Genetic variation in glia-neuron signalling modulates ageing rate.

The rate of behavioural decline in the ageing population is remarkably variable among individuals. Despite the considerable interest in studying natural variation in ageing rate to identify factors that control healthy ageing, no such factor has yet been found. Here we report a genetic basis for variation in ageing rates in Caenorhabditis elegans. We find that C. elegans isolates show diverse lifespan and age-related declines in virility, pharyngeal pumping, and locomotion. DNA polymorphisms in a novel peptide-coding gene, named regulatory-gene-for-behavioural-ageing-1 (rgba-1), and the neuropeptide receptor gene npr-28 influence the rate of age-related decline of worm mating behaviour; these two genes might have been subjected to recent selective sweeps. Glia-derived RGBA-1 activates NPR-28 signalling, which acts in serotonergic and dopaminergic neurons to accelerate behavioural deterioration. This signalling involves the SIR-2.1-dependent activation of the mitochondrial unfolded protein response, a pathway that modulates ageing. Thus, natural variation in neuropeptide-mediated glia-neuron signalling modulates the rate of ageing in C. elegans.

OsGA3ox genes regulate rice fertility and plant height by synthesizing diverse active GA.

Gibberellin (GA) is an important hormone, which is involved in regulating various growth and development. GA biosynthesis pathway and synthetase have been basically clarified. Gibberellin 3ß hydroxylase (GA3ox) is the key enzyme for the synthesis of various active GA. There are two GA3ox genes (OsGA3ox1 and OsGA3ox2) in rice, and their physiological functions have been preliminarily studied. However, it is not clear how they work together to synthesize active GA to regulate rice development. In this study, the knockout mutants ga3ox1 and ga3ox2 were obtained by CRISPR/Cas9 technology. The pollen fertility of ga3ox1 decreased significantly, while the plant height of ga3ox2 decreased significantly. It shows that OsGA3ox1 is necessary for normal pollen development, while OsGA3ox2 is necessary for stem and leaf elongation. Tissue expression analysis showed that OsGA3ox1 was mainly expressed in unopened flowers, while OsGA3ox2 was mainly expressed in unexpanded leaves. The GA in different tissues of wild type (WT), and two ga3ox mutants were detected. It was found that pollen fertility is most closely related to the content of GA7, and plant height is most closely related to the content of GA1. It was found that OsGA3ox1 catalyzes GA9 to GA7 in flowers, which is closely related to pollen fertility; OsGA3ox2 catalyzes the GA20 to GA1 in unexpanded leaves, thereby regulating plant height; OsGA3ox1 catalyzes the GA19 to GA20 in roots, regulating the generation of GA3. OsGA3ox1 and OsGA3ox2 respond to developmental and environmental signals, and cooperate to synthesize endogenous GA in different tissues to regulate rice development. This study provides a reference for clarifying its role in GA biosynthesis pathway and further understanding the function of OsGA3ox.

Pyrroloquinoline quinone ameliorates diabetic cardiomyopathy by inhibiting the pyroptosis signaling pathway in C57BL/6 mice and AC16 cells.

