患者男性,56岁,主因"进行左侧肢体力弱5年,右上肢力弱1年"于2019年3月5日入院.患者5年前无明显诱因出现左上肢力弱,远端明显.4年前逐渐出现左下肢力弱,自觉左足行走费力,上下楼、蹲起活动正常.3年前发现双侧乳房发育.近2年间断出现双侧腹部肉跳感.1年前出现右上肢无力,手部力弱为主,伴双手小肌肉萎缩,手部用力时偶有麻木感.近1年出现吐字欠清,偶有饮水呛咳.患者肢体无力缓慢加重,症状无晨轻暮重、波动性特点.否认记忆力及认知减退,无头晕、呼吸困难、二便障碍.既往史、个人史及家族史:高血压、脂肪肝病史.间断少量饮酒30年.其母70余岁时出现肢体无力、震颤,未行基因检测,当地医院诊断"小脑萎缩".其他近3代直系亲属无类似肌无力病史.内科系统查体:心、肺、腹部查体未见异常,男性乳房发育.神经系统査体:神清,构音障碍,舌肌萎缩,可见舌肌纤颤.感觉系统查体无异常.颈屈肌肌力3级,双上肢肌力4级,左下肢4+级,右下肢5级;双侧肩胛带肌及前臂肌肉轻度萎缩;双手大小鱼际肌、骨间肌明显萎缩;双侧肌张力正常,四肢腱反射未引出,可见双上肢肌束震颤及姿势性震颤.双侧共济试验稳准,双侧病理征阴性.

Background:The area postrema syndrome (APS) is a unique diagnostic criterion for neuromyelitis optica spectrum disorders (NMOSD). However, APS has rarely been reported in cases of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). Case presentation:A 36-year-old woman presented with APS and clinical features of diffuse central nervous system involvement during the early stage of the disease. Owing to the absence of serum aquaporin 4 antibodies, she was initially misdiagnosed as a case of seronegative NMOSD. However, the distinct neuroimaging characteristics [symmetrical small punctuate gadolinium enhancing lesions (pepper-like)], typical clinical/radiological relapse, and intense steroid-dependence in this case, prompted us to correct the diagnosis as probable CLIPPERS. To prevent relapse, long-term oral steroids and an immunosuppressive agent were administered. Conclusions:CLIPPERS may present as APS, and should be considered in the differential diagnosis of NMOSD.

Myelopathy with nitrous oxide presents as paralysis and numbness in limb extremities. In imaging, cervical spinal cord damage is common, accompanied by thoracic spinal cord damage. The horizontal axis is more common in the "inverted V-type". Treatment with high doses of vitamin B12 is effective.

Objective To analyze the clinical manifestation,imaging data and genetics mutation variants of late onset familial Alzheimer's disease concomitant with a novel mutation of presenilin 1.Methods The clinical manifestations and auxiliary examination recordings of the pedigree were analyzed.DNA was extracted from peripheral blood samples of the proband and her sons.Mutational analysis was performed by the next-generation sequencing technology and the mutation event was confirmed by Sanger sequencing technology.Results Two patients of the family presenting as Alzheimer's dementia were late onset.MRI of the proband showed extensive cerebral microbleeds.The gene detection showed p.S289P mutation in the exon 8 of presenilin 1 of the proband.Conclusion Mutation of p.S289P in the presenilin 1 gene may contribute to late onset Alzheimer's disease accompanied by amyloid angiopathy.

