BACKGROUND:Glial fibrillary acidic protein-immunoglobulin G (GFAP-IgG) positivity is associated with autoimmune GFAP astrocytopathy (GFAP-A), but also with other autoimmune encephalitides and viral infections. We attempted to elucidate the characteristics of GFAP-A in relation to other GFAP-IgG-positive encephalitides and constructed a differential diagnosis model. METHODS:141 GFAP-IgG-positive cases were identified, including 52 astrocytopathy (GFAP-A group), 48 autoimmune encephalitis (AE-G), and 41 viral encephalitis (VE-G). Multivariate logistic regression was employed to create a diagnostic model, with validation using an external cohort. RESULT:Compared to the AE-G group, the GFAP-A patients showed more onset age ≥ 50 years, headache, fever, consciousness disturbance, MRI radial vascular enhancement, cerebrospinal fluid (CSF) antibody titer grade ≥ 4, and CSF proteins ≥ 700 mg/L, but less female sex, limb numbness, visual disturbances, and CSF chloride ≤ 120 mmol/L. Among these, CSF antibody titer grade ≥ 4, CSF protein ≥ 700 mg/L, and absence of visual disturbances were independent risk factors for GFAP-A diagnosis. Compared to the VE-G group, the GFAP-A patients showed more course ≥ 14 days, onset age ≥ 50 years, limb weakness, serum potassium ≤ 3.9 mmol/L, CSF antibody titer grade ≥ 4, CSF leukocytes ≤ 46*10, MRI radial vascular enhancement, MRI involvement of brainstem, and MRI involvement of spinal cord, but less headache, fever, nausea, and vomiting. Among these, serum potassium ≤ 3.9 mmol/L, MRI spinal cord involvement, and absence of nausea and vomiting were independent risk factors for GFAP-A diagnosis. CONCLUSIONS:Based on critical clinical indicators identified, we constructed a differential diagnosis model for GFAP-A.

BACKGROUND:The Boston Naming Test (BNT) is the most widely used measure to assess anomia. However, it has been criticized for failing to differentiate the underlying cognitive process of anomia.OBJECTIVE:We validated the color-picture version of BNT (CP-BNT) in a sample with diverse neurodegenerative dementia diseases (NDDs). We also verified the differential ability of the composite indices of CP-BNT across NDDs groups.METHODS:The present study included Alzheimer's disease (n = 132), semantic variant primary progressive aphasia (svPPA, n = 53), non-svPPA (n = 33), posterior cortical atrophy (PCA, n = 35), and normal controls (n = 110). We evaluated psychometric properties of CP-BNT for the spontaneous naming (SN), the percentage of correct responses on semantic cuing and word recognition cuing (% SC, % WR). Receiver operating characteristic analysis was used to examine the discriminatory power of SN alone and the composite indices (SN, % SC, and % WR).RESULTS:The CP-BNT had sufficient internal consistency, good convergent, divergent validity, and criterion validity. Different indices of CP-BNT demonstrated distinct cognitive underpinnings. Category fluency was the strongest predictor of SN (β= 0.46, p < 0.001). Auditory comprehension tests highly associated with % WR (Sentence comprehension: β= 0.22, p = 0.001; Word comprehension: β= 0.20, p = 0.001), whereas a lower visuospatial score predicted % SC (β= -0.2, p = 0.001). Composite indices had better predictability than the SN alone when differentiating between NDDs, especially for PCA versus non-svPPA (area under the curve increased from 63.9% to 81.2%).CONCLUSION:The CP-BNT is a highly linguistically relevant test with sufficient reliability and validity. Composite indices could provide more differential information beyond SN and should be used in clinical practice.

