Objective To explore the clinical characteristics of neuromyelitis optica combined with antiN-methyl-D-aspartate (NMDA) receptor encephalitis.Methods A case of neuromyelitis optica combined with anti-NMDA receptor encephalitis was reported,and the diagnosis and treatment were analyzed.The related literatures of this disease were reviewed.Results A 21-year-old woman suffered from sudden lower limb numbness and weakness,lethargy and blurred vision after diarrhea.MRI revealed multiple abnormal signals in bilateral basal ganglias,hippocampus,pontine arm,dentate gyrus and dorsalis medulla oblongata.Many abnormal long T2 signals were found in cervical cord.The antibody of NMDA receptor was positive in cerebrospinal fluid,and aquaporin-4 antibody was also positive in blood and cerebrospinal fluid.Bradycardia was also found in this patient without tumors.Impulsive therapy with steroid and immunotherapy with gammaglobulin achieved a good clinical outcome.Conclusion Neuromyelitis optica combined with anti-NMDA receptor encephalitis can occur after intestinal infection,and the symptoms and imaging characteristics are presented with the two clinical syndromes of neuromyelitis optica and anti-NMDA encephalitis.Bradycardia can also occur in this disease,and timely immunotherapy is effective.

Objective To analyze clinical features of intracerebral hemorrhage in young people.Methods Clinical date of 694 young people(≤45 years) with acute cerebral hemorrhage in the latest five years were retrospectively collected,and they were divided into younger group(＜35 years)and adult group(35 to 45 years).Then clinical characteristics and etiology of these patients were analyzed.Results The number of young people with cerebral hemorrhage accounted for 24.4％-30.5 ％ of the totle number of people with cerebral hemorrhage in the latest five years.And the sex ratio(male to female)was 1.9 ∶ 1 in the young people.The main symptoms were headache (59.5 ％),hemiplegia (46.5 ％),confusion (29.5 ％),aphasia (10.1 ％).The maj or risk factors were hypertension(53.9 ％),smoking (40.4 ％),alcohol abuse(29.4 ％),hyperlipidemia(26.1 ％),family history of cerebral hemorrhage (17.3％),diabetes mellitus (5.9％).The common location of hemorrhage was deep hemisphere (58.6％)and cerebral lobe(37.9％).Hemorrhage in cerebellum and brainstem accounted for 4.3％ and 4.9％,respectively.Proportion of deep hemisphere hemorrhage was significantly higher in the younger group than in the adult group(P＜0.01).With the age increesing,the proportion of cerebral lobe hemorrhage gradually declined.The common causes were high blood pressure and arteriosclerosis cerebral hemorrhage(37.9 ％),vascular malformations (19.3 ％),moyamoya disease(13.4 ％),aneurysm (8.8 ％),tumor (3.2 ％),coagulation abnormal(2.0 ％),other or unknown reasons (19.9 ％).Etiology constituent ratio was significantly different between the two groups,and incidence of intracranial vascular malformation was significantly higher in the younger group than in the adult group(P＜0.01).As the age was decreased by 10 years,incidence of vascular malformation was inceased by 2.44-fold.Conclusion Occurrence of cerebral hemorrhage in young people becomes increaselycommon.The symptom is wild.The main pathogenesis is hypotension.The incidence of cerebrovascular malformation and bleeding in the lobe is significanlty increased,and the younger the age,the more significant this trend.Simultaneously,moyamoya should be paid more attention to in young people with intracerebral hemorrhage.