To the Editor: A 38-year-old man was admitted to our hospital with transient aphasia and weakness of the right extremities. As a habitual smoker, he had been diagnosed with hypertension and hyperlipidemia 3 and 10 years prior, respectively. With regard to family history, he stated that his father had suffered cerebral infarction. On admission, he was found to have abnormal blood pressure (150/90 mmHg; 1 mmHg = 0.133 kPa) and low-density lipoprotein level (3.8 mmol/L). Cranial magnetic resonance imaging (MRI) showed multiple ischemic lesions under both frontal cortices. Common carotid angiograms showed symmetrical anomalies in both external carotid arteries. The facial, lingual, and superior thyroid arteries arose from the ipsilateral common carotid artery [Figure 1a and 1b]. Right internal carotid angiogram showed complete occlusion of the right middle cerebral artery and the formation of moyamoya vessels in the basal ganglia and a persistent primitive trigeminal artery (PPTA) that branched from the C4 portion of the right internal carotid artery and terminated at the upper portion of the basilar artery [Figure 1c]. Left internal carotid angiogram revealed occlusion of the left middle cerebral artery and the formation of a few moyamoya vessels [Figure 1d]. Left vertebral artery angiogram showed that the posterior circulation system provided the compensatory blood supply to the anterior circulation through bilateral posterior communicating arteries and distal cortical branches [Figure 1e]. Computed tomography angiography also revealed the incidental finding of an associated fenestration of the basilar artery [Figure 1f]. The patient was treated conservatively with medications and was discharged two weeks later. His symptoms have not recurred during the follow-up period of one year.Figure 1: (a and b) Common carotid angiograms showed that bilateral facial artery, lingual artery, and superior thyroid artery originated from the ipsilateral common carotid artery; (c and d) internal carotid angiograms showed the complete occlusion of both middle cerebral arteries and the formation of moyamoya vessels and a persistent primitive trigeminal artery (black arrow); (e) left vertebral artery angiogram showed the collateral circulation established from the posterior circulation to the anterior one; (f) computed tomography angiography showed the fenestration of the basilar artery (white arrow).PPTA is a temporary embryonic vascular anastomosis between the carotid and vertebrobasilar arteries, with a reported incidence of 0.03–2.20%.[1] There is a female sex predilection, and it may occur in patients of any age.[2] PPTA generally causes no specific symptoms and occasionally presents with other cerebrovascular variants.[3] Only 14 patients with anastomosis in association with moyamoya disease have been reported, with initial symptoms mainly caused by cerebrovascular diseases.[34] Our case was diagnosed as a transient ischemic attack based on clinical symptoms and cranial MRI, most likely caused by low cerebral blood perfusion due to moyamoya disease. The first and only case of the association of PPTA and fenestration of the basilar artery was reported in 1997 by Hattori et al.,[5] who described a 39-year-old man with acute putaminal hemorrhage with the coexistence of both anomalies. The PPTA in our patient was not only combined with moyamoya disease and fenestration of the basilar artery but also with consolidated symmetrical variations of branches of both external carotid arteries, which has never been reported. What are the clinical implications about these abnormal vascular structures? Although we did not find their inner links among the cerebrovascular anomalies appeared simultaneously in the same patient, we considered this was not an isolated or occasional clinical phenomenon. These vascular anomalies may mainly be associated with abnormal embryonic development, suggesting that numerous variations are possible in cerebral artery development in the human embryo; they may further help us understand the specific cerebrovascular variations and anatomy. Future studies should focus on the existence of such diseases. This would be very useful in the development of in vivo models for researching the pathogenesis of these vascular anomalies. Financial support and sponsorship This study was supported by grants from National Natural Science Foundation of China (No. 81173595), China-Japan Friendship Hospital Youth Science and Technology Excellence Project (No. 2014-QNYC-A-04), and the Research Fund of the China-Japan Friendship Hospital (No. 2015-2-QN-39). Conflicts of interest There are no conflicts of interest.

DOI: 10.3969/j.issn.1672-6731.2016.08.013

A 58-year-old man presented with intermittent white flashes in both eyes during the past year. Six years earlier (2004), the patients received a diagnosis of superior sagittal sinus (SSS) thrombosis on the basis of elevated intracranial pressure and imaging findings, for example, computed tomography, magnetic resonance imaging, magnetic resonance venography, and cerebral angiography, and was treated with urokinase and anticoagulatants. Symptoms resolved and the patient remained well until March 2009, when intermittent white flashes started to occur in both the eyes. The patient did not seek medical help until 1 year later (March 2010). Cerebral angiography (digital subtraction arteriography) revealed SSS thrombosis and a network of collateral venous circulation. Computed tomography and magnetic resonance imaging demonstrated a mass in the parietooccipital lobe that surrounded the SSS. Pathologic examination of the specimen removed during surgery revealed meningioma.

