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Improvements in clinical signs and symptoms of Parkinson's disease using photobiomodulation: a five-year follow-up. 利用光生物调节改善帕金森病的临床症状和体征:五年随访。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-09 DOI: 10.1186/s12883-024-03857-z
Ann Liebert, Brian Bicknell, E-Liisa Laakso, Sharon Tilley, Gillian Heller, Hosen Kiat, Geoffrey Herkes

Background: Parkinson's disease is a progressive neurodegenerative disease characterized by clinical motor signs and non-motor symptoms that severely impact quality of life. There is an urgent need for therapies that might slow, halt or even reverse the progression of existing symptoms or delay the onset of new symptoms. Photobiomodulation is a therapy that has shown potential to alleviate some symptoms of Parkinson's disease in animal studies and in small clinical trials.

Objective: To assess long-term effectiveness of photobiomodulation therapy in a cohort of Parkinson's disease individuals after five years of continuing therapy.

Methods: Eight participants of the initial 12 in a previously published study agreed to be reassessed after five years. Seven of these participants had continued home-based, self-applied photobiomodulation therapy three times per week for five years. One participant had discontinued treatment after one year. Participants were assessed for a range of clinical motor signs, including MDS-UPDRS-III, measures of mobility and balance. Cognition was assessed objectively, and quality of life and sleep quality were assessed using self-reported questionnaires. A Wilcoxon Signed Ranks test was used to evaluate change in outcome measures between baseline (before treatment) and after five years, with the alpha value set to 0.05.

Results: Of the seven participants who had continued photobiomodulation therapy, one had a preliminary diagnosis of multisystem atrophy and was excluded from the group analysis. For the remaining six participants, there was a significant improvement in walk speed, stride length, timed up-and-go tests, tests of dynamic balance, and cognition compared to baseline and nonsignificant improvements in all other measures, apart from MDS-UPDRS-III, which was unchanged and one measure of static balance (single leg stance, standing on the unaffected leg with eyes open) which declined. Five of six participants either improved or showed no decline in MDS-UPDRS-III score and most participants showed improvement or no decline in all other outcome measures. No adverse effects of the photobiomodulation therapy were reported.

Conclusions: This study provides a signal that photobiomodulation therapy might safely reduce important clinical motor signs and non-motor symptoms in some Parkinson's disease patients, with improvements maintained over several years. Home-based photobiomodulation therapy has the potential to complement standard therapies to manage symptoms and potentially delay Parkinson's symptom progression.

Trial registration: Australian New Zealand Clinical Trials Registry, registration number ACTRN12618000038291p, registered on 12/01/2018.

背景:帕金森病是一种进行性神经退行性疾病,以临床运动症状和非运动症状为特征,严重影响生活质量。目前迫切需要能够减缓、阻止甚至逆转现有症状发展或延缓新症状出现的疗法。在动物实验和小型临床试验中,光生物调节疗法已显示出缓解帕金森病某些症状的潜力:评估光生物调制疗法在帕金森病患者群中持续治疗五年后的长期疗效:方法:在之前发表的一项研究中,最初的 12 名参与者中有 8 人同意在 5 年后接受重新评估。其中七名参与者在五年内坚持每周三次在家自行应用光生物调制疗法。一名参与者在一年后停止了治疗。对参与者进行了一系列临床运动体征评估,包括 MDS-UPDRS-III、活动能力和平衡能力测量。对认知能力进行了客观评估,对生活质量和睡眠质量则使用自我报告问卷进行了评估。采用 Wilcoxon Signed Ranks 检验来评估基线(治疗前)和五年后结果指标的变化,α值设为 0.05:在继续接受光生物调节治疗的七名参与者中,有一人被初步诊断为多系统萎缩,因此被排除在小组分析之外。与基线相比,其余六名参与者的步行速度、步幅长度、定时上下行走测试、动态平衡测试和认知能力均有显著改善,除MDS-UPDRS-III无变化和一项静态平衡测试(单腿站立,睁眼站立在未受影响的腿上)有所下降外,其他测试均无显著改善。六名参与者中有五人的 MDS-UPDRS-III 评分有所改善或没有下降,大多数参与者的所有其他结果指标均有所改善或没有下降。光生物调控疗法没有不良反应:这项研究提供了一个信号,即光生物调控疗法可以安全地减轻一些帕金森病患者的重要临床运动症状和非运动症状,而且这种改善可以维持数年。基于家庭的光生物调节疗法有可能辅助标准疗法来控制症状,并有可能延缓帕金森病症状的发展:澳大利亚-新西兰临床试验注册中心,注册号:ACRN12618000038291p,注册日期:2018年1月12日。
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引用次数: 0
Migration of cervical spine screws to the sacral canal: a case report. 颈椎螺钉移位至骶管内:病例报告。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-09 DOI: 10.1186/s12883-024-03878-8
Miao Fang, Yong Zeng, Yueming Song

