Cerebral small vessel disease (CSVD) is a primary contributor to vascular cognitive impairment. Although extensive research has examined white matter alterations in CSVD, cortical mechanisms underlying cognitive dysfunction remain incompletely characterized. To address this gap, we conducted a systematic review and meta-analysis of 26 studies investigating whether structure-cognition relationships in CSVD could be interpreted through biologically defined functional brain networks. By mapping structural features to the Yeo-7 functional atlas, we offer a network-based perspective on cognitive impairment in this population. Our integrated results demonstrate significant associations between structural alterations and all cognitive domains in CSVD patients. Notably, higher-order cognitive processes (e.g., executive function, attention and processing speed) involved more extensive functional networks than other domains. These findings help synthesize heterogeneous neuroanatomical literature on CSVD through contemporary network neuroscience frameworks, suggesting structure-cognition relationships may align with functional network architecture.

RATIONALE:Acute ischemic stroke is an important cause of in worldwide mortality and morbidity. nevertheless, in certain instances of concomitant idiopathic tremor, stroke lesions may have a therapeutic effect in alleviating the symptoms of idiopathic tremor. Limited reports exist on the improvement of essential tremor (ET) following a stroke. This research presents a case of symptom improvement in ET following acute stroke thrombolysis in the right centrum semiovale of a patient. PATIENT CONCERNS:The patient is a retired 75-year-old male who is right-handed. He was hospitalized on January 1, 2021, due to limited movement in his left limbs and difficulties with speech. The patient has experienced a bilateral tremor in the upper limbs for 30 years, with exacerbation on the left side. The left finger-nose test lacked stability and precision. DIAGNOSES:The cranial computed tomography revealed scattered lacunar infarctions in the brain. The magnetic resonance imaging revealed many lacunar lesions in the bilateral basal ganglia and the centrum semiovale. A fresh lesion was seen in the right centrum semiovale. OUTCOMES:In the treatment of cerebral infarction, patients did not receive treatment and intervention for tremor symptoms. However, the patient also showed significant improvement in tremor in both upper extremities after the symptoms of acute cerebral infarction subsided, and the finger-nose test was consistent and precise on both sides. Fahn-Tolosa-Marin tremor rating scale 7 points. LESSONS:The three-dimensional T1-weighted imaging, diffusion weighted imaging and diffusion tensor imaging sequences of magnetic resonance imaging images were analyzed, and BrainVoyager was used to visualize the location relationship between the infarct focus, thalamus and related fiber conduction tracts. It was inferred that the descending corticospinal tract and the 2 ascending conduction tracts from thalamus to cerebral cortex formed a complete neural circuit. The location of the infarct intersects the above conduction tract and thus interferes with the oscillatory network within it. Therefore, it is possible to break the oscillation network of ET by interfering with a certain node, which can provide more ideas for the treatment of ET in the future.

RATIONALE:With the development of magnetic resonance imaging (MRI) technology, most of the research tends to find that there is a significant positive correlation between white matter hyperintensities (WMHs) and cognitive dysfunction in cerebral small vessel vascular disease. In this paper, we report 2 cases of cerebral small vessel disease with significant differences in cognitive function and analyze them by multidimensional assessment using imaging technology so as to provide a methodological reference for identifying and diagnosing the causes of differences in cognitive function in cerebral small vessel disease patients. PATIENT CONCERNS:Patient 1 was a 64-year-old middle-aged man who presented 10 years ago with slow reaction time, memory loss, and loss of self-care ability, and MRI suggested multiple ischemic infarct foci with cerebral white matter changes. Patient 2 was a 69-year-old middle-aged woman, who did not have any significant abnormalities in cognitive function, and imaging suggested multiple ischemic foci, infarct foci, and cerebral white matter degeneration. DIAGNOSIS:MRI showed a large fusion of high signal in the cerebral white matter in both patients, which belonged to the category of cerebral small vessel disease according to the Fazekas classification of grade 3. INTERVENTIONS:We used imaging techniques to compare the 2 MRI brain white matter high signals in a multidimensional manner and further compared the differences in cognitive functioning between the 2 in terms of brain age, brain functional networks, focal loading of white matter fiber tracts, and neuropsychological scales. OUTCOMES:Brain age difference was assessed by whole-brain level and brain function network, white matter fiber bundle lesion load, and Montreal Cognitive Assessment and Mini-Mental State Examination scale scores; the results suggested that patient 1 had relatively poor cognitive function. LESSONS:In this paper, we concluded that the volume of high white matter signal in WMH is not positively correlated with the severity of cognitive impairment. In addition to cerebral WMHs, we believe that alterations in cerebral network connectivity and white matter microstructure may be the neuroimaging basis of cognitive decline in patients with WMH, which may provide a new idea for the early diagnosis of cognitive function in patients with cerebral small vessel disease.