Objective:To understand the awareness and application status of drugs used with caution in myasthenia gravis (MG) patients.Methods:The list of drugs that should be used with caution in MG patients was formulated through discussion among pharmaceutical experts and neurology experts in Xuanwu Hospital, Capital Medical University, including 10 categories and more than 50 drugs like anti-infective drugs, cardiovascular drugs, sedative-hypnotics, statins, antiepileptics, antipsychotics, analgesics, anaesthetics, spasmolytics, and others. The questionnaire survey on knowledge of drugs used with caution was conducted in outpatients with MG in the Department of Neurology between January 2021 and February 2022 in Xuanwu Hospital, Capital Medical University. The contents of the questionnaire included the general demographic data of patients, the disease course and type of MG, comorbidities, drug utilization, awareness and application of drugs used with caution in MG patients, and accesses to relevant drug use knowledge. The questionnaire was distributed on-site after the patient ended the visit, and the patients were asked to participate voluntarily and answer and return the questionnaire on the spot. The participants were divided into the with and without relevant knowledge groups according to whether they were aware of drugs used with caution in MG patients, and the clinical characteristics of the patients in the 2 groups were compared. Multivariate logistic regression analysis was used to analyze the influencing factors of awareness of drugs used with caution, and the odds ratio ( OR) and 95% confidence interval ( CI) were calculated. Results:A total of 290 questionnaires were distributed and all of them were recovered. Among the 290 patients, 165 were male and 125 were female, and the disease course of MG ranged from 3 weeks to 360 months. The clinical subtypes were ocular MG in 179 patients and non-ocular MG in 111 patients. One or more chronic disease coexisted in 174 patients (60.0%), including hypertension, hyperlipidemia, diabetes mellitus, coronary atherosclerotic heart disease, immune system disease, anxiety/depression, etc. There were 248 patients (85.5%) who had received medications for MG. In the MG patients having access way to knowledge about drugs used with caution, there were 191 (92.7%), 26 (12.6%), 22 (10.7%), and 7 (3.4%) patients through the propagation by healthcare staff, bulletin boards/display boards in the hospital, networks, and books, respectively. There were 64.8% (188/290) of the patients knowing nothing about the drugs used with caution. After the diagnosis of MG, 110 patients had used the drugs that should be used with caution, and 7 (6.4%) had aggravated MG or adverse reactions later, of which 4 applied eye drops (quinolones and macrolides in 2 patients respectively). The independent influencing factors of low awareness of drugs used with caution were not receiving drugs for MG and not obtaining precautions in medication at the time of diagnosis ( OR=6.811, 95 %CI: 2.252-20.593, P=0.001; OR=5.615, 95 %CI: 3.223-9.785, P<0.001). Conclusion:Patients with MG have low awareness of the drugs used with caution, and neurology staffs should take more effective measures to the patient education about drugs used with caution.

Despite the ubiquity of the Boston naming test (BNT) in clinical practice and research, concerns have been expressed about its poor quality pictures, insufficient psychometric properties, and cultural bias in non-English language backgrounds. We modified the black-and-white BNT with a set of color pictures since color effects have been suggested to improve naming accuracy in the visual naming test. This study aimed to examine and compare the reliability and validity of the color-picture version of BNT (CP-BNT) and the black-and-white version of BNT (BW-BNT) to differentiate amnestic mild cognitive impairment (aMCI) or mild Alzheimer's disease (AD) from the cognitive normals. This study included two subgroups, and each subgroup had 101 normal controls, 51 aMCI, and 52 mild AD. One subgroup undertook BW-BNT and the other conducted CP-BNT. The reliability, convergent and discriminant validity, and the diagnostic accuracy of two versions of BNT were evaluated. The CP-BNT showed a greater area under the curve (AUC) than the BW-BNT for aMCI (80.3 vs.s 69.4%) and mild AD (93.5 vs. 77.6%). The CP-BNT also demonstrated better convergent validity with CDR global scores and better reliability (Cronbach's coefficient 0.66 for the CP-BNT vs. 0.55 for the BW-BNT). At the optimal cutoff value of spontaneous naming, the CP-BNT demonstrated improved sensitivity and specificity for differentiating mild AD from NC with a higher positive predictive value, negative predictive value, and lower false-positive rate. Compared with BW-BNT, CP-BNT is a more reliable and valid test to assess cognitive and naming impairment.

