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Objective To investigate the diagnostic value of next-generation sequencing (NGS) in α-herpes virus meningitis or encephalitis.Methods A multicenter clinical registration study of encephalitis based on Department of Neurology of Peking Union Hospital from July 2015 to July 2018 was performed;15 patients with meningitis or encephalitis caused by α-herpes virus in Nanjing Brain Hospital and Peking Union Hospital were identified by NGS of cerebrospinal fluid (CSF).The verification results of further CSF virus PCR or antibody detection,the results of lumbar puncture,electroencephalogram and MRI detection,and the nucleic acid sequence analysis results of background bacteria in these 15 patients were observed.Results In these 15 patients with CSF α-herpes virus infection,8 were with herpes simplex virus (HSV)-1 infection,two with HSV-2 infection and 5 with varicella zoster virus (VZV) infection;four were further tested by CSF virus PCR,and 8 were further tested by antibody IgM,and the results were all positive.The protein content in CSF biochemical examination was slightly increased to (0.91±0.50) g/L.EEG abnormalities were observed in 9 patients;MR imaging abnormalities were observed in 6 patients with HSV-1 encephalitis,presenting as abnormal high signals in MR imaging T2 phase in the medial temporal lobe,hippocampus,cingulate gyrus and insula,which could be mainly involved in one side or both sides simultaneously.Eleven patients had fever,and the highest temperature was (38.6±0.61) ℃;13 patients had headache,8 had abnormal mentalbehavior and 7 had decreased consciousness.All patients showed different levels of suspicious background microorganisms;the most common background bacteria were propionibacterium acacne (13.7％),staphylococcus epidermidis (9.59％),pseudomonas (8.22％) and acid-eating bacteria (6.85％).Conclusion CSF NGS could be used in diagnosis of intracranial α-herpes virus infection,which can be a supplement diagnostic method currently.
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Neuron-antibody mediated movement disorders are a class of movement disorders caused by abnormal immune responses to nerve auto-antigens,which could be paraneoplastic,infectious or idiopathic.The clinical manifestations of nervous system symptoms varied,and movement disorders can be used as part of various phenotypes,including chorea,dystonia,Parkinson's syndrome,myoclonus,stiffness syndrome,autoimmune encephalitis and cerebellar ataxia and so on.The clinical diagnosis of this disease is mainly based on the positive specific anti-central or peripheral nerve autoantibodies in serum or cerebrospinal fluid.The specificity of antibodies helps to predict associated cancer and its response to immunotherapy.Early and accurate diagnosis is very important because of the good therapeutic effect of early immunization.
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Objective To study the alterations of renal function in patients with acute ischemic stroke and diabetes and to analyze the risk factors of contrast-induced nephropathy (CIN) after digital subtraction angiography (DSA).Methods Eight hundred and seventy-one cerebral infarction patients with diabetes who underwent DSA were selected in the Third Affiliated Hospital of Chongqing Medical University and Nanjing Brain Hospital Affiliated to Nanjing Medical University from August 2012 to August 2016.The patients were divided into diabetic group (n =178) and non-diabetic group (n =693).The alterations of renal function and the incidence rate of CIN were observed between two groups 3 days after DSA.Univariate analysis and multi-factor Logistic regression analysis were used to analyze the independent risk factors of CIN.Results The levels of estimated glomerular filtration rate (eGFR,ml · min-1 · 1.73 m-2) in diabetic group at 1,2 and 3 days after DSA(81.94 ±9.38,75.36 ±8.21,84.43 ±9.72) were lower than that in non-diabetic group (84.62 ± 10.06,79.08 ±9.84,87.62 ± 10.15,t =3.213,4.645,3.772,all P ＜ 0.05).The levels of serum creatinine (Scr) and cystatin (CysC) in diabetic group at 1,2 and 3 days after DSA (Scr:85.63 ±9.83,92.37 ±10.07,83.43 ±9.07;CysC:1.08 ±0.12,1.35 ±0.14,0.95 ±0.10) were higher than that in non-diabetic group (Scr:81.36 ± 8.98,87.84 ± 9.85,80.31 ± 8.64,t =5.548,5.448,4.253;CysC:0.97 ±0.11,1.21 ±0.12,0.88 ±0.09;t =11.677,13.400,9.043;all P ＜ 0.05).The incidence rate of CIN in diabetic group (25.84％ (46/178)) was higher than that in nondiabetic group (7.07％ (49/693),x2 =51.358,P =0.001).Multi-factor Logistic regression analysis showed allergies,plasma brain natriuretic peptide,heart failure,the original renal insufficiency,NIHSS score,contrast agent dosage,preoperative eGFR,preoperative Scr and preoperative CysC were the independent risk factors of CIN in cerebral infarction patients with diabetes.Conclusions The renal function decreased significantly and the incidence rate of CIN was high in cerebral infarction patients with diabetes after DSA.Allergies,plasma brain natriuretic peptide,heart failure,the original renal insufficiency,contrast agent dosage,preoperative eGFR,preoperative Scr and preoperative CysC were the independent risk factors of CIN in cerebral infarction patients with diabetes.
