目的:分析比较脑电图(EEG)Young分级和振幅整合脑电图(aEEG)在昏迷患者预后判断中的应用.方法:选取2020年1月—2022年8月中日友好医院收治的70例昏迷患者作为研究对象,采用EEG分级和aEEG 2种方法对患者预后进行预判,并与实际临床预后进行比较.结果:70例昏迷患者EEG Young分级与aEEG对预后的判断与临床预后的Kappa值分别0.572和0.561(P＜0.05),二者间的一致性检验Kappa值为0.854(P＜0.05).EEG与aEEG预判预后的敏感性分别为82.22％、75.56％,特异性分别为76.00％、84.00％,阳性预测值分别为86.05％、89.47％,阴性预测值分别为70.37％、65.63％,两者间差异均有统计学意义(均P＜0.05).对于伴癫痫波形的分析aEEG需结合EEG分析鉴别.结论:EEG和aEEG对昏迷患者的预后判断均有一定价值,二者的一致性较强,表明aEEG这一新的脑电监护技术可以应用于昏迷患者预后的判断.EEG的敏感性、阴性预测值高于aEEG,aEEG的特异性、阳性预测值高于EEG;两者联合分析值得临床推广应用.

目的:探讨成人弱视患者的脑功能和视空间功能的变化规律.方法:选取中日友好医院眼科门诊成人弱视患者21例(弱视组)和性别年龄相仿的正常人20例(对照组)进行常规脑电图(EEG)检查,记录EEG信号数据,运用光电QP-160A软件分析delta(δ)和beta(β)频段的峰值频率、频谱边缘频率(SEF)及相对功率值.2组均进行蒙特利尔认知量表视空间功能测验和Rey-Osterrieth复杂图形测验,并统计分析视空间功能情况.结果:与对照组比较,成人弱视组患者枕区δ频段和β频段SEF95值、频段峰值频率明显下降,差异有统计学意义(P＜0.01);左顶叶δ相对功率值(δRPP)增大、β相对功率值(βRPP)值增大和δ频段SEF95值减小,差异有统计学意义(P＜0.05).双侧后颞区δ频段SEF95值增大,差异有统计学意义(P＜0.01).视空间功能评估测验结果,2组差异无统计学意义(P＞0.05).结论:脑电图量化分析可能反映弱视患者脑功能重组变化规律.

目的:探索老年人衰老过程中定量脑电图的变化特征.方法:选取2016年1月～2020年6月在中日友好医院神经科行脑电图检查的健康老年人(＞60岁)89例,分为A组(45例,年龄60～79岁)和B组(44例,年龄≥80岁),均进行定量脑电图分析,研究各导联的相对功率比(DTABR)(δ+θ)/(α+β)、α、θ频段的功率值及均值变化.结果:与A组低龄老年人相比,B组高龄老年人全脑的DTABR值均增大,全脑的α、θ频段功率值均降低,尤以左侧优势半球改变显著,差异有统计学意义(P＜0.01).结论:定量脑电图是反映老年人脑功能衰退的监测手段之一.

目的 通过定量脑电图来探讨慢性血栓栓塞性肺动脉高压患者长期低血氧饱和度对大脑认知功能的影响.方法 选取2020年5月至2021年8月中日友好医院心脏血管外科收治的34例慢性血栓栓塞性肺动脉高压患者为研究对象,由于入组患者症状较重,均为中重度慢性血栓栓塞性肺动脉高压患者,根据肺动脉压力升高程度不同将其分为中度组(肺动脉压力为36～45mmHg,16例)和重度组(肺动脉压力>45mmHg,18例).另择同期来医院进行健康体检的30例正常人为对照组.受试者均进行常规脑电图检查,记录脑电图检查结果,并计算大脑各功能区域的相对功率比值([delta+theta]/[alpha+beta]ratio,DTABR),比较分析三组大脑各功能区域的DTABR.分析慢性血栓栓塞性肺动脉高压患者血氧饱和度与大脑各功能区域DTABR的相关性.采用简易智能精神状态检查量表(mini-mental state examination,MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)比较分析三组的认知功能.结果 中度组和重度组患者左前额区FP1、右前额区FP2、左额区F3、右额区F4、左中央区C3、右中央区C4、左顶区P3、右顶区P4、左前颞区F7、右前颞区F8、左中颞区T3、右中颞区T4、左后颞区T5、右后颞区T6、左枕区O1、右枕区O2的DTABR均显著高于对照组(P<0.05);重度组患者左枕区O1、右枕区O2的DTABR均显著高于中度组(P<0.05).Pearson相关性分析结果显示,慢性血栓栓塞性肺动脉高压患者血氧饱和度与大脑各功能区域的DTABR均呈负相关(P<0.05).中度组和重度组患者的MMSE评分、MoCA评分均显著低于对照组(P<0.05);中度组与重度组患者的MMSE评分、MoCA评分比较差异均无显著性(P>0.05).结论 长期低血氧饱和度可使慢性血栓栓塞性肺动脉高压患者的大脑认知功能降低,而定量脑电图可反映慢性血栓栓塞性肺动脉高压患者的脑功能变化,且可为脑功能的变化提供客观、量化的分析方法.

