Application of Prognostic Nutritional Index in the Predicting of Prognosis in Young Adults with Acute Ischemic Stroke.

BACKGROUND: The incidence of ischemic stroke in young adults (18-45 years old) is increasing gradually. However, performing nutritional assessment in stroke patients is often challenging due to the lack of an accepted standard for nutritional assessment. METHODS: Two hundred sixty young stroke patients were recruited in this study and 144 cases in the good prognosis group and 116 cases in the poor prognosis group were scored according to the modified Rankin scale 90 days after treatment. The National Institutes of Health Stroke Scale was performed on admission and discharge of patients. Serum interleukin 6 and high-sensitivity C-reactive protein were detected at patient presentation. The Prognostic Nutritional Index (PNI) was assessed on admission. Calculation formula of PNI score: serum albumin (g/L) + 5× total lymphocyte count (109/L). RESULTS: The PNI at admission of young stroke patients with poor prognosis was higher than that of those with good prognosis. PNI at admission was significantly negatively correlated with National Institutes of Health Stroke Scale at discharge and modified Rankin scale score after 90 days in young stroke patients. PNI at admission was also significantly negatively correlated with serum levels of high-sensitivity C-reactive protein and interleukin -6 at admission. CONCLUSIONS: PNI has a statistically predictive value for the 90-day prognosis of young stroke patients.

Delayed gadolinium contrast-enhanced 3D-T1 SPACE STIR sequence can better visualize abnormal cranial nerves: a case report.

With the advancement of magnetic resonance imaging (MRI) techniques, general radiographic methods are no longer sufficient for accurately displaying the structure and pathway of cranial nerves. Various sequences, including 3-dimensional sampling perfection with application-optimized contrast using different flip angle evolution (SPACE), have been developed through MRI technology to effectively display the location and severity of damaged cranial nerves. This current case report describes a 36-year-old male patient with multiple cranial nerve injuries resulting from an invasive Mucor infection. While performing MRI scanning on this patient, a 1-h delayed enhanced MRI 3D-T1 SPACE short tau inversion recovery (STIR) sequence proved more effective in eliminating background interference and assessing neurological damage with greater clarity than conventional enhancement methods. This approach may prove beneficial in accurately evaluating the extent of cranial neuropathy, thus facilitating clinical applications.

Next-Generation Sequencing of Cerebrospinal Fluid for the Diagnosis of VZV-Associated Rhombencephalitis.

BACKGROUND: Rhombencephalitis (RE) is a general term for a group of inflammatory diseases of the rhombencephalon caused by different etiologies. Patients of RE caused by the varicella-zoster virus (VZV) are sporadic in medical practice. The VZV-RE is easily misdiagnosed and causes a poor prognosis for patients. METHODS: In this study, we analyzed the clinical symptoms and imaging features of five patients with VZV-RE diagnosed by the next-generation sequencing (NGS) technique of cerebrospinal fluid. Magnetic resonance imaging (MRI) examination was used to characterize the imaging of the patients. The McNemar test was used to analyze the cerebrospinal fluid testing (CSF) values and MRI test of the 5 patients. RESULTS: We finally used NGS technology to confirm the diagnosis in 5 patients with VZV-RE. MRI revealed T2/FLAIR high signal lesions in the patients' medulla oblongata, pons, and cerebellum. All patients had early signs of cranial nerve palsy; some had herpes or pain in the corresponding cranial nerve distribution areas. The patients develop headaches, fever, nausea, vomiting, and other signs and symptoms of brainstem cerebellar involvement. McNemar's test showed no statistical difference between multi-mode MRI and CSF values for diagnosing VZV-RE (p = 0.513). CONCLUSIONS: This study showed that patients with herpes in the skin and mucous membranes at the distribution area of the cranial nerves and with the underlying disease were prone to RE. We suggest that the NGS analysis should be considered and selected based on the level of parameters, such as MRI lesion characteristics.