PURPOSE: Diabetic cardiomyopathy (DCM), a common complication of diabetes mellitus and is characterized by myocardial hypertrophy and myocardial fibrosis. Pyrroloquinoline quinone (PQQ), a natural nutrient, exerts strong protection against various myocardial diseases. Pyroptosis, a type of inflammation-related programmed cell death, is vital to the development of DCM. However, the protective effects of PQQ against DCM and the associated mechanisms are not clear. This study aimed to investigate whether PQQ protected against DCM and to determine the underlying molecular mechanism. METHODS: Diabetes was induced in mice by intraperitoneal injection of streptozotocin, after which the mice were administered PQQ orally (10, 20, or 40 mg/kg body weight/day) for 12 weeks. AC16 human myocardial cells were divided into the following groups and treated accordingly: control (5.5 mmol/L glucose), high glucose (35 mmol/L glucose), and HG + PQQ groups (1 and 10 nmol/L PQQ). Cells were treated for 24 h. RESULTS: PQQ reduced myocardial hypertrophy and the area of myocardial fibrosis, which was accompanied by an increase in antioxidant function and a decrease in inflammatory cytokine levels. Moreover, myocardial hypertrophy-(ANP and BNP), myocardial fibrosis-(collagen I and TGF-ß1), and pyroptosis-related protein levels decreased in the PQQ treatment groups. Furthermore, PQQ abolished mitochondrial dysfunction and the activation of NF-κB/IκB, and decreased NLRP3 inflammation-mediated pyroptosis in AC16 cells under high-glucose conditions. CONCLUSION: PQQ improved DCM in diabetic mice by inhibiting NF-κB/NLRP3 inflammasome-mediated cell pyroptosis. Long-term dietary supplementation with PQQ may be greatly beneficial for the treatment of DCM. Diagram of the underlying mechanism of the effects of PQQ on DCM. PQQ inhibits ROS generation and NF-κB activation, which stimulates activation of the NLRP3 inflammasome and regulates the expression of caspase-1, IL-1ß, and IL-18. The up-regulated inflammatory cytokines trigger myocardial hypertrophy and cardiac fibrosis and promote the pathological process of DCM.

New clinical characteristics and risk factors of hand knob infarction.

Hand knob infarction (HKI) is a rare clinical condition which is often misdiagnosed as peripheral neuropathy. This study aimed to identify the clinical characteristics and risk factors of HKI. Nine HKI patients admitted between January 2013 and March 2016 were confirmed by magnetic resonance imaging. Their medical records were collected and analyzed. The modified Rankin Scale was used to assess clinical outcomes. Routine laboratory tests, electrocardiogram, echocardiography, cranial magnetic resonance imaging, magnetic resonance angiography, computed tomography angiography, and Doppler ultrasonography examinations were performed. Seven patients had uniform involvement of all digits. One patient with radial weakness had a lesion in the lateral area of hand knob, and another patient with ulnar weakness had a lesion distributed in the medial area of hand knob. Hyperhomocysteinemia was a most common risk factor for HKI. Most HKI patients had a benign disease course, but three patients (33.33%) with the stroke type of large artery atherosclerosis had disease recurrence. We characterized clinical characteristics and risk factors of HKI which will help the diagnosis and management of HKI.

Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review.

BACKGROUND: Nitrous oxide (N2O), a long-standing anesthetic, is also neurotoxic by interfering with the bioavailability of vitamin B12 if abused. A few case studies have reported the neurological and psychiatric complications of N2O. CASE PRESENTATION: Here, we reported a patient of N2O induced subacute combined degeneration (SCD) with longitudinally extensive myelopathy with inverted V-sign exhibiting progressive limb paresthesia and unsteady gait. CONCLUSIONS: This case raises the awareness of an important mechanism of neural toxicity of N2O, and clinical physicians should be well recognized this in the field of substance-related disorders.

Disconnections of Cortico-Subcortical Pathways Related to Cognitive Impairment in Patients with Leukoaraiosis: A Preliminary Diffusion Tensor Imaging Study.

BACKGROUND: We aimed to explore the relation between the microstructural integrity of white matter using the technique of diffusion tensor imaging (DTI) and changes of cognition in leukoaraiosis (LA). METHODS: Fifty patients with LA and 50 age- and gender-matched controls were recruited consecutively. The average values of mean diffusivity (MD) and fractional anisotropy (FA) were quantified both within white matter lesions (WMLs) and normal-appearing white matter (NAWM) from the regions of interest (ROIs). RESULTS: We found significantly decreased FA and increased MD in WMLs at the 5 ROIs than that in NAWM and controls (p < 0.05). The values of FA in NAWM were significantly lower at centrum semiovale and posterior periventricular white matter than those of controls (p < 0.05). The values of MD in NAWM were significantly higher at the anterior periventricular white matter and corpus callosum than those of controls (p < 0.05). The values of FA in NAWM located at anterior periventricular white matter correlated inversely with the Z scores of executive function (r = -0.420, p = 0.028). CONCLUSIONS: DTI may provide some important information about the cognitive dysfunction in patients with LA, which may largely attribute to the "disconnection" of cortico-subcortical pathways, with the evidence of reduced FA and increased MD.