目的:探讨焦虑障碍患者脑电图的量化分析及光驱动反应的特点.方法:选取焦虑障碍患者60例和性别年龄相仿的正常人30例进行常规脑电图(EEG)检查,记录EEG检查结果,并计算全脑、额、颞、中央、顶、枕、左额、右额、左中央、右中央、左顶、右顶、左枕、右枕、左颞、右颞区各频段的相对功率比值DTABR=(δ+θ)/(α+β).同时分析2组脑电图光驱动反应的出现率.结果:EEG量化分析结果,焦虑障碍组与正常对照组相比,DTABR值在额、颞、左中央、左枕、右中央、左顶、右枕的差异有统计学意义(P＜0.01,P＜0.05).EEG显示光驱动反应的出现率焦虑障碍组(81.67％)高于对照组(66.67％),两组间差异有统计学意义(P＜0.01).结论:定量脑电图有可能反映焦虑障碍患者脑功能变化,为理解焦虑障碍的电生理学机制提供客观量化分析方法,有助于焦虑障碍患者鉴别诊断.

目的:探讨语义性痴呆(semantic dementia,SD)患者的脑电图量化分析特点.方法:选取SD患者9例和性别年龄匹配的正常人30例进行脑电图(electroencephalogram,EEG)检查.记录EEG检查结果,测量全脑、左额、右额、左前颞叶、右前颞叶、左中后颞、右中后颞、左中央、右中央、左顶、右顶、左枕、右枕区各频段(δ+θ)/(α+β)相对功率比(DTABR).对2组DTABR值及视觉分析结果进行比较,同时观察SD组患者EEG双侧大脑脑电活动的对称性.结果:与正常对照组相比,SD患者慢波活动增多,DTABR值增大,差异均有统计学意义(P＜0.01).SD患者左侧DTABR值高于右侧对应部位,以前颞叶明显不对称为著,差异均有统计学意义(P＜0.05).结论:定量EEG能够反映SD患者脑功能的变化,为理解SD的电生理学机制提供客观量化指标.

Objective:To explore the value of triple fusion positron emission tomography (PET)/MRI in location of epileptogenic focus in patients with focal cortical dysplasia (FCD).Methods:Three patients with refractory partial epilepsy, admitted to our hospital from December 2016 to June 2017, were chosen in our study. The raw MRI and PET images of these patients were processed using Freesurfer and FSL image processing softwares. After extraction and coregistration, precise PET/MRI fusion images were obtained; and the grey-white matter dividing line was highlighted on this fusion image to form triple-fusion images to observe the hypometabolic area and clarify the location.Results:Triple-fusion images of these 3 patients were acquired. In patient 1, a marked decrease in metabolism was noted in the gyrus region delineated by the gray-white matter boundary in the right cingulate gyrus. In patient 2, the area with slightly increased local signal in the right superior frontal gyrus (MRI FLAIR sequence) was the area with reduced metabolism. In patient 3, an area of local decreased metabolism was noted in the right cingulate gyrus. The preoperative evaluation of all 3 patients showed that the above areas were epileptic foci; the patients were followed up for 2 years after surgical resection, no clinical seizures occurred in all patients, and antiepileptic drugs were gradually stopped. All 3 patients were diagnosed as having FCD by postoperative pathology.Conclusion:Triple fusion PET/MRI is a powerful way to assist FCD diagnosis, especially for those FCD cases which are difficult to be diagnosed by other imaging methods, and has a potential clinical application value in epilepsy patients.

