Case report: the etiology of anterior inferior cerebellar artery infarction: what does basi-parallel anatomic scanning magnetic resonance imaging tell us?

BACKGROUND: The precise etiology of anterior inferior cerebellar artery (AICA) infarction is difficult to identify because of the high anatomic variability of vertebrobasilar arteries and the limitations of conventional vascular examinations. Basi-parallel anatomic scanning magnetic resonance imaging (BPAS-MRI) can reveal the outer contour of the intracranial vertebrobasilar arteries, which may be helpful to distinguish the arteriosclerosis from congenital dysplasia and dissection. CASE PRESENTATION: In this study, we reported 3 cases of AICA infarction and discussed the diagnostic value of BPAS-MRI in the evaluation of vascular etiology. CONCLUSIONS: The BPAS-MRI could be considered as an important supplementary in the diagnosis of vascular etiology of infarction in AICA territory.

[Diagnosis of Muscular Dystrophy Using Western Blot with Micro-sample of Muscle].

OBJECTIVE: To diagnose muscular dystrophy using Western blot (WB) by improving the method of the protein extraction. METHOD: Firstly,we compared the effect of different sample buffer solutions and processing Methods on the extraction of muscle protein in rats,then selected the appropriate extracting method and the process of the muscular protein. RESULTS: We put the selected sample buffer into the micro-sample,then mixed. The concentration of the extracting protein was much more,and the loss during the process was much less. We extracted enough protein in 62 cases. The protein bands were showed clearly by WB,and the abnormal protein bands were shown in some patients. Compared with the Results of immunohistochemical staining detected the severe abnormal expressions of Dys-R,Dys-C,and Dys-N in the specimens,we did not detect the corresponding target band in WB. We detected the target protein band of the specimens were abnormal position,light or normal staining in WB,while Dys were mildly expressed in immunohistochemical staining. CONCLUSIONS: The improved protein extraction method can save the muscle tissue,and the protein bands can be used for diagnosing the muscular dystrophy. For clinically suspected patients with dystrophinopathy,if normal or mild deficiency is shown by immunohistochemistry,WB should be applied to detect the dystrophin protein band.

[Clinical features of ultra longitudinally extensive transverse myelitis].

OBJECTIVE: To analyze the clinical features of ultra longitudinally extensive transverse myelitis (uLETM). METHODS: Four first-onset uLETM patients hospitalized during September 2009 and March 2011 were recruited and retrospectively analyzed for clinical and MRI (magnetic resonance imaging) features, as well as therapeutic profiles and prognoses. RESULTS: The male-to-female ratio was 1:3 and the age-of-onset 29 - 33 years old. Extremity paralysis and intrinsic sphincter disorders were initially observed. The clinical manifestations include visual, motor, sense and intrinsic sphincter disorders caused by optic nerve and spinal cord lesions. Uric acid decreased in 3 cases. Seropositivity for autoimmune antibody spectrum and NMO-IgG (neuromyelitis optica-immunoglobulin G) was found in some patients. Spinal MRI showed overall hypointense T1 and hyperintense T2 lesions in spinal cord with partial swelling and negative in brain MRI. Sjogren's syndrome associated with uLETM was diagnosed in 2 patients. Three cases improved after treatment with high-dose corticosteroids, intravenous immunoglobulin and other immunosuppressive agents. One patient died. CONCLUSION: uLETM is commonly found in young women. Spinal cord is frequently affected. And it may occur concurrently with optical abnormalities and other autoimmune diseases. Intracranial parenchyma is rarely affected. The therapy of corticosteroids is recommended.

[Clinical characteristics and imaging analysis of vertebrobasilar dolichoectasia].

