目的探讨急性脑梗死（acute cerebral infarction,ACI）患者应用参芎葡萄糖注射液治疗前后外周血白介素-33（IL-33）和动静脉血糖差（Da-jvGlu）的变化及临床意义。方法检测126例不同梗死体积急性脑梗死患者及10名健康体检者（正常对照组）的外周血IL-33水平和动静脉葡萄糖差,比较各组结果。结果治疗前各组血清IL-33与正常对照组比较,大体积脑梗死组IL-33水平显著增高（P ＜0.05）;小体积和中等体积脑梗死组无显著差异。静脉给予参芎葡萄糖注射液+常规治疗7 d后各组血清IL-33与治疗前比较,大体积脑梗死组IL-33水平无显著变化（P＞ 0.05）;小体积和中等体积脑梗死组两组IL-33水平均有显著增高（P ＜0.05）。各组ACI患者治疗前后Da-jvGlu变化比较,治疗前各组与正常对照组比较,大体积脑梗死组Da-jvGlu显著增高（P ＜0.05）;小体积和中等体积脑梗死组无显著差异（P＞ 0.05）。结论参芎葡萄糖注射液可通过调整IL-33水平抑制促炎作用,促进脑细胞损伤的修复和再生,同时并未干扰体内葡萄糖代谢水平。

Immunoglobulin G4 (IgG4)-related disease is a systemic disease characterized by sclerosing lesions and an increased serum IgG4 level. This condition can involve any organ, but IgG4-related spinal pachymeningitis is relatively rare. In the current study, we report a case of spinal cord compression caused by IgG4-related spinal pachymeningitis. A 39-year-old man presented to us with a 15-day history of back pain and a 3-day history of dysuresia, exacerbated by weakness in the lower extremities for 2 days. Cervical magnetic resonance imaging (MRI) showed strip-shaped abnormal signals along the anterior and posterior borders of the spinal cord at the C5-T4 levels. The IgG level in cerebrospinal fluid was 718.0 mg/L. Thoracic MRI revealed strip-shaped abnormal signals with remarkable enhancement along the anterior and posterior borders of the dural sac at the T1-T6 levels. Histopathological examination confirmed IgG4-related spinal pachymeningitis. The symptoms worsened rapidly, and surgical resection of the space-occupying lesion in the vertebral canal was performed for spinal decompression. Corticosteroid therapy was administered, and the patient's motor functions were mildly improved. IgG4-related disease can manifest as spinal pachymeningitis and cause spinal cord compression. Clinicians should be aware of this rare condition, and early diagnosis, timely surgical decompression, and appropriate corticosteroid therapy should be highlighted.

自发性低颅压(spontaneous intracranial hypotension,SIH)又称自发性低脑脊液容量(pontaneous cerebrospinal fluid hypovolemia,SCFH) 是一种少见的神经系统疾患.虽然其典型的临床特点是体位性头痛,在临床上的漏诊和误诊率仍较高.由于国内很多神经诊疗中心一直沿用陈旧的诊疗观念,有些明确诊断的患者得不到规范的治疗.低颅压的病理基础是硬脊膜脑脊液瘘,文献报道瘘口以胸腰段脊柱多发,而颈段特别是高位颈段相对罕见.本文报道 1 例轻微外伤后高颈段脑脊液瘘导致 SIH 的患者.通过文献复习,对其致病机制、 诊断手段和治疗方法进行梳理.

Toxoplasmosis is a worldwide zoonosis caused by an intracellular protozoan parasite, Toxoplasma gondii. We report here a diabetic patient who was diagnosed as toxoplasmosis with multiple cranial nerve palsies and cavernous sinusitis. A 37-year-old male presented with an 11-day history of gingival pain, one day history of ptosis and diplopia. He has been having diabetes mellitus for 6 years, and has a history of contact with cats. After admission, his symptoms worsened with right 3rd to 7th cranial nerve palsies. The brain magnetic resonance imaging (MRI) showed cavernous sinusitis in the right sellar region. Serology for toxoplasma was positive for IgM and negative IgG. The patient was treated with oral clindamycin (900 mg/day) and dexamethasone (15 mg/day). The right visual acuity and lid-conjunctival swelling improved after 3 days. At follow-up after a month, the movement of the right eye significantly improved. This case demonstrate the rare occurrence of multiple cranial nerve (3rd to 7th) palsies from toxoplasmosis cavernous sinusitis, which is a potentially treatable condition.