Cervical open door laminoplasty is widely used in multilevel decompression, which is a motion-sparing decompression treatment option for multilevel cervical myelopathy. Implant distance migration in cervical laminoplasty has not been reported. A 61-year-old woman underwent cervical laminoplasty, three months postoperatively, she experienced left shoulder pain and left upper limb pain, and underwent cervical magnetic resonance imaging, which showed no abnormalities. She gradually developed dizziness, headache, unstable walking, incomplete urinary incontinence, and fluctuating neck lumps. The X-ray showed that the screws of the C7 lateral mass had disappeared and migrated to the sacral canal. The patient underwent cerebrospinal leakage repair and removal of the screws in the spinal canal. Displacement of fixators implanted into the spinal canal after cervical laminoplasty is a rare complication that can cause permanent neurological injury.

颈椎开门椎板成形术广泛应用于多椎间孔减压术,是多椎间孔颈椎病的一种保留运动的减压治疗方案。颈椎板层成形术中植入物距离移位的情况尚未见报道。一名 61 岁的女性接受了颈椎板成形术,术后三个月出现左肩疼痛和左上肢疼痛,接受了颈椎磁共振成像检查,结果显示无异常。她逐渐出现头晕、头痛、行走不稳、不完全尿失禁、颈部肿块波动等症状。X 光片显示,C7 侧肿块的螺钉已消失并移至骶管。患者接受了脑脊液漏修复手术,并取出了椎管内的螺钉。颈椎板成形术后植入椎管的固定器移位是一种罕见的并发症,可造成永久性神经损伤。
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引用次数: 0
Brain volume loss in relapsing multiple sclerosis: indirect treatment comparisons of available disease-modifying therapies. 复发性多发性硬化症的脑容量损失:现有疾病改变疗法的间接治疗比较。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-08 DOI: 10.1186/s12883-024-03888-6
Robert Zivadinov, Alexander J Keenan, Hoa H Le, Maria Ait-Tihyaty, Kavita Gandhi, Matthew L Zierhut, Elizabeth M Salvo-Halloran, Abril Oliva Ramirez, Vivian Vuong, Sumeet Singh, Brian Hutton

Background: Brain volume loss (BVL) has been identified as a predictor of disability progression in relapsing multiple sclerosis (RMS). As many available disease-modifying treatments (DMTs) have shown an effect on slowing BVL, this is becoming an emerging clinical endpoint in RMS clinical trials.

Methods: In this study, a systematic literature review was conducted to identify BVL results from randomized controlled trials of DMTs in RMS. Indirect treatment comparisons (ITCs) were conducted to estimate the relative efficacy of DMTs on BVL using two approaches: a model-based meta-analysis (MBMA) with adjustment for measurement timepoint and DMT dosage, and a network meta-analysis (NMA).

Results: In the MBMA, DMTs associated with significantly reduced BVL versus placebo at two years included fingolimod (mean difference [MD] = 0.25; 95% confidence interval [CI] = 0.15 - 0.36), ozanimod (MD = 0.26; 95% CI = 0.12 - 0.41), teriflunomide (MD = 0.38; 95% CI = 0.20 - 0.55), alemtuzumab (MD = 0.38; 95% CI = 0.10 - 0.67) and ponesimod (MD = 0.71; 95% CI = 0.48 - 0.95), whereas interferons and natalizumab performed the most poorly. The results of NMA analysis were generally comparable with those of the MBMA.

Conclusions: Limitations of these analyses included the potential for confounding due to pseudoatrophy, and a lack of long-term clinical data for BVL. Our findings suggest that important differences in BVL may exist between DMTs. Continued investigation of BVL in studies of RMS is important to complement traditional disability endpoints, and to foster a better understanding of the mechanisms by which DMTs can slow BVL.