目的:回顾性评价长程视频脑电图监测中头部电极固定的不同方法的稳定性.方法:选取2010年10月～2019年12月间600例行长程脑电图监测患者,按头部电极固定方法分组,A组为无弹性医用绷带固定头部电极,B组用一次性医用弹力网帽固定头部电极,C组用3M胶带结合医用弹力绷带固定头部电极,每组各200例.观察头部电极脱落、头部电极移位、头皮损伤、电极安放固定时间、电极拆卸时间,比较分析3组患者监测时的头部电极固定效果.结果:A、C两组在电极脱落、电极移位、头皮损伤的发生率及电极安放和拆卸用时上均存在显著性差异(均P＜0.01),C组显著优于A组.C组的电极脱落、电极移位的发生率均显著少于B组(均P＜0.01).A、B组之间仅在头皮损伤发生率上差异有统计学意义(P＜0.01).结论:医用弹力绷带兼备了弹性好、通气性好、舒适、可塑性强、操作便利等特点,3M胶带结合医用弹力绷带固定头部电极的方法,适宜在临床长程脑电图监测中推广应用.

Background Mesial temporal lobe epilepsy (MTLE) is the most common form of focal epilepsy, which is frequently characterized by hippocampal sclerosis (HS). Accumulating studies have suggested widespread cortico-cortical connections related to MTLE. The role of subcortical structures involved in general epilepsy has been extensively investigated, but it is still limited in MTLE. Our purpose was to determine the specific morphological correlation between sclerotic hippocampal and thalamic sub-regions, using quantitative analysis, in MTLE. Methods In this study, 23 MTLE patients with unilateral hippocampal sclerosis and 24 healthy controls were examined with three-dimensional T1 MRI. Volume quantitative analysis in the hippocampus and thalamus was conducted and group-related volumetric difference was assessed. Moreover, vertex analysis was further performed using automated software to delineate detailed morphological patterns of the hippocampus and thalamus. The correlation was used to examine whether there is a relationship between volume changes of two subcortical structures and clinical characteristics. Results The patients had a significant volume decrease in the sclerotic hippocampus ( p < 0.001). Compared to controls, obvious atrophic patterns were observed in the bilateral hippocampus in MTLE ( p < 0.05). Only small patches of shrinkage were noted in the bilateral thalamus ( p < 0.05). Moreover, the volume change of the hippocampus had a significant positive correlation with that of the thalamus ( P < 0.001). Intriguingly, volume changes of the hippocampus and thalamus were correlated with the duration of epilepsy (hippocampus: P = 0.024; thalamus: P = 0.022). However, only volume changes of thalamus possibly differentiated between two prognostic groups in patients ( P = 0.026). Conclusions We demonstrated the morphological characteristics of the hippocampus and thalamus in MTLE, providing new insights into the interrelated mechanisms between the hippocampus and thalamus, which have potential clinical significance for refining neuromodulated targets.

目的:分析并总结遗传性痉挛性截瘫 7型(HSP7)患者的临床表现及基因突变特点.方法:收集 2例HSP7患者的临床资料,完善头核磁平扫检查,行共济失调量表及认知功能量表评分,提取患者及其直系亲属外周血 DNA,全外显子测序进行基因检测,结合一代测序验证突变位点.结果:2例 HSP7患者临床表现均有走路不稳,小脑性共济失调、下肢肌张力增高、肌力减退及轻度认知功能减退,头核磁平扫发现轻度小脑萎缩,基因检测发现 2例患者痉挛性截瘫 7基因(SPG7)存在复合杂合突变,病例 1:c.1047dupC(p.Gly349fs),c.1904C＞T(p.Ser635Leu);病例 2:c.2771delG(p.Met757fs),c.1529C＞T(p.Ala510Val),均为已报道致病突变,家系验证证实突变分别来自于患者的父母且存在基因型-表型共分离.结论:HSP7患者临床上可以表现有小脑性共济失调及认知功能减退,本研究的 2例 HSP7患者经基因检测证实为 SPG7基因复合杂合突变所致.

