2017年 · 第97卷第09期

large hemispheric infarction (LHI) is an infarction of ≥2/3 of the middle cerebral artery supply area (with or without anterior/posterior cerebral artery supply area infarction). If the patient has an early neurological deficit with progressive aggravation of disturbance of consciousness and rapid cerebral hernia formation, it is called malignant middle cerebral artery infarction (malignant middle cerebral artery infarction, MMI)^[1]。 The prognosis of MMI patients is poor, and the mortality rate is as high as 78%^[1]； Even if they survived, the rate of severe neurological disability (mRS score 4-5) was as high as 89%^[2]。 In the 21st century, neurologists, especially critical care neurologists, are beginning to challenge this serious cerebrovascular disease.

Patients with spontaneous intracerebral hemorrhage (ICH) develop localized neurological deficit with disturbance of consciousness, unequal pupil size, and abnormal respiratory rhythm in the early stage of the disease. Head CT scan shows supratentorial hematoma volume ≥30 ml, pontic hematoma volume ≥5 ml, thalamic or cerebellar hematoma ≥15 ml, which is called larger volume of intracerebral hemorrhage (LICH)^[1]。 The first thing neurologists and neurocritical care physicians think about when they face patients with LICH is how to keep the patient alive. Studies have shown that the mortality rate of supratentorial LICH patients treated by internal medicine is as high as 74% ~91%^[1]The mortality rate of cerebellar LICH patients was 81%^[2]The mortality rate of patients with pontine LICH reached 100%^[1]。 The direct cause of high mortality is cerebral hernia formation. Therefore, how to remove hematoma, reduce the occupying effect and reduce the formation of cerebral hernia becomes the key to reduce the mortality of LICH.

large hemispheric infarction (LHI) is an infarction of ≥2/3 of the blood supply area of the middle cerebral artery, with or without infarction of the blood supply area of the anterior/posterior cerebral artery. The incidence of LHI was (10~20) per 100,000 persons per year^[1]。 The clinical manifestations of patients with LHI are hemiplegia, hemiparesthesia, hemianopsia, gaze disorders, head-eye separation and aphasia (dominant hemisphere)^[2]。 If the neurological deficit and disturbance of consciousness progressively aggravate in the early onset of LHI patients, and cerebral hernia develops rapidly, it is called malignant middle cerebral artery infarction (MMI)^[3]。 The mortality rate of MMI is 60.9% ~78%, and the cause of death is mostly cerebral hernia^[3,4]。 Even if the patient survives, there will be severe neurological disability (modified Rankin score 4-5 accounts for 43%-89%)^[4,5,6]。 Neurologists must identify LHI as early as possible, and if conditions permit, admit patients to a neuro-intensive care unit (NCU) as early as possible for monitoring and treatment.

intracerebral hemorrhage (ICH) refers to the spontaneous, non-traumatic rupture of blood vessels in the brain parenchyma, resulting in the accumulation of blood in the brain parenchyma. In 2010, a meta-analysis (36 studies in 21 countries around the world) showed that the incidence of ICH was 24.6 per 100,000 persons-years (95%CI19.7~30.7), and the mortality rate within 30 days of ICH was 40.4% (13.1% ~61.0%)^[1,2]Where predominantly large-volume ICH patients^[1]。 Neurologists must identify large-volume ICH as early as possible, and if conditions permit, be admitted to a neuro-intensive care unit (NCU) for monitoring and treatment.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is currently the highest incidence of autoimmune encephalitis. Since 2007 Dalmau et al.^[1]Anti-NMDAR encephalitis has attracted increasing attention since its first report. Despite the risk of death, nearly 80% of patients can significantly improve neurological function through tumor resection and early immunotherapy. This study aimed to analyze the clinical characteristics of 20 patients in order to increase the knowledge of the disease and provide assistance for early diagnosis. In addition, by combining domestic and foreign literatures, it can provide help for the early standardized application of immunosuppressants.

Cushing's disease, or pituitary adrenocorticotropic hormone (ACTH) adenoma, is one of the important causes of endogenous Cushing's syndrome, accounting for about 60% of endogenous Cushing's syndrome^[1,2,3]。 Cyclical Cushing's disease (CCD) is a rare form of Cushing's disease. Unlike classical Cushing's disease, where cortisol levels rise relatively steadily, CCD is characterized by periodic fluctuations in cortisol levels. 1956 Birke et al.^[4]The first case of periodic Cushing's syndrome is reported; 1973, Brown et al.^[5]The first case of CCD, periodic Cushing's syndrome caused by an ACTH adenoma, is reported. Diagnosis of CCD requires long-term and continuous endocrine monitoring. If the diagnosis is wrongly established according to the cortisol level at individual moments, it is easy to lead to missed diagnosis and misdiagnosis. In addition, there are many differences between CCD and classic Cushing's disease in treatment and prognosis. This article reviews the relevant literature and reviews the characteristics of CCD in epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment and prognosis, so as to improve the understanding of CCD in clinical work.

Unified clinical classification can not only provide an academic basis for clinical communication, but also provide guidance on treatment options and clinical prognosis. At present, there are relatively unified clinical classification for idiopathic, congenital and neuromuscular scoliosis, but there is no unified clinical classification standard for adult degenerative scoliosis. adult degenerative scoliosis (ADS), also known as de novo scoliosis, is defined as a spinal deformity with a Cobb angle>10° in a population with mature skeletal development^[1]。 Adult degenerative scoliosis is different from other types and scoliosis, mainly due to asymmetric degeneration of spinal segments. Adult degenerative scoliosis occurs mainly in the elderly population. As the average human life expectancy increases, the incidence of degenerative scoliosis increases year by year^[2]。 Through reviewing the research progress of clinical classification of adult scoliosis and evaluating the contents, advantages and disadvantages of four adult degenerative scoliosis classification systems, it can play a guiding role in clinical treatment.