目的 探讨颈动脉支架成形术(carotid angioplasty stenting,CAS)术后持续性血流动力学抑制(persistent hemodynamic depression,PHD)相关的预测因子,总结对这种情况的处理经验,阐明PHD对术后患者预后的影响.方法 连续收集184例患有重度颈动脉狭窄并接受CAS的患者.采用单因素分析及和二分类Logistic回归分析鉴别PHD的预测因子,同时分析PHD对术后缺血性卒中、心脏及肾脏并发症的影响.结果 既往心肌梗死(P=0.04)、术中血管升压药支持(P=0.01)、钙化斑块(P=0.02)及重复血管扩张(P=0.003)是术后PHD的独立危险因素;术中血管升压药支持(P =0.003)、钙化斑块(P=0.04)、重复血管扩张(P=0.02)外,年龄＞80 y(P=0.02)和女性(P=0.01)是术后需要血管升压药使用＞24 h的PHD的独立危险因素.围手术期缺血性卒中、心脏并发症及肾脏并发症的发生率在3组患者中间无差别.结论 老年女性、术中存在HD、钙化斑块及反复球囊扩张是PHD的预测指标.发生PHD的患者给予适当治疗后并不影响患者总体预后.

To the Editor: A 36-year-old man with intermittent migraine-like headache with aura for 20 years underwent cerebrovascular computed tomography angiography (CTA) revealing very small calibers of bilateral internal carotid arteries (ICAs) in other hospital. He was admitted to our hospital for further examination several days later. He had no vascular risk factors, and no family history of atherosclerotic or cerebrovascular diseases. On admission, general physical and neurological examinations were normal and vascular systolic murmur was not detected in the neck. Blood tests, including items relevant to diabetes, dyslipidemia, and vasculitis, were unremarkable. Carotid ultrasound [Figures 1a and 1b] showed small diameters of the bilateral extracranial carotid arteries without arterial wall thickening or atherosclerotic plaque, consistent with CTA findings. Transcranial doppler examination showed increased mean flow velocities (MFVs) in the bilateral posterior cerebral arteries (right, 75.5 ± 1.3 cm/s; left, 73.5 ± 1.3 cm/s) compared with the bilateral middle cerebral arteries in the headache-free period (right, 54.5 ± 2.4 cm/s; left, 57.2 ± 1.9 cm/s) and during the attacks (right, 43.8 ± 1.5 cm/s; left, 46.5 ± 1.3 cm/s). Catheter angiography [Figure 1c–1e] revealed symmetrical hypoplasia along the entire course of bilateral ICAs and development of collateral circulation by the bilateral posterior communicating arteries (PCOMAs). CT of skull base [Figure 1f] revealed hypoplasia of bilateral carotid canals (CCs). Cranial MRI, electroencephalogram, and aortic, renal, and lower extremity angiography were normal.Figure 1: Carotid ultrasound (a, b) showed thin calibers of bilateral carotid arteries [right common carotid artery (CCA), 3.9 mm; Left CCA, 4.1 mm; right internal carotid artery (ICA), 1.6 mm; Left ICA, 1.5 mm]. Catheter angiography (c-e) revealed symmetrical hypoplasia of bilateral internal carotid arteries (arrows) along the entire course and the collateral circulation established from posterior circulation into anterior one by development of bilateral posterior communicating arteries (arrows). Computerized tomography of skull base (f) showed hypoplasia of bilateral carotid canals (arrows).Hypoplasia of the ICA is a rare arterial anomaly with an incidence below 0.01%,[1] whose exact cause of is not known. The probable cause is due to some insult sustained by the growing embryo during the 4th–8th weeks of gestational life.[1] The CC is closely linked to the development of the ICA during embryonic life. Thus the CC is small and not well developed in cases of hypoplasia. The diagnosis of our patient, congenital hypoplasia of the bilateral ICAs is based on its characteristic angiographic findings and the presence of hypoplastic CCs by CT of the skull base. Most patients with this anomaly are asymptomatic, and it is identified only incidentally due to sufficient cerebral collateral circulation, commonly through the bilateral PCOMAs. Symptomatic patients often present with ischemic or hemorrhagic stroke.[1] However, to our knowledge migraine-like headache with aura has not been reported as a symptom of the hypoplasia. The migraine-like headache in our patient may be associated with hypoplastic ICAs. Lovrenciζ et al.,[2] suggested that cerebral hypoperfusion in the posterior circulation due to vertebral artery hypoplasia may induce a migraine aura. Agostoni et al.,[3] noted that migraine with aura may be the outcome rather than the cause of cerebral ischemia, and cerebral hypoperfusion could reduce the threshold for developing spreading depression preceding a migraine aura.[4] An association between decreased cerebral blood flow and migraine or migraine-like headache had been reported.[5] MFVs in the anterior circulation of our patient were obviously decreased owing to hypoplasia of bilateral ICAs, which were lower during the attacks, and therefore we speculated that this might have induced his migraine-like headache with aura. In conclusion, bilateral ICA hypoplasia is a very rare condition. Many cases are probably asymptomatic, being identified only incidentally. However, migraine-like headache with aura may be the sole clinical symptom because of seriously reduced cerebral blood flows.