背景:脑容量损失(BVL)已被确定为复发性多发性硬化症(RMS)残疾进展的预测指标。由于许多现有的改变病情疗法(DMTs)都显示出了减缓脑容量损失的效果,因此脑容量损失正成为RMS临床试验中一个新兴的临床终点:本研究对文献进行了系统性回顾,以确定DMTs治疗RMS随机对照试验的BVL结果。采用两种方法进行了间接治疗比较(ITC),以估计DMTs对BVL的相对疗效:一种是基于模型的荟萃分析(MBMA),对测量时间点和DMT剂量进行了调整;另一种是网络荟萃分析(NMA):结果:在MBMA中,与安慰剂相比,两年后BVL明显减少的DMT包括芬戈莫德(平均差[MD] = 0.25; 95%置信区间[CI] = 0.15 - 0.36)、奥扎尼莫德(MD = 0.26; 95% CI = 0.12 - 0.41)、特利氟莫德(MD = 0.26; 95% CI = 0.12 - 0.4141), teriflunomide (MD = 0.38; 95% CI = 0.20 - 0.55), alemtuzumab (MD = 0.38; 95% CI = 0.10 - 0.67) and ponesimod (MD = 0.71; 95% CI = 0.48 - 0.95), 而干扰素和纳他珠单抗表现最差。NMA分析结果与MBMA分析结果基本相当:这些分析的局限性包括假性萎缩可能造成的混淆,以及缺乏BVL的长期临床数据。我们的研究结果表明,DMTs之间的BVL可能存在重要差异。在RMS研究中继续调查BVL对于补充传统的残疾终点以及促进更好地了解DMT减缓BVL的机制非常重要。
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引用次数: 0
Anti-NMDAR encephalitis with delayed ovarian teratoma in a young woman: a case report with 5 years of follow-up. 一名年轻女性的抗 NMDAR 脑炎伴迟发性卵巢畸胎瘤:随访 5 年的病例报告。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-08 DOI: 10.1186/s12883-024-03891-x
Hailong Xue, Junhao Hu, Yingge Chen, Wenbin Huang, Haoling Liu, Hongli Xu, Ming Shi

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder with a variety of clinical manifestations. It has been established that anti-NMDAR encephalitis may be related to ovarian teratoma in female patients. However, a considerable number of patients have no obvious evidence of ovarian teratoma during the onset of the disease.

Case: A 25-year-old previously-healthy female experienced a series of acute symptoms within two days, including confusion, disorientation, short-term memory loss, auditory hallucinations, abnormal behavior, refractory status epilepticus, etc. Her brain MRI and abdominal imaging showed no definite abnormality while her electroencephalogram exhibited the presence of low to moderate amplitude sharp, spike, and multi-spike waves. Serum and cerebrospinal fluid tests yielded positive results for anti-NMDAR antibodies. However, an ultrasound scan failed to identify an ovarian teratoma. Consequently, the diagnosis of anti-NMDAR encephalitis without teratoma was made after 4 days onset. After the plasma exchange and immunoglobulin therapy, her neurological symptoms improved and obtained a clinical cure. In the next eight months of follow-up, the patient accidentally touched a lump in the lower abdomen without any symptoms, and abdominal ultrasound and CT scan revealed a left ovarian tumor. Then she underwent left ovarian teratoma resection surgery and histopathology showed a mature cystic teratoma with neural components. The patient continued to receive five years of follow-up, and her condition remained stable without any recurrence, except that there had been a low titer of anti-NMDAR antibody in her serum.

Conclusion: Our case demonstrated the importance of long-term follow-up for female patients with anti-NMDAR encephalitis, since anti-NMDAR encephalitis-associated ovarian teratomas may develop in a delayed manner, even without any symptoms.

背景:抗 N-甲基-D-天冬氨酸受体(NMDAR)脑炎是一种自身免疫性疾病,临床表现多种多样。已有研究证实,抗 NMDAR 脑炎可能与女性患者的卵巢畸胎瘤有关。然而,相当多的患者在发病时并没有卵巢畸胎瘤的明显证据:病例:一名 25 岁的健康女性在两天内出现一系列急性症状,包括意识模糊、定向障碍、短期记忆丧失、幻听、行为异常、难治性癫痫等。她的脑部核磁共振成像和腹部造影显示没有明确的异常,而脑电图则显示存在中低幅尖波、棘波和多棘波。血清和脑脊液检测结果显示抗 NMDAR 抗体阳性。然而,超声波扫描未能发现卵巢畸胎瘤。因此,在发病 4 天后,诊断为无畸胎瘤的抗 NMDAR 脑炎。在接受血浆置换和免疫球蛋白治疗后,她的神经症状有所改善,临床治愈。在接下来 8 个月的随访中,患者在没有任何症状的情况下无意中触及下腹部肿块,腹部超声和 CT 扫描发现左侧卵巢肿瘤。随后,她接受了左侧卵巢畸胎瘤切除手术,组织病理学检查显示为成熟的囊性畸胎瘤,并伴有神经成分。患者继续接受了五年的随访,除了血清中抗 NMDAR 抗体滴度较低外,病情保持稳定,未见复发:我们的病例表明,对女性抗 NMDAR 脑炎患者进行长期随访非常重要,因为抗 NMDAR 脑炎相关卵巢畸胎瘤可能会延迟发展,甚至没有任何症状。
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引用次数: 0
Association between neutrophil-to-lymphocyte ratio and motor subtypes in idiopathic Parkinson's disease: a prospective observational study. 特发性帕金森病患者中性粒细胞与淋巴细胞比率与运动亚型之间的关系:一项前瞻性观察研究。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-08 DOI: 10.1186/s12883-024-03887-7
Hongyan Yi, Xiaojing Liang, Fugui Xu, Tiantian Li, Xiu Yang, Ming Wei, Zhou Ou, Lijun Wang, Qiang Tong