BACKGROUND:Naoxueshu oral liquid is the only approved drug for acute treatment of cerebral hemorrhage in China. It has been used widely for the treatment of acute ischemic stroke and acute hemorrhagic stroke. However, safety and efficacy data on the early use of Naoxueshu oral liquid are lacking. The main purpose of this study is to observe the benefit and safety of early use of Naoxueshu oral liquid (< 72 h of cerebral hemorrhage) and offer evidence into the potential superiority of Naoxueshu oral liquid in patients with hemorrhagic stroke, and its healthcare costs.METHODS:This registration study for the prevention and treatment of cerebral hemorrhage using Naoxueshu oral liquid will be a quantitative, prospective, multicenter, observational clinical registry study. We aim to register 2000 patients with cerebral hemorrhage within 7 days of disease onset. This study will be an observational study and not interfere with the medication regimen of participants. Hence, we will not allocate patients. The main observation indicators will be the hematoma volume and the proportion of reduction 14 days post-cerebral hemorrhage (or at hospital discharge), onset of new stroke (ischemic stroke, hemorrhagic stroke) within 12 months of disease onset, independence in everyday life activities (modified Rankin Scale score ≤ 2), total cost during hospitalization, and treatment costs.CONCLUSION:This registration study will offer strong evidence for the efficacy and safety of Naoxueshu oral liquid for the prevention and treatment of cerebral hemorrhage, particularly with regard to early use (72 h after onset). It will offer evidence into the potential advantages of Naoxueshu oral liquid in patients with hemorrhagic stroke, including healthcare costs.

This paper retrospectively analyzes the clinical data of a patient with progressive myoclonus-ataxia admitted to the First Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, and discusses its clinical characteristics, diagnosis, and treatment. The patient started with myoclonus, and gradually developed symptoms of ataxia.Molecular genetic testing revealed a heterozygous mutation of the ATL1 gene. After oral administration of Clonazepam, the symptoms of myoclonus were relieved. This paper analyzes the diagnosis and treatment process and clinical data of the patient and reviews the literature reports related to the molecular genetics of the disease, providing experience for the clinical diagnosis of this disease for the reference of clinicians.

克-雅病是一种罕见的由朊病毒蛋白诱导的神经退行性脑病,此病平均生存期为 6 个月,病死率高,预后极差.本报告回顾性分析了北京中医药大学东直门医院收治的克-雅病患者 1 例,该患者表现为快速进展的痴呆、视觉障碍、明显的锥体外系受损,并迅速进展至昏迷,最终死于重症肺炎,总病程 1 年 4 个月.西医缺乏针对该病有效的治疗手段,基于个体的同源脑功能网络分析显示,中医辨治可对延缓疾病进展起到一定作用.本文分析1例克-雅病患者的中医诊治过程,并进行文献回顾,以期加强对本病的认识,探索中医药治疗优势.

巨刺为传统刺法之一,其左右交叉取穴的治疗理念与人体解剖中神经传导束的交叉走形、左右联通的特点符合,常用于中风病患者的治疗.临床实践中发现巨刺可促进中风病人康复.由于神经交叉支配的特性,脑卒中后患侧多在颅内病灶对侧."左右分治"正是基于中风病后偏身障碍的性质,以病发于左、右侧为辨证论治要点的特色理论,与巨刺的治疗机制相符.本文从中医基础理论和西医神经解剖生理病理角度探讨巨刺法在中风患者中是如何通过左右分治来实现对于患侧疾病的治疗,进一步阐释巨刺治疗中风病的理论依据.