目的 了解门诊重症肌无力患者对抗感染类慎用药物的知晓状况.方法 选择204例门诊重症肌无力患者,采用抗感染类慎用药物相关知识问卷对其进行调查,了解患者对重症肌无力慎用药物相关知识的掌握情况.结果 204例患者中,71.1％(145/204)的患者具有获取用药相关知识的途径,55.9％(114/204)的患者就诊时接受过有关用药注意事项的宣教,但仅有37.3％(76/204)的患者知晓抗感染类慎用药物,8例患者在确诊重症肌无力后服用过抗感染类慎用药物.病程为12～60个月、就诊时被告知用药注意事项、有获取用药相关知识途径的患者对抗感染类慎用药物知识的知晓率更高(均P<0.05).结论 门诊重症肌无力患者对抗感染类慎用药物的知晓率较低,病程、就诊时是否被告知用药注意事项、是否有获取用药相关知识的途径可能是重症肌无力患者对抗感染类慎用药物知晓状况的影响因素.

目的 通过分析门诊就诊成年癫痫患者的发作诱因,总结针对性的管理策略,以减少患者发作频率.方法 选取2019年1-12月首都医科大学宣武医院就诊的成年癫痫患者518例,收集癫痫诱发因素资料,分析癫痫发作的常见诱因,以及诱因与人口学特征和癫痫临床特点之间的关系.结果 518例患者中,64.7％的患者在发作前至少存在一种诱发因素,其中疲劳(45.7％)是最常见的诱因,其余依次为睡眠紊乱(43.0％)、情绪因素(42.4％)和饮食相关(18.2％)等.同一患者可有多种诱因,在有诱因的患者中,62.4％认为同时存在≥2种诱因.常见诱因中疲劳与性别、病程和居住地有关,差异有统计学意义(P＜0.05),发作频率与情绪因素有关,差异有统计学意义(P＜0.05);518例患者的发病总诱因在性别、年龄、起病年龄、起病年龄分段、病程、民族、居住地、发作频率和发作类型方面,差异均无统计学意义(P＞0.05).结论 疲劳、睡眠紊乱和情绪因素是常见的癫痫诱因,总诱因与患者人口学和临床特征无关,但各种诱因在不同人口学和临床特征的患者之间的分布存在显著差异.明确癫痫发作的诱发因素,加强门诊癫痫患者的综合管理,有助于减少癫痫发作.

目的 了解帕金森病(Parkinson's disease,PD)患者对左旋多巴药物相关知识的掌握情况.方法 选取2019年1-12月于首都医科大学宣武医院神经内科门诊就诊服用左旋多巴药物的PD患者91例,进行左旋多巴药物相关知识的问卷调查,了解患者对服药相关知识的掌握情况,并分析其人口学特征对掌握情况的影响.结果 91例患者对左旋多巴相关知识知晓度的总体得分为(6.73±1.63)分,知晓度为67.3％,其中"饮食"相关知识得分为(2.22±0.84)分,知晓度为74.0％;"药物"相关知识得分为(2.51±0.60)分,知晓度为62.8％;"疾病"相关知识得分为(2.00±0.80)分,知晓度为66.7％.复诊患者对左旋多巴药物相关知识的得分高于初诊患者[(7.68±0.90)分比(4.97±1.12)分,P＜0.05];61.5％的患者通过医院途径获得左旋多巴相关用药知识,得分为(7.70±0.89)分,显著高于说明书途径[(5.57±1.17)分]、网络途径[(5.13±1.36)分]和其他途径[(3.83±0.75)分],差异均有统计学意义(P＜0.05).性别、年龄、受教育年限、发病年龄、服药年限对PD患者服用左旋多巴药物的总体得分无影响(P＞0.05).结论 PD患者的总体知识掌握情况有待提高,其中在我院复诊的患者知识掌握程度较高,医院途径是患者获得相关用药知识的主要途径,且与其他途径相比更为有效.医护人员应加强对患者的健康教育,帮助患者提高遵医行为,从而改善疾病状态.