Post-stroke depression often seriously affects the prognosis and quality of life of patients and many clinical trials had shown that Chai Hu Shu Gan San combined with selective serotonin reuptake inhibitors (SSRIs) had good efficacy and minor side effects. We aimed to conduct this meta-analysis to evaluate the efficacy and safety of Chai Hu Shu Gan San as an adjuvant drug for SSRI in treating post-stroke depression. We searched PubMed, EMBASE, Cochrane Library, Wanfang, China Biology Medicine disc (CBM), Chongqing VIP, and CNKI (China National Knowledge Infrastructure) from their date of foundation to December 15, 2018. Literature screening, data extraction and quality assessment were conducted by two authors independently. The data synthesis and analysis were performed by using Review Manager (RevMan) 5.3 software and sensitivity analysis was conducted to assess the robustness of the results. Finally, a total of 22 articles were included. The meta-analysis confirmed the advantages of the combination of SSRI and Chai Hu Shu Gan San, mainly from four aspects: the Hamilton Depression (HAMD) scale score (MD=3.66; 95% DI=2.33-4.98; p<0.001), the Modified Edinburgh Scandinavian Stroke Scale (MESSS) score (MD=4.87; 95% CI=2.32-7.43; p<0.001), the efficacy rate (OR=3.50; 95% CI=2.61-4.69; p<0.001) and the incidence of adverse reactions (OR=0.28; 95% CI=0.17-0.46; p<0.001). No significant publication bias was observed, and sensitivity analysis suggested a good stability of the results. According to the present evidence, we concluded that Chai Hu Shu Gan San in combination with SSRI may be effective and safe in the treatment of post-stroke depression.

脑淀粉样血管病（CAA）是指在软脑膜和脑皮层血管中可见淀粉样蛋白沉积,尤其是在脑小动脉和毛细血管内,具有这种特征的一组脑血管病称为CAA[1]。目前,CAA已成为老年非高血压性脑出血的重要原因之一,本病大多数发生在60岁以上的老年患者,临床特点为多发或反复发作的脑叶出血。

神经梅毒是病原体苍白螺旋体感染神经系统后出现大脑、脑膜或脊髓损害的一组临床综合征[1]. 神经梅毒可发生于梅毒的各个时期[2] ,临床表现复杂,易误诊、漏诊. 现将我科2017年收治的1例以脊髓炎为首发症状的神经梅毒病例进行回顾性分析.

病毒性脑炎是由多种病毒感染引起的中枢神经系统感染性疾病，主要以发热、头痛、不同程度意识障碍、精神行为异常为主要表现。急性视网膜坏死综合征（acute retina nec－rosis syndrome，ARN）是病毒性脑炎的严重合并症之一，可导致不同程度的视力障碍，严重者失明。

Primary angiitis of the central nervous system (PACNS) is a rare, but severe vascular disease. The present study reports the case of a 42-year-old male who developed PACNS. Magnetic resonance imaging (MRI) scans initially led to a misleading diagnosis of malignant glioma, and surgery was performed. The mass was resected, and a pathological examination confirmed a cerebral vasculitis. Single therapy with high doses of steroid did not improve the patient's condition, while a subsequent lesion appeared on the opposite side one year later. Combined therapy with methylprednisone and cyclophosphamide resulted in a great improvement for the patient. No relapse occurred during one year's follow-up. Although a tumor-mimicking PACNS has no established imaging features, a diagnosis of tumor-mimicking PACNS should be suspected when the MRI reveals inappropriate presentations of a tumor. Greater awareness of this potential manifestation of PACNS may facilitate more prompt diagnosis and treatment.