OBJECTIVETo observe the feasibility and safety of carotid angioplasty stenting (CAS) for high-grade extracranial carotid artery stenosis combined with severe tortuosity.METHODSTwenty patients diagnosed with high-grade extracranial carotid artery stenosis combined with severe tortuosity by cerebral angiography, who were in hospital in neurology department of China-Janpan friendship from June 2011 to June 2014. Twelve of these patients were symptomatic. All cases weren't suit for or disagreed with carotid endarterectomy (CEA) to accept CAS. We retrospectively discussed the rates of technical success, the perioperative complications and clinical improvement. During the follow-up for 4 to 40 months we observed the events of cured carotid artery territory stroke and death, and record the plaque hyperplasia in stent, in-stent restenosis, stent deformation or fracture by color doppler ultrasonography or craniocervical CT angiography.RESULTS(1) The results of operation: the rate of technical success was 19/20 and the rate of the distal protection device placement was 18/20. One stent and 2 distal protection device were difficult to pass the tortuous access vessels. The kinking was the most common in circuity classification of internal carotid artery. The stenosis was significantly improved after stenting, and the mean degree of stenosis was reduced from (82% ± 9%) before stenting to (7% ± 6%) after stenting. Although 5 patients were with perioperative complications, all symptoms disappeared within 1 weeks, and there was no stent related death and disability. There were 4 cases with vascular spasm, one of them was combined with carotid sinus reaction, and anther with transient ischemic attack (TIA) during operation. There was one with ipsilateral carotid territory minor stroke. (2) The results of prognosis and follow up: The clinical symptoms from 12 symptomatic patients were improved significantly on discharge, and the average NIHSS scores on admission were reduced from (4 ± 4) to (2 ± 2) on discharge. One patient experienced ipsilateral carotid territory minor stroke and another patient experienced ipsilateral carotid territory TIA during the follow-up for an average of 19 months, and there were 5 cases with mild plaque hyperplasia in stent and no in-stent restenosis, stent deformation or fracture.CONCLUSIONThe severe tortuosity of extracranial carotid artery may affect the using of intervention materials and increase the complexity of CAS, but for the patients who disagree with CEA or were with the contraindications to CEA, CAS may be still a relatively safe, effective and alternative treatment.

目的 探讨椎基底动脉扩张延长症(VBD)患者发生脑梗死的危险因素,以提高对VBD诊治.方法 对25例经影像学确诊的VBD患者的临床资料进行回顾分析,比较后循环脑梗死组(n=9)与无后循环脑梗死组(n=16)的一般资料、影像学特点等.结果 基底动脉侧向偏移程度在脑梗死组与无脑梗死组间差异有统计学意义(P＜0.05),偏移程度3级发生脑梗死的可能性更高.结论 VBD临床表现多样,表现为后循环脑梗死并不少见,且基底动脉严重侧向偏移可能与其发生脑梗死相关.