Background: Peripheral immunity and neuroinflammation interact with each other and they play important roles in the pathophysiology of idiopathic Parkinson's disease (IPD). There have been very few real-world reports on the relationship between peripheral immune inflammation and motor phenotypes of IPD. This study aimed to investigate the potential correlation between peripheral inflammatory indicators and motor subtypes in patients with IPD.

Methods: This observational, prospective case-control study examined patients with IPD and healthy controls (HC) matched for age and sex between September 2021 and July 2023 at the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University. The levels of peripheral inflammatory indicators were collected from each patient with IPD and HCs. Differences in the levels of peripheral inflammatory indicators among groups were compared. Binary logistic regression analysis was used to explore the inflammatory mechanism underlying the motor subtype of IPD.

Results: A total number of 94 patients with IPD were recruited at the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University between September 2021 and July 2023, including 49 males and 45 females, and 37 healthy volunteers matched for age and sex were also enrolled as the control group. Of the 94 patients with IPD, 42.6% performed as the TD motor subtype and 57.4% performed as the AR motor subtype. NLR and the plasma levels of IL-1βand TNF-α in the IPD group were higher than those in the HC group (P < 0.05). The disease duration, Hoehn and Yahr (H-Y) stage, NLR, and the levels of IL-1β in the AR group were higher than those in the TD group (P < 0.05). Additionally, IL-1β plasma levels and NLR were positively correlated with disease duration, H-Y stage, movement disorder society-Unified Parkinson's Disease Rating Scale-III motor score, and AR subtype. The binary logistic regression model revealed that the plasma level of IL-1β was mildly associated with the AR motor subtype and NLR was strongly associated with the AR motor subtype. The combination of NLR and IL-1β showed better performance in identifying the AR motor subtype.

Conclusion: NLR is strongly associated with the AR motor subtype in IPD, and peripheral immunity is probably involved in the pathogenesis of AR motor subtype in IPD.

背景:外周免疫和神经炎症相互影响,在特发性帕金森病(IPD)的病理生理学中发挥着重要作用。关于外周免疫炎症与特发性帕金森病运动表型之间关系的实际报道很少。本研究旨在探讨外周炎症指标与 IPD 患者运动亚型之间的潜在相关性:这项前瞻性病例对照研究于 2021 年 9 月至 2023 年 7 月在南京医科大学附属淮安市第一人民医院对 IPD 患者和年龄、性别匹配的健康对照(HC)进行了观察。研究人员收集了每位IPD患者和健康对照组的外周炎症指标水平。比较各组间外周炎症指标水平的差异。采用二元逻辑回归分析探讨 IPD 运动亚型的炎症机制:2021年9月至2023年7月期间,南京医科大学附属淮安市第一人民医院共招募了94名IPD患者,其中男性49名,女性45名,并招募了37名年龄和性别匹配的健康志愿者作为对照组。在94名IPD患者中,42.6%为TD运动亚型,57.4%为AR运动亚型。IPD 组的 NLR 和血浆中 IL-1β 和 TNF-α 的水平均高于 HC 组(P 结论:IPD 组的 NLR 和血浆中 IL-1β 和 TNF-α 的水平均高于 HC 组:NLR与IPD的AR运动亚型密切相关,外周免疫可能参与了IPD的AR运动亚型的发病机制。
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引用次数: 0
Convexity subarachnoid hemorrhage revealed contralateral internal carotid artery dissection due to Eagle syndrome: a case report. 凸面蛛网膜下腔出血显示对侧颈内动脉夹层是由伊格尔综合征引起的:病例报告。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-08 DOI: 10.1186/s12883-024-03890-y
Kazuki Obara, Takahiro Furuta, Chikako Yagi, Noriyoshi Nakai, Junichiro Suzuki, Masahisa Katsuno, Yasuhiro Ito

Background: Atraumatic localized convexity subarachnoid hemorrhage (cSAH) is an uncommon form of nonaneurysmal subarachnoid hemorrhage characterized by bleeding limited to the cerebral convexities. Ipsilateral cSAH can result from a variety of causes, such as internal carotid artery stenosis, obstruction, and dissection, although concomitant contralateral cSAH is exceptionally rare. In this case, the initial findings of cSAH led us to discovering contralateral internal carotid artery dissection (ICAD) and an elongated styloid process (ESP). ESP is recognized as a risk factor for ICAD, which is a hallmark of Eagle syndrome. This sequence of findings led to the diagnosis of Eagle syndrome, illustrating a complex and intriguing interplay between cerebrovascular conditions and anatomical variations.