We report a case of histopathologically-confirmed primary central nervous system lymphoma who was initially diagnosed as demyelinating encephalopathy. A 58-year-old woman was admitted with confusion and left hemiparesis. Head MR showed abnormal flaky hypointense T1 and hyperintense T2 signals at right thalamus, splenium of corpus callosum, bilateral cerebral peduncle, pons, medulla oblongata, basal ganglia and right corona radiata. Her mental status improved a little and she was discharged from hospital after neuroprotective treatment. 10 days after her discharge, her confusion appeared again with hallucination and unsteady walking. Pathological examination revealed non-Hodgkin's lymphoma (WHO classification: DLBCL). The patient continued to deteriorate after the surgery and died 10 days later.

This study describes the case of a 41-year-old woman admitted for anterograde memory loss, right facial grimacing and right arm posturing that had begun 1 month previously. Cranial magnetic resonance-diffusion weighted imaging and -fluid-attenuated inversion recovery imaging revealed a hyperintense signal in the left hippocampus and right basal ganglia, but no contrast enhancement. An electroencephalogram revealed rhythmic sharp and slow waves and rhythmic θ build-ups in the left temporal area. Single-photon emission computed tomography showed increased regional blood flow perfusion in the left cerebral frontal lobe and the right basal ganglia. The cerebrospinal fluid was normal, with the exception of the presence of leucine-rich glioma-inactivated 1 (LGI1) antibodies, and LGI1 antibodies were also found in the blood serum. The presence of the antibodies, the faciobrachial dystonic seizures (FBDSs) and the memory loss indicated limbic encephalitis. After 3 months of immunotherapy, the patient was free from epileptic seizures and had undergone a partial memory restoration. FBDSs alone justify the immediate initiation of immunotherapy, even prior to laboratory confirmation of the disease, as early treatment limits the duration of the illness.

A few cases of cerebral cavernous malformation (CCM) have been reported in Chinese families with different mutations during the past decade. Herein, we report a case of CCM in a proband in a Chinese family, for whom the mutation type of the CCM remains to be identified. The proband of the family presented a range of clinical symptoms and features that included paralysis, aphasia, multiple lesions in the brain, and cutaneous capillary–venous malformations. PCR was performed to amplify all of the coding exons of the three CCM genes (CCM1, CCM2, and CCM3) in the proband and revealed a heterozygous T deletion in exon 15 (c.1542delT) of CCM1 gene. Targeted mutation analysis in family members demonstrated that this mutation segregated with the disease in the family. This is the first report of a heterozygous CCM1 deletion mutation. Our findings provide a new CCM gene mutation profile in a Chinese family which will be of significance in genetic counseling for CCM.

目的 探讨养血清脑颗粒对脑梗死患者颈动脉内-中膜厚度以及动脉粥样硬化斑块大小的影响,以及养血清脑颗粒对脑梗死患者的二级预防作用机制.方法 将100例脑梗死患者随机分成两组.第1组为对照组,给予常规抗血小板聚集,改善循环,营养神经等对症治疗,住院治疗2 w后,只给予口服拜阿司匹林6 m.第2组为治疗组,除给予上述常规治疗外,同时给予养血清脑颗粒4 g,每日3次口服,住院治疗2w后,继续口服拜阿司匹林加养血清脑颗粒6 m.6 m后测量患者颈动脉内-中膜厚度及动脉粥样硬化斑块大小以及检测血常规、凝血常规、血脂、血糖、血液粘度.对两组患者数据进行统计学分析.结果 对照组50例患者6 m后随诊复查,颈部彩超显示斑块面积缩小7例,无明显改变者20例,斑块面积增大者23例.治疗组50例患者颈部彩超显示斑块面积缩小25例,无明显改变者16例,斑块面积增大者9例.治疗组患者,颈动脉内膜的动脉粥样硬化斑块面积治疗前后比较均有明显缩小,有显著性差异(P＜0.01).而对照组患者治疗前后斑块面积无明显改变,无显著性差异(P＞0.05).结论 养血清脑颗粒可改善脑梗死患者的颈动脉内-中膜厚度,对脑梗死患者的二级预防有一定价值.