Correlation Analysis of TSB Level and Globus Pallidus-Related Metabolite Indexes of Proton Magnetic Resonance Spectroscopy in the Newborn with Neonatal Jaundice.

Objective: To investigate the correlation between serum total serum bilirubin (TSB) levels and globus pallidus-related metabolic indexes of proton magnetic resonance spectroscopy (1H-MRS) in the newborn with neonatal jaundice. Methods: 50 children with neonatal jaundice admitted to our hospital from January 2019 to January 2021 were recruited and assigned to a mild condition group (TSB < 221 µmol/L, n = 16), a moderate condition group (221 µmol/L ≤ TSB < 3 42 µmol/L, n = 18), and a severe condition group (342 µmol/L ≤ TSB < 428 µmol/L, n = 16) based on peak TSB. The differences in globus pallidus-related metabolic indexes of 1H-MRS between the groups were compared and their correlation with TSB levels was analyzed. Results: The three groups had comparable N-acetylaspartic acid (NAA)/creatine (Cr), choline (Cho)/Cr, lactic acid (Lac)/Cr, and ml/Cr levels (P > 0.05), while there were statistical differences in glutamine (Glx)/Cr levels (P < 0.05). The severe condition group showed the highest levels of neuron-specific enolase (NSE), creatine kinase-MB (CK-MB), and troponin (cTnl), followed by the moderate group, and then the mild group (P < 0.05). The TSB level is positively correlated with the 1H-MRS metabolic index Glx/Cr. Conclusions: The serum TSB level is correlated with the 1H-MRS metabolic index Glx/Cr in the newborn with neonatal jaundice, and the levels of TSB and Glx/Cr provide a reference for the diagnosis of bilirubin encephalopathy.

Next-generation sequencing of cerebrospinal fluid for diagnosis of atypical herpes simplex encephalitis.

OBJECTIVES: Herpes simplex encephalitis (HSE) is one of the most common causes of severe viral encephalitis. The characteristic manifestations of HSE include cerebrospinal fluid with mild cytopenia, dominated by lymphocytes, elevated protein, and normal blood glucose values (3.9-6.1 mmol/L). Although it is not difficult to diagnose classical HSE, diagnosing clinically atypical cases is more difficult. METHODS: We reviewed the results of next-generation sequencing (NGS) of CSF in a series of patients diagnosed with atypical HSE. RESULTS: Four patients lacking classical clinical manifestations of HSE, including no fever, headache, or other typical neurological deficit symptoms, 1-2 × 106 cells/L CSF leucocyte count, and no typical imaging features, were diagnosed with atypical HSE by NGS of CSF. The NGS reads corresponding to herpes simplex virus type 1 ranged from 2 to 13,174. CONCLUSIONS: Mild HSE may not present with classic frontotemporal lobe syndrome and fever may not be an inevitable symptom in patients with immunosuppression. However, the possibility of HSE should be considered in patients with atypical intracranial infection, and these patients should be tested by NGS.

Application and comparative analysis of 3.0T MRI and ultrasound in diagnosing CSP after caesarean section.

OBJECTIVE: To investigate the effect of 3.0T MRI and ultrasonography in the diagnosis of uterine scar pregnancy (CSP) after caesarean section, and to compare their diagnostic value for CSP. MATERIALS AND METHODS: A retrospective analysis was conducted on 60 patients with CSP treated in our hospital over a period of July 2018 to March 2020. All patients underwent 3.0T MRI, ultrasonography, and surgical termination of pregnancy and pathological analysis. The value of 3.0T MRI and ultrasonography in the diagnosis of CSP was analyzed. RESULTS: (1) The 60 patients were pathologically analyzed. Among these patients, 2 of whom were trophoblastic diseases, 5 were pregnancy abortion, 8 were cervical pregnancy, and 45 were CSP. (2) The results of ultrasound detection were 37 cases of CSP, 7 cases of misdiagnosis, and 8 cases of missed diagnosis; 3.0T MRI results were 44 cases of CSP, 1 case of misdiagnosis, and 1 case of missed diagnosis. (3) The sensitivity (97.78%), specificity (93.33%), coincidence rate (96.67%), positive diagnosis rate (97.78%), negative diagnosis rate (93.33%), AUC (0.973), and 95% CI (0.914-0.996) of 3.0T MRI in diagnosing CSP were significantly higher than those of ultrasound diagnosis (82.22%, 53.33%, 84.09%, 84.09%, 50%, 0.681, 0.051-0.776) (P<0.05). CONCLUSION: The coincidence rate of 3.0T MRI in the diagnosis of CSP after caesarean section is significantly better than that of ultrasound diagnosis, and it can be used to provide reference for clinical diagnosis of CSP after cesarean section.

