2016年 · 第49卷第12期

Ischemic stroke has the characteristics of high morbidity, high mortality, high disability rate and high recurrence rate, and is the main subtype of stroke^[1]。 Worldwide, stroke has become the most common cause of functional disability^[2]。 According to the Global Burden of Disease Survey, stroke has become the first cause of death in China^[3]； Countries around the world are trying to reduce the incidence and recurrence of stroke, but the results vary. The data show that in the past 20 years, the incidence of stroke in high-income countries has decreased by 12%, while that in low-and middle-income countries has increased by 12%^[4]。 Meta-analysis of large clinical trials from developed countries showed a declining stroke recurrence rate year by year^[5]； However, the latest research data show that the recurrence rate of ischemic stroke in China is as high as 17.7%^[6]。 Why there is such a contrast is worth pondering. A series of studies and guidelines from all over the world believe that standardized secondary prevention of stroke can significantly reduce the recurrence rate, reduce disability and improve the quality of life of patients. Therefore, it is of great clinical significance to improve the secondary prevention level of stroke.

Insomnia, pain, fatigue, general discomfort, abnormal sensation and autonomic dysfunction of cardiovascular, digestive, respiratory and genitourinary systems are common physical symptoms and the main reasons for seeing a doctor in patients with anxiety, depression and somatization. Emotional symptoms are often masked by physical symptoms and are difficult to pay attention to. Doctors in general hospitals can't identify and deal with them correctly, which causes patients' illness to prolong, go around to see a doctor, consume a lot of medical resources, damage social functions, and even aggravate the contradiction between doctors and patients. How to quickly identify anxiety, depression and somatization symptoms and use effective means to intervene has become a problem that doctors in general hospitals must face and urgently need to solve. Therefore, the Neuropsychology and Behavioral Neurology Group of Neurology Branch of Chinese Medical Association organized relevant experts to form this consensus in accordance with the principles of evidence-based medicine, referring to the latest guidelines formulated by American Psychiatric Federation, Canadian Anxiety Disorder Association, American Society of Clinical Oncology and other professional societies, and combining the clinical practice of diagnosis and treatment of anxiety, depression and somatization symptoms in general hospitals in China, so as to provide reference and help for clinicians in general hospitals.

Without antibiotic therapy, 5% to 10% of people infected with Treponema pallidum (subsp. pallidum) develop neurosyphilis^[1]。 The most common forms of neurosyphilis in the early stage involve cerebrospinal fluid, meninges, and vasculature, and are manifested as asymptomatic meningitis, symptomatic meningitis, and meningeal vascular diseases, while the most common forms of the late stage of the disease are paralytic dementia and spinal tuberculosis. However, in the age of antibiotics, some atypical forms of neurosyphilis have been reported continuously. For example, syphilitic myelitis accounts for 1.5% of neurosyphilis^[2]。

restless legs syndrome (RLS) is typically characterized by indescribable and unbearable discomfort mainly in both calves during sleep at night, including burning, itching, ant walking, soreness, tearing and electric shock. Patients often can't sleep at night and are forced to get out of bed to pace or beat their legs, which may temporarily relieve the symptoms^[1]。 RLS mainly involves the deep parts of both lower limbs, but as the disease progresses, it can also involve the upper limbs or face. Our department recently diagnosed a patient with abdominal symptoms similar to RLS, which is reported below.

neuromyelitis optica spectrum disorders (NMOSD) are a group of neurological demyelinating diseases whose underlying pathological mechanisms are similar to those of neuromyelitis optica (NMO), with a high positive rate of aquaporin 4 (AQP4) antibodies, but with limited clinical involvement, which do not fully meet the diagnostic criteria of NMO^[1]。 This disease is a demyelinating disease of central nervous system, and there are no reports of peripheral nerve damage at home and abroad. The diagnosis and treatment of a case of NMOSD recently admitted to our hospital is reported as follows.

peripheral neuropathy is a common type of disease in the clinical work of neurologists. Its etiology is complex, pathological manifestations are diverse, clinical manifestations are similar, and the severity of the disease is different, which brings challenges to the diagnosis of the disease. The application of ultrasound technology in peripheral neuropathy has been a hot research topic in recent years. With the development of quantitative ultrasound, it has become a very meaningful auxiliary examination method in the diagnosis of this kind of disease.

phobic postural vertigo (PPV) is a neuropsychological disease closely related to neurootological diseases and psychiatric behavioral factors. It is the cause of chronic dizziness often encountered by specialists in the diagnosis and treatment of dizziness. PPV has a clear relationship with mental and psychological disorders such as anxiety and depression, which can be distinguished from simple neurootological diseases. Some experts believe that it is an independent disease entity. Looking at the research related to dizziness in China, PPV has not been included in the diagnosis, and the proportion of its corresponding incidence has not been reported. It can be seen that little is known about this concept in China. The author summarizes the research progress of PPV in combination with foreign PPV related research and his own clinical practice.

Parkinson's disease is the second most common neurodegenerative disease in clinic, with an incidence rate of 1% to 2% in people over 65 years old^[1]。 At present, clinical manifestations are mainly used as the diagnostic criteria of Parkinson's disease in clinical work. However, because most patients with Parkinson's disease have atypical early clinical manifestations, it is difficult to differentiate from other Parkinson's syndromes. Even in the outpatient clinic of movement disorders, 10% ~30% of patients are misdiagnosed^[2]。 In recent years, the development of imaging has provided important reference value for the diagnosis and differential diagnosis of Parkinson's disease, including MRI, PET, transcranial sonography, etc. Among them, transcranial ultrasound has the advantages of simple operation, safety, non-invasive, low cost and strong repeatability, which makes transcranial ultrasound attract much attention in clinical application.

microRNA (miRNA) is a kind of non-coding small RNA of eukaryotic cells with a length of about 22 nucleotides. It is widely found in all tissues and body fluids such as blood, urine, saliva, milk and cerebrospinal fluid^[1]。 In body fluid, miRNA often exists in the form of complexes with proteins, which resist the degradation of RNase, has a high degree of stability and conservation, and plays a key regulatory role in the pathophysiological process of the body^[2]。 The expression profile of miRNA is more consistent among healthy individuals, but the expression profile can change significantly under different disease states. This expression profile changes often earlier than biochemical and imaging changes, which is an ideal potential marker for early diagnosis of disease^[3,4]。 With the further deepening of the understanding of miRNA and the optimization of miRNA functional analysis technology, the role of miRNA in various physiological processes has been deeply explained, and the changes of miRNA expression profiles in various diseases have gradually received attention. In the early stage, scholars mainly focused on the application of miRNA in plasma in diseases. Due to the existence of blood-brain barrier, the entry of central-specific miRNA into the blood is restricted. In recent years, the research on the mechanism of miRNA in cerebrospinal fluid in central nervous system diseases is gradually getting attention.