OBJECTIVE:To explore the relationship between basal artery hypoplasia (BAH) and posterior circulation ischemic stroke and its clinical characteristics to improve the understanding of BAH.METHODS:A total of 328 hospitalized patients from April 2012 to April 2014 were enrolled retrospectively. With normal course and regular shape of basilar artery on brain magnetic resonance angiography (MRA), other causes of posterior circulation ischemic stroke were excluded. They were divided into BAH (n = 48) and non-BAH (n = 280) groups according to the morphology and diameter of basilar artery on head MRA. We compared the general information and intracranial vascular variations between two groups, especially the incidence rate of posterior circulation infarction and mean blood flow velocity (Vm) of basal artery by analyzing clinical information and MRI findings. Meantime, their clinical outcomes were observed through follow-ups. And detailed clinical features were discussed for the patients with posterior circulation infarction in the BAH group.RESULTS:(1) The concurrent lesions included vertebral artery intracranial segment hypoplasia (n = 24, VAH), fetal type posterior artery (n = 18, FTPA), persistent trigeminal artery (n = 1) and giant fenestration variation on vertebral artery (n = 1) in the BAH group. In comparison, it was more liable to cranial vascular variations in the BAH group (P < 0.05). (2) The incidence rates of posterior circulation infarction for two groups were 35.4% (17/48) and 8.6% (24/280) respectively. In comparison, these cases in the BAH group were more likely to suffer from posterior circulation ischemic stroke (P < 0.05) and the Vm of basal artery in the BAH group was obviously lower than that in the non-BAH group (P < 0.05). (3) these cases with stroke in two groups had no mortality during a follow-up period of 4-28 months. There were 3 cases with recurrent posterior circulation stroke in the non-BAH group. The number of cases with mRS scoring 2 points or less in the BAH group was more than that in the non-BAH group at discharge, 30 or 90 days after discharge (P < 0.05). (4) these cases with posterior circulation stroke in the BAH group often presented as lacunar syndrome (9/17), paramedian infarction in pons (9/17) and bilateral VAH plus unilateral FTPA (8/17).CONCLUSION:As a relatively rare disease, BAH often has other intracranial vascular variants. Posterior circulation stroke occurs due to reduced blood supply of vertebrobasilar system, especially pons infarction. Though with relatively good clinical outcomes, we still need to make an early diagnosis and strengthen stroke prevention.

目的:探讨急性脑梗死患者外周血T、B淋巴细胞亚群和自然杀伤细胞(NK细胞)数量的变化及其临床意义.方法:用流式细胞仪直接荧光抗体染色法检测29例急性脑梗死患者和29例体检健康人员的外周血CD3+(T)％、CD3+CD4+(Th)％、CD3+CD8+(Ts)％、Th/Ts、CD16+56+(NK)％、CD19+CD5+(B1)％和CD19+CD5-(B2)％.结果:急性脑梗死患者发病后外周血Th％、Th/Ts和B2％的均值较正常对照组显著升高(P＜0.05);Ts％和NK％的均值较正常对照组显著降低(P＜0.05).结论:急性脑梗死患者发病初期,T淋巴细胞总数较正常人群低,Th/Ts较正常对照高;B淋巴细胞总数较正常人群高,B2比B1升高更多;NK细胞较正常人群低.