Case presentation: A 47-year-old Japanese woman experienced acute onset of headache radiating to her neck, reaching its zenith approximately two hours after onset. Given the intractable nature of the headache and its persistence for three days, she presented to the emergency department. Neurological examination revealed no abnormalities, and the coagulation screening parameters were within normal ranges. Brain computed tomography (CT) revealed right parietal cSAH, while CT angiography (CTA) revealed ICAD and an ESP measuring 30.1 mm on the left side, positioned only 1.4 mm from the dissected artery. The unusual occurrence of contralateral cSAH prompted extensive and repeated imaging reviews that excluded reversible cerebral vasoconstriction syndrome (RCVS), leading to a diagnosis of left ICAD secondary to Eagle syndrome. The patient underwent conservative management, and the dissected ICA spontaneously resolved. The patient has remained recurrence-free for two and a half years.

Conclusions: Managing cSAH requires diligent investigation for ICAD, extending beyond its identification to explore underlying causes. Recognizing Eagle syndrome, though rare, as a potential etiology of ICAD necessitates the importance of evaluating ESPs. The method for preventing recurrent cervical artery dissection due to Eagle syndrome is controversial; however, conservative management is a viable option.

背景:创伤性局部凸面蛛网膜下腔出血(cSAH)是一种不常见的非动脉瘤性蛛网膜下腔出血,其特点是出血局限于大脑凸面。造成同侧蛛网膜下腔出血的原因有很多,如颈内动脉狭窄、阻塞和夹层等,但同时并发对侧蛛网膜下腔出血的情况非常罕见。在该病例中,cSAH 的初步发现让我们发现了对侧颈内动脉夹层(ICAD)和伸长的蝶骨髁突(ESP)。ESP被认为是ICAD的危险因素,而ICAD是伊格尔综合征的标志。这一系列发现导致了伊格尔综合征的诊断,说明脑血管疾病和解剖变异之间存在复杂而有趣的相互作用:病例介绍:一名 47 岁的日本妇女急性发作头痛,并向颈部放射,大约在发病两小时后达到顶峰。由于头痛难以缓解,且持续了三天,她来到急诊科就诊。神经系统检查未发现异常,凝血检查指标也在正常范围内。脑部计算机断层扫描(CT)显示患者右侧顶叶有囊性脑出血,而 CT 血管造影(CTA)显示患者左侧有 ICAD 和一个 30.1 毫米的 ESP,距离断裂动脉仅 1.4 毫米。对侧 cSAH 的不寻常发生促使患者进行了大量反复的影像学检查,排除了可逆性脑血管收缩综合征(RCVS),最终诊断为继发于伊格尔综合征的左侧 ICAD。患者接受了保守治疗,裂开的 ICA 自动愈合。两年半以来,患者一直没有复发:治疗 cSAH 需要认真检查 ICAD,不仅要识别 ICAD,还要探究其潜在病因。伊格尔综合征虽然罕见,但也是 ICAD 的潜在病因之一,因此有必要对 ESP 进行评估。预防伊格尔综合征导致的颈动脉夹层复发的方法尚存在争议;不过,保守治疗是一种可行的选择。
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引用次数: 0
Mediastinal and thoracic hematoma following transradial cerebral angiography: a case report. 经桡动脉脑血管造影术后的纵隔和胸腔血肿:病例报告。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-07 DOI: 10.1186/s12883-024-03896-6
Jiashan Tu, Wei Qiu

Background: Cerebral angiography through the transradial approach (TRA) is associated with a low risk of complications, but in rare cases, these complications can be life-threatening.

Case presentation: A 56-year-old female patient was admitted for transradial cerebral angiography due to the complaint of right limb weakness and the diagnosis of cerebral infarction and cerebral artery stenosis. During the procedure, the patient coughed with expectoration and complained of throat discomfort, palpitations, and pains in the right shoulder and back. Emergency CT scan indicated hematoma in the middle mediastinum and the right thoracic cavity, and perforation of a branch of the subclavian artery was highly suspected. Subclavian artery angiography was conducted immediately, which revealed a patchy contrast medium overflow in a branch of the right costocervical trunk. Selective endovascular occlusion therapy was performed successfully with gelfoam particles and placement of 2 microcoils. At 12 days after cerebral angiography, the patient recovered well and was discharged from the hospital.

