1 病例资料 1.1 患者病史 患者女性,61岁,主因"双下肢乏力3个月余,四肢远端麻木2个月"于2021年11月30日于上海市徐汇区中心医院神经内科住院.患者8月下旬起无明显诱因下出现双下肢乏力,可独自行走,自感运动耐量下降,休息后未见好转.9月初自觉四肢末端麻木,下肢麻木逐渐加重,从足底上升至膝部.

目的 探讨以双侧丘脑病变导致认知功能减退起病的硬脑膜动静脉瘘(dAVFs)的临床、影像学特点和鉴别诊断、诊治方法.方法 分析1例dAVFs患者的临床资料,结合国内外文献进行分析讨论.结果 本例患者临床表现为进展性的认知功能减退,MRI T2相见双侧丘脑高信号,经DSA确诊为dAVFs,行血管内栓塞治疗后症状基本恢复.本研究系统检索了具有相似影像学表现的dAVFs相关文献报道30例,其临床表现以记忆力减退最为显著,部分伴有精神行为异常,经介入治疗或手术治疗大多预后良好.结论 以双侧丘脑受累表现为认知功能减退的dAVFs报道较少,临床中出现类似病例应考虑到该诊断.

Objective To explore the clinical characteristics of the neurological damage caused by the a buse of laughing gas(nitrous oxide).Methods The clinical characteristics and outcome of the nervous system lesions of a patient abusing laughing gas were retrospectively anaylzed.Results The pathological changes of the nervous system caused by the nitrous oxide were easily missed in the clinic,with the most young people.The laughing gas poisoning resulted in clinical manifestations of nervous system lesions (the spinal cord damage of subacute combined degeneration,in order to exercise axon damage to give priority to the length of the dependence of peripheral neuropathy,and ataxia,and so on),and there was vitamin B12 level drop,high homocysteine levels.Magnetic resonance (MRI) showed the irregular white mass demyelination of the cervical spinal cord and the posterior cord of the thoracic spinal cord,and the T2 WI of the spinal cord showed the "V" signal of the neck or thoracic pulp.The main manifestation of the electrogram was the peripheral neuropathy,which was mainly caused by the injury of the motor axon.Conclusion Patients with subacute or chronic onset of youth,performance and change,peripheral nerve damage,and so on,need to ask for details of any contact laughing gas.The blood vitamin B12,homocysteine levels,cervical spinal magnetic resonance and EMG were used to make clear diagnosis,probably ruled out laughing gas poisoning.

雌激素在诸多急慢性神经系统疾病中发挥神经保护作用,其具体机制目前认为主要包括神经营养作用、抗凋亡作用和抗炎作用[1].在癫痫中研究最多的是雌激素神经营养作用[2-3],对其抗炎作用研究甚少,而免疫炎症机制在癫痫中的作用越来越受重视[4-5].化学致痫剂、电刺激等多种癫痫模型中均可观察到痫性发作后快速诱导的炎症反应,主要包括小胶质细胞和星形胶质细胞活化、经典炎性细胞因子如白细胞介素( interleukin,IL-1β)、肿瘤坏死因子(tumor necrosis factor,TNF-α)表达增加,同时伴随下游炎症级联反应产生[6].炎症反应在一定程度上可促进癫痫发作病理生理进程,并可导致癫痫相关的海马病理性改变[4,6-7]。