ObjectiveMotor recovery is crucial in stroke rehabilitation, and acupuncture can influence recovery. Neuroimaging and machine learning approaches provide new research directions to explore the brain functional reorganization and acupuncture mechanisms after stroke. We applied machine learning to predict the classification of the minimal clinically important differences (MCID) for motor improvement and identify the neuroimaging features, in order to explore brain functional reorganization and acupuncture mechanisms for motor recovery after stroke.MethodsIn this study, 49 patients with unilateral motor pathway injury (basal ganglia and/or corona radiata) after ischemic stroke were included and evaluated the motor function by Fugl–Meyer Assessment scores (FMA) at baseline and at 2-week follow-up sessions. Patients were divided by the difference between the twice FMA scores into one group showing minimal clinically important difference (MCID group, n = 28) and the other group with no minimal clinically important difference (N-MCID, n = 21). Machine learning was performed by PRoNTo software to predict the classification of the patients and identify the feature brain regions of interest (ROIs). In addition, a matched group of healthy controls (HC, n = 26) was enrolled. Patients and HC underwent magnetic resonance imaging examination in the resting state and in the acupuncture state (acupuncture at the Yanglingquan point on one side) to compare the differences in brain functional connectivity (FC) and acupuncture effects.ResultsThrough machine learning, we obtained a balance accuracy rate of 75.51% and eight feature ROIs. Compared to HC, we found that the stroke patients with lower FC between these feature ROIs with other brain regions, while patients in the MCID group exhibited a wider range of lower FC. When acupuncture was applied to Yanglingquan (GB 34), the abnormal FC of patients was decreased, with different targets of effects in different groups.ConclusionFeature ROIs identified by machine learning can predict the classification of stroke patients with different motor improvements, and the FC between these ROIs with other brain regions is decreased. Acupuncture can modulate the bilateral cerebral hemispheres to restore abnormal FC via different targets, thereby promoting motor recovery after stroke.Clinical trial registrationhttps://www.chictr.org.cn/showproj.html?proj=37359, ChiCTR1900022220.

Motor dysfunction is common in patients with stroke. Acupuncture has become an acceptable alternative method for stroke rehabilitation. Previous studies have shown various functional connectivity changes activated by acupuncture. We introduced intersubject correlation (ISC) and intersubject functional correlation (ISFC) analyses into the functional magnetic resonance imaging (fMRI) for ischemic stroke to seek a common activation and suppression pattern triggered by acupuncture. In this study, 63 ischemic stroke patients with motor dysfunction and 42 normal controls were analyzed. Three functional scans were conducted during the resting state, motor task, and acupuncture at Yanglingquan (GB34) task. Twenty-two sensory, motor, and movement-imagination cortices in the bilateral hemispheres were selected as the region of interest (ROI). We performed ISC and ISFC analyses among these ROIs in three fMRI runs on patients and controls. Subgroup analyses by course or severity were also conducted. The results showed that acupuncture at GB34 triggered ISFC among upper limb motor, upper limb/hand/face, lower limb, tongue/larynx sensory, and movement imagination regions in the patient group. Subgroup ISC and ISFC analyses showed that patients tended to have increasing responses in the early stage of stroke (within 1 month) and decreasing responses afterward (1-3 months). Patients with mild clinical functional damage (NIHSS 2-4) tended to generate more responses via acupuncture than those with moderate damage (NIHSS 5-15). Our findings may help understand the clinical effects and modulatory features of acupuncture based on the group-level post-stroke neuroplasticity.

Multiple system atrophy (MSA) is a common atypical parkinsonism, characterized by a varying combination of autonomic, cerebellar, and pyramidal systems. It has been noticed that the patients with MSA can be accompanied by some neuropsychiatric disorders, in particular depression. However, there is limited understanding of MSA-related depression. To bridge existing gaps, we summarized research progress on this topic and provided a new perspective regarding pathological, clinical, and imaging aspects. Firstly, we synthesized corresponding studies in order to investigate the relationship between depression and MSA from a pathological perspective. And then, from a clinical perspective, we focused on the prevalence of depression in MS patients and the comparison with other populations. Furthermore, the associations between depression and some clinical characteristics, such as life quality and gender, have been reported. The available neuroimaging studies were too sparse to draw conclusions about the radiological aspect of depression in MSA patients but we still described them in the presence of paper. Finally, we discussed some limitations and shortcomings existing in the included studies, which call for more high-quality basic research and clinical research in this field.