Four patients with infarction in key areas of the Papez circuit, with anterograde amnesia as the main manifestation.

The Papez circuit is an important brain structure that is closely associated with learning and memory. In this report, we present four patients with anterograde amnesia as the main manifestation induced by Papez circuit infarction. In addition, we review the distribution of the responsible arteries in key and rare regions to investigate the pathogenesis of these infarctions.

Birt-Hogg-Dubé syndrome caused by a mutation of FLCN gene in a CVST patient: a case report.

Background: To our knowledge, this is the first report of patient with BHD syndrome caused by a novel mutation in the FLCN gene who developed a cerebral venous sinus thrombosis(CVST).Case presentation: A 62-year-old male patient with a history of hypertension and two case of spontaneous pneumothorax. He had a 1-month history of headache and was admitted to the hospital one day after the headache aggravated. The patient had a family history of BHD syndrome which was confirmed by FLCN gene sequencing. Sequencing analysis revealed a novel nonsense mutation (NM_144997; c.607A > T; p.Lys203Ter) in the FLCN gene exon 6 of the patient, which was proved to be a pathogenetic mutation by pedigree verification. BHD syndrome was finally definitive diagnosis. Low molecular weight heparin (21 days) was given for anticoagulant therapy before and after resection of renal tumor which is confirmed to be clear cell carcinoma in the kidney. After discharge, warfarin was given for anticoagulant therapy (6 months).Conclusions: There was no recurrence of CVST. And no recurrence of tumor and new renal tumor were found in renal MRI examination after 6 months.

Acute diffuse edematous-hemorrhagic Epstein-Barr virus meningoencephalitis: A case report.

INTRODUCTION: In this study, we presented a rare case of Epstein-Barr virus (EBV) meningoencephalitis presented with meningoencephalitis-like symptoms and diffuse edematous hemorrhage. PATIENT CONCERNS: A 77-year-old male patient was admitted to our hospital with fever, headache, confusion, and unconsciousness for 7 days. Physical examination revealed unconsciousness and stiffness of the neck. DIAGNOSIS: The final diagnosis was EBV meningoencephalitis. INTERVENTIONS: Ganciclovir (two times 350 mg/day, 21 days), methylprednisolone sodium succinate (120 mg, 5 days), and IV immunoglobulins (IV Ig) (0.4 g/kg, 5 days) were given to this patient. OUTCOMES: But the patient's clinical symptoms did not improve, and he was still in a coma. His family refused to be further diagnosed and discharged. After discharge for 2 months, the patient was in a coma. Four months later, the patient died of complications of pulmonary infection. CONCLUSION: The patient is an adult, and imaging was dominated by intracranial diffuse microhemorrhage and edema, which was different from the typical imaging characteristics of EBV encephalitis as previously reported. This specific imaging change may provide new clinical value for the diagnosis of EBV encephalitis.

Ramsay Hunt syndrome with pontine lesion: A case report.

