2016年 · 第49卷第03期

With the rapid development of medical imaging technology, it has played an important role in the diagnosis of neurological diseases, especially cerebrovascular diseases, the formulation of treatment plan, prognosis judgment and related basic and clinical research, and has gradually become an indispensable and unreplaceable medical technology. In order to better and more flexibly apply imaging technology, the Cerebrovascular Disease Group of Neurology Branch of Chinese Medical Association published the Guidelines for the Application of Cerebrovascular Disease Imaging in China for the first time this year. Therefore, the author makes a relevant interpretation of the guidelines.

Imaging technology plays an irreplaceable role in the diagnosis, evaluation of curative effect and prognosis of cerebrovascular diseases. Imaging techniques commonly involved in clinical diagnosis and treatment and clinical research are: (1) computerized tomographic scanning (CT): including non-contrast CT (NCCT), enhanced CT scan, CT perfusion (CTP) and CT arteriography (CTA); (2) magnetic resonance imaging (MRI): including conventional MRI, diffusion-weighted imaging (DWI), perfusion-weighted imaging (MRP or PWI), fluid attenuated inversion recovery (FLAIR), magnetic resonance angiography (MRA), magnetic resonance venography (MRV), magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), blood oxygen level dependent (BOLD), sensitivity weighted imaging (SWI), etc.; (3) Digital Subtraction Angiography (digital substraction angiography, DSA). In order to let clinicians better understand the characteristics of various technologies, and correctly and effectively apply these technologies for timely diagnosis, treatment plan formulation, efficacy evaluation, prognosis judgment and clinical research of different cerebrovascular diseases, the Cerebrovascular Disease Group of Neurology Branch of Chinese Medical Association specially formulated the Guidelines for the Application of Cerebrovascular Disease Imaging in China. This guide is compiled on the basis of a comprehensive review of the results and guidelines of neurovascular imaging research published at home and abroad and combined with the actual situation in China, and a consensus has been reached after many discussions. The recommended strength and evidence level criteria refer to the Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2014^[1]。 The imaging techniques related to cerebrovascular diseases are described from four aspects, namely, brain imaging technique, cerebral perfusion imaging technique, cerebrovascular imaging technique and other imaging techniques. Please refer to the relevant guidelines for cerebrovascular ultrasound techniques.

After intracranial vascular rupture, blood flows into the subarachnoid space, which is called subarachnoid hemorrhage (SAH). Clinically, SAH is divided into two categories: traumatic and non-traumatic. Non-traumatic SAH, also known as spontaneous SAH, is a common disease with high fatality rate. The main cause is aneurysm, accounting for about 85% of all cases. Other causes include perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH), vascular malformation, dural arteriovenous fistula (DAVF), coagulation dysfunction, cocaine use and pituitary stroke. In recent years, there have been great progress in vascular intervention techniques, diagnostic methods and perioperative management. However, the prognosis of SAH patients remains poor, with a mortality rate of up to 45% and a high disability rate in survivors. The Guidelines for the Prevention and Treatment of Cerebrovascular Diseases in China, published by the Cerebrovascular Disease Group of the Neurology Branch of the Chinese Medical Association in 2007, contains chapters on SAH^[1]。 The Neurosurgery Branch of Chinese Medical Association published the book "Guidelines for the Diagnosis and Treatment of Clinical Diseases-Neurosurgery" in 2006, which also contains the guidelines for the diagnosis and treatment of SAH. In recent years, new clinical studies and corresponding international guidelines have been published, and several multicenter, prospective, randomized controlled trials and prospective cohort studies have proposed new methods for the treatment of SAH. Therefore, the Neurology Branch of Chinese Medical Association and its Cerebrovascular Disease Group organized a revision of the 2007 version of the guidelines to form a new version of the guidelines to guide clinicians' operation practice. Due to the relative lack of information on SAH for other causes, this guideline is mainly developed for non-traumatic, aneurysmal SAH.

Cerebrovascular disease has become a chronic non-communicable disease that seriously threatens human health. Cerebrovascular disease has a high mortality and disability rate, which can bring a heavy burden to society, family and individuals. In China, cerebrovascular disease has surpassed ischemic heart disease as the number one cause of death, and it is also the leading cause of adult disability. Relevant data show that more than 20% of stroke patients need to be transferred to rehabilitation institutions when discharged from hospital, while 30% of patients have permanent disability and need long-term care.

optical coherence tomography (OCT) is a new high-resolution tomography technique. Because its resolution is significantly higher than that of intravenous ultrasound (IVUS), it can depict the structural characteristics of blood vessel wall in more detail, and its image almost exactly matches the tissue section, which has attracted widespread attention^[1]。 1991 Huang et al.^[2]The concept of OCT was first expounded and published inScienceIn the magazine. Clinically, OCT is first applied to the detection of fundus lesions, which can clearly show the anatomy of the retina, including ganglia, which is called "optical biopsy"; In recent years, intravascular OCT has been applied to evaluate coronary atherosclerotic plaque and the postoperative condition of stent, which has improved the curative effect. OCT is also gradually used to evaluate carotid atherosclerosis and carotid artery stenting (CAS), but there are no reports at home and abroad on the diagnosis of in-stent thrombosis by OCT. We evaluated carotid plaque and CAS postoperatively using OCT before and after surgery and found acute in-stent thrombosis.

lymphomatoid granulomatosis (LyG) is a blood vessel-centered lymphocyte proliferative disease with destruction of blood vessel walls, which is associated with Epstein-Barr virus infection^[1]Which may involve multiple systems throughout the body. This disease is a rare disease, and LyG involving the central nervous system alone is even rarer. A case of primary central nervous system LyG admitted to the Department of Neurology of Huashan Hospital affiliated to Fudan University is reported as follows, and its clinical, imaging manifestations, pathological and molecular diagnostic characteristics are discussed in combination with the literature.