目的 探讨过氧化物酶体增殖物激活受体γ辅激活子(peroxisome proliferator-activated receptor-γ coactivator,PGC)-1α在海人酸(kainic acid,KA)诱导的培养大鼠海马神经元氧化应激及神经损伤中的作用.方法 离体培养大鼠海马神经元,采用电穿孔基因转染技术分别转染PGC-1α shRNA质粒和空载体质粒.培养7天后,用KA刺激上述海马神经元24 h,检测转染空载体质粒海马神经元(空白对照组,n=10)、KA刺激的转染PGC-1α shRNA质粒(实验组,n=11)和KA刺激的空载体质粒海马神经元(KA对照组,n=10)的谷胱甘肽(glutathione,GSH)含量、超氧化物歧化酶(superoxidase dismutase,SOD)和乳酸脱氢酶(lactic dehydrogenase,LDH)活性变化.FJB染色检测KA刺激24 h后实验组和KA对照组培养大鼠海马神经元神经损伤情况.结果 KA刺激24 h,培养的大鼠海马神经元GSH含量和SOD活性分别为(5.74±0.54) μmol·L-1·μg-1 protein和(10.57±1.25) U/mg protein,较空白对照组显著降低[(9.38±0.72) μmol·L-1·μg-1 protein,P＜0.01；(23.12±3.23) U/mg protein,P＜0.01]；LDH活性为(2.21±0.18) mmol NADH,H+/min/100 mg protein,较空白对照组海马神经元显著增高[(1.29±0.09) mmol NADH,H+/min/100 mg protein,P＜0.01].转染PGC-1αshRNA质粒组,KA刺激24 h海马神经元GSH含量和SOD活性分别为(3.37±0.42)μmol·L-1·μg-1 protein和(4.54±0.91) U/mg protein,较KA对照组海马神经元明显降低(P均＜0.05)；LDH活性为(2.74±0.19) mol/NADH+/min/mg protein,较KA对照组海马神经元显著增加(P＜0.01).FJB染色显示转染PGC-1α shRNA质粒组,KA刺激24h培养大鼠海马神经元损伤较KA对照组明显增加(P＜0.05).结论 PGC-1α基因下调加重KA刺激后培养大鼠海马神经元损伤,可能与其加重氧化应激损伤有关.

脑栓塞是常见的卒中类型(约占10%～20%),碘油相关性脑栓塞(lipiodol brain embolism,LBE)却非常罕见.绝大多数LBE为经导管肝动脉化疗栓塞(hepatic transcatheter arterial chemoembolization,TACE)治疗肝癌过程中或延后发生.TACE治疗病史、关联性临床表现及特征性神经影像学表现对本病的诊断有重要意义[1,2].本文报道新近诊断的1例LBE病例并结合目前已有病例报道对该病进行详细阐述.

Objective To observe the changes of GAD67 expression in the hippocampus of epileptic rat model induced by kainic acid(KA) introamgydale injection when adding estradiol(E) or/and curcumin(C) by intraperitoneal injection,and to explore the effects of estradiol on GAD67 expression while interfered with curcumin. Methods Thirty-two ovariotomized female rats were divided into the following groups: E+KA group,C+KA group,EC(estradiol and curcumin)+KA group,and KA group.Rats were given estradiol or/and curcumin by intraperitoneal injection respectively,and epilepsy was induced by microinjection of KA into the amygdala five days later.Immunohistochemical method was used to measure GAD67 expression in the hippocampi of epileptic rats of all groups. Results The number of cells with positive GAD67 expression was counted in the left hippocampi,the opposite site to KA injection.In CA1 region,the number of cells with positive expression of GAD67 in C+KA group was greater than that in KA group(P0.01) and E+KA group(P0.05),it was also greater in EC+KA group than in KA group(P0.05).In CA3 and DG region,the number of cells with positive GAD67 expression in C+KA group was greater than in KA group,E+KA group(CA3 region: P0.01,DG region: P0.05) and EC+KA group(P0.05).In DG region,higher positive cells with GAD67 expression in E+KA group than in KA group was also found. Conclusions GAD67 expression in the hippocampi of epileptic rats induced by KA introamgydale injection is upregulated by estradiol or curcumin respectively,especially more obvious by curcumin.After interfered with curcumin,the changes of effects of estradiol on GAD67 expression are not significant,but there are still more positive cells with GAD67 expression in CA1 region by the joint action of estradiol and curcumin.

Objective:To elucidate the possible effect of curcumin on the electrophysiological property of Na/K-ATPase,EAAC1 and GAT1.Methods: The Xenopus Laevis oocytes were utilized as a protein expression model and heterogeneous cRNA of SD rats were expressed in the oocytes.Two-electrode voltage clamp was employed to detect the steady-state current induced by these proteins.Curcumin was administered to the oocytes via different methods respectively,perfusion,incubation or intracellular injection,for example.The changes before and after the treatment of curcumin were observed.Results:(1) Application of a series list of curcumin(7.5 μmol/L,15 μmol/L,30 μmol/L and 75 μmol/L) could not affect the stead-state current induced by Na/K pump.Neither could curcumin by the protocol of incubation or intracellular injection.(2) Current of EAAC1 was not sensitive to curcumin(30 μmol/L) either.(3) Current of GAT1 was slightly decreased after the treatment of curcumin 30 μmol·L-1.Conclusions: Curcumin could not affect the current induced by Na/K-ATPase or EAAC1,but could slightly suppress the current induce by GAT1.