RATIONALE: The coexistence of Ramsay Hunt syndrome (RHS) and varicella-zoster virus (VZV) encephalitis is rare. A patient who developed RHS after being infected with VZV, along with a pontine lesion, is reported in the present study. PATIENT CONCERNS: A 41-year-old male patient presented with his mouth askew for 7 days, and dizziness, accompanied by hearing loss for 3 days. DIAGNOSES: The patient was initially diagnosed with RHS. Brainstem encephalitis was confirmed by lumbar puncture and cerebrospinal fluid. Brain magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) revealed how VZV entered the intracranial space along the vestibulocochlear nerve and facial nerve in the acute period. INTERVENTIONS: Intravenous acyclovir, IV, immunoglobulins (IVIg) and methylprednisolone were administered. OUTCOMES: The herpes was cleared up and left facial nerve palsy was improved, but hearing loss in the left ear did not improve. LESSONS: An MRI was necessary for some VZV infections limited to the cranial nerve, although there was no evidence of brain stem injury. DWI provided evidence, showing how VZV entered the brain in the early stage. This allowed the doctor to judge the necessity of a lumbar puncture.

Third ventricle tumor with Bruns sign as the first manifestation: a case report.

This article reported a case of a third ventricle tumor with Bruns syndrome sudden disturbance of consciousness as the first manifestation, to improve the clinician's understanding and awareness of the fatal signs. A 38-year-old healthy man was admitted to our hospital for a sudden onset coma for 2 hours. Head magnetic resonance imaging (MRI) showed midbrain aqueduct occlusion, intraductal abnormal nodule signal, considering space-occupying lesions. On the fourth day of admission, the patient was scheduled to undergo ventriculoscopic resection of the mass, but the patient had a small ventricular foramen, which was difficult to explore the posterior part of the third ventricle, and the possibility of injuring the vein was high. Finally, the third ventriculostomy was performed by ventriculoscope. 6 months later, the tumor grew slowly and the patient had no hydrocephalus.

Successive occurrence of vertebrobasilar dolichectasia induced trigeminal neuralgia, vestibular paroxysmia and hemifacial spasm: A case report.

RATIONALE: Study reported an extremely rare case of trigeminal neuralgia, vestibular paroxysmia, and hemifacial spasm successively occurring in a patient with vertebrobasilar dolichoectasia (VBD). PATIENT CONCERNS: A 66-year-old female patient presented with episodic vertigo for 20 days before she was admitted to our hospital. Vertigo suddenly occurred when the patient rotated her head 20 days ago, the symptoms of vertigo were improved after continuous 1 to 3 seconds, and similar symptoms were repeated in sleep and rest, with a frequency of 30 to 40 times per day. The patient had a history of hypertension with poor blood pressure control for more than 20 years. DIAGNOSES: The final diagnosis was vertebrobasilar dolichectasia, right trigeminal neuralgia, and vestibular paroxysmia. INTERVENTIONS: Vitamin B1 (10 mg), methylcobalamin (0.5 mg), and carbamazepine (0.1 g) were given orally 3 times a day to relieve the symptoms. OUTCOMES: On the seventh day of drug treatment, the symptoms of paroxysmal vertigo and trigeminal neuralgia were completely relieved, but occasional episodes occurred during the follow-up period. Five months after discharge, right hemifacial spasm appeared in the patient, which did not affect the quality of life of the patient, so the patient did not choose further treatment. Six months after discharge, the patient was lost to follow-up. LESSONS: Comprehensive treatment to control VBD risk factors, delay the progression of VBD, and improve clinical symptoms may have a better effect on such patients. However, further research is needed.

Spinal dural arteriovenous fistula presenting with subarachnoid hemorrhage: A case report.

RATIONALE: Subarachnoid hemorrhage (SAH) is a common and serious disease and one of the most important differential diagnoses in the emergency department. PATIENT CONCERNS: A 39-year-old female patient with a 12 years' history of migraine, presented with a sudden headache combined with motor aphasia. Physical examination suggested probable positive neck resistance. SAH was confirmed by magnetic resonance imaging. In addition, spinal digital subtraction angiography and spinal vascular computed tomography angiography indicated spinal arteriovenous malformation (SAVM). DIAGNOSES: The final diagnosis was spinal dural arteriovenous fistula presenting with SAH. INTERVENTIONS: Following diagnosis, appropriate drugs were administered, but the therapeutic effect was poor. Then the patient was then transferred to a superior hospital where she was treated with interventional embolization. OUTCOMES: Through 2 years of follow-up, intermittent migraine was found in the patient, but the symptoms of occipital pain, nausea, and vomiting did not occur again. LESSONS: For patients who have been diagnosed with SAH but have no definite cause, we should pay attention to the etiological screening of SAH, and the possibility of the spinal cord SAH should be vigilant. The pain in the chest and back and the signs of spinal cord may be an important breakthrough in patients with spinal cord SAH, and medical history and physical examination are particularly important.