OBJECTIVE: To discuss the clinical characteristics and imaging findings so as to improve the understanding of vertebrobasilar dolichoectasia (VBD). METHODS: The clinical profiles of 25 VBD patients diagnosed by magnetic resonance imaging (MRI) were retrospectively collected during January 2009-January 2010. Their clinical characteristics and imaging findings were analyzed. RESULTS: (1) Clinical characteristics: Posterior circulation ischemia (84%) was predominant. Different degrees of dizziness (40%) was the most common clinical manifestation. (2) Imaging analysis: two cases (8%) had a missed diagnosis by head computerized tomography. The diagnostic accuracy rate of head MRI and MRA was 100%. The degree of bifurcation height or lateral deviation of basal artery was mainly of the 2nd degree according to the Smoke's criteria. The lateral deviation of basal artery was mostly of a rightward shift (60%). The medulla oblongata was often compressed to deformation (40%). Basal artery calcification (12%) and VBD-associated hydrocephalus (4%) were rare. VBD was usually complicated with arteriosclerosis plaques of intracranial arteries in posterior circulation (> 40%). (3) Follow-up results: three cases (12%) suffered serious brainstem infarction during a follow-up period of 0.5 - 1.5 years. Two (8%) of them were dead. The degree of bifurcation height or lateral deviation of basal artery was of the 3rd degree in 3 cases. CONCLUSION: The clinical manifestations of VBD are multiple. But posterior circulation ischemia is not rare, especially for the elderly patients. Because of a high rate of disability and mortality, early diagnosis is essential. MRI is of a great value in confirming the diagnosis and evaluating the prognosis.

[A study on PARKIN gene in three pedigrees with autosomal recessive early-onset Parkinson's disease].

OBJECTIVE: To detect the possible relationship between PARKIN gene and the Chinese pedigree with autosomal recessive early-onset Parkinson's disease(AREP). METHODS: Clinical examination was carried out in 6 patients from 3 Chinese pedigrees with AREP and their 23 family members. PCR amplification of all exons of PARKIN gene was performed. The PCR products were analyzed by denaturing high-performance liquid chromatography(DHPLC) to screen for point mutation and polymorphism. And in the samples with abnormal DHPLC result, further sequencing was conducted to confirm the type of mutation and polymorphism. RESULTS: All exons of PARKIN gene from the research subjects were successfully amplified. A heterozygous point mutation (Gly284Arg) in exon 7 was found in one pedigree. A polymorphism (Ser167Asn) in exon 4 was found in another pedigree. All the patients had the past history of exposure to environmental poison. CONCLUSION: When acting together with risky environmental factors, the heterozygous mutation Gly284Arg in PARKIN gene may cause AREP. The polymorphism Ser167Asn in PARKIN gene increases the risk of developing Parkinson's disease and may cause AREP when acting together with hydrargyrism.

[Glucocorticoid-induced diabetes in severe acute respiratory syndrome: the impact of high dosage and duration of methylprednisolone therapy].

OBJECTIVE: Over-dose glucocorticoid was frequently used in patients with severe acute respiratory syndrome (SARS), the aim of the present study is to investigate the frequency and risk factors of corticosteroid-induced diabetes in this situation. METHODS: One hundred thirty-three cases of SARS admitted from May to June 2003 in our hospital were included in the study. Maximal dose, average daily dose, treatment course and fasting plasma glucose level (FPG) were recorded. Corticosteroid-induced diabetes was diagnosed if FPG was equal to or higher than 7 mmol/L twice or more after the administration of glucocorticoids. RESULTS: Ninety five patients (71.9%) were prescribed with glucocorticoid among the 132 patients. Thirty-three patients (36.3%) were diagnosed as corticosteroid-induced diabetes according to the FPG. Significant differences were found in daily maximal dosage, duration of treatment and average dosage of methylprednisolone between the patients with and without corticosteroid-induced diabetes (275 mg/d vs 136 mg/d, 24 d vs 16 d, 139 mg/d vs 91 mg/d, P < 0.01). As compared with the lowest tertile, the frequency of diabetes in SARS patients treated with highest tertile of maximal daily dosage, treatment duration, average dosage or total dosage were significantly higher (64.7% vs 13.0, 61.9% vs 17.4%, 62.5% vs 21.7%, and 59.2% vs 13.6%, P < 0.05 for all comparisons). If the patients were treated with an average dose less than 90 mg/d and treatment duration shorter than 15 days, the diabetes incidence was 10.5%. After adjusting age and sex, the daily maximal dosage of methylprednisolone was the only factor that might predict the occurrence of diabetes. CONCLUSIONS: Over-dose administration of methylprednisolone in SARS patients leads to a high frequency of diabetes. Decreasing the daily maximal dosage may be beneficial to the reduction of corticosteroid-induced of diabetes.