2017年 · 第50卷第06期

neuromyelitis optica spectrum disorders (NMOSD) are a class of autoimmune diseases of the central nervous system (CNS), with recurrent optic neuritis and long-segment transverse myelitis as the main clinical features. In 2004, the discovery of aquaporin 4 (AQP4) antibody made NMOSD a separate disease entity from multiple sclerosis (MS)^[1]。 In China, AQP4 antibodies can be detected in the serum and cerebrospinal fluid of about 70% of NMOSD patients^[2]。 The pathogenesis of NMOSD is complex, and the body's immune intolerance to AQP4 is considered to be the central link in the occurrence of the disease. Therefore, restoring the body's immune homeostasis, inhibiting the production of AQP4 antibodies and blocking downstream related immune responses have become the treatment and prevention of the disease. An important strategy for recurrence. Although new immunotherapy drugs or strategies are constantly emerging, some of which have remarkable short-term efficacy and are expected to become new hopes for the treatment of this disease, the medium-and long-term efficacy, treatment duration, adverse reactions, long-term efficacy and safety of these drugs or strategies. Many issues need to be further studied and determined. We briefly summarize and review the development status of immunotherapy strategies for NMOSD.

Stroke is characterized by high morbidity, disability and mortality. There are about 2 million new stroke patients in China every year, of which 70% to 80% of stroke patients cannot live independently because of disability^[1]。 Stroke rehabilitation is the most effective method to reduce the disability rate proved by evidence-based medicine, and it is an indispensable key link in the organizational management of stroke. Modern rehabilitation theory and practice prove that effective rehabilitation after stroke can accelerate the rehabilitation process, reduce functional disability and save social resources. The fundamental purpose of early rehabilitation of stroke is to prevent complications, minimize barriers and improve functions, improve the ability of daily life, and its ultimate goal is to make the patient return to family and society. Standardized rehabilitation procedures and rehabilitation treatment schemes are of great significance to reduce the disability rate of acute cerebrovascular disease and improve the quality of life of patients^[2]。

Magnetic resonance sensitivity weighted imaging (SWI) is widely used in patients with cerebral infarction. It can clearly show microbleeding in infarcted lesions and also find acute thrombosis in large blood vessels^[1]。 The blood oxygenation level dependent (BOLD) imaging study of SWI found that the diameter of cortical veins in the ischemic area of patients with acute cerebral infarction was increased or significantly developed compared with the contralateral, which was called asymmetric cortical veins sign (CVS), suggesting that the blood oxygen saturation of brain tissue decreased, which was equivalent to the ischemic hypoperfusion area of brain tissue in acute stage to some extent^[2,3,4]。 However, there are some differences between current studies: Some researchers found that the range of CVS is consistent with that of ischemic hypoperfusion areas^[5]Some researchers believe that it is beyond the ischemic hypoperfusion area^[6]； Some researchers found that patients with asymmetric CVS had poor prognosis^[7]Some researchers believe that patients with asymmetric CVS have improved prognosis^[8]Some show that there is no direct connection between the two^[9]。 Therefore, we summarized a group of patients with acute middle cerebral artery (MCA) infarction to observe the positive rate of asymmetric CVS displayed by SWI in the acute phase and analyze its relationship with clinical prognosis and other variables.

Stiff-person syndrome (SPS) is a rare neurological disease characterized by fluctuating myotonia and paroxysmal painful spasm, rarely complicated by rhabdomyolysis. We report a case of SPS with rhabdomyolysis for the reference of clinicians.

dural arteriovenous fistulas (DAVFs) are a kind of vascular malformations involving the dura mater and its ancillary structures, which can occur in any part of the dura mater. The transverse sinus-sigmoid sinus, cavernous sinus and tentorium are more common, and the arteriovenous fistulas in the superior sagittal sinus area are less common, accounting for only 4.7% of DAVFs^[1]。 Patients with DAVFs presenting with intracranial hypertension are mostly accompanied by obvious headache, and only blurred vision is rarely reported. We collected the clinical and imaging data of a patient with arteriovenous fistula in the superior sagittal sinus area who was presented with blurred vision and are reported below.

Intracranial chondroma is a benign intracranial tumor with a very low incidence, and chondroma occurring in the parafalx of the brain is even more rare. One case of giant parafalx chondroma of the brain was admitted to our hospital, which was confirmed by surgery and pathology, and is reported as follows.

hypereosinophilic syndrome (HES) is a rare cause of ischemic cerebrovascular disease, and secondary HES combined with cerebral infarction is more rare^[1]。 A case of cerebral infarction secondary to HES after Schistosoma japonicum infection admitted to our department is reported as follows.