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Objective To investigate the value of the Changsha version of the Montreal Cognitive Assessment Scale (MoCA) in the assessment of vascular cognitive impairment after cerebral infarction .Methods 112 cases of clinically diagnosed cerebral infarc-tion were selected and divided into the normal cognition (NC) group and vascular cognitive impairment(VCI) group .The Changsha version of MoCA and the mini-mental state examination(MMSE) were adopted to detect the cognitive function ,the correlation of two scales was analyzed and the cutoff values of the Changsha version of MoCA were preliminarily studied .Results The total scores of the Changsha version of MoCA and MMSE in the VCI group were 15 .12 ± 4 .60 and 20 .44 ± 3 .22 respectively ,which were lower than 22 .75 ± 1 .79 and 25 .21 ± 1 .74 in the NC group ,the difference had statistical significance (P< 0 .05);the total scores of the Changsha version of MoCA was positively correlated with the total scores of MMSE (r=0 .84 ,P<0 .01);the best cut-off value of the Changsha version of MoCA was 20/21 ,the sensitivity and specificity were 92% and 95% respectively .Conclusion The Changsha version of MoCA can screen VCI well and has a high screening value ,and its optimal cutoff value is 20/21 .
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Objective To investigate the relationship between spontaneous hemorrhagic transformation and prognosis after cerebral infarction.Methods Three hundred and thirty-seven cases with acute ischemic stroke at the Brain Hospital Affiliated to Nanjing Medical University from Nov.2011 to Jul.2012 were selected as our subjects.All the relevant clinic and laboratory examination data which influencing spontaneous hemorrhagic transformation were collected.Brain CT or MRI within 3 d after admission or when neurological deficit deterioration happened was performed.Based on brain CT scan or MRI,patients were divided into hemorrhagic transformation(HT) group or non-HT(NHT) group.All cases were followed up for 3 month.Results All of 337 patients,44 cases occurred in spontaneous hemorrhagic transformation,accounting for 13.1％.The mortality rate was 6.8％ (3 cases) in 3 months followed-up at HT group,and the death/disability rate was 47.7％ (21 cases).Meanwhile,the mortality rate was 7.5％ (21 cases) in 3 months followed-up at NHT group,and the death/ disability rate was 35.5％ (104 cases).There was no significant difference between the two groups(x2 =3.10,P =0.376).Multivariate logistic regression analysis demonstrated that age (OR =1.054,95 ％ CI 1.021-1.087),gender(OR =2.131,95％ CI 1.151-3.945) and the national institutes of health stroke scale(OR =1.275,95％ CI 1.174-1.384) were independent predictors of death/dependence at 3 months after ischemic stroke attacked.Conclusion Spontaneous hemorrhagic transformation is not the risk factor of death/dependence on 3 month after symptom onset for ischemic stroke patients.Spontaneous hemorrhagic transformation should be detected as early as possible and adjusted therapy scheme in time,which will help in terms of prognosis.
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This article reviews the recent advances in many aspects including classification,risk factors,treatment and prognosis of hemorrhagic transformation after cerebral infarction,which will provide references for the treatment and research of cerebral infarction.