Journal of Neurorestoratology最新文献

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.

We describe a unique case in which a patient was initially diagnosed with meningoencephalitis and then detected anti-myelin oligodendrocyte glycoprotein (MOG) antibody and demyelinating brain lesions. A 43-year-old Chinese man who complained of headache and fever, was diagnosed with meningoencephalitis after cerebrospinal fluid (CSF) analysis. One month after onset, brain imaging revealed multiple lesions in bilateral white matter, and the anti-MOG antibody was detected in his serum and CSF (titer is 1:32 and 1:10, respectively). After a 3-month glucocorticoid therapy, repeated brain imaging and serological analysis for anti-MOG antibodies showed significant improvement. Multiple intracranial demyelinating lesions secondary to meningoencephalitis may be accompanied by anti-MOG antibody positivity, which can be reversed by hormone therapy.

The scales evaluating patients' neurological functions and quality of life are the basis of clinical evaluation and/or scientific research of nervous system diseases. Neurological functions of patients with spinal cord injury (SCI) are commonly assessed by using American Spinal Injury Association (ASIA) Impairment Scale or International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Generally, the quality of life for SCI patients is evaluated by using several available evaluating scales. International Association of Neurorestoratology (IANR) Spinal Cord Injury Functional Rating Scale (IANR-SCIFRS) was designed as one single method to assess various items of quality of life related with SCI, including male sexual function. However, in clinical practice, the ability of returning to society is an important index of quality of life after SCI. Additionally, the female patients' sexual function after SCI that has been neglected in the past should be reconsidered following neurorestorative treatments. Even more, this scale also can be applied to assess the quality of life in patients with spinal cord dysfunction due to diseases or disorders. Thus, the IANR added the ability of returning to society and female patients’ sexual function in the current revised version and renamed the scale as Spinal Cord Injury or Dysfunction Quality of Life Rating Scale (SCIDQLRS) (IANR 2022 version). Hopefully, this revised scale is widely used to expand enhanced improvements of quality of life following neurorestorative treatments in patients with SCI or spinal cord dysfunction.