目的利用meta分析方法评价卒中急性期NIHSS评分与卒中后抑郁（post-stroke depression,PSD）发生的相关性,为临床防治PSD提供证据。方法计算机检索PubMed、中国知网、万方数据知识服务平台及维普数据库,搜集建库至2019年10月有关PSD与神经功能评分关系的病例对照研究,纳入符合标准的文献,由2名研究人员独立筛选文献、提取有效数据资料,并根据纽卡斯尔-渥太华量表进行质量评估。应用ReviewManager5.3软件对各研究中的原始数据进行统计,根据纳入研究的异质性检验结果选用固定效应模型或随机效应模型进行合并效应量分析。结果共纳入15篇文献,共计3050例研究对象,其中PSD组1157例,非PSD组1893例。整体meta分析结果显示:PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 0.92,95%CI 0.48～1.37,P＜0.01）。亚组分析结果显示:（1）以地域分组,在中国人群中,PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 0.81,95%CI 0.36～1.27,P＜0.01）;（2）以卒中是否首发分组,首发卒中人群中,PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 1.24,95%CI 0.82～1.67,P＜0.01）,再发卒中两组间NIHSS评分差异无统计学意义（MD-0.25,95%CI-1.53～1.03,P=0.70）;（3）以卒中类型分组,缺血性卒中PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 0.83,95%CI 0.38～1.29,P＜0.01）;（4）以PSD诊断时间分组,卒中1个月内诊断PSD的研究中,两组间NIHSS评分差异无统计学意义（MD 0.64,95%CI0.01～1.28,P=0.05）,卒中1个月以上诊断PSD的研究中,PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD1.29,95%CI 0.78～1.81,P＜0.01）;（5）根据NIHSS评估时间分组,在卒中后2周内进行NIHSS测评的研究中,PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 1.01,95%CI 0.62～1.41,P＜0.01）,在卒中后3～4周进行NIHSS测评的研究中,两组间NIHSS评分差异无统计学意义（MD 1.00,95%CI-0.96～2.96,P=0.32）。结论卒中急性期NIHSS评分与PSD的发生显著相关,NIHSS评分是影响PSD发生的重要危险因素,特别是在中国人群、首发卒中、缺血性卒中、卒中1个月后PSD及卒中发病2周内评估NIHSS的患者人群中。

目的 探讨参麦注射液对急性脑梗死的治疗效果.方法 回顾性分析2017年6月至2019年6月于北京中医药大学东直门医院脑病科一区治疗的急性脑梗死患者122例的临床资料,根据治疗方法将其分为治疗组(66例)和对照组(56例).两组均随症给予抗血小板、降脂、降压、控制血糖等常规治疗,治疗组在常规治疗基础上给予参麦注射液静脉滴注;对照组给予丹红注射液静脉滴注,两组均治疗14 d.比较两组治疗前与治疗14 d后的美国国立卫生研究院脑卒中量表(NIHSS)评分及不良事件发生情况.结果 治疗14 d后,两组NIHSS评分均较治疗前降低,且治疗组低于对照组,差异有统计学意义(P<0.05).两组病因不明(UE)亚型NIHSS评分治疗前后比较,差异无统计学意义(P>0.05).治疗14 d后,两组心源性栓塞(CS)、大动脉粥样硬化型(LAA)、穿支动脉疾病(PAD)、其他病因(OE)亚型NIHSS评分均较治疗前降低,差异有统计学意义(P<0.05),治疗组LAA亚型NIHSS评分低于对照组,差异有统计学意义(P<0.05),两组CS、PAD、OE、UE亚型NIHSS评分比较,差异无统计学意义(P>0.05).两组在治疗过程中均未发现明显不良反应.结论 参麦注射液能够有效改善急性脑梗死患者神经功能缺损程度,其对LAA亚型脑梗疗效明显优于丹红注射液,在其他亚型中与丹红注射液作用相似.

目的:观察左归丸联合碳酸钙D3片治疗肾阴虚型老年性骨质疏松的疗效.方法:筛选180例肾阴虚型老年性骨质疏松患者为研究对象,随机等分为对照组和左归丸组.对照组采用碳酸钙D3片治疗,左归丸组在对照组同等治疗基础上加用左归丸,治疗周期为6个月.观察疼痛积分(VAS)、骨密度(BMD)、25羟维生素D3[25(OH)D3]、甲状旁腺素(PTH)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)变化、中医证候积分和治疗有效率变化.结果:治疗后左归丸组较对照组能显著改善患者BMD,减轻患者疼痛VAS积分及中医证候积分,提高25(OH)D3含量及治疗总有效率,降低PTH含量(P＜0.01),而β-CTX无明显变化.结论:左归丸联合碳酸钙D3片治疗肾阴虚型老年性骨质疏松临床疗效好,安全性高,值得推荐.