Background Mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE?HS) is the most common type of focal epilepsy involving complex networks. 18F?fluoro?2?deoxy?D?glucose (18F?FDG) PET provides unique brain metabolic information for epilepsy. This study aims to explore the spatial metabolic characteristics of mTLE?HS based on a quantitative analysis of 18F?FDG PET. Methods A total of 23 patients with mTLE?HS and 26 sex? and age?matched healthy controls were enrolled in this study. All of them were performed head MRI and 18F?FDG PET scanning. PET images were registered to standard template and further divided into 90 regions of interest (ROIs) based on anatomical automatic labeling (AAL). Normalized standard uptake value (SUV) in whole brain, bilateral cerebral hemispheres and each ROI were calculated. Results The normalized SUV of whole brain in mTLE?HS patients was significantly lower than healthy controls (1.13 ± 0.06 vs. 1.20 ± 0.10; t = ? 3.245, P = 0.002). The normalized SUV of left hemisphere was significantly lower than right hemisphere (1.10 ± 0.06 vs. 1.15 ± 0.06; t = ? 2.710, P = 0.010) in mTLE?HS patients. Compared with controls, the normalized SUV in 15 ROIs of mTLE?HS patients were identified with hypometabolism significantly, which were located in left temporal lobe (hippocampus, parahippocampal gyrus, amygdala, superior temporal pole, middle emporal pole, inferior temporal gyrus and fusiform gyrus, transverse temporal gyrus) and left extratemporal cortex (inferior frontal operculum, Rolandic operculum, insular lobe, median cingulate gyrus, caudate nucleus, putamen and thalamus). Conclusions This study revealed the spatial metabolic characteristics of mTLE?HS based on a quantitative analysis of 18F?FDG PET from the metabolic perspective, deepened the understanding on pathophysiological mechanisms of mTLE?HS, and provided a framework for further analyzing the functional change and seizure progression of mTLE?HS. DOI: 10.3969/j.issn.1672-6731.2018.05.007

Purpose: It has been challenging to detect early changes preceding seizure onset in patients with epilepsy. This study investigated the preictal discharges (PIDs) by intracranial electroencephalogram of 11 seizures from 7 patients with mesial temporal lobe epilepsy. Methods: The EEG segments consisting of 30 seconds before ictal onset and 5 seconds after ictal onset were selected for analysis. After PID detection, the amplitude and interval were measured. According to the timing of PID onset, the 30-second period preceding seizure onset was divided into two stages: before PID stage and PID stage. The autocorrelation coefficients during the two stages were calculated and compared. Results: Preictal discharge amplitude progressively increased, while PID interval gradually decreased toward seizure onset. The autocorrelation coefficients of PID channels were significantly higher during PID stage than before PID stage. There was an overlap between channels with PIDs and seizure onset channels (80.77%). Conclusions: Preictal discharges emerge prior to ictal event, with a dynamic change and a spatial correlation with seizure onset zone. These findings deepen our understanding of seizure generation and help early prediction and localization of seizure onset zone.

Objective To investigate the value of subtraction ictal SPECT co-registered to MRI (SISCOM) on localizing epileptogenic focus.Methods Two representative patients were enrolled.One suffered from refractory seizure due to diffuse encephalomalacia on left parietal lobe,while another showed MRI negative with frequency uncontrolled seizure,of which the origin from the medial temporal lobe or the temporal lobe needed to be identified.As the conventional approaches including semiological analysis,MRI and scalp electroencephalogram failed to describe the epileptogenic zone exactly,interictal and ictal 99mTcethyl cysteinate dimer (ECD) SPECT was further performed,followed by SISCOM processing,including linear coregister,voxel normalization and subtraction with ictal and interictal 99mTc-ECD SPECT.Three standard deviation of focal area hyperperfusion above the interictal period was considered as statistical significance.Results Definitely,significant hyperperfusion changes were observed on both patients.Although the lesions of 1 patient were diffuse,significant hyperperfusion appeared on limited areas surrounding the lesions;meanwhile,typical pattern of medial temporal lobe was observed in the other patient.The epileptogenic zones were located in the brains of both patients,without attack after surgical treatment.Conclusion SISCOM is of great help in localizing epileptogenic zone in presurgical evaluation in intractable epilepsy,especially in complex patients.