癫痫是一种常见神经内科疾病,病程长,治疗效果不佳,长期、反复的发作可影响患者身心健康,导致生活质量受到不同程度的影响,其焦虑、抑郁等不良情绪发生率也远高于普通人群.女性患者的生活质量与男性存在一定差异,本文对女性癫痫患者生活质量影响因素的研究进展进行综述,以期能够对改善女性癫痫患者的生活质量提供帮助.

目的 探讨交替卧位对腰椎穿刺患者术后不良反应的影响.方法 选择2016年1月至2018年3月首都医科大学宣武医院神经内科门诊进行腰椎穿刺检查的患者纳入本研究,随机分为对照组(术后去枕平卧位4h)和交替卧位组(术后去枕平卧0.5 h后采取交替卧位).比较两组患者术后腰背疼痛、颈部疼痛及头痛的发生情况.结果 本研究共纳入337例患者,交替卧位组169例,对照组168例.交替卧位组术后腰背疼痛的发生率较对照组明显降低(21.3％ vs.33.9％,P=0.010),程度明显减轻(P=0.003);交替卧位组术后颈部疼痛的发生率较对照组明显降低(27.2％ vs.38.7％,P=0.025),程度明显减轻(P=0.019).两组患者头痛的发生率和疼痛程度的差异无统计学意义(P=0.773,P=0.771).结论 交替卧位在腰椎穿刺术后可明显改善患者腰背部及颈部疼痛,对头痛的发生无明显影响.

A 70-year-old male patient with chronic obstructive pulmonary disease received compound phenytoin sodium,ephedrin hydrochloride and theophylline tablets (each tablet containing phenytoin sodium 50 mg,chlorpheniramine maleate 1 mg,ephedrine hydrochloride 5 mg,caffeine 7.5 mg,theobromine 12.5 mg,theophylline 12.5 mg,belladonna flow extract 0.009 ml) 3 tablets thrice daily by mouth.Gait instability and clumsiness of his lower limbs appeared after 29 months of medication and gradually worsened with mental disorders (such as sparoxysmal unconsciousness,increased daytime sleep and balderdash) after 35 months of medication.Laboratory tests showed that the blood phenytoin concentration was 30 mg/L.Phenytoin poisoning was considered.Compound phenytoin sodium,ephedrin hydrochloride and theophylline tablets were stopped,and symptomatic and supportive treatments were given.Ten days later,the patient became conscious,his mental disorders disappeared,and the blood phenytoin concentration decreased to be 15 mg/L.Fourteen days later,he could walk independently.

To make neurological intensive nurses understand the nursing operation method of endovascular therapeutic hypothermia in patients with severe cerebral ischemia and improve the effectiveness of hypothermia in patients, we searched PubMed and CNKI for literature of endovascular therapeutic hypothermia in the past 20 years. We used evidence-based medicine clinical level of Oxford evidence classification of 2009 to confirm the evidence and recommendations, discuss the nursing operation method of endovascular therapeutic hypothermia process. The nursing practice and evidence of three distinct phases about induction, maintenance and rewarming in endovascular therapeutic hypothermia process were explored. It can help neurological intensive nurses implement nursing early, safely and effectively, and promote patients better.

>患者男性,19岁,主因"突发意识丧失,四肢抽搐,双上肢屈曲,双下肢伸直,口吐白沫",于2007年9月以"症状性癫痫"收入神内ICU治疗,入院后查体:由患者神志始终处于药物镇静状态,双侧瞳孔直径3mm,光反应灵敏,吞咽、言语、四肢肌力检查均不合作,生命体征平稳,血压100/58 mm Hg

>患者女性,26岁,主因"谵语10 d,发作性四肢抽搐,意识丧失9 d"于2009年8月以"病毒性脑炎"收入神经内科ICU治疗。既往有左颜面外伤史9年,吸烟史3年。头颅CT未见异常,腰穿压力290 mm H 2 O（1 cm H 2 O=0.098 kPa）,白细胞计数10×10～6/L,脑脊液蛋白521 mg/dl,脑脊液糖、氯正常,涂片找菌阴性。入院后查体:神志处于药物镇静状态,双