目的 探讨逍遥散合化痰通络汤加盐酸度洛西汀片治疗抑郁症的临床效果.方法 采取随机、对照、盲法的原则,选取2018年1月—2019年8月于北京中医药大学东直门医院门诊及住院的肝郁脾虚型抑郁症患者90例,根据随机数字表法将其分为西药组、中药组、联合组,各30例.西药组口服盐酸度洛西汀肠溶片,中药组口服逍遥散合化痰通络汤颗粒,联合组同时服用逍遥散合化痰通络汤颗粒剂和盐酸度洛西汀肠溶片,均治疗6周.观察三组抑郁症疗效、中医证候疗效及治疗前后汉密尔顿抑郁量表(HAMD)评分、中医证候量表评分.结果 联合组抑郁症总有效率、中医证候总有效率均高于西药组及中药组,差异有统计学意义(P<0.017).整体分析发现,HAMD评分和中医证候量表评分的组间效应、时间效应差异均有统计学意义(P<0.05),交互作用差异无统计学意义(P>0.05).组内比较:三组治疗3、6周后HAMD评分和中医证候量表评分均较治疗前降低(P<0.05).组间比较:联合组治疗3、6周后HAMD评分及中医证候量表评分均低于西药组和中药组,差异有统计学意义(P<0.05).结论 逍遥散合化痰通络汤加盐酸度洛西汀肠溶片治疗抑郁症的效果好,可在临床上作为较为理想的方法治疗抑郁症.

克雅氏病(creutzfeldt-jakob disease,CJD)是一种被朊蛋白病毒感染的具有传播性的退行性脑病,致死率可高达100％,虽然有抗朊蛋白作用的药物疗法、细胞自噬疗法、抑制朊蛋白变性的免疫疗法、RNA干扰抑制朊蛋白基因表达法以及PrP抗体、核酸疫苗等多种方法[1],但本病目前并无有效的治疗方法,临床治疗较为局限,只能进行对症处理和支持疗法.中医药治疗在对症治疗方面发挥着至关重要的作用,可为其提供新思路,故就中药治疗克雅氏病1例进行报道并对其论治过程进行阐述.

脑膜癌病(meningeal carcinomatosis,MC)是指恶性肿瘤弥漫性或多灶性软脑膜播散或浸润,为中枢神经系统转移瘤的一种特殊分布类型,是恶性肿瘤致死的重要原因之一.该病起病隐匿,临床症状复杂多变,头颅CT及磁共振成像(MRI)平扫难以发现异常,早期误诊率较高.现报道我科近期收治的1例脑膜癌病,并结合文献进行讨论,旨在提高对本病的认识.

DOI: 10.3969/j.issn.1672-6731.2017.05.014

Objective:To analyze the different types of vertigo in patients with isolated vertigo. Methods: The clini-cal data of 119 patients with isolated vertigo were retrospectively analyzed. Results: In 119 patients, 12 cases caused by posterior circulation ischemia, 8 cases by migraine vertigo, 99 cases by peripheral vestibular vertigo. There are no significant differences in clinical manifestation among the three groups. There are statistically signifi-cant differences (P<0.05 or P<0.01) in age, smoking history, hypertension, diabetes, coronary heart disease , history of stroke, hyperuricemia, ESRS>3 points between central vertigo and vestibular peripheral vertigo. Between central vertigo and migraine vertigo, there are statistically significant differences (P<0.05 or P<0.01) in age, hypertension, diabetes, history of stroke, ESRS>3 points. Conclusion: Isolated vertigo are mostly peripheral vestibular vertigo, central vascular vertigo can be manifested as isolated vertigo.

目的：分析尤瑞克林联合依达拉奉治疗急性进展性脑梗死的近期疗效。方法急性进展性脑梗死住院患者134例,随机分为联合组(尤瑞克林+依达拉奉静点70例),对照组(单用依达拉奉静点64例)。两组均按照《中国脑血管病防治指南》原则给予抗血小板聚集、脑保护、控制血压及神经康复等治疗,观察分析两组患者治疗前、治疗后14 d 的神经功能缺损程度(the National In-stitutes of Health stroke scale,NIHSS)评分、日常生活活动能力(Activities of daily living,ADL)、临床疗效及不良反应发生情况。结果两组患者治疗后14 d NIHSS、ADL评分均较治疗前明显改善(P<0.05)；联合组显著高于对照组(P<0.01)；临床有效率达90.42%,近期治愈率达49.8%,显著高于对照组(P<0.05),两组均未发现严重不良反应。结论尤瑞克林联合依达拉奉治疗急性进展性脑梗死有一定疗效,且较安全。