2018年 · 第51卷第06期

idiopathic inflammatory myositis (IIM), as a large class of acquired skeletal muscle diseases, has attracted much attention because it can be treated. The debate over its diagnosis and classification criteria has never ceased. For a long time, IIM has been classified into three main groups, namely dermatomyositis, polymyositis (PM), and sporadic inclusion body myositis (sIBM). In 2004, the European Center for Neuromuscular Diseases (ENMC) proposed new diagnostic and classification criteria for IIM. According to the pathological characteristics of muscle biopsy (biopsy), PM in the traditional sense was classified into PM, immune mediated necrotizing myopathy (NAM) and non-specific myositis (NSM) 3 Subtypes, coexisting with dermatomyositis and sIBM^[1]。 Among them, the pathological basis for the diagnosis of PM is "intimal T cells surrounding and invading non-necrotic muscle fibers"; Probably the pathological basis of PM is "intimal CD₈⁺T cells surrounding but indeterminately invading non-necrotic muscle fibers, or diffuse expression of major histocompatibility complex-I (MHC-I) "; the pathological basis of NSM is" perivascular or perifascular lymphocyte infiltration, or CD₈⁺The pathological basis of NAM is that "necrosis is the main pathological manifestation, only a small number of inflammatory cells, and lymphocyte infiltration around blood vessels or fascicles is not obvious". Since then, there has been great confusion in the understanding of the connotation and extension of the three subtypes of PM, NAM and NSM by different researchers: on the one hand, the standard lacks strict definitions for some pathological expressions, such as "T cells surrounding", "T cells scattered in the intima" and "only a small number of inflammatory cells", etc. Different researchers have different understanding and judgment criteria for the above pathological descriptions, resulting in serious bias in the judgment of subtypes. In addition, the limitation of biopsy samples seriously affects the repeatability and reliability of the judgment of the three subtypes of PM, NAM and NSM^[2]； On the other hand, some researchers have adopted strict diagnostic criteria for PM, which makes PM a very rare IIM subtype, and even tend to abandon the concept of PM^[3]。 By reviewing the historical evolution of the concept of PM over the past 100 years, we hope to sort out the concepts of IIM, PM and NAM.

Sciatica is often caused by lumbar spine disease, sciatic nerve trauma, neurofibroschwannoma, piriformis syndrome, etc. Other causes of sciatica are relatively rare. In April 2017, a patient with left sciatica was admitted to the Department of Neurology of our hospital. After electromyography, neuroultrasound, MRI, PET-CT, surgical pathology and other technical means, he was finally diagnosed as neurolymphomatosis (NL). NL refers to the direct infiltration of lymphoma into the peripheral nervous system, and the main clinical manifestations are peripheral nerve, nerve plexus and nerve root damage. It is an extremely rare extranodal manifestation of non-Hodgkin lymphoma^[1]。 The report is now as follows.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease that widely involves the central white matter. It often occurs after infection with rubella, influenza, Epstein-Barr virus, etc., and it is rarely reported to occur after infection with cytomegalovirus (CMV) with normal immune function. Myelin oligodendrocyte glycoprotein (MOG) is a protein expressed only on the surface and myelin of oligodendrocytes in the central nervous system^[1]。 Demyelinating diseases associated with MOG antibodies include ADEM, optic neuritis and transverse myelitis and their recurrent forms. We admitted a patient with ADEM secondary to CMV infection who was positive for serum anti-MOG antibodies, as reported below.

Traditional theory holds that neurosyphilis includes asymptomatic meningitis, symptomatic meningitis and meningeal vascular diseases in the early stage, and the most common forms in the late stage are paralytic dementia and spinal tuberculosis. However, in the age of antibiotics, the classic forms of paralytic dementia and spinal tuberculosis are increasingly rare^[1,2]。 Some atypical forms of neurosyphilis are continuously reported, with several modern case reports describing patients with neurosyphilis similar to herpetic encephalitis^[3]。 There are no relevant reports in Chinese literature. A case of neurosyphilis similar to herpes simplex encephalitis that we treated is reported below.

spinal dural arteriovenous fistula (SDAVF), originally known as Foix-Alajouanine syndrome, accounts for about 70% of all spinal arteriovenous malformations, mostly occurring in T₆and L₂Isolated lesions between 50 and 60 years old, commonly first occurring in men^[1,2,3]。 Epidemiological investigation showed that the incidence of SDAVF was (0.5~1.0) /100,000^[4]。 The etiology of SDAVF is unclear, and the most important pathological feature is the formation of a pathological slow, low-volume, high-pressure arteriovenous shunt fistula on the spinal dura, and the resulting venous hypertension and spinal cord congestion^[5]。 The symptoms and signs of SDAVF lack specificity, and are easily confused with inflammatory diseases such as demyelinating myelopathy, multiple sclerosis, neuromyelitis optica, etc., and are prone to clinical misdiagnosis and misdiagnosis^[2,6]。