Purpose: Marchiafava-Bignami Disease (MBD) is a rare condition mainly associated with alcoholism, although a few non-alcoholic cases have been reported. We performed a comparative study of demographic and clinical dif...Purpose: Marchiafava-Bignami Disease (MBD) is a rare condition mainly associated with alcoholism, although a few non-alcoholic cases have been reported. We performed a comparative study of demographic and clinical differences between alcoholic and non-alcoholic and assessed whether any treatment can be recommended. Methods: We reviewed 157 reports containing data on 168 subjects with Alcoholic MBD (AMBD) and 23 subjects with Non-Alcoholic MBD (NAMBD). The following data were extracted: demographic characteristics;delay from the onset of symptoms to admission;MRI features;location of the corpus callosum lesions;the presence of Wernicke’s disease;drug treatment (thiamine, other vitamins and steroids);outcome. Results: The subjects with AMBD were more frequently men (84.5% vs 47.8, P = 0.000);the ones with AMBD were frequently reported as suffering from malnutrition (81.3% vs 50%, P = 0.019), whereas the NAMBD was frequently reported as suffering from diabetes mellitus (30.4% vs 7.1%, P = 0.002). The lesions in the NAMBD are often located in the splenium (47.8%), whereas single splenial lesions are seen only in 18.7% of the AMBD. 43.5% (10/23) of the NAMBD was reported to have recovered completely, whereas only 15.4% (24/156) AMBD showed a complete recovery. Conclusions: It is important to diagnose NAMBD in the early stage with MRI and to treat the symptoms with thiamine and/or corticosteroids according to aetiology. We recommend prompt treatment of MBD with parenteral thiamine in subjects associated with malnutrition, anorexia nervosa and prolonged vomiting, and reduction of food intake. Corticosteroids may aid in recovery by reducing oedema in subjects associated with diabetes mellitus.展开更多
Background: As a common and high incidence of disease, the minor ischemic stroke (MIS) has become an important public health problem. The aim of this study was to address whether patients with MIS have different types...Background: As a common and high incidence of disease, the minor ischemic stroke (MIS) has become an important public health problem. The aim of this study was to address whether patients with MIS have different types and outcome in the elderly in northern China. Methods: A retrospective cohort of consecutive patients was selected for study;all registered neurologic outpatients of the tertiary teaching hospital in northern Jiangsu, China between February, 2011 and February, 2012. A total of 433 outpatients, clinically only having had an initial visit and a MRI study of the brain, were enrolled. Results: Of 433 outpatients, 247 (57.0%) patients with MIS were diagnosed. The clinical types of MIS included stable MIS in 58.3%, acute progressive MIS in 5.3%, and chronic progressive MIS in 36.4% of patients. After adjusted Odd ratio (OR), only aged (OR, 1.0;95% confidence interval [CI], 1.007 - 1.087, p = 0.021), episode duration (OR, 1.8;95% CI, 1.011 - 1.024, p = 0.001), initial number of MIS (OR, 1.1;95% CI, 1.047 - 1.207, p = 0.001), and infarcts volume (OR, 1.8;95% CI, 1.253 - 2.681, p = 0.002) were independently associated with stable MIS and progressive MIS. Total survival was favorable among groups (p = 0.094), but the followed mRS score was significantly higher among those progressive MIS than those stable MIS (2.3 ± 1.0 vs 0.1 ± 0.3, p Conclusion: MIS had a very high prevalence and different clinical types. Stable MIS is a benign stroke, whereas those progressive MIS may have long-term instability or acute and chronic progressive trend. This information is important in prospectively determining outcome of MIS and in patient treatment.展开更多
Hemichorea with corresponding putamenal T1 hyper-intensity and T2 hypointensity on MR imaging has occasionally been reported in diabetes mellitus with nonketotic hyperglycemia. However, the signal intensity in pu-tame...Hemichorea with corresponding putamenal T1 hyper-intensity and T2 hypointensity on MR imaging has occasionally been reported in diabetes mellitus with nonketotic hyperglycemia. However, the signal intensity in pu-tamenal and cerebellum lesion on MR imaging, which is believed to be pathogenetically related to hemichorea, is rarely documented in diabetes mellitus with nonketotic hyperglycemia. We describe a 57-year-old man with nonketotic hyperglycemic hemichorea on his right arm and legs, whose signal intensity in putamenal and cerebellum lesion was demonstrated by MR imaging.展开更多