目的:探讨神经电生理检查和面肌运动功能评分在面神经炎诊断和面肌功能评估中的相关性.方法:选取符合入选标准的面神经炎病人37例,在发病第7、28天分别予以神经电生理检查和面肌运动功能评分.神经电生理检查选用瞬目反射和面神经电图;面肌运动功能评分采用House Brackmann分级量表(HB)评分和Nottingham面神经分级量表评分(选用VMG指数),比较不同评分标准对面神经炎评估的异同,并应用Pearson相关分析法探讨不同评分标准之间的相关性.结果:与神经电图评分法相比较,瞬目反射评分法和HB评分法更为一致.Pearson相关性分析结果显示VMG指数与HB评分法相关性最强 (r=-0.925),神经电图评分法和HB评分法相关性相对较差.结论:针对面神经炎病人的评估应将面神经运动功能评估和神经电生理学评估结合起来,才能达到最好的客观性和准确性.HB评分、VMG指数联合以瞬目反射为最优指标的神经电生理检测是较为理想、科学的面神经炎的诊断和评估方法,可以较为可信地应用到临床诊治和科学研究工作中.

多种神经系统疾病可引发抑郁症状,甚至引起抑郁症,如脑卒中后抑郁、癫痫后抑郁,帕金森病(PD)和阿尔茨海默病可合并多种抑郁症状或与抑郁症共病.目前大量的临床和基础研究集中于继发或伴发抑郁症状疾病的病理生理机制和防治方面的研究.近年国外研究显示,抑郁症状亦可增加多种常见神经系统疾病(如脑卒中、痴呆、癫癎、PD)的患病风险,并使之预后变差.然而迄今国内还未见相关的临床和基础研究报道,现综述国外在此方面的研究进展.

目的了解雌激素和姜黄素对海人酸(kainic acid,KA)杏仁核点燃大鼠癫痫发作的影响。方法给去势的雌性大鼠添加雌激素治疗,添加姜黄素治疗,或添加雌激素和姜黄素治疗,比较各组大鼠致痫后癫痫发作的行为学、脑电图和海马神经元损伤的变化。结果给雌激素治疗的大鼠重型发作(Racine 4/5级)评分最高,而雌激素加姜黄素治疗组评分最低(P<0.05)。脑电图的变化与行为学的改变基本一致。致痫后大鼠注射KA侧海马CA3区、CA4区可见到明显的细胞损伤,而该侧海马CA1区、齿状回区(DG)及对侧海马CA3区、CA1区及DG区神经元损害不明显。雌激素组大鼠双侧海马CA3区均出现加重的神经元损害,姜黄素组及雌激素加姜黄素组大鼠海马注射对侧CA3区存活神经元较雌激素组明显增加(P<0.01)。结论高水平的雌激素可以加重癫痫的发作,给姜黄素治疗可以减轻大鼠海马CA3区神经元损害。

bjective:To introduce a novel and highly efficient method of electroporation hased gene transfection into the cul- tured hippocampal neurons.Methods:Primary embryonic day 17 rat hippocampal tissues were obtained,and dissociated until homogeneously dispersed in the media.Following dissociation,the suspension was centrifugated.The supernatant was aspi- rated and the ceils were re-suspended in 100μl Rat Neuron Nucleofector(tm) solution (Amaxa Biosystems) followed by addition of 2μg of CAG-RE plasmid.The mixture of cells,Nucleofector(tm) solution and cDNA were transfered to a 2 mm electropo- ration cuvette inserted in the Nucleofector(tm).Program O-03 was used for transfecting the cells.Immediately after transfec- tion,cells were plated into the dishes with the cultured medium at densitiy of 1.0×10~5cells/cm~2.Changed the medium 4 hours later,ells were observed with fluorescent microscope in different time after transfection.Results:Neurons grew well.The ex pression of gene could be observed 24 hours after transfection until 2 weeks.The efficiency of transfection was about 60% 80%.Conclusion:Nucleofection provides the possibility for a fast and efficient method for cDNA delivery and gene function in cultured hippocampal neurons.