Over the past twenty years, improvements in neuroimaging have greatly improved the ability to diagnose cerebral venous sinus thrombosis, as well as isolated cortical venous thrombosis. Neuroimaging allows for variatio...Over the past twenty years, improvements in neuroimaging have greatly improved the ability to diagnose cerebral venous sinus thrombosis, as well as isolated cortical venous thrombosis. Neuroimaging allows for variations to be detected in the cortical vein and venous sinus. Diagnosis of thromboses in the venous system should not depend entirely on angiography of undeveloped veins or venous sinus. Currently, the combination of magnetic resonance imaging and magnetic resonance venography is the gold standard for diagnosing cerebral venous sinus thrombosis, rather than digital subtraction angiography. This article summarizes clinical manifestations, results from computed tomography and magnetic resonance imaging in two cases of isolated cortical venous thrombosis, analyzed relevant literature, and discussed the clinical and imaging characteristics of isolated cortical venous thromboses.展开更多
OBJECTIVE： Polymyositis （PM） mainly involves proximal limb and trunk muscles. Ocular muscles are not affected, except in rare cases with both PM and myasthenia gravis （MG）. Thus, the results of laboratory examina...OBJECTIVE： Polymyositis （PM） mainly involves proximal limb and trunk muscles. Ocular muscles are not affected, except in rare cases with both PM and myasthenia gravis （MG）. Thus, the results of laboratory examinations in such a patient deserve to be reported. METHODS： To analyze the clinical, imaging and pathology datas on a 65-year-old woman patient with PM with complex symptoms, who presented mainly ophthalmoplegia. The patient consented to all examinations and the hospital Ethics Committee approved the study. The laboratory examinations included creatine kinase （CK）, ENA, tumor marker, function of thyroid, cranial MRI, and electromyogram （EMG）. Biopsy of the left quadriceps femoris was performed, frozen specimens were stained with hematoxylin and eosin, ATPase, NADH tetrazolium reductase, periodic acid Schiff, oil red O, modified Gomory trichrome and MHC-I, to investigate the pathology of muscle fibers RESULTS： Laboratory results showed： CK, 108.32μ kat/L; antinuclear antibody： （＋）; ENA, （-）; tumor marker, （-）; normal thyroid function, MRI showed no abnormal signals in brain and extraocular muscles. Electromyography of the bilateral deltoid, biceps brachii, musculus quadriceps fexoris, anterior tibialis showed fibrillation potentials, positive potentials and short-duration, small-amplitude polyphasic potentials on voluntary movements with a full interference pattern on mild exertion. Repetitive stimulation did not result in any increment or decrement in these potentials. A muscle biopsy of the left quadriceps femoris showed many small round muscle fibers without peripheral bundle distribution and apparent myofiber degeneration, necrosis and phagocytosis. There were several focal lymphocyte infiltrations. MHC-I immunohistochemical staining was positive in most fibers revealing inflammatory infiltration of normal fibers with MHC-I expression. CONCLUSION： This patient showed increased CK, typical triad of myopathy in EMG, and apparent degeneration and necrosis in biopsy of quadriceps femoris. Therefore, the diagnosis of PM and involvement of extraocular muscles were definite.展开更多
BACKGROUND:The clinical manifestations of Wernicke encephalopathy(WE)are atypical and short of effective auxiliary examination means.The effects of magnetic resonance imaging(MRI)in the diagnosis of WE have been repor...BACKGROUND:The clinical manifestations of Wernicke encephalopathy(WE)are atypical and short of effective auxiliary examination means.The effects of magnetic resonance imaging(MRI)in the diagnosis of WE have been reported successively.But its imageological detection needs to be further investigated.OBJECTIVE:To analyze the characteristics of clinical manifestations,skull MRI examination and pathological results in patients with WE.DESIGN:Retrospective analysis.SETTING:The General Hospital of Chinese PLA.PARTICIPANTS:Ten patients of WE admitted to the Department of Neurology,General Hospital of Chinese PLA were recruited.Among them,five patients were diagnosed pathologically after death.Their pathological changes accorded with the pathological characteristics of WE.The other 5 patients were diagnosed clinically before death.Their pathological changes accorded with clinical and imageological manifestations and had definite reaction to the treatment of thiamine.Ten patients,7 males and 3 females,were aged(47±13)years ranging from 33 to 73 years.Their disease courses averaged 6 weeks ranging from 3 to 10 weeks.They all were non-alcoholics.Four patients developed WE after acute pancreatitis,two patients after the recurrence of gastric cancer,two patients after cholecystectomy,one patient after hepatitis medicamentosa,one patient after Alzheimer disease.Informed consents were obtained from all the patients and their relatives.METHODS:After admission,clinical manifestations of patients were observed and recorded.Five patients underwent skull MRI examination and their detected results were recorded.Five dead patients underwent autopsy and brain pathological examinations.Neuropathological examination involved cerebrum,cerebellum and brain stem.MAIN OUTCOME MEASURES:Clinical manifestations,MRI examination results,pathological analysis results and prognosis of all the patients.RESULTS:Ten patients with WE were involved in the final analysis.