Journal of Neurorestoratology最新文献

Objective

Ceruloplasmin (CP), a key human ferroxidase, can maintain the iron balance in the brain, and the familial hypoceruloplasminemia might be rare. Ceruloplasmin reduction is one of the most common features in Wilson's disease. Some patients with hypoceruloplasminemia do not fulfill the criteria for the diagnosis of Wilson's disease or other known diseases. Moreover, these patients always suffer from various degrees of abnormal brain iron deposition. We sought to investigate the genetic basis of non-Wilson's disease hypoceruloplasminemia using whole-exome sequencing.

Methods

We recruited four patients with non-Wilson's disease hypoceruloplasminemia, who visited the Department of Neurology, Shanghai First People's Hospital, China from December 2010 to February 2011. Three of them were from the same pedigree, and the other patient shared no blood relation with the others. Iron deposition in the brain was assessed using quantitative susceptibility mapping and peripheral blood DNA was extracted. The part of the exons' genome were sequenced using the NimbleGen Sequence Capture Array and high-throughput sequencing technologies. Intersection analysis at the single nucleotide polymorphism (SNP) loci was carried out. The selected loci were verified with Sanger sequencing.

Results

Magnetic resonance imaging revealed that the magnetic susceptibility in the globus pallidus, which showed with a high signal intensity, was apparently higher in three patients than that in the normal controls, indicating the presence of abnormal iron deposition in the brain. The whole-exome sequencing and Sanger sequencing primarily excluded the possibility of mutations in the CP, ATP7B, and ATP7A genes that may impact ceruloplasmin levels. The four patients presented the homozygous mutation c.3611A>C in the C12orf51 gene; this was suspected to be a causative mutation after excluding SNP loci that were the same as those in the common population, as per The 1000 Genomes Project.

Conclusion

Non-Wilson's disease hypoceruloplasminemia showed varying degrees of abnormal iron deposition in the brain, and was possibly associated with the c.3611A>C mutation in C12orf51. How copper and iron regulate the levels of one another in the body is still not fully understood. The reduction of ceruloplasmin levels and brain iron deposition probably participated in the occurrence and development of neurodegenerative diseases. Following the combination of pre-existing techniques with a new generation of gene sequencing, the early diagnosis, prevention, and treatment of non-Wilson's disease hypoceruloplasminemia and other neurodegenerative diseases can be achieved.

Restoration of walking ability in stroke patients is the basis for their return to their families and society. Motor-cognitive dual-task training (MCDTT) can effectively strengthen the functional network connection between motor and cognitive brain regions and promote brain functional network remodeling, which is more relevant to daily life than single-task training in improving walking dysfunction of stroke patients and can more effectively train patients' adaptive walking ability. This paper summarizes the application and research progress of MCDTT in post-stroke walking rehabilitation, and aims to provide a theoretical basis for further research on systematic motor-cognitive therapy techniques to promote walking rehabilitation in stroke patients.

A 38-year-old male patient with disorders of consciousness (DOC) successfully recovered consciousness and get obvious motor function improvements through three stages of cervical spinal cord stimulation (SCS) treatment (6 Hz, 40 Hz, and combined frequency stimulation). We used the Coma Recovery Scale-Revised (CRS-R), Fugl–Meyer Assessment Scale, activities of daily living, and Berg Balance Scale to detect changes in consciousness and motor function during the 7-month postoperative follow-up. Electroencephalography-based individual alpha frequency (IAF) and relative power spectral density (RP) were used to assess changes in cognitive function and brain network function before and after the combined stimulation. The results revealed a gradually increased patient's CRS-R score after stimulation at 6 Hz, and the patient recovered consciousness 12 weeks postoperatively. The patient's motor function score gradually increased after adjusting the stimulation frequency to 40 Hz. However, the patient regressed in motor function when the stimulation frequency was decreased to 2 Hz. The patient's fine motor control of both hands significantly improved, accompanied by an increased RP in the beta band but the IAF decreased, after combined stimulation (40 Hz and 6 Hz). Then, motor function continued to improve with an increased IAF and RP in the alpha band after switching the stimulation order to 6 Hz and 40 Hz. Our results demonstrated that different frequency stimulations of cervical SCS may improve consciousness and motor function in patients with DOC.

Ischemic cerebrovascular and cardiovascular diseases in brain and heart tissues caused by hyperlipidemia, blood viscosity, atherosclerosis, hypertension, etc. Have been increasing in morbidity and mortality in the middle-aged and elderly population over several years. In recent years, the Eph/ephrin signaling pathway has been found to have a major role in the processes of neurogenesis, synaptic plasticity, and angiogenesis, which is likely a key pathway in the modulation of neurological and cardiac functions. Therefore, an in-depth understanding of the role of the Eph/Ephrin signaling pathway in pathophysiological processes will be the emphasis of future research. In ischemic cardiovascular and cerebrovascular diseases, in particular, the development of effective treatment to modulate the Eph/Ephrin signaling pathway to promote neural and vascular repair and regeneration is of great clinical significance and social value. In this study, the role of the Eph/ephrin signaling pathway in ischemic cerebrovascular and cardiovascular diseases is reviewed.

Background

Stroke is a common disease in neurology, which often causes prolonged disorder of consciousness (pDOC) and brings a heavy burden to the patient's family and society. This study aims to explore the epidemiological factors of pDOC after stroke and the factors affecting the outcome of consciousness.