Conclusion: Mediastinal and thoracic hematoma may occur due to vessel perforation during TRA cerebral angiography, in which guidewire advancement must be cautious. Early detection and appropriate countermeasures can reduce the severity of vascular perforation and subsequent hematoma.

背景:经桡动脉入路脑血管造影术(TRA)的并发症风险较低,但在极少数情况下,这些并发症可能危及生命:一名 56 岁的女性患者因主诉右侧肢体无力入院接受经桡动脉脑血管造影术,诊断为脑梗塞和脑动脉狭窄。手术过程中,患者咳嗽并伴有痰液排出,主诉咽喉不适、心悸、右肩和背部疼痛。急诊 CT 扫描显示中纵隔和右胸腔有血肿,高度怀疑是锁骨下动脉分支穿孔。随即进行了锁骨下动脉造影,结果显示右侧肋骨颈干的一个分支有造影剂溢出。患者成功地使用了凝胶泡沫颗粒和两个微线圈进行了选择性血管内闭塞治疗。脑血管造影术后 12 天,患者康复出院:结论:在 TRA 脑血管造影术中,血管穿孔可能导致纵隔和胸腔血肿,必须谨慎推进导丝。结论:在 TRA 脑血管造影术中,血管穿孔可能导致纵隔和胸腔血肿,必须谨慎推进导丝,及早发现并采取适当的应对措施可降低血管穿孔和血肿的严重程度。
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引用次数: 0
Hereditary haemorrhagic telangiectasias with recurrent ischemic stroke hinted by manganese deposition in the basal ganglia: a case report and literature review. 遗传性出血性毛细血管扩张症伴有基底节锰沉积暗示的复发性缺血性中风:病例报告和文献综述。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-07 DOI: 10.1186/s12883-024-03889-5
Qiwen Tang, Ping Xia, Xingyue Hu, Yuquan Shao

Background: Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant inherited vascular disorder that can involve multiple organs, thus can be associated with so many clinical departments that proper screening and diagnosis of HHT are needed for providing better management of both patients and their family members.

Case presentation: We present a 58-year-old female patient with recurrent paradoxical brain embolism due to HHT. She received aspirin therapy and underwent pulmonary arteriovenous malformation embolization, recovering well and discharged 3 days postoperatively. Though ischemic stroke caused by HHT-induced vascular disorders has been reported, our patient presented with both recurrent paradoxical brain embolisms and radiologic findings of bilateral globus pallidus manganese deposition at the same time, a combination rarely reported. We also review the literature on the clinical features and management of HHT for prompt diagnosis of this genetic disease behind paradoxical embolism.

Conclusions: When patients with ischemic stroke, especially recurrent ischemic stroke, have combined arteriovenous malformations (AVMs) in single or multiple organs, or clues for AVMs like manganese deposition in globus pallidus, genetic diseases such as HHT may be the reason for ischemic stroke and shouldn't be missed in the evaluation of embolic sources.

背景:遗传性出血性毛细血管扩张症(HHT遗传性出血性毛细血管扩张症(HHT)是一种罕见的常染色体显性遗传性血管疾病,可累及多个器官,因此可与许多临床科室相关联,需要对HHT进行适当的筛查和诊断,以便为患者及其家属提供更好的治疗:我们为您介绍一位 58 岁的女性患者,她因 HHT 而反复出现矛盾性脑栓塞。她接受了阿司匹林治疗,并接受了肺动静脉畸形栓塞术,术后恢复良好,3 天后出院。虽然 HHT 引起的血管病变导致缺血性中风已有报道,但我们的患者同时出现反复发作的矛盾性脑栓塞和双侧球状苍白球锰沉积的影像学发现,这种合并症很少见。我们还回顾了有关 HHT 临床特征和处理方法的文献,以便及时诊断这种隐藏在矛盾性脑栓塞背后的遗传性疾病:结论:当缺血性脑卒中患者,尤其是复发性缺血性脑卒中患者合并单个或多个器官的动静脉畸形(AVM),或有动静脉畸形的线索(如球海绵锰沉积)时,遗传性疾病(如HHT)可能是缺血性脑卒中的原因,在评估栓塞源时不应遗漏。
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引用次数: 0
A case of isolated dystextia due to subcortical infarction: a novel condition of digital device era. 一例皮层下梗塞导致的孤立性肌张力障碍:数字设备时代的新病症。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-05 DOI: 10.1186/s12883-024-03892-w
Masahiro Hatakeyama, Takeshi Kanayama, Saori Tokunaga, Toshiya Kizaki, Shintaro Tsuboguchi, Masato Kanazawa, Osamu Onodera

Background: In recent years, cases of dystextia (texting disabilities) and dystypia (typing disabilities) have been reported. However, reports describing isolated dystextia without aphasia or other cognitive impairments are rare, and the detailed pathophysiology is not fully understood. Most Japanese people use the alphabetical spelling system (Romaji) for texting and typing. Herein, we report the case of a man with isolated dystextia and dystypia resulting from Romaji conversion difficulties.