Efficacy of Cholinesterase Inhibitors in Vascular Dementia: An Updated Meta-Analysis.

BACKGROUND/AIMS: The objective of this study was to determine whether treatment with acetylcholinesterase inhibitors would provide cognitive benefit for patients with vascular dementia. METHODS: Studies in patients with vascular dementia, who had not taken acetylcholinesterase inhibitors or memantine for at least 6 weeks, were included. RESULTS: Twelve studies were included in the final analysis. Donepezil showed significant improvement in Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) as compared to placebo, at the doses tested, that is, 5 and 10 mg/day (difference in means -1.389 and -1.680, respectively, p ≤ 0.008), but not on the Mini Mental State Examination (MMSE) (p ≥ 0.259). Galantamine also improved the ADAS-cog in comparison to the placebo (difference in means -2.191, p < 0.001), whereas, rivastigmine did not show any benefit on ADAS-cog. However, the findings with rivastigmine are difficult to interpret, given there were only 2 studies. Treatment with cholinesterase inhibitors was associated with a twofold increase in the odds of discontinuation, due to adverse events (pooled OR 1.966, 95% CI 1.630-2.371, p < 0.001). CONCLUSION: The present results reveal the therapeutic benefits of donepezil and galantamine in patients with vascular dementia. Interestingly, the ADAS-cog and MMSE varied considerably in detecting cognitive improvement.

Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement after Stroke.

AIMS: the goal of this study was to identify important prognostic variables affecting placement of a percutaneous endoscopic gastrostomy (Peg) tube after acute stroke. METHODS: We retrospectively reviewed our patient database to identify acute ischemic stroke patients who placed Peg or nasogastric tube (NGT) tube, but were free of other confounding conditions affecting swallowing. A total of 340 patients were involved in our study. We assessed the influence of age, National Institutes of Health stroke scale (NIHSS) score, infarct volume, stroke subtype based on the toAst criteria, swallowing disorders, bilateral lesions in cerebrum and length of stay (los) in a logistic regression analysis. RESULTS: In univariate analysis, age (p=0.048), NIHSS score (p<0.0001), lesion volume (p<0.0001), los (p<0.0001), stroke location (p=0.045), and swallowing disorders (p<0.0001) were found to be the primary predictors of placing Peg. the presence of lesions in bilateral cerebral was included in the final model based on clinical considerations. After multivariate adjustment, only NIHSS score (odds ratio [oR], 4.055; 95% confidence interval [CI], 2.398-6.857; p=0.0001), lesion volume (oR, 1.69; 95% CI, 1.09­4.39; p=0.014), swallowing disorders (oR, 1.151; 95% CI, 1.02-1.294; p=0.047), los (oR, 0.955; 95% CI, 0.914-0.998; p=0.0415) and bilateral lesions (oR, 2.8; 95% CI, 1.666-4.705; p=0.0001) remained significant. CONCLUSION: our data shows that NIHSS score, lesion volume, swallowing disorders, los and bilateral lesions in cerebrum can predict the requiring of Peg tube insertion in patients after stroke.Facteurs de prédiction de la mise en place d'un tube de gastrostomie par endoscopie percutanée après un accident vasculaire cérébral.

Bilateral hippocampal abnormalities in magnetic resonance imaging in transient global amnesia.

Transient global amnesia (TGA) is an isolated amnesic syndrome with normal neurologic examination. Patients remain alert and communicative with no loss of personal identity; however, they experience striking loss of memory for recent events and an impaired ability to retain new information. We report a case of TGA in a patient with acute ischemia in bilateral hippocampal abnormalities. This provides evidence in support of an ischemic hypothesis as the possible etiology of TGA.