>急性感染后或炎症性脱髓鞘疾病包括急性播散性脑脊髓炎、急性横贯性脊髓炎和吉兰-巴雷综合征（GBS）。脱髓鞘改变既可见于中枢神经系统,也可发生在周围神经系统中,儿科患者中偶有见到报道GBS合并脊髓炎的病例 [1] ,但在成人较为少见 [2] ,吉林大学白求恩第一医院二部神经内科于2013年3月收治1例GBS合并视神经脊髓炎的病例,现结合文献报道如下。患者女性,53岁,因四肢无力2 d、加重伴四肢麻木1 d入院。患者于入院前2 d无诱因出现四肢无力,此后2 d内病情迅

<正>血管性痴呆(VD)是老年期痴呆中较常见的形式,发病机制尚未清楚。病理观察发现白质存在脱髓鞘等一系列改变,认为白质脱髓鞘可能是VD的发病机制之一。已知神经束蛋白155(NF155)在保持髓鞘的稳定中起到了关键的作用。通过检测NF155水平,确定其表达变化与认知障碍水平的相关

Objective To explore the association between the serum level of brain derived neurotrophic factor(BDNF) and vascular dementia(VD).Methods 32 patients of VD,35 cerebral infarct patients were selected.35 health examinated people were chosen simultaneously as controls.in.Enzyme-linked immunosorbant assay(ELISA) was used to measure the serum levels of BDNF.Analyze clinical data to search risk factors to vascular dementia.Results Hypertension showed significantly difference among the three groups(P 0.05).Serum BNDF concentration of three groups in nondemented cerebral infarction group was the highest,while lowest in vascular dementia group,we found that there are significantly difference between VD and CI,but nosignificantly difference between VD and normal control.Conclusion Serum BDNF level of cerebral infarction patients were slightly above normal controls,but no obvious difference was found.VD patients serum levels of BDNF significantly below the CI,and has the significant difference,there was no obvious difference compared with the normal group,BDNF may be involved in the cerebral infarction progress for vascular dementia pathophysiological events.

目的探讨趋化因子受体4(CXCR4)在前列腺癌细胞中的组织转移趋化特异性及其在转移组织内的表达水平及作用。方法在体外将人前列腺癌PC3M细胞与人淋巴结及横纹肌匀浆提取物混合培养,采用反转录聚合酶链反应(RT-PCR)及免疫荧光标记和流式细胞仪表型检测分析细胞上CXCR4在基因及蛋白质水平的表达,观察人淋巴结及横纹肌匀浆提取物对PC3M细胞CXCR4表达的影响;同时通过大鼠抗人CXCR4单克隆抗体对PC3M细胞淋巴组织趋化性的抑制试验,观察CXCR4在前列腺癌淋巴结转移中的作用。结果与IMEM培养液组和横纹肌提取物组比较,淋巴组织提取物组对PC3M细胞有明显趋化作用,而大鼠抗人CXCR4单克隆抗体能明显抑制淋巴组织提取物组对PC3M细胞的趋化性迁移,抑制率达60%～70%。把人前列腺癌PC3M细胞与人淋巴结及横纹肌匀浆提取物混合培养24 h后,与非添加组相比,人淋巴结匀浆提取物组CX-CR4在基因水平表达明显降低。而人横纹肌匀浆提取物组CXCR4的表达水平则无明显差异。混合培养48 h后,人淋巴结匀浆提取物组CXCR4在基因和蛋白水平表达进一步降低。而在人横纹肌匀浆提取物组CXCR4的表达水平只见少量减低。结论 CXCR4在前列腺癌细胞浸润、转移过程中具有组织选择特异性,而且其表达与细胞生长环境密切相关,受周围组织的调控,进一步证明CXCR4是抑制前列腺癌细胞浸润、转移的重要靶点。

<正>脑出血是常见的脑血管疾病,随着社会的老龄化,脑出血患者的发病率呈逐年上升趋势[1,2]。近年来国内外对缺血性脑血管病早期脑保护进行了大量的研究,但对脑出血的研究相对较少,尤其是对脑出血后血肿周围白质损害情况及机制尚不完全明确[3]。目前的研究多局限于注重神经元的