①Nine patients presented various degrees of mental and conscious disturbance.Six patients initially presented vertigo,nausea,and vomiting.Five patients showed opthalmoplegia.Three patients presented hypotension(BP<120/60 mm Hg,1 mm Hg=0.133 kPa).Two patients showed ataxia.One patient showed severe polyneuropathy.Both lower extremities were more severe.EMG showed axonal degeneration.②Five patients accepted skull MRI examination.Three patients showed typical high signals in periaqueductal regions and circumference of third and fourth ventriculus in T2-weighted and flair-weighted images,two of them showed high signals in fornixes in T2-weighted and flair-weighted images,and one of them showed high signals in optic chiasma,both mammillary bodies,and subcortical white matter.No abnormality was found in the other two patients.Two patients who accepted the supplements of thiamine showed obviously improvements in the second MRI examination.③Macroscopically,the border between gray and white matters was clear in the coronal section of cerebrum.Congestions,edema and multiple petechial hemorrhages were found in periaqueductal regions,circumference of third and fourth ventriculus,and both mammillary bodies.Microscopically,various degrees of necrosis of parenchymal structures,loss of nerve cells and ischemic changes were found.Myelinated fibers were more affected than neurons.There were focal capillary proliferation and multiple petechial hemorrhages.Prominent astrocytic proliferations were found in gelatinous fiber staining.And demyelinations were found in myelin staining.These pathological findings were all in accord with the diagnostic criteria of WE.④In the diagnosis before death,4 of 5 patients who were supplemented with thiamine had obvious improvement 2 weeks later and 1 of them abandoned therapy due to progressive aggravation of jaundice caused by recurrence of stomach cancer.The other 5 patients who were not diagnosed definitely before death and not supplemented with thiamine died.Final diagnosis was performed in autopsy examination.CONCLUSION:The clinical manifestations of this group of WE patients are atypical.MRI and pathological examination results are corresponding,and both have the characteristic manifestations of WE.展开更多
文摘Over the past twenty years, improvements in neuroimaging have greatly improved the ability to diagnose cerebral venous sinus thrombosis, as well as isolated cortical venous thrombosis. Neuroimaging allows for variations to be detected in the cortical vein and venous sinus. Diagnosis of thromboses in the venous system should not depend entirely on angiography of undeveloped veins or venous sinus. Currently, the combination of magnetic resonance imaging and magnetic resonance venography is the gold standard for diagnosing cerebral venous sinus thrombosis, rather than digital subtraction angiography. This article summarizes clinical manifestations, results from computed tomography and magnetic resonance imaging in two cases of isolated cortical venous thrombosis, analyzed relevant literature, and discussed the clinical and imaging characteristics of isolated cortical venous thromboses.
文摘OBJECTIVE： Polymyositis （PM） mainly involves proximal limb and trunk muscles. Ocular muscles are not affected, except in rare cases with both PM and myasthenia gravis （MG）. Thus, the results of laboratory examinations in such a patient deserve to be reported. METHODS： To analyze the clinical, imaging and pathology datas on a 65-year-old woman patient with PM with complex symptoms, who presented mainly ophthalmoplegia. The patient consented to all examinations and the hospital Ethics Committee approved the study. The laboratory examinations included creatine kinase （CK）, ENA, tumor marker, function of thyroid, cranial MRI, and electromyogram （EMG）. Biopsy of the left quadriceps femoris was performed, frozen specimens were stained with hematoxylin and eosin, ATPase, NADH tetrazolium reductase, periodic acid Schiff, oil red O, modified Gomory trichrome and MHC-I, to investigate the pathology of muscle fibers RESULTS： Laboratory results showed： CK, 108.32μ kat/L; antinuclear antibody： （＋）; ENA, （-）; tumor marker, （-）; normal thyroid function, MRI showed no abnormal signals in brain and extraocular muscles. Electromyography of the bilateral deltoid, biceps brachii, musculus quadriceps fexoris, anterior tibialis showed fibrillation potentials, positive potentials and short-duration, small-amplitude polyphasic potentials on voluntary movements with a full interference pattern on mild exertion. Repetitive stimulation did not result in any increment or decrement in these potentials. A muscle biopsy of the left quadriceps femoris showed many small round muscle fibers without peripheral bundle distribution and apparent myofiber degeneration, necrosis and phagocytosis. There were several focal lymphocyte infiltrations. MHC-I immunohistochemical staining was positive in most fibers revealing inflammatory infiltration of normal fibers with MHC-I expression. CONCLUSION： This patient showed increased CK, typical triad of myopathy in EMG, and apparent degeneration and necrosis in biopsy of quadriceps femoris. Therefore, the diagnosis of PM and involvement of extraocular muscles were definite.