Replication and extension of the simplified modified rankin scale in 150 Chinese stroke patients.

BACKGROUND: Recently, a simplified modified Rankin Scale (mRS) questionnaire (smRSq) showed good reliability but has not been tested for its validity by its original creators. Our study aimed to test its reliability and validity in Chinese stroke patients. METHODS: Randomly chosen paired raters scored the smRSq, the conventional mRS, and the NIH Stroke Scale (NIHSS) face-to-face in 150 hospitalized stroke patients. Inter-rater reliability and concurrent validity were assessed for this translated questionnaire. RESULTS: For inter-rater reliability of the smRSq, the overall agreement among the raters was 84%, the κ was 0.79 (95% CI 0.72-0.87), and the κw was 0.91 (95% CI 0.88-0.94). For inter-rater reliability of the mRS, the overall agreement among the raters was 81%, the κ was 0.75 (95% CI 0.67-0.83), and the κw was 0.88 (95% CI 0.84-0.92). The agreement between the mRS and smRSq was 71%, κ = 0.63 (95% CI 0.54-0.71), and κw = 0.83 (95% CI 0.79-0.88). The correlation between the NIHSS and the smRSq (concurrent validity) was moderate (Spearman's correlation coefficient 0.70, p < 0.0001). CONCLUSIONS: Our results confirm the value of the smRSq in the assessment of stroke functional outcome in China. As this is a novel stroke tool, further validations are needed.

[Characteristics of cognitive impairment in patients with leukoaraiosis].

OBJECTIVE: To explore the characteristics of cognitive impairment in patients with leukoaraiosis (LA). METHODS: Forty-six LA patients and 38 age and gender-matched healthy subjects were recruited from the Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between September 2010 and March 2011. All participants underwent the neuropsychological tests recommended by the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards (NINDS/CSN). The were divided into 3 different groups (mild, moderate and severe) according to the Fazekas scale. The differences of neuropsychological performances were compared among 3 groups. RESULTS: The LA patients were associated with comprehensive cognitive function deficits, including MMSE (24.4 ± 3.2 vs 28.3 ± 1.2), MoCA (20.4 ± 3.0 vs 26.2 ± 0.8), digital span forward (5.7 ± 0.9 vs 6.8 ± 1.0), digital span backward (3.5 ± 0.7 vs 4.1 ± 0.7), Stroop-B (69 ± 13 vs 43 ± 5), Stroop-C (141 ± 42 vs 65 ± 10), trail making test-A (73 ± 15 vs 31 ± 7), trail making test-B (126 ± 18 vs 82 ± 6) and digit symbol test (25 ± 6 vs 37 ± 5, P < 0.05). However, there was no difference in the performance of verbal fluency (12.7 ± 2.5 vs 13.4 ± 2.5, P > 0.05). Correlation analysis showed that the severity of LA had a negative correlation with the performance of MoCA (r = -0.601, P = 0.002). CONCLUSIONS: The LA patients are closely correlated with cognitive impairments of attention, memory, executive function and information processing speed. It may be attributed to the frontal-subcortical circuitry dysfunction.

[Correlates of cognitive impairment in patients with leukoaraiosis by magnetic resonance spectroscopy].

