Bingjun Zhang

Comparative Brain Stem Lesions on MRI of Acute Disseminated Encephalomyelitis