Case presentation: A 48-year-old, right-handed Japanese man developed texting and typing difficulties. The standard neuropsychological tests showed no signs of aphasia or other cognitive impairments, except for slight executive dysfunction. Thus, isolated dystextia and dystypia were diagnosed. Furthermore, the patient experienced Romaji conversion difficulties. Magnetic resonance imaging revealed a subcortical infarction in the left cerebral hemisphere. Single photon emission tomography revealed hypoperfusion, including in the left dorsolateral frontal cortex.

Conclusions: The left dorsolateral frontal cortex may be related to Romaji conversion in Japanese individuals. Therefore, diaschisis of the left dorsolateral frontal cortex due to subcortical lesions may have impaired Romaji conversion, leading to dystextia and dystypia, in this patient.

背景:近年来,有报道称出现了发短信障碍(dystextia)和打字障碍(dysteypia)病例。然而,描述孤立的肌张力障碍而不伴有失语或其他认知障碍的报告并不多见,详细的病理生理学也不完全清楚。大多数日本人使用字母拼写系统(罗马字)发短信和打字。在此,我们报告了一例因罗马字转换困难而导致的孤立性肌张力障碍和肌张力障碍的男性病例:病例介绍:一名 48 岁的右撇子日本男子出现了发短信和打字困难。标准神经心理测试显示,除了轻微的执行功能障碍外,没有失语或其他认知障碍的迹象。因此,他被诊断为孤立性肌无力和肌无力症。此外,患者还出现了罗马字转换困难。磁共振成像显示左侧大脑半球皮质下梗塞。单光子发射断层扫描显示左侧额叶背外侧皮层等部位灌注不足:左侧额叶背外侧皮层可能与日本人的罗马字转换有关。因此,皮层下病变导致的左侧额叶背外侧皮层缺损可能会影响罗马字的转换,从而导致该患者出现肌张力障碍和肌张力障碍。
{"title":"A case of isolated dystextia due to subcortical infarction: a novel condition of digital device era.","authors":"Masahiro Hatakeyama, Takeshi Kanayama, Saori Tokunaga, Toshiya Kizaki, Shintaro Tsuboguchi, Masato Kanazawa, Osamu Onodera","doi":"10.1186/s12883-024-03892-w","DOIUrl":"10.1186/s12883-024-03892-w","url":null,"abstract":"<p><strong>Background: </strong>In recent years, cases of dystextia (texting disabilities) and dystypia (typing disabilities) have been reported. However, reports describing isolated dystextia without aphasia or other cognitive impairments are rare, and the detailed pathophysiology is not fully understood. Most Japanese people use the alphabetical spelling system (Romaji) for texting and typing. Herein, we report the case of a man with isolated dystextia and dystypia resulting from Romaji conversion difficulties.</p><p><strong>Case presentation: </strong>A 48-year-old, right-handed Japanese man developed texting and typing difficulties. The standard neuropsychological tests showed no signs of aphasia or other cognitive impairments, except for slight executive dysfunction. Thus, isolated dystextia and dystypia were diagnosed. Furthermore, the patient experienced Romaji conversion difficulties. Magnetic resonance imaging revealed a subcortical infarction in the left cerebral hemisphere. Single photon emission tomography revealed hypoperfusion, including in the left dorsolateral frontal cortex.</p><p><strong>Conclusions: </strong>The left dorsolateral frontal cortex may be related to Romaji conversion in Japanese individuals. Therefore, diaschisis of the left dorsolateral frontal cortex due to subcortical lesions may have impaired Romaji conversion, leading to dystextia and dystypia, in this patient.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Determinants of low satisfaction with life among wheelchair users with spinal cord injury in Egypt: a cross-sectional study. 埃及脊髓损伤轮椅使用者生活满意度低的决定因素:一项横断面研究。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-05 DOI: 10.1186/s12883-024-03836-4
Sarah Abdelaaty Ayed, Safaa M El-Zoghby, Maha Emad Ibrahim, Wael Ahmed Zeid, Hebatallah Nour-Eldein

Background: Spinal cord injury (SCI) is one of the most catastrophic injuries that might lead to permanent use of a wheelchair and severely affects the quality of life, hence SCI patients report lower satisfaction with life (SWL) than the general population. Therefore, it is important to identify factors that determine SWL among wheelchair users with SCI. Our study aimed to assess the prevalence of low SWL and to identify its determinants among wheelchair users with SCI in Egypt.