The huge?congenital?intracranial teratoma is very rare. We report a case of a 77 years old male with giant congenital brain teratoma without clinical symptoms. His computed tomography (CT) scan showed a massive tumor ...The huge?congenital?intracranial teratoma is very rare. We report a case of a 77 years old male with giant congenital brain teratoma without clinical symptoms. His computed tomography (CT) scan showed a massive tumor (6 × 5 × 6 cm) of irregular high density (inside with some point flaky low density) in left temporal lobe region, the lower corner of the left ventricle downward shift, and enhanced CT scan no enhancement. Magnetic resonance imaging (MRI) on brain showed an irregular huge tumor in the left temporal lobe area, with multiple nodular or lobulated mixd high and low or equal signal changes, in which the liquid signal based. The midline was shift to the right, and the posterior horn of the left ventricle was compressed and downward shift, expansion, and hydrocephalus. After follow-up 12 months, the patient presents a normal daily life and work and no neurological signs as usual. Our observations show that the huge tumor in brain with multiple nodular or lobulated variety of mixed signal changes on MRI without symptoms is a congenital intracranial silent teratoma.展开更多
Despite the increasing number of reports of patients with perimesencephalic subarachnoid hemorrhage (PMSAH), a minor or atypical PMSAH on CT changes has not been reported. We present the first described case of a mino...Despite the increasing number of reports of patients with perimesencephalic subarachnoid hemorrhage (PMSAH), a minor or atypical PMSAH on CT changes has not been reported. We present the first described case of a minor subarachnoid hemorrhage located in the right perimesencephalic cistern on CT 4 h after headache onset. Twenty-six hours after headache on-set, another CT of the head showed that blood dis-persion. On the third day in hospital, examination of cerebrospinal fluid revealed xanthochromia. Minor PMSAH is rare type of SAH, and can been missed if there is a delay in CT imaging of the head. Any pa-tient with a suspected minor PMSAH or equivocal results on CT should undergo routine lumbar punc-ture.展开更多
Background: Although patients with acute headache frequently present in emergency department, the causes and predictors of short-term outcome in patients with acute headache in general neurology have not been adequate...Background: Although patients with acute headache frequently present in emergency department, the causes and predictors of short-term outcome in patients with acute headache in general neurology have not been adequately investigated. Methods: We prospectively reviewed the medical records of 130 hospitalized acute headache pa-tients in general neurology of China. Their initial CT scan was assessed, as was their lumbar puncture (LP) examination if performed. Results: The main cause of acute headache was acute secondary headache (80.8%), which was mainly attributable to acute cerebrovascular events (72.4%) followed by intracranial infection (19.0%). Among the 10.8% of patients who died during hospitalization most (85.7%) had subarachnoid hemorrhage (SAH). Significant predictors of survival were severe headache versus thunderclap headache, meningismus, de-layed loss of consciousness, and hypertension (all p < 0.05). Multiple logistic regression analyses showed significant differences in severe headache or thunderclap headache (OR, 0.255;95%CI, 0.066 - 0.990;p = 0.048) and delayed loss of consciousness (OR, 0.060;95%CI, 0.016 - 0.224, p = 0.000) between patients who died and those who survived. Conclusions: The main underlying cause of hospitalized acute headache was acute cerebrovascular events. Severe headache and delayed loss of consciousness are predictors for poor outcome of acute headache.展开更多
We report isoniazid (INH) induced tics in one male patient on hemodialysis at end-stage renal failure. He had pulmonary tuberculosis, accepted isoniazid, rifampin, ethambutol, pyrazinamide and rifampicin. He developed...We report isoniazid (INH) induced tics in one male patient on hemodialysis at end-stage renal failure. He had pulmonary tuberculosis, accepted isoniazid, rifampin, ethambutol, pyrazinamide and rifampicin. He developed tics on both sides of the face. Surprisingly, he was also found the bilateral symmetrical frontal lobe and dentate nucleus hyperintensities on T2-weighted and T2 FLAIR MR imaging. After excluding other causes, INH induced neurological side effect was suspected so the drug was stopped, pyridoxine was added and hemoperfusion was applicated. Tics disappeared after 1 week.展开更多
