with multiple GBM was reported. Neurology and imaging experts were invited to discuss the clinical and imaging characteristics of GBM based on literature reviews.

    Results: One patient was diagnosed of multiple GBM with the onset of seizures and a history of transient memory loss. Cerebrospinal fluid (CSF) examination showed no indications for malignant tumors. Cranial magnetic resonance imaging (MRI) demonstrated multiple subcortical lesions which exhibited hypo-intense on T1-weighted image and hyper-intense on T2-weighted image and fluid attenuated inversion recovery (FLAIR) image; there was also hyper-intense on diffusion weighted imaging (DWI) with patchy enhancement. Magnetic resonance spectroscopy (MRS) showed elevated choline level in the lesion sites. The final pathological diagnosis was glioblastoma multiforme, not otherwise specified (NOS).

    Conclusion: GBM is the most prevalent and malignant primary brain tumor and its clinical manifestations are diverse and untypical. Computed tomography (CT) and enhanced MRI examinations show no specificity of the lesions. GBM should be distinguished from cerebrovascular diseases and intracranial metastatic tumors. MRS can analyze the metabolism of the lesions to help identifying the lesions properly.
  • HONG Ronghua1, LIN Yan1, CHEN Gang1, LU Qinchi1, CHEN Zengai2, GUAN Yangtai1
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 18-24. https://doi.org/10.12022/jnnr.2018-0020
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    Objective: To investigate the clinical and imaging characteristics of spinal dural arteriovenous fistula (SDAVF) and improve the understanding of SDAVF in the clinical practice.

    Methods: The clinical diagnosis and treatment of a patient with SDAVF were reported. Neurology and imaging experts were invited to discuss the clinical and imaging characteristics of SDAVF based on literature reviews.

    Results: A SDAVF patient manifested progressive numbness of the right lower extremity and unstable working with numbness starting from the right little toe and propagating upwards along the outboard of the right leg to crissum. The patient developed low back pain and incontinence later. Thoracic spine magnetic resonance imaging (MRI) enhanced scan showed a long central strip with hyper-intensity on T2-weighted imaging below the ninth thoracic vertebrae, and small vascular shadows were enhanced around the spinal cord. Lumbar spine MRI showed the signal of T2-weighted imaging of the conus was increased. A surgical resection for SDAVF under general anesthesia was performed. One and a half years later after the surgery, the symptoms of the patient were alliviated a lot.

    Conclusion: The clinical manifestation of SDAVF is mixed and usually atypical. However, SDAVF should be considered in the elders with slowly progressive myelopathic symptoms. Spinal MRI plays an important role in suggesting the diagnosis of SDAVF. Both clinicians and radiologists should be well aware of the classical MRI characteristics of SDAVF to make the correct diagnosis as soon as possible. Early treatment can improve the prognosis and prevent the symptoms from irreversibility.
  • Review
  • XIAO Yuan, WANG Yue, LI Gang
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 25-32. https://doi.org/10.12022/jnnr.2018-0007
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    Epilepsy is a common neurological disease caused by abnormal discharge of neurons in the brain. There are 70% to 80% of chronic epilepsy patients with cognitive impairment. At present, there is still little attention on the cognitive impairment in epileptic patients. The clinical features, pathogenesis, and influencing factors of cognitive impairment in epileptic patients are not completely clear. This article analyzes the influences of social psychological factors, etiology of epilepsy, epileptic forms and therapy of epilepsythe on the cognitive function of epileptic patients, in order to find out the factors that affect the cognitive
    impairment of epileptic patients, and to find out new strategies to improve the cognitive function of epileptic patients, so as to improve the quality of their lives.
  • HUANG Huan1, 2, SU Weidong1, 2, TAN Hong2
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 33-37. https://doi.org/10.12022/jnnr.2017-0075
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    The early and precise treatment of high-risk non-disabling ischemic cerebrovascular event (HR-NICE) has directly influenced on prognosis, and it attracts more attention. Although intravenous thrombolysis is generally acknowledged as the most effective therapy for ischemic stroke, but it is still in dispute for HR-NICE. This article reviews the domestic and abroad progress in HR-NICE in recent years.
  • LI Na,ZHAN Qing
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 38-41. https://doi.org/10.12022/jnnr.2017-0068
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    Amyotrophic lateral sclerosis (ALS), which has the main syndrome of myasthenia and muscular atrophy, belongs to the category of "flaccidity disease" and "spleen bi" in traditional Chinese medicine. The ALS belongs to the category of "apoplectic aphasia" and "pyretic aphasia with sudamina" with the main syndrome of medullary paralysis. In traditional Chinese medicine, it is believed that the main pathogenesis of ALS is asthenia in origin and sthenia in superficiality, and the five zang viscera can cause flaccidity disease. The most common disease site is spleen and stomach, and the treatment mostly begins with replenishing spleen and stomach. It helps to delay the progression of muscular atrophy and bulbar palsy, and prolong the survival time of patients. In this paper, the historical evolution of ALS is discussed from the point of view of traditional Chinese medicine, and the pathogenesis, diagnosis and treatment of ALS and its research progress are summarized.
  • Case Report
  • HONG Ronghua, DU Yunlan, GUAN Yangtai
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 42-48. https://doi.org/10.12022/jnnr.2018-0013
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    Objective: To improve the understanding of Sneddon’s syndrome (SS) in clinical practice. 

    Methods: The clinical diagnosis and treatment of a patient with SS complicated with splenomegaly and lymphadenectasis were reported. The clinical manifestations, diagnosis and possible mechanism of SS were discussed based on literature review.

    Results: A SS patient firstly manifested recurrent ischemic cerebrovascular accidents followed by livedo racemosa of the skin, accompanying hearing impairment, mild cognition decline, headache and other symptoms. Anti-phospholipid antibody (APA) was negative. Imaging examination showed splenomegaly and lymphadenectasis. Skin biopsy found atypical pathological changes. After treatment with antiplete and circulation-improving drugs, symptoms of the patient were alleviated a lot. 

    Conclusion: SS complicated with splenomegaly and lymphadenectasis is rare. The precise mechanism is unknown, may be related to some antibodies targeting endothelial system, which are different from anti-phospholipid antibodies (APAs) and could not be detected currently. When the symptoms of SS are atypical or unspecific, misdiagnosis or missed diagnosis is likely to happen. With recurrent attacks of stroke, the possibility of severe damage to neurologic
    function and vascular dementia is increased. Therefore, early recognition of SS to make correct diagnosis and treatment as soon as possible is very important.
  • CHEN Haiyan1, LIU Ning2, WANG Tianhong2, WANG Mingyuan1, ZHANG Yanpeng1
    Journal of Neurology and Neurorehabilitation. 2018, 14(1): 49-56. https://doi.org/10.12022/jnnr.2017-0059
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    Objective: To explore the effectiveness and safety of treatment with low molecular heparin combined with warfarin for patients diagnosed of cerebral venous sinus thrombosis (CVT) in puerperium.

    Methods: The clinical diagnosis and treatment of a patient with CVT in puerperium were reported. The clinical characteristics of CVT and the related progress in diagnosis and treatment of CVT were reviewed.

    Results: A patient suffered from headache, vomiting and seizure in puerperium. The lumbar puncture was conducted, showing significantly increased intracranial pressure. The superior magnetic resonance venography (MRV) showed superior sagittal sinus thrombosis. Based on clinical manifestations and examinations, this patient was diagnosed of CVT. Low molecular heparin combined with warfarin were given to the patient, and the condition was effectively controlled.

    Conclusion: For patients with CVT, anticoagulant therapy is safe and effective, and thrombolytic therapy is feasible when it is necessary.