Up to a third of all patients with epilepsy are refractory to medical therapy even in the context of the introduction of new antiepileptic drugs (AEDs) with considerable advantages in safety and tolerability over the last two decades. It has been widely accepted that epilepsy surgery is a highly effective therapeutic option in a selected subset of patients with refractory focal seizure. There is no doubt that accurate localization of the epileptogenic zone (EZ) is crucial to the success of resection surgery for intractable epilepsy. The pre-surgical evaluation requires a multimodality approach wherein each modality provides unique and complimentary information. Accurate localization of EZ still remains challenging, especially in patients with normal features on MRI. Whereas substantial progress has been made in the methods of pre-surgical assessment in recent years, which widened the applicability of surgical treatment for children and adults with refractory seizure. Advances in neuroimaging including voxel-based morphometric MRI analysis, multimodality techniques and computer-aided subtraction ictal SPECT co-registered to MRI have improved our ability to identify subtle structural and metabolic lesions causing focal seizure. Considerable observations from animal model with epilepsy and pre-surgical patients have consistently found a strong correlation between high frequency oscillations (HFOs) and epileptogenic brain tissue that suggest HFOs could be a potential biomarker of EZ. Since SEEG emphasizes the importance to study the spatiotemporal dynamics of seizure discharges, accounting for the dynamic, multidirectional spatiotemporal organization of the ictal discharges, it has greatly deep our understanding of the anatomo-electro-clinical profile of seizure. In this review, we focus on some state-of-the-art pre-surgical investigations that contribute to the precision medicine. Furthermore, advances also provide opportunity to achieve the minimal side effects and maximal benefit individually, which meets the need for the current concept of precision medicine in epilepsy surgery.

目的:探讨重症中枢神经系统李斯特菌感染的病因、发病机制、临床表现、影像学特点、治疗及预后.方法:回顾中日友好医院神经内科2014年10月～2015年6月期间收治的2例重症中枢李斯特菌感染患者的临床资料,分析其临床特点、实验室检查、治疗及预后,并复习相关文献.结果:神经系统李斯特菌感染主要累及免疫抑制的患者,但其中脑干脑炎的患者常为没有易感因素的年轻人.中枢神经系统李斯特菌感染常引起脑膜炎、脑炎或者脑干脑炎.影像学检查异常率不高,主要表现为脑干脑炎、脑室扩张等.目前没有中枢神经系统李斯特菌感染的最佳治疗方案和治疗时限,早期联合使用抗菌素被认为可能有较好的效果.结论:重症中枢神经系统李斯特菌感染病情进展迅速,死亡率高,需要尽早诊治,从而改善预后.

OBJECTIVE To study the clinical and imaging characteristics of Chinese atopic myelitis (AM) patients. METHODS Three diagnosed AM patients were retrospectively analyzed for the clinical data, serum IgE level, antigen specific IgE, cerebrospinal fluid, spinal MRI and therapeutic efficacy profiles. RESULTS All the three patients were male and presented as subacute AM with the onset at 25, 47 and 49 years old respectively. Two patients were allergic to pollen and other drugs, while another patient suffered from allergic rhinitis. Elevated serum total IgE and mite antigen specific IgE were found in all cases. Paraesthesia in limb extremities and positive Lhermitte sign were the main clinical features, while no optic, motor, urinary and defecation disturbance were found. Oligoclonal banding of cerebrospinal fluid and serum aquaporin 4 (AQP4) antibody were both negative in all cases. Spinal MRI showed lesions were hypointense on T1 and hyperintense on T2 at the posterior column of T2-3 segment with abnormal enhancement in case 1, hypointense on T1 and hyperintense on T2 at C2/3 segment with mild swelling in case 2 and hypointense on T1 and hyperintense on T2 at C3-5 segments with swelling and abnormal enhancement in case 3. Vitamin B were used in one patient, while the other two patients improved after the treatment with high-dose corticosteroids. CONCLUSIONS Subacute myelitis predominantly presents as paraesthesia in limb extremities with elevated serum total IgE and mite antigen specific IgE, while severe motor disorders are rare. Swelling and abnormal enhancement lesions at the posterior column of cervical cord are the common imaging features. Treatment with corticosteroids is recommended to be sustained for 3-6 months.

Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis was increasingly recognized as a distinct auto-immune entity with clinical significance in the past few years, which was characterized by acute or subacute neuropsychiatric and neurological symptoms, and progressed to death or disability in many cases [ 1 Dalmau J. Lancaster E. Martinez-Hernandez E. Rosenfeld M.R. Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011; 10: 63-74 Abstract Full Text Full Text PDF PubMed Scopus (1776) Google Scholar , 2 Florance N.R. Davis R.L. Lam C. Szperka C. Zhou L. Ahmad S. Campen C.J. Moss H. Peter N. Gleichman A.J. Glaser C.A. Lynch D.R. Rosenfeild M.R. Dalmau J. Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann. Neurol. 2009; 66: 11-18 Crossref PubMed Scopus (862) Google Scholar ]. The clinical manifestations, however were variable, which resulted in the difficulty of diagnosis or confusion with other neurological disorders, especially in pediatric patients [ 3 Bigi S. Hladio M. Twilt M. Dalmau J. Benseler S.M. The growing spectrum of antibody-associated inflammatory brain diseases in children. Neurol. Neuroimmunol. Neuroinflamm. 2015; 2;2 (eCollection 2015): e92https://doi.org/10.1212/NXI.0000000000000092 Crossref Scopus (26) Google Scholar , 4 Sands T.T. Nash K. Tong S. Sullivan J. Focal seizures in children with anti-NMDA receptor antibody encephalitis. Epilepsy Res. 2015; 112: 31-36 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar ].