OBJECTIVE: To explore the pathological changes in patients with leukoaraiosis (LA) by magnetic resonance spectroscopy (MRS) and examine its relationship with cognitive function. METHODS: Twenty-three LA patients and 23 age and gender-matched healthy subjects were recruited from the Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between August 2010 and November 2010. All participants underwent the neuropsychological tests. Multi-voxel chemical shift imaging was performed and the regions of interest were positioned in bilateral frontal white matter. The relative metabolite ratios, involving N-acetyl aspartate/choline ratio (NAA/Cho), N-acetyl aspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr), were estimated. The correlation of the MRS data and the performance of cognitive function was analyzed. RESULTS: The LA patients were associated with a worse performance of mini mental state examination (MMSE) versus the healthy controls (24 ± 3 vs 28 ± 1, P < 0.05). Univariate analysis of the MRS data revealed the ratios of NAA/Cho and NAA/Cr significantly decreased in bilateral frontal white matter lesions in the LA group versus the control group (1.72 ± 0.20 vs 1.96 ± 0.36, 1.67 ± 0.17 vs 1.85 ± 0.21, P < 0.05). The values of NAA/Cr and NAA/Cho in normal appearing white matter increased versus the LA group (1.83 ± 0.24 vs 1.72 ± 0.20, 1.78 ± 0.28 vs 1.67 ± 0.17) and decreased versus the control group (1.83 ± 0.24 vs 1.96 ± 0.36, 1.78 ± 0.28 vs 1.85 ± 0.21). But no significant differences were found (P > 0.05). The ratio of Cho/Cr did not differ among 3 groups (P > 0.05). The pathological change of NAA/Cr in white matter lesion in LA patients was markedly correlated with the performance of MMSE (r = 0.47, P < 0.05). CONCLUSION: NAA may be a marker of axonal loss/dysfunction in LA patients. And the changes of NAA/Cr have a positive correlation with cognitive impairment.

The sage genome provides insight into the evolutionary dynamics of diterpene biosynthesis gene cluster in plants.

The widely cultivated medicinal and ornamental plant sage (Salvia officinalis L.) is an evergreen shrub of the Lamiaceae family, native to the Mediterranean. We assembled a high-quality sage genome of 480 Mb on seven chromosomes, and identified a biosynthetic gene cluster (BGC) encoding two pairs of diterpene synthases (diTPSs) that, together with the cytochromes P450 (CYPs) genes located inside and outside the cluster, form two expression cascades responsible for the shoot and root diterpenoids, respectively, thus extending BGC functionality from co-regulation to orchestrating metabolite production in different organs. Phylogenomic analysis indicates that the Salvia clades diverged in the early Miocene. In East Asia, most Salvia species are herbaceous and accumulate diterpenoids in storage roots. Notably, in Chinese sage S. miltiorrhiza, the diterpene BGC has contracted and the shoot cascade has been lost. Our data provide genomic insights of micro-evolution of growth type-associated patterning of specialized metabolite production in plants.

Acute infarct of the corpus callosum presenting as alien hand syndrome: evidence of diffusion weighted imaging and magnetic resonance angiography.

BACKGROUND: Infarcts of the corpus callosum are rare and have not been well documented previously. As for a variety of signs and symptoms presented, alien hand syndrome (AHS) can be easily overlooked. CASE PRESENTATION: In this report, we present a patient with a mixed types of AHS coexistence secondary to the corpus callosum infarction, including a motor type of AHS by intermanual conflict (callosal type AHS) and a sensory type of AHS by alien hand and left hemianesthesia (posterior AHS). CONCLUSIONS: Our case may contribute to the early recognition of AHS and to explore the abnormal neural mechanism of AHS. To our knowledge, rare reports have ever documented such mixed AHS coexisting secondary to the callosal lesion, based on advanced neuroimaging methods as in our case.

Monitoring of medical complications after acute ischemic stroke in a neurological intensive care unit.

BACKGROUND/AIMS: Post-stroke complications may influence prognosis, and may even become potentially life-threatening. The aim of this prospective study was to examine the frequency and timing of medical complications during the acute stage of critical ischemic stroke in patients treated in a neurological intensive care unit. METHODS: Seventy acute ischemic stroke patients in a critical condition with morbid changes in organs other than the brain or with severe complications were admitted to a neurological intensive care unit and followed up with assessments of 15 specified complications during the first 2 weeks on days 2, 4, 7, and 14. RESULTS: The most common complications within 2 weeks of onset were chest infection (90%), fever (64%), hypoalbuminemia (56%), arrhythmia (46%), irritable ulcer (44%), gastrointestinal dysfunction (39%), progression or recurrence of stroke (33%), and urinary tract infection (30%). The incidence of progression or recurrence of stroke and urinary tract infection peaked at day 2, and the incidence of arrhythmia, fever, chest infection, irritable ulcer, gastrointestinal dysfunction, and malnutrition peaked from 1 to 2 weeks. CONCLUSION: Progression or recurrence of stroke, fever, and chest infection are common complications in the acute stage of critical ischemic stroke.

