The domestic epidemic of coronavirus disease 2019 (COVID-19) has been significantly improved, but the number of oversea cases and imported cases is on the rise. Relevant prevention and control measures still need to be paid attention to. Botulinum toxin injection is an important method for the treatment of spasticity, dystonia and other diseases. The operation process requires close contact with the patients and there is a risk of infection. In order to meet the needs of patients receiving botulinum toxin injection during the epidemic period, and to guide relevant medical personnel to make reasonable protection, this consensus is hereby formulated to ensure the safety of both doctors and patients.
Primary angiitis of the central nervous system (PACNS) is an uncommon immune-mediated inflammatory disease in which lesions are limited to the small and medium blood vessels of the brain parenchyma, spinal cord and pia mater. Because of its various clinical and neuroimaging manifestations, PACNS has been considered in the differential diagnosis of many diseases. The diagnosis of PACNS is challenging, and the complementation of angiography and brain biopsy is helpful in the diagnosis. Compared with the foreign counterparts, few cases of PACNS had been reported in China, and the level of diagnosis and treatment are far from satisfaction. Therefore, it is urgent to promote the understanding of PACNS among Chinese medical care providers. This paper focuses on the content of Chinese expert consensus on the diagnosis and treatment of PACNS, and combines with the clinical diagnosis and treatment experiences in PACNS, in order to improve the understanding of PACNS.
How to make an accurate diagnose of multiple sclerosis (MS) is a challenging clinical problem. Although many guidelines and consensus have clearly defined the typical imaging characteristics of MS, other neurological diseases are often misdiagnosed as MS due to the interference of untypical manifestations and radiological mimickers in clinical practice. Cerebral small vessel disease (CSVD) is likely to be misdiagnosed as MS due to its similarity in clinical manifestations and radiological pattern. By reviewing the misdiagnosed cases reported in the previous literature, it is found that the atypical imaging manifestations of hereditary CSVD and acquired CSVD can mimic MS and lead to misdiagnosis in satisfying the diagnostic criteria for MS. However, through research in the pathologic mechanism, it reveals that MS and CSVD have corresponding characteristics and there are distinct differences in morphology and distribution of the white matter hyperintensity between MS and CSVD. Such differences in imaging manifestations reflect the discrepancy in the pathogenesis of two kinds of diseases. This paper reviews the cases of CSVD misdiagnosed as MS reported in the previous literature, and discusses the similarities and differences between them from the perspective of imaging features and pathological mechanism, so as to help clinicians better distinguish MS from CSVD and avoid misdiagnosis.
Isolated vertigo is usually caused by perivestibular lesions. Vertigo caused by posterior circulation ischemia is usually accompanied by other local symptoms and signs. However, with the development of neurootology and neuroimaging, more and more isolated central vertigoes caused by cerebellar and brainstem infarction have been diagnosed. About 11% of the patients with isolated cerebellar infarction present with isolated vertigo, nystagmus and postural instability. Positive results of head impulse test (HIT) can distinguish acute isolated vertigo related to cerebellar stroke from benign diseases involving inner ear. Acute vestibular hearing loss may indicate the infarct in the anterior inferior cerebellar artery region. Bedside examinations including head impulse test, nystagmus and test of skew (HINTS) are superior to magnetic resonance imaging. In this paper, the diagnosis of acute isolated vertigo syndrome complicated by brainstem and posterior cerebellar circulation stroke is reviewed.
The decline of cognitive function caused by aging and neurological diseases seriously decreases the ability of daily life and the quality of life in old people. Therefore, it has been paid more and more attention to find effective interventions to improve the cognitive function and quality of life of the old people. Exercise can reduce the risks of Alzheimer disease (AD) and depression, improve the memory and cognitive function, and keep brain healthy, but the underlying molecular mechanism remains unclear. Irisin is a muscle cytokine, which is a cleaved version of fibronectin type Ⅲ domain-containing protein 5 (FNDC5), and the exercise is the main factor to promote the synthesis and secretion of irisin. Irisin can promote the differentiation of neural stem cells, increase the neuroplasticity, and improve the memory and cognitive function. Recent studies have shown that exercise can directly promote the expression of FNDC5 in nerve tissue, and influence the microstructure and function of the brain by peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α)-FNDC5-brain-derived neurotrophic factor (BDNF) pathway. Exercise can also stimulate the muscles and other tissues to synthesize and secrete a large amount of irisin, and promote the brain to secrete BDNF. In view of the important role of irisin in the regulation of nervous system and its close relationship with exercise, this paper reviews the research progress in the mechanism of irisin regulating exercise to promote the brain function.
Objective: To observe the effect of mirror therapy synchronized with bilateral movement training for upper limb complex regional pain syndrome type Ⅰ (CRPSⅠ) after craniocerebral injury.
Methods: A 65 year old patient with CRPS Ⅰ of hemiplegic upper limb after craniocerebral injury received mirror therapy synchronized with bilateral movement training for four weeks. Before treatment, at two weeks and four weeks of treatment and one month of follow-up, the pain [visual analogue scale (VAS)], edema of the affected hand, motor function and joint range of motion (Fugl-Meyer Assessment Scale) of hemiplegic upper limbs, and the differences in temperature between bilateral palms and shoulders were evaluated.
Results: After 2 and 4 weeks of treatment, the pain of the affected upper limb was significantly reduced, the VAS score of the shoulder and hand and the edema of the affected hand were significantly decreased, and the motor function and joint range of motion of the hemiplegic upper limb were significantly improved. After one month of follow-up, these observed measurements improved continuously. After four weeks of treatment, the differences in temperature between bilateral palms and shoulders were significantly reduced compared with those before treatment.
Conclusion: Mirror therapy synchronized with bilateral movement training can significantly reduce the symptoms of CRPS Ⅰ and improve the motor function of the affected upper limb.