Method

The patients that admitted in Tianjin Huanhu Hospital from January 2019 to December 2021 and met the inclusion criteria were selected. Descriptive statistics was initially performed on the relevant factors of the stroke group, and statistical analysis was subsequently performed. Finally, to judge the sensitivity and specificity of the significant factors to the prediction of outcome, the receiver operating characteristic (ROC) curve of the participants was used.

Result

The statistical results showed that the location of brain injury (λ² = 7.550, P = 0.023), cerebral hernia (λ² = 7.534, P = 0.006), and Glasgow Coma Scale (GCS) score at onset (t = −2.479, P = 0.017) were statistically significant indicators in the improvement of consciousness in patients with pDOC after stroke. The ROC curve showed that the sensitivity and specificity of predicting the outcome of brain injury site (area under the curve [AUC] = 0.766, 95% confidence interval [CI]: 0.708–0.824) were 0.50 and 0.90, respectively, and that of cerebral hernia (AUC = 0.663, 95% CI: 0.594–0.732) were 0.73 and 0.60, respectively. The GCS score (AUC = 0.660, 95% CI: 0.596–0.724) predicted the outcome with sensitivity and specificity of 0.35 and 0.92, respectively.

Conclusion

The incidence rate of pDOC after stroke in men was higher than that in women, and the improvement rate in the consciousness level was significantly higher than that of ischemic–hypoxic encephalopathy. However, the improvement rate of the consciousness level in patients with pDOC after stroke was not related to age and gender. Cerebral hernia occurred at the time of onset, stroke occurred in the brainstem, and the low GCS score at the time of onset was significantly associated with the poor prognosis of consciousness level.

Objective

To describe the surgical strategy, curative effect and postoperative complications of trigeminal neuralgia (TN) without vascular compression using head magnetic resonance imaging (MRI).

Methods

We retrospectively enrolled 184 patients with TN who were admitted to the Department of Neurosurgery of Zhoukou Central Hospital from January 2018 to March 2021 and had complete clinical data. Preoperative MRI reveled that 35 patients (19.0%) had no vascular compression. Among them, 16 (45.7%) had simple venous compression during surgery, 9 (25.7%) had venous compression and arachnoid adhesion during surgery, 5 (14.3%) had arachnoid adhesion during surgery, 3 (8.6%) had no venous compression or arachnoid adhesion during surgery, and 2 (5.7%) had simple artery compression during surgery. During the operation, the corresponding surgical strategies for the various types of venous compression were developed. Postoperative efficacy was assessed using the Barrow Neurological Institute pain intensity and facial numbness scores.

Results

According to the four types of compression identified during the operation, which did not reveal obvious vascular compression on preoperative head MRI, appropriate decompression methods were found to effectively relieve or eliminate pain (97.1%), and the postoperative effect was relatively satisfactory. There was no recurrence after 1–2 years of follow-up. After operation, two patients (5.7%) experienced occasional pain, one patient (2.9%) reported minor pain, and two patients (5.7%) reported numbness on the affected side of the face. Furthermore, one patient had aseptic meningitis (2.9%) and one patient (2.9%) had transient tinnitus or hearing loss on the affected side.

Conclusion

For patients with (TN) without vascular compression on head MRI prior to surgery, different surgical strategies can be implemented based on microvascular decompression and adequate trigeminal nerve decompression findings. Our results showed that these strategies could achieve satisfactory postoperative results without increasing postoperative complications.

Objective

To investigate the effectiveness and safety of tirofiban in patients with acute ischemic stroke (AIS) without large-vessel occlusions and not receiving intravenous thrombolysis.

Methods

Overall, 267 cases were included in the study (134 cases in tirofiban group; 133 cases in control group). After admission, patients in the tirofiban group were administered tirofiban for at least 72 h, and aspirin 100 mg and hydroclopidogrel 75 mg were administered 4 h before discontinuation of tirofiban administration. All patients were followed for 3 months, and the National Institutes of Health Stroke Scale (NIHSS) scores on admission, 24 h, and 7 d after treatment, intracerebral hemorrhage transformation within 48 h from stroke onset, and bleeding were assessed.

Results

There was no significant difference between both groups in the incidence of non-symptomatic and symptomatic intracranial hemorrhage (sICH), extracranial hemorrhage events, and thrombocytopenia (p > 0.05). There was a significant different between the NIHSS scores at baseline and 7 d after treatment in the tirofiban group (p = 0.043). At 90 d after treatment, the proportion of patients with a good prognosis in the tirofiban group (modified Rankin Scale [mRS] = 0, 1) was higher than that in the control group (p = 0.021). There was no difference in the proportion of patients with a mRS score of 0–2 between the two groups (p > 0.05).

Conclusion

Administration of tirofiban for >72 h (72 h–108 h) is safe and can improve the long-term (90 d) prognosis of patients with AIS without large-vessel occlusions and not receiving intravenous thrombolysis.

Hemorrhagic mirror stroke is a rare subtype of recurrent hemorrhagic stroke, similar to a cerebral hemorrhage in mirror position of the contralateral hemisphere. Here report two cases of hemorrhagic mirror stroke in the nondominant hemisphere of a right-handed man and a left-handed woman several years after the first similar onset in the dominant one. During rehabilitation after the first-time stroke, patients showed excellent recovery despite the development of atrophy in the cerebral peduncle on the affected side and aphasia and quadriplegia after the mirror stroke in the nondominant hemisphere. These cases not only highlight some uncommon clinical symptoms or the rare stroke type but also demonstrate the association between recovery of patients with atrophic cerebral peduncle after stroke and functional reorganization in the undamaged hemisphere.