文摘BACKGROUND:The clinical manifestations of Wernicke encephalopathy(WE)are atypical and short of effective auxiliary examination means.The effects of magnetic resonance imaging(MRI)in the diagnosis of WE have been reported successively.But its imageological detection needs to be further investigated.OBJECTIVE:To analyze the characteristics of clinical manifestations,skull MRI examination and pathological results in patients with WE.DESIGN:Retrospective analysis.SETTING:The General Hospital of Chinese PLA.PARTICIPANTS:Ten patients of WE admitted to the Department of Neurology,General Hospital of Chinese PLA were recruited.Among them,five patients were diagnosed pathologically after death.Their pathological changes accorded with the pathological characteristics of WE.The other 5 patients were diagnosed clinically before death.Their pathological changes accorded with clinical and imageological manifestations and had definite reaction to the treatment of thiamine.Ten patients,7 males and 3 females,were aged(47±13)years ranging from 33 to 73 years.Their disease courses averaged 6 weeks ranging from 3 to 10 weeks.They all were non-alcoholics.Four patients developed WE after acute pancreatitis,two patients after the recurrence of gastric cancer,two patients after cholecystectomy,one patient after hepatitis medicamentosa,one patient after Alzheimer disease.Informed consents were obtained from all the patients and their relatives.METHODS:After admission,clinical manifestations of patients were observed and recorded.Five patients underwent skull MRI examination and their detected results were recorded.Five dead patients underwent autopsy and brain pathological examinations.Neuropathological examination involved cerebrum,cerebellum and brain stem.MAIN OUTCOME MEASURES:Clinical manifestations,MRI examination results,pathological analysis results and prognosis of all the patients.RESULTS:Ten patients with WE were involved in the final analysis.①Nine patients presented various degrees of mental and conscious disturbance.Six patients initially presented vertigo,nausea,and vomiting.Five patients showed opthalmoplegia.Three patients presented hypotension(BP<120/60 mm Hg,1 mm Hg=0.133 kPa).Two patients showed ataxia.One patient showed severe polyneuropathy.Both lower extremities were more severe.EMG showed axonal degeneration.②Five patients accepted skull MRI examination.Three patients showed typical high signals in periaqueductal regions and circumference of third and fourth ventriculus in T2-weighted and flair-weighted images,two of them showed high signals in fornixes in T2-weighted and flair-weighted images,and one of them showed high signals in optic chiasma,both mammillary bodies,and subcortical white matter.No abnormality was found in the other two patients.Two patients who accepted the supplements of thiamine showed obviously improvements in the second MRI examination.③Macroscopically,the border between gray and white matters was clear in the coronal section of cerebrum.Congestions,edema and multiple petechial hemorrhages were found in periaqueductal regions,circumference of third and fourth ventriculus,and both mammillary bodies.Microscopically,various degrees of necrosis of parenchymal structures,loss of nerve cells and ischemic changes were found.Myelinated fibers were more affected than neurons.There were focal capillary proliferation and multiple petechial hemorrhages.Prominent astrocytic proliferations were found in gelatinous fiber staining.And demyelinations were found in myelin staining.These pathological findings were all in accord with the diagnostic criteria of WE.④In the diagnosis before death,4 of 5 patients who were supplemented with thiamine had obvious improvement 2 weeks later and 1 of them abandoned therapy due to progressive aggravation of jaundice caused by recurrence of stomach cancer.The other 5 patients who were not diagnosed definitely before death and not supplemented with thiamine died.Final diagnosis was performed in autopsy examination.CONCLUSION:The clinical manifestations of this group of WE patients are atypical.MRI and pathological examination results are corresponding,and both have the characteristic manifestations of WE.