objectal To study the relation between CT and etiology of acute headache without hemiplegia. Methods 118 cases of acute headache without hemiplegia were studied with CT scan. The patients with normal CT were diagnosed...objectal To study the relation between CT and etiology of acute headache without hemiplegia. Methods 118 cases of acute headache without hemiplegia were studied with CT scan. The patients with normal CT were diagnosed with lumbar punc -tura or diagnostic standard for establishing disease. Results The first three etiologies were cerebrovescular disease (65 cases, 55%), migraine (25 cases, 21%), meningitis and encephalitis (19 cases, 155. 9%). 53% of patients with subarachnoid hemorrhage(SAH) was diagnosed in CT unnormal group, and 12.4% of patients with Sall was showed by lumbar puncture in CT normal group(P＜0. 001). CT was normal in 18% of patients with a definite SAH(7/39). The positive rates of intracranial infection in CT normal group(by lumbar puncture) was reearkably higher than in CT unnormal group (18/58 versus 2/60, p＜0.005), Conolusion CT is more sensitive to intracranial hemorrhage, tumor and infarction. SAH of a negative Ctscan is not rare. CT is far inferior to lumbar puncture in meningitis or encephalitis.展开更多
文摘Purpose: Marchiafava-Bignami Disease (MBD) is a rare condition mainly associated with alcoholism, although a few non-alcoholic cases have been reported. We performed a comparative study of demographic and clinical differences between alcoholic and non-alcoholic and assessed whether any treatment can be recommended. Methods: We reviewed 157 reports containing data on 168 subjects with Alcoholic MBD (AMBD) and 23 subjects with Non-Alcoholic MBD (NAMBD). The following data were extracted: demographic characteristics;delay from the onset of symptoms to admission;MRI features;location of the corpus callosum lesions;the presence of Wernicke’s disease;drug treatment (thiamine, other vitamins and steroids);outcome. Results: The subjects with AMBD were more frequently men (84.5% vs 47.8, P = 0.000);the ones with AMBD were frequently reported as suffering from malnutrition (81.3% vs 50%, P = 0.019), whereas the NAMBD was frequently reported as suffering from diabetes mellitus (30.4% vs 7.1%, P = 0.002). The lesions in the NAMBD are often located in the splenium (47.8%), whereas single splenial lesions are seen only in 18.7% of the AMBD. 43.5% (10/23) of the NAMBD was reported to have recovered completely, whereas only 15.4% (24/156) AMBD showed a complete recovery. Conclusions: It is important to diagnose NAMBD in the early stage with MRI and to treat the symptoms with thiamine and/or corticosteroids according to aetiology. We recommend prompt treatment of MBD with parenteral thiamine in subjects associated with malnutrition, anorexia nervosa and prolonged vomiting, and reduction of food intake. Corticosteroids may aid in recovery by reducing oedema in subjects associated with diabetes mellitus.
文摘Background: As a common and high incidence of disease, the minor ischemic stroke (MIS) has become an important public health problem. The aim of this study was to address whether patients with MIS have different types and outcome in the elderly in northern China. Methods: A retrospective cohort of consecutive patients was selected for study;all registered neurologic outpatients of the tertiary teaching hospital in northern Jiangsu, China between February, 2011 and February, 2012. A total of 433 outpatients, clinically only having had an initial visit and a MRI study of the brain, were enrolled. Results: Of 433 outpatients, 247 (57.0%) patients with MIS were diagnosed. The clinical types of MIS included stable MIS in 58.3%, acute progressive MIS in 5.3%, and chronic progressive MIS in 36.4% of patients. After adjusted Odd ratio (OR), only aged (OR, 1.0;95% confidence interval [CI], 1.007 - 1.087, p = 0.021), episode duration (OR, 1.8;95% CI, 1.011 - 1.024, p = 0.001), initial number of MIS (OR, 1.1;95% CI, 1.047 - 1.207, p = 0.001), and infarcts volume (OR, 1.8;95% CI, 1.253 - 2.681, p = 0.002) were independently associated with stable MIS and progressive MIS. Total survival was favorable among groups (p = 0.094), but the followed mRS score was significantly higher among those progressive MIS than those stable MIS (2.3 ± 1.0 vs 0.1 ± 0.3, p Conclusion: MIS had a very high prevalence and different clinical types. Stable MIS is a benign stroke, whereas those progressive MIS may have long-term instability or acute and chronic progressive trend. This information is important in prospectively determining outcome of MIS and in patient treatment.
文摘Hemichorea with corresponding putamenal T1 hyper-intensity and T2 hypointensity on MR imaging has occasionally been reported in diabetes mellitus with nonketotic hyperglycemia. However, the signal intensity in pu-tamenal and cerebellum lesion on MR imaging, which is believed to be pathogenetically related to hemichorea, is rarely documented in diabetes mellitus with nonketotic hyperglycemia. We describe a 57-year-old man with nonketotic hyperglycemic hemichorea on his right arm and legs, whose signal intensity in putamenal and cerebellum lesion was demonstrated by MR imaging.