Objective To map the basal temporal language area (BTLA) in native Chinese and investigate the functional characteristics of BLTA.Methods Three patients with refractory mesial temporal lobe epilepsy were studied.Due to controversial results from non-invasive methods,the chronic subdural electrodes were implanted.The language function on the basal temporal lobe was investigated by means of electrocortical stimulation.Patients were asked to read sentences aloud and perform specific language task during the test.Any responses to electrocortical stimulation with gradual increased current intensity were recorded.Results Left dominant hemispheres of all patients were revealed by Wada test.With low current intensity (7,5,7 mA),slowing speech was observed when stimulating anterior to middle of fusiform gyrus on the left basal temporal lobe.Meanwhile,stimulation with high intensity (11,11,13 mA)produced global aphasia.Furthermore,semantic errors occurred when stimulating electrode 3 cm from temporal pole,while the impairment of naming and face recognition was elicited by stimulating electrode 4 cm from temporal pole with 9 mA current intensity in all three patients.Conclusions The preliminary study confirmed the BTLA in native Chinese,which localized on anterior to middle basal temporal lobe in the dominant hemisphere and involved in the semantic and naming function.The identification of BTLA would be helpful for the clarification of language mechanism and protection of the language function in the surgical treatment of epilepsy.

Background Myasthenia gravis ( MG ) is an autoimmune disorder with predominantly neuromuscular junction involvement,the typical clinical manifestations were symptoms of muscle weakness,such as volatility and fatigability of skeletal muscles. Atypical MG can easily be misdiagnosed,thus the treatment is delayed. Objective To improve the understand-ing of atypical MG,so as to decrease the misdiagnosis rate. Methods The clinical manifestation,therapeutical and prognostic profile as well as misdiagnosis reasons of two MG patients were analyzed. Results Case 1,72-year old female,abrupt onset of multi-brainstem symptoms combined with positional vertigo and urination disorder, the case was diagnosed with progressive stroke for posterior circulation or high cervical spinal cord disorder initially. According to wide Jitter wave and conduction block of single fiber electromyography,chest CT suggests thymic hyperplasia,and immune therapy( pyridostigmine bromide and intra-vous immunoglobulin)was effective,the case was diagnosed with MG;case 2,27-year old male,suffered from multi-cranial nerve disorder including facial paresthenia,along with protein -cell separation in cerebrospinal fluid,the case was diagnosed with multiple cranial neuropathy more than once. According to seropositive RyR antibody and Titin antibody,wide Jitter wave and conduction block of single fiber electromyography,as well as chest CT and pathology suggest B3 type thymoma,the case was di-agnosed with MG. Conclusion MG has diverse clinical manifestations except for myasthenia,clinicians should pay more atten-tion to these,analysis of atypical clinical manifestations may enhance understanding of the pathogenesis of MG.

OBJECTIVE:To explore the etiologies and imaging features of longitudinally extensive spinal cord lesion (LESCL).METHODS:The etiologies and magnetic resonance (MR) imaging features of 51 hospitalized LESCL patients from January 2011 to August 2013 were reviewed and retrospectively analyzed.RESULTS:Among them, the causes were neuromyelitis optica spectrum disorder (NMOSD, n = 25), isolated longitudinally extensive transverse myelitis (n = 6), subacute combined degeneration (n = 4), multiple sclerosis (MS, n = 3), paraneoplastic myelopathy (n = 3), anterior spinal artery syndrome (n = 3), acute disseminated encephalomyelitis (n = 2), spinal dural arteriovenous fistula (n = 2), intramedullary spinal cord metastasis (n = 1), myelopathic leukemia (n = 1) and syringomyelus (n = 1). For MR imaging, at least one lesion of each patient presented continuously longitudinal profile and whole-length spinal cord was involved in 11 patients.CONCLUSION:LESCL may be caused by various diseases. And the imaging features may aid its diagnosis despite a lack of specificity.