Acute febrile neutrophilic dermatosis, also known as Sweet's syndrome or Sweet's disease, is a rare disease caused by increased neutrophils and extensive infiltration of the superficial and middle layers of the dermis caused by painful erythema bulge of the skin, accompanied by fever and other organ damage. The disease often occurs in the limbs and neck and face, and the skin of the trunk and oral mucosa can also be involved. It can be distributed on both sides, but it is asymmetrical. The lesions are red infiltrating spots or nodules at the initial stage, which gradually expand and increase, become darker in color, and the bulge is annular with clear edges. The surface may resemble "blisters" due to coarse granules or papillary shapes. Some patients may have scattered needle tip-sized or larger blisters or pustules, and the acupuncture reaction can be positive. There is spontaneous pain and tenderness. Oral mucosal lesion with shallow erosion and ulcer^[1]。 Sweet disease is very rare to affect the nervous system and is named Neuro-Sweet disease (NSD). We treated a patient with NSD, whose clinical manifestations, diagnosis and treatment are reported below.

Lipodystrophy is a disease characterized by atrophy or deficiency of subcutaneous adipose tissue, which is often combined with various metabolic disorders in clinic, such as insulin resistance, diabetes, hypertriglyceridemia, fatty liver, low leptin and low adiponectin, etc. According to the different range of fat disappearance, it is clinically divided into two types: systemic lipodystrophy and partial lipodystrophy. The latter manifests as regional lipoatrophy, while the non-atrophic site can be normal and accompanied by abundant fat deposition. A case of partial lipodystrophy with wide range of lipoatrophy and parotid gland hypertrophy admitted to our hospital is reported as follows.

temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is a common and familiar epileptic syndrome. The proportion of drug-resistant epilepsy is high, and the effect of surgical treatment is relatively good. However, it is not uncommon for hippocampal sclerosis to be neglected or misdiagnosed in clinical work, which is often caused by the failure to select hippocampal phase magnetic resonance scan or the scan quality is not up to the requirements. In addition, there are still some misunderstandings about hippocampal sclerosis, such as "hippocampal atrophy is hippocampal sclerosis" or "hippocampal sclerosis represents epilepsy on the medial side of the temporal lobe". TLE-HS has been a hot spot in clinical research. We summarize its research progress from the following aspects.

reversible splenial lesion syndrome (RESLES) is a clinical imaging syndrome involving the corpus callosum caused by various etiologies proposed in recent years. It is characterized by an oval, non-enhanced lesion of the corpus callosum pressure section (SCC) visible on MRI, which can completely disappear after a period of time. The clinical symptoms of this disease lack specificity, and most of them have good prognosis after treatment, and generally do not leave nervous system dysfunction.

tuberculous meningitis, referred to as tuberculosis, is the most common form of tuberculosis in the central nervous system and is caused by Mycobacterium tuberculosis (Mycobacterium tuberculosis) cause. Because the clinical manifestations of tuberculosis are non-specific, the level of clinical diagnosis takes a long time, and the initial treatment is often delayed, resulting in death or disability in half of the infected patients, which may leave behind serious chronic neurological sequelae^[1]。 According to the World Health Organization (WHO) report, in 2012, there were 8.6 million new tuberculosis patients and 1.3 million deaths worldwide. China is one of the 22 countries with a high burden of tuberculosis in the world^[2]。 Tuberculosis accounts for only 1% of all tuberculosis and is generally thought to be caused by the transmission of Mycobacterium tuberculosis through the blood from the lungs to the meninges, brain parenchyma, spinal cord or meninges^[3,4]5% to 15% of pulmonary tuberculosis patients have secondary tuberculous meningitis^[5]。 Some tuberculosis patients develop tuberculosis and some do not develop tuberculosis, and some tuberculosis patients do not have tuberculosis causes are not very clear^[6]。 In addition to environmental and Mycobacterium tuberculosis factors, host response to pathogens plays an important role in the development of tuberculosis^[7]。 The clinical manifestations of tuberculosis are mainly the result of the host's immune system and the antagonism of Mycobacterium tuberculosis. Therefore, the identification of specific biomarkers of tuberculosis is helpful for timely diagnosis and treatment, and is conducive to understanding the pathogenesis of tuberculosis. The study of human gene polymorphism can help to write and improve the gene profile, and understand the heterogeneity of human disease development and anti-inflammatory treatment and the adjustment of drugs.