Spinal epidural abscess (SEA) is a suppurative infection of the epidural space. Most of its pathogens originate from hematogenous dissemination or adjacent infected tissues^[1]。 A case of SEA caused by long-term heroin injection admitted to our hospital is reported as follows.

metronidazole-induced encephalopathy (MIE) is a rare disease caused by long-term use of metronidazole under clinical conditions. Its clinical characteristics usually include many forms of progressive neurological function and typical imaging changes. However, at present, neurologists have relatively insufficient understanding of this disease, and there are few related reports in China. We report the diagnosis and treatment process of a patient with MIE, and review relevant literature for clinical reference.

Epilepsy is a common chronic brain disease caused by repeated abnormal firing of brain neurons^[1]。 According to the etiology, it can be divided into hereditary epilepsy, metabolic or structural epilepsy and epilepsy of unknown etiology. In all types of epilepsy, genetic factors are important factors in their pathogenesis^[2]。 The variation types of human genetic material mainly include gene mutation, chromosome structure or number variation, and these genetic variations can lead to epilepsy^[3]。

Cerebral artery stenosis may cause hemodynamic changes, and the pressure difference between the proximal and distal ends of stenosis is the main factor of hemodynamic changes. Intravascular pressure measurement after coronary atherosclerosis stenosis has been used in clinical practice for many years, and as a major evaluation index of endovascular therapy^[1]。 With the extensive development of endovascular treatment of cerebral artery stenosis, the degree of vascular stenosis is the main indication at present. Some studies have shown that the degree of vascular stenosis cannot be used as the only way to prevent stroke. For example, the degree of stenosis in patients with asymptomatic carotid artery stenosis cannot be used as the index of carotid stent or endarterectomy^[2]。 At present, there are few reports on the measurement of intravascular pressure after cerebral artery stenosis. We will review the significance and progress of intravascular pressure measurement after cerebral artery stenosis.

Antithrombotic drugs, including antiplatelet, anticoagulant and thrombolytic drugs, have been widely used in the prevention and treatment of ischemic cerebrovascular disease. Cerebral hemorrhage is the most serious complication during the use of antithrombotic drugs. Studies have shown that cerebral microhemorrhage is associated with an increased risk of cerebral hemorrhage (OR8.52，95%CI4.23～17.18，P＝0.007)^[1]。 A pooled analysis of a prospective study of 768 stroke patients treated with antiplatelet or anticoagulant therapy [555 ischemic stroke (IS) and 90 cerebral hemorrhage] and transient ischemic attack (TIA) patients (123) showed that patients with cerebral microhemorrhage had a 12.1-fold higher risk of cerebral hemorrhage than those without cerebral microhemorrhage^[2]。 A meta-analysis of 10 prospective cohort studies of 3 067 patients with IS/TIA showed that cerebral microhemorrhage was associated with both recurrent IS and cerebral hemorrhage, and that cerebral microhemorrhage was strongly associated with an increased risk of cerebral hemorrhage in the Asian population^[1]。 Moreover, the risk and mortality of cerebral hemorrhage increased with the increase of the number of cerebral microhemorrhage, suggesting that the number of cerebral microhemorrhage had a predictive effect on antithrombotic-related cerebral hemorrhage^[3,4]。 Therefore, cerebral microhemorrhage is considered as one of the risk factors of cerebral hemorrhage, which can predict the risk of future cerebral hemorrhage in patients. However, there is still controversy about whether antithrombotic drugs can increase the number of cerebral microhemorrhage. Most studies have shown that users will have an increased number of cerebral microhemorrhages and an increased risk of fatal cerebral hemorrhage compared with patients without antithrombotic drugs^[5,6,7]。 However, some studies have shown that antithrombotic drugs do not significantly increase the risk of cerebral microbleeding^[8,9]and antithrombotic therapy has no effect on the risk of future cerebral hemorrhage in patients with cerebral microhemorrhage without a history of cerebral hemorrhage^[10]。 This creates confusion about how to use antithrombotic drugs in patients with cerebral microhemorrhage. In this article, we mainly expound the relationship between cerebral microhemorrhage, antithrombotic therapy and cerebral hemorrhage, and provide some guidance for the use of clinical antithrombotic drugs.