Aquaporin-4 antibody positive neuromyelitis optica with syndrome of inappropriate antidiuretic hormone secretion.

Neuromyelitis optica (NMO) has been reported to be associated with endocrinopathies, such as amenorrhea, galactorrhea, and diabetes mellitus. However, its association with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is extremely rare. We herein report an adult case of NMO with SIADH in a female Chinese patient. The patient was aquaporin-4 antibody positive, and her hypothalamic dysfunction may have been related to the development of SIADH.

[Serum uric acid level and related clinical features in neuromyelitis optica].

OBJECTIVE: To investigate serum uric acid (UA) levels and related clinical characteristics of neuromyelitis optica (NMO). METHODS: The serum uric acid levels were measured in 65 patients with NMO, compared to control groups which were 76 cases with multiple sclerosis (MS), 126 cases with cerebral vascular diseases (CVD) and 130 healthy controls (HC). The disability severity in NMO was assessed by the Expanded Disability Status Scale (EDSS). Magnetic resonance imaging (MRI) was performed to strengthen assessment the involved lesions. Serum AQP4 antibody was tested in a cell based immunofluorescence assay. RESULTS: In male groups, serum UA levels in NMO patients [(298.90 ± 74.14) µmol/L] were significantly lower than that in CVD [(355.37 ± 50.30) µmol/L] and HC subjects [(340.33 ± 58.23) µmol/L, P < 0.05]. No difference was found between NMO and MS [(292.36 ± 92.95) µmol/L] groups. In female groups, serum UA levels in NMO patients [(198.21 ± 62.62) µmol/L] were significantly lower than that in CVD [(274.51 ± 70.66) µmol/L] and HC subjects [(243.26 ± 60.65) µmol/L, P < 0.05]. No difference was found between NMO and MS [(232.29 ± 71.95) µmol/L] groups. UA levels were significantly lower in females [(198.21 ± 62.62) µmol/L] than in males [(298.90 ± 74.14) µmol/L]. UA levels were significantly lower in patients with EDSS ≥ 5 [(195.48 ± 83.70) µmol/L] than EDSS < 5 [(241.00 ± 63.20) µmol/L] NMO patients. In our study UA levels were not correlated with longitude of spinal lesions, activity revealed by MRI and AQP4 antibody tires. CONCLUSION: Lower serum UA levels were found in patients with NMO and related to more severe symptoms.

[Extracorporeal membrane oxygenation support in acute cardiorespiratory function failure patients after cardiac surgery].

OBJECTIVE: To investigate the treatment experience of extracorporeal membrane oxygenation (ECMO) support after cardiac surgery. METHODS: Retrospectively analyze the clinical data of 117 postoperative patients supported with ECMO in cardiac intensive care unit from March 2005 to June 2008. There were 32 female and 85 male patients, with a mean age of (48.7 +/- 16.5) years old. The cardiac operations included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle (n = 9), coronary artery bypass grafting and valvular operation (n = 5), repair of ventricular septal perforation following acute myocardial infarction (n = 2), valvular operation (n = 46), heart transplantation (n = 20), lung heart transplantation and repair of ventricular septal defect (n = 1), correction of congenital heart defects (n = 10), aortic operations (n = 4). Venoarterial bypass was instituted in 115 for hemodynamic failure and venovenous in 2 patient for hypoxemia following cardiac surgery. ECMO was established in 110 patients by cannulation of the right atrium and femoral artery, and 5 of the right atrium and ascending aorta. And 2 case added left atrial drainage to ECMO. Heparin was infused to maintain the whole blood activated coagulation time (ACT) of 160 to 200 s in centrifugal pump (14 cases), and 200 to 250 s in roller pump (3 cases) to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 15 patients and continuous renal replacement therapy in 29 cases. RESULTS: Mean ECMO duration was 61 h (ranged 3 to 225 h) and the mean duration of ICU stay was 5 d. 87 patients (74.4%) were successfully weaned from ECMO. 69 patients (59.0%) survived to discharge. The most common complications were re-exploration for bleeding (n = 24) and alimentary tract hemorrhage (n = 14), renal failure required renal replacement therapy (n = 29), infection(n = 32), limb ischemia (n = 5), plasma leak of oxygenators (n = 29), hemolysis (n = 7), neurological complication (n = 4). CONCLUSIONS: ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure. Indication should be controlled strictly. Earlier institution of ECMO and prevent complication may improve outcome.

