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Objective:To evaluate the correlation between vascular hyperintensity of magnetic resonance fluid-attenuated inversion recovery (FLAIR) sequence(FVH) and related parameters of magnetic resonance perfusion weighted imaging (MR-PWI) in patients with middle cerebral artery stenosis cerebral infarction, and to explore the hemodynamic factors related to FVH and the effect of FVH on the short-term clinical prognosis of patients.Methods:A total of 116 patients with middle cerebral artery stenosis cerebral infarction in the Department of Neurology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from January 2020 to December 2022 were collected.According to the diagnostic criteria of FVH, they were divided into FVH (+ ) group (78 cases) and FVH(-) group (38 cases). All patients underwent magnetic resonance(MR) and MR-PWI scans.Demographic and cerebrovascular risk factors were collected, clinical neurological function of patients was assessed by national institate of health stroke scale(NIHSS) upon admission and discharge, and cognitive function of patients was assessed by mini-mental state examination (MMSE). Short-term clinical outcome was assessed using modified Rankin scale(mRS) at the 90th day after discharge.The degree of middle cerebral artery stenosis, positive or negative FVH, FVH score, hypoperfusion volume and MR-PWI related parameters, including peak time (Tmax), mean transit time (MTT), cerebral blood volume (CBV) and cerebral blood flow (CBF), were evaluated in relation to clinical symptoms.SPSS 22.0 statistical software was used for t test, Chi-square test and Pearson correlation analysis. Results:There were significant differences in hypoperfusion volume, Tmax, MTT and CBF between FVH (+ ) group and FVH(-) group( t=1.989, 3.830, 5.223, 3.911, all P<0.05). In terms of short-term clinical outcome, the improvement rate of neurological function ((8.25±6.39)%, (12.22±6.08)%) and MMSE score(25.48±1.59), (26.31±1.26) in FVH (+ ) group were significantly lower than those in FVH(-) group, and the number of patients with progressive stroke during hospitalization in FVH(+ ) group was more than that of FVH(-) group(22(28.21%), 4(10.53%)) (all P<0.05). Pearson correlation analysis showed that FVH score was positively correlated with hypoperfusion volume ( r=0.786, P<0.01) and MTT ( r=0.692, P<0.01), and negatively correlated with CBF ( r=-0.568, P<0.01), but no significant correlation with the degree of arterial stenosis ( r=0.363, P>0.05). Conclusion:FVH is closely related to the Tmax, MTT and CBF values shown in MR-PWI, and the incidence of stroke in progression and short-term adverse prognosis are more likely in FVH(+ ) group, suggesting that FVH can be used as a convenient imaging indicator to reflect the hypoperfusion status of patients with middle cerebral artery stenosis cerebral infarction, and can provide an objective basis for further individualized treatment.
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Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a specific subtype of the stiff-person syndrome, which is rare and difficult to diagnose clinically. A case of PERM in a 66-year-old female with a fluctuating progressive course was reported in this article. She had increased facial muscle tone, pruritus and sensory hypersensitivity mainly in the head and neck, medullary involvement syndrome and bilateral lower limb rigidity as the main clinical manifestations, and a previous history of pulmonary malignancy, thymoma, typeⅠ diabetes and Hashimoto′s thyroiditis. The patient′s serum and cerebrospinal fluid were positive for anti-glutamic acid decarboxylase antibody. The electromyogram showed a large number of motor unit potentials in the trunk and proximal extremities in the quiet state, which were significantly enhanced during spastic episodes, consistent with the electromyographic manifestations of stiff-person syndrome. The final diagnosis was PERM, and immunotherapy including gamma globulin and hormone responded well. PERM is a rare neurological autoimmune disease with atypical early symptoms, which can be easily misdiagnosed, and it requires attention to avoid delaying the diagnosis.
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Organ transplantation is an effective treatment for end-stage organ failure. However, organ shortage has always been a common problem faced by countries around the world. The recognition and active participation of intensive care unit (ICU) medical staff in organ donation contributes to promoting the development of organ donation, thereby alleviating the shortage of donor organ. In this article, the key strategies of ICU donor management to promote organ donation and the key strategies of ICU medical staff management to promote organ donation were summarized, aiming to provide reference for organ donation practitioners (especially ICU medical staff) and jointly facilitate the professional development of organ donation.
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Objective:To investigate the correlation between fluid-attenuated inversion recovery vascular hyperintensities(FVH) and prognosis and cognitive dysfunction in patients with internal watershed cerebral infarction(IWI).Methods:Totally106 patients with IWI were selected.According to FVH diagnostic criteria, there were 59 cases in FVH (+ ) group and 47 cases in FVH (-) group.Demographic data and risk factors of cerebrovascular disease were collected to assess the clinical neurological function of the patients at admission and discharge, and the short-term outcome was assessed by modified RANKIN scale (mRS) score at 90 days after discharge.The cognitive function of patients was assessed by MMSE scale.Results:There was no significant difference in NIHSS score between the two groups on admission ( P>0.05). The NIHSS score of FVH (+ ) group((3.37±2.33))at discharge was significantly lower than that of the FVH (-) group ((4.43±2.72))( P<0.05). The rate of neural function improvement and mRS score after discharge 90 days in FVH (+ ) group((42.16±12.20)%, (1.75±1.12)) was significantly higher than that in FVH (-) group((37.58±13.64)%, (2.19±1.38))(both P<0.05). The scores of orientation, recall and language ability of MMSE in FVH (+ ) group ((9.26±0.21), (1.66±0.27), (7.69±0.44) respectively)were significantly lower than those of FVH (-) group((9.43±0.36), (1.83±0.34), (7.85±0.28) respectively)(all P<0.05). There was no significant difference in memory, attention and calculation between the two groups ( P>0.05). Conclusion:FVH has no correlation with the severity of IWI patients when they are admitted to hospital.FVH may be used as an imaging sign for prognosis evaluation of patients with IWI .However, IWI patients with FVH may have more severe cognitive impairment.
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ObjectiveTo investigate the executive functions of the frontal and temporal lobe epilepsy patients.MethodsFifty-five epilepsy patients (twenty-five frontal lobe epilepsy patients and thirty temporal lobe epilepsy patients) and fifty age,gender and education matched healthy controls were evaluated by means of Mini Mental State Examination ( MMSE ).Executive function was assessed using Stroop color words test and trail making test.ResultsMMSE total score of frontal and temporal lobe epilepsy patients were ( 26.02 ± 0.30) and (25.82 ± 0.67 ),respectively.There was significant abnormality between epilepsy patients and the controls (P ＜0.05).Compared with normal control group,FLP group and TLP group took longer time and their score was lower in stroop color words test (P＜0.05).There were significant difference between FLP and TLP on card B and C's reading time,correct number and strcop interference effects (P＜0.05).The epilepsy patients performed significantly worse than the controls in whole trail making test (P＜0.05).The scores indicate that the TLE group outperformed the FLE group on all analysis values (P ＜ 0.05 ).ConclusionThe frontal and temporal lobe epilepsy patients have executive function deficit.The FLE group has prominent deficits in executive functioning.