文摘The huge?congenital?intracranial teratoma is very rare. We report a case of a 77 years old male with giant congenital brain teratoma without clinical symptoms. His computed tomography (CT) scan showed a massive tumor (6 × 5 × 6 cm) of irregular high density (inside with some point flaky low density) in left temporal lobe region, the lower corner of the left ventricle downward shift, and enhanced CT scan no enhancement. Magnetic resonance imaging (MRI) on brain showed an irregular huge tumor in the left temporal lobe area, with multiple nodular or lobulated mixd high and low or equal signal changes, in which the liquid signal based. The midline was shift to the right, and the posterior horn of the left ventricle was compressed and downward shift, expansion, and hydrocephalus. After follow-up 12 months, the patient presents a normal daily life and work and no neurological signs as usual. Our observations show that the huge tumor in brain with multiple nodular or lobulated variety of mixed signal changes on MRI without symptoms is a congenital intracranial silent teratoma.
文摘Despite the increasing number of reports of patients with perimesencephalic subarachnoid hemorrhage (PMSAH), a minor or atypical PMSAH on CT changes has not been reported. We present the first described case of a minor subarachnoid hemorrhage located in the right perimesencephalic cistern on CT 4 h after headache onset. Twenty-six hours after headache on-set, another CT of the head showed that blood dis-persion. On the third day in hospital, examination of cerebrospinal fluid revealed xanthochromia. Minor PMSAH is rare type of SAH, and can been missed if there is a delay in CT imaging of the head. Any pa-tient with a suspected minor PMSAH or equivocal results on CT should undergo routine lumbar punc-ture.
文摘Background: Although patients with acute headache frequently present in emergency department, the causes and predictors of short-term outcome in patients with acute headache in general neurology have not been adequately investigated. Methods: We prospectively reviewed the medical records of 130 hospitalized acute headache pa-tients in general neurology of China. Their initial CT scan was assessed, as was their lumbar puncture (LP) examination if performed. Results: The main cause of acute headache was acute secondary headache (80.8%), which was mainly attributable to acute cerebrovascular events (72.4%) followed by intracranial infection (19.0%). Among the 10.8% of patients who died during hospitalization most (85.7%) had subarachnoid hemorrhage (SAH). Significant predictors of survival were severe headache versus thunderclap headache, meningismus, de-layed loss of consciousness, and hypertension (all p < 0.05). Multiple logistic regression analyses showed significant differences in severe headache or thunderclap headache (OR, 0.255;95%CI, 0.066 - 0.990;p = 0.048) and delayed loss of consciousness (OR, 0.060;95%CI, 0.016 - 0.224, p = 0.000) between patients who died and those who survived. Conclusions: The main underlying cause of hospitalized acute headache was acute cerebrovascular events. Severe headache and delayed loss of consciousness are predictors for poor outcome of acute headache.
文摘We report isoniazid (INH) induced tics in one male patient on hemodialysis at end-stage renal failure. He had pulmonary tuberculosis, accepted isoniazid, rifampin, ethambutol, pyrazinamide and rifampicin. He developed tics on both sides of the face. Surprisingly, he was also found the bilateral symmetrical frontal lobe and dentate nucleus hyperintensities on T2-weighted and T2 FLAIR MR imaging. After excluding other causes, INH induced neurological side effect was suspected so the drug was stopped, pyridoxine was added and hemoperfusion was applicated. Tics disappeared after 1 week.
文摘objectal To study the relation between CT and etiology of acute headache without hemiplegia. Methods 118 cases of acute headache without hemiplegia were studied with CT scan. The patients with normal CT were diagnosed with lumbar punc -tura or diagnostic standard for establishing disease. Results The first three etiologies were cerebrovescular disease (65 cases, 55%), migraine (25 cases, 21%), meningitis and encephalitis (19 cases, 155. 9%). 53% of patients with subarachnoid hemorrhage(SAH) was diagnosed in CT unnormal group, and 12.4% of patients with Sall was showed by lumbar puncture in CT normal group(P＜0. 001). CT was normal in 18% of patients with a definite SAH(7/39). The positive rates of intracranial infection in CT normal group(by lumbar puncture) was reearkably higher than in CT unnormal group (18/58 versus 2/60, p＜0.005), Conolusion CT is more sensitive to intracranial hemorrhage, tumor and infarction. SAH of a negative Ctscan is not rare. CT is far inferior to lumbar puncture in meningitis or encephalitis.