Vertebrobasilar artery dissection manifesting as Millard-Gubler syndrome in a young ischemic stroke patient: A case report.

BACKGROUND: Millard-Gubler syndrome (MGS) is caused by a lesion in the brainstem at the level of the facial nerve nucleus, and it is also a rare ventral pontine syndrome. Vertebrobasilar artery dissection (VAD) is an uncommon cause of ischemic stroke. To the best of our knowledge, this is the first case report on the coexistence of MGS and VAD in a young acute ischemic stroke patient. CASE SUMMARY: We herein describe an unusual case of young acute ischemic stroke patient, presenting with acute right peripheral facial palsy, right abducens palsy, and contralateral hemihypesthesia, manifesting as MGS. After receiving dual antiplatelet therapy with aspirin and clopidogrel, as well as rosuvastatin, the patient recovered significantly. The high-resolution magnetic resonance imaging (MRI) indicated a diagnosis of VAD. CONCLUSION: Our finding further demonstrated that high-resolution MRI is a useful technique to early detect underlying dissection in posterior circulation ischemic stroke.

Clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging.

BACKGROUND: Syphilitic myelitis caused by Treponema pallidum is an extremely rare disease. However, symptomatic neurosyphilis, especially syphilitic myelitis, and its clinical features have been infrequently reported. Only a few cases of syphilitic myelitis have been documented. To the best of our knowledge, there are only 19 reported cases of syphilitic myelitis. However, the clinical features of syphilitic myelitis with longitudinally extensive myelopathy have been still not clear. AIM: To explore the clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging (MRI). METHODS: First, we report a patient who suffered from syphilitic myelitis with symptoms of sensory disturbance, with longitudinally extensive myelopathy with "flip-flop sign" on spinal MRI. Second, we performed a literature search to identify other reports (reviews, case reports, or case series) from January 1987 to December 2018, using the PubMed and Web of Science databases with the terms including "syphilis", "neurosyphilis", "syphilitic myelitis", "meningomyelitis", "central nervous system", and "spine". We also summarized the clinical features of syphilitic myelitis with longitudinally extensive myelopathy. RESULTS: A total of 16 articles of 20 cases were identified. Sixteen patients presented with the onset of sensory disturbance (80%), 15 with paraparesis (75%), and 9 with urinary retention (45%). Eleven patients had a high risk behavior (55%). Five patients had concomitant human immunodeficiency virus infection (25%). Serological data showed that 15 patients had positive venereal disease research laboratory test (VDRL)/treponema pallidum particle agglutination (TPHA), and 17 had positive VDRL/TPHA in cerebrospinal fluid (CSF). Seventeen patients were found to have elevated leukocytosis and protein in CSF. On MRI, 16 patients showed abnormal hyperintensities involved the thoracic spine, 6 involved the cervical spine, and 3 involved both the cervical and thoracic spine. There were 3 patients with the "flip-flop sign". All the patients were treated with penicillin, and 15 patients had a good prognosis. CONCLUSION: Our case further raises awareness of syphilitic myelitis as an important complication of neurosyphilis due to homosexuality, especially in developing countries such as China.