Methods: A cross-sectional study included 105 wheelchair users with SCI from the Al Hassan Foundation for wheelchair users in Egypt. The main outcome measure was low SWL, while the independent variables included sociodemographic characteristics, injury-related characteristics, anxiety, depression, neuropathic pain, functional independence, and environmental barriers.

Results: The prevalence of low SWL among study participants was 57.1%. We found significant associations between SWL and age, area of living, and age at injury. Additionally, SWL correlated negatively with anxiety, depression, neuropathic pain, and environmental barriers, and positively with functional independence. Finally, the binary multiple logistic regression revealed that living in Upper Egypt (p = 0.017, OR = 13.7), depression (p = 0.034, OR = 6.08), older age (p = 0.002, OR = 1.21), and work and school environmental barriers (p = 0.022, OR = 0.46) were the predictors of low SWL.

Conclusion: To improve the SWL for wheelchair users with SCI we need to effectively manage neuropathic pain, depression, and anxiety, and promote functional independence. There is an urgent need to reinforce legislation to improve the living conditions for wheelchair users with SCI in Egypt, especially in Upper Egypt.

背景:脊髓损伤(SCI)是可能导致永久使用轮椅的最严重损伤之一,严重影响生活质量,因此 SCI 患者的生活满意度(SWL)低于普通人群。因此,确定决定 SCI 轮椅使用者生活满意度的因素非常重要。我们的研究旨在评估埃及 SCI 轮椅使用者中低生活满意度的发生率,并确定其决定因素:这项横断面研究纳入了埃及哈桑轮椅使用者基金会(Al Hassan Foundation for wheelchair users in Egypt)的 105 名患有 SCI 的轮椅使用者。主要结果指标为低SWL,自变量包括社会人口学特征、损伤相关特征、焦虑、抑郁、神经性疼痛、功能独立性和环境障碍:研究参与者中低SWL患病率为57.1%。我们发现,SWL 与年龄、居住地区和受伤年龄之间存在明显关联。此外,SWL 与焦虑、抑郁、神经性疼痛和环境障碍呈负相关,而与功能独立性呈正相关。最后,二元多元逻辑回归显示,居住在上埃及(p = 0.017,OR = 13.7)、抑郁(p = 0.034,OR = 6.08)、年龄较大(p = 0.002,OR = 1.21)以及工作和学校环境障碍(p = 0.022,OR = 0.46)是预测低SWL的因素:为了改善患有 SCI 的轮椅使用者的 SWL,我们需要有效控制神经性疼痛、抑郁和焦虑,并促进功能独立性。埃及,尤其是上埃及,迫切需要加强立法,改善患有 SCI 的轮椅使用者的生活条件。
{"title":"Determinants of low satisfaction with life among wheelchair users with spinal cord injury in Egypt: a cross-sectional study.","authors":"Sarah Abdelaaty Ayed, Safaa M El-Zoghby, Maha Emad Ibrahim, Wael Ahmed Zeid, Hebatallah Nour-Eldein","doi":"10.1186/s12883-024-03836-4","DOIUrl":"10.1186/s12883-024-03836-4","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) is one of the most catastrophic injuries that might lead to permanent use of a wheelchair and severely affects the quality of life, hence SCI patients report lower satisfaction with life (SWL) than the general population. Therefore, it is important to identify factors that determine SWL among wheelchair users with SCI. Our study aimed to assess the prevalence of low SWL and to identify its determinants among wheelchair users with SCI in Egypt.</p><p><strong>Methods: </strong>A cross-sectional study included 105 wheelchair users with SCI from the Al Hassan Foundation for wheelchair users in Egypt. The main outcome measure was low SWL, while the independent variables included sociodemographic characteristics, injury-related characteristics, anxiety, depression, neuropathic pain, functional independence, and environmental barriers.</p><p><strong>Results: </strong>The prevalence of low SWL among study participants was 57.1%. We found significant associations between SWL and age, area of living, and age at injury. Additionally, SWL correlated negatively with anxiety, depression, neuropathic pain, and environmental barriers, and positively with functional independence. Finally, the binary multiple logistic regression revealed that living in Upper Egypt (p = 0.017, OR = 13.7), depression (p = 0.034, OR = 6.08), older age (p = 0.002, OR = 1.21), and work and school environmental barriers (p = 0.022, OR = 0.46) were the predictors of low SWL.</p><p><strong>Conclusion: </strong>To improve the SWL for wheelchair users with SCI we need to effectively manage neuropathic pain, depression, and anxiety, and promote functional independence. There is an urgent need to reinforce legislation to improve the living conditions for wheelchair users with SCI in Egypt, especially in Upper Egypt.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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BMC Neurology
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