Objective Toinvestigatetheoperativeeffectandsafetyofendovascularstentingfor thetreatmentofsymptomaticvertebralarteryostialstenosis.Methods Fortypatientswithsymptomatic vertebral artery ostial stenosis and stenosis rate ≥70% were admitted to the Department of Neurology, China-Japan Friendship Hospital from November 2010 to January 2013 were enrolled retrospectively. All patients received endovascular stenting therapy,15 of them were implanted bare metal stents,and 25 were implanted drug eluting stents. The technical successful rate of operation,perioperation complications,and symptom remission rate of the patients were analyzed. At the same time,stroke and death incident as well as the related ischemic symptoms of the stent vascular feeding area in the follow-up period (13 to 36 months)wereobservedandtherestenosisratewasdocumented.Results Atotalof42stentswereimplanted in 40 patients,and the technical success rate was 100. 0%. The preoperative stenosis rate of vertebral artery ostial stenosis was 75% to 99%(mean 85 ± 7%);the postoperative stenosis rate was 0% to 20%(mean 6 ± 4%). There was no perioperative complication. The clinical symptoms of 19 patients disappeared completely,16 were improved significantly within the follow-up period,and the symptom remission rate was 87. 5%. No stent vascular feeding area related stroke and death occurred. Four patients had transient ischemic attack in posterior circulation,13 had restenosis after procedure (10 of them with bare mental stents and 3 with drug eluting stents). There was significant difference in restenosis rate between the bare mental stents andthedrugelutingstents(10/15vs3/25,P=0.001).Conclusion Endovascularstentingforthe treatment of the severe symptomatic vertebral artery ostial stenosis is a safe and efficient method. Although its restenosis rate is high,but it can improve the symptom of posterior circulation ischemia effectively.

Objective:To investigate the efficacy and safety of endovascular stenting angioplasty in preventing ischemic stroke in patients with extracranial artery stenosis.Methods:We treated 280 patients with extracranial artery stenosis in the hospital from June 2005 to May 2009.Of them,180 carotid artery stenosis,48 subclavian artery stenosis,84 vertebral artery stenosis;178 symptomatic and 102 asymptomatic lesions.Antiplatelet therapy with arspirin and clopidogrel were administered before and after the procedure.The basic information,effect of the procedure,periprocedure complications were obtained while in-hospital,long-term prognosis was obtained during the follow-up.Results:Technical success was achieved in all patients.The 1 month transient ischemic attack/stroke was 1.43%;over-perfusion was found in 7 cases(2.5%),myocardial infarction in 1 case(0.35%),prolonged carotid sinus reaction in 21 cases(7.5%).No contrast induced nephropathy,cerebral hemorrhage and periprocedure death were found.Fourteen(4.49%)in-stent restenosis occurred during a follow-up up to 78 months,6 cases(3.33%)in carotid artery stenting,5 cases(5.95%)in vertebral artery stenting and 3 cases(6.25%)in subclavian artery stenting;long-term ischemic events occurred in 17 cases(6.07%),14 cases(82.4%)in carotid artery system.No cerebral hemorrhage occurred during the follow-up.Conclusion:A retrospective analysis of our experience suggests that endovascular stenting angioplasty is a safe and effective procedure in preventing stroke,with low restenosis rate.

Objective In the context of worldwide shortage of amytal,explore the intracarotidpropofol test for lateralizing language area and assessing hemispheric memory function.Methods Fourteen patients with refractory partial epilepsy who were candidates for surgical intervention were included in the study.With guide under a digital subtraction angiography,propofol was injected in bilateral intracarotidsequentially.Muscle power deceasing to level 0 at the contralateral limb and eyes gazing to contralateral side were used as the mark of hemispheric anesthesia completely.The immediate language alterations were recorded.To evaluate the bilateral language and memory functions,the visual and auditory memory tasks were performed sequentially once patient could concentrate his attention ; and after limb muscle power recovering to normal level,patients were required to perform a free recall test.Any abnormal responses were recorded.Results Language dominant hemisphere was determined in 14 patients.Nine patients were confirmed as left language dominance,2 patients were right language dominance.The remained 3 patients were considered as bilateral language dominance.Meanwhile,the hemispheric memory function was able be evaluated in 13 patients.More than 67％ memory function was sustained in hemisphere contralateral to mesial temporal lesions.Transient responses including eye pain,facial muscle spasms,laughers and involuntary movements were observed.Conclusion Hemispheric language and memory functions can be assessed with direct intracarotidpropofol injection,and propofol could be an alternative drug to amobarbital used in the Wada test.

<正> 患者男,63岁。因头晕、行走不稳伴言语不清3 d,加重2 d,于2008年11月就诊于卫生部中日友好医院神经内科。体检:血压为165/105 mm Hg,意识清楚,构音障碍。双眼侧视时可见细小的水平眼震,右肢共济运动差,其余未见异常。急诊行头部CT,提示左侧小脑高密度影(图1),当时诊断为"小脑少量出血",给予脱水等对症治疗后症状未改善,当晚出现吞咽困难、饮水呛咳及右侧面部与左侧肢体麻

OBJECTIVE:To discuss the clinical characteristics and imaging findings so as to improve the understanding of vertebrobasilar dolichoectasia (VBD).METHODS:The clinical profiles of 25 VBD patients diagnosed by magnetic resonance imaging (MRI) were retrospectively collected during January 2009-January 2010. Their clinical characteristics and imaging findings were analyzed.RESULTS:(1) Clinical characteristics: Posterior circulation ischemia (84%) was predominant. Different degrees of dizziness (40%) was the most common clinical manifestation. (2) Imaging analysis: two cases (8%) had a missed diagnosis by head computerized tomography. The diagnostic accuracy rate of head MRI and MRA was 100%. The degree of bifurcation height or lateral deviation of basal artery was mainly of the 2nd degree according to the Smoke's criteria. The lateral deviation of basal artery was mostly of a rightward shift (60%). The medulla oblongata was often compressed to deformation (40%). Basal artery calcification (12%) and VBD-associated hydrocephalus (4%) were rare. VBD was usually complicated with arteriosclerosis plaques of intracranial arteries in posterior circulation (> 40%). (3) Follow-up results: three cases (12%) suffered serious brainstem infarction during a follow-up period of 0.5 - 1.5 years. Two (8%) of them were dead. The degree of bifurcation height or lateral deviation of basal artery was of the 3rd degree in 3 cases.CONCLUSION:The clinical manifestations of VBD are multiple. But posterior circulation ischemia is not rare, especially for the elderly patients. Because of a high rate of disability and mortality, early diagnosis is essential. MRI is of a great value in confirming the diagnosis and evaluating the prognosis.

【Objective】 To investigate the relationship between the peroxisome proliferator activated receptors gamma(PPARγ) C161T polymorphism and the atherosclerotic cerebral infarction(ACI).【Methods】 The study population was comprised of 168 atherosclerotic cerebral infarction patients and 165 healthy individuals.The PPARγC161T genotypes were detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP).【Results】 The genotype frequencies of CC,CT and TT in ACI group were 76.2%,21.4% and 2.4% respectively,and the allele frequencies of C and T were 86.9% and 13.1% respectively.There were significant differences in genotype frequencies and allele frequencies between ACI group and control group,except for the genotype frequencies of TT(no statistical analysis because of small example).The genotype frequency of CC in ACI was significantly higher than that in control(P 0.05),but the allele frequencies of T allele carrier(CT+TT) were significantly lower than those in control(P 0.05).【Conclusions】 The polymorphism of PPARγ C161T is associated with the incidence of the atherosclerotic cerebral infarction,and T allele carrier may have a low risk for ischemic stroke.

Objective:To investigate the value of virtual stenting in carotid angioplasty and stenting(CAS).Methods:Forty-five carotid stenosis cases accorded with the interventional treatment criteria were collected.The degree and location of carotid stenosis were determined with ultrasound sonography,MR angiography(MRA),digital subtraction angiography(DSA)and three-dimensional reconstruction.Applying virtual stent analysis technology to obtain the data parameters of virtual carotid stent.Results:The site,shape,degree of stenosis can be clearly demonstrated in the 3D reconstruction images.Select suitable stent to treatment basis on the virtual stent data parameters.The overall satisfaction rate being 100%.Conclusion:The technique of virtual stent is valuable for selecting appropriate type of stent in CAS.