Recurrent cerebral infarction in anterior and posterior circulation territories associated with persistent primitive hypoglossal artery and carotid artery dissection: a case report.

The persistent primitive hypoglossal artery (PPHA) is the second most common persistent carotid-vertebrobasilar anastomosis. We present a rare case of an 82-year-old woman who diagnosed as acute cerebral infarction three times in both the anterior and posterior circulation territories with a right-sided PPHA and ipsilateral carotid artery dissection (CAD). Microembolus monitoring results suggested that microembolic caused by CAD associated with PPHA should be recognized as a possible cause of multiple infarctions in both the anterior and posterior circulation territories. For these patients, appropriate treatment measures should be taken for prevention of stroke recurrence.

Lateral medullary infarction with similar features of Brown Sequard syndrome caused by vertebrobasilar dysplasia and Klippel-Feil syndrome: A case report.

RATIONALE: Patients with Klippel-Feil syndrome (KFS) are always anomaly associated with vertebrobasilar dysplasia. That may present commonly as infarction of brainstem, medulla, and cerebellum. In this article, we reported a rare case of lateral medullary infarction (LMI) with similar features of Brown Sequard syndrome caused by vertebrobasilar dysplasia and KFS, and the 2 rare conditions that are causally related. The case is being reported because of its unusual and rare presentation. PATIENT CONCERNS: A 38-year-old female presented with acute unsteadiness, along with a tendency to lean to the left side while walking or sitting, and paresthesia in the right lower limb and trunk, at 2 days before admission. She had no history of hypertension and diabetes, but had a 20 years history of neck pain and dizziness, which was related to head movement. DIAGNOSES: Brown Sequard syndrome and a lesion of the left thoracic spinal cord were suspected initially. KFS was confirmed by the cervical magnetic resonance imaging (MRI) and computed tomographic angiography (CTA) results. Transcranial Doppler (TCD) results confirmed that there was a causal link between LMI and KFS. INTERVENTIONS: The patient rejected the operation of stabilization of the cervical spine with fusion at appropriate levels. OUTCOMES: No recurrence of stroke, but neck pain and dizziness remained after 6 months of discharge. LESSONS: For such patients, the conventional treatment of cerebral infarction might be ineffective, but stabilization of the cervical spine with fusion at appropriate levels can successfully prevent further episodes of syncope and stroke.

Miller Fisher syndrome with acute angle-closure glaucoma as the first manifestation: A case report.

RATIONALE: There were no reports of Miller Fisher syndrome (MFS) with acute angle-closure glaucoma as the first manifestation. PATIENT CONCERNS: A 78-year-old female patient was admitted to our hospital with pain in her left eye, blurred vision along with nausea, and vomiting for 2 days. It was extremely rare that ophthalmoplegia, loss of tendon reflexes, and ataxia, did not occur in the early stages of MFS, and initial presentation was only dilated pupis and an increase in intraocular pressure. DIAGNOSES: The final diagnosis of the patient was MFS. INTERVENTIONS: Intravenous immunoglobulins were administered. OUTCOMES: Ophthalmoplegia, walking instability, and ataxia gradually improved. At 3 months follow-up, there was no neurological deficit, and the patient could completely self-care. LESSONS: This is the first report of MFS patient with acute angle closure glaucoma as the first manifestation. Consideration should be given to the possibility of incorporating autonomic nervous system dysfunction, or even MFS, in patients with acute angle-closure glaucoma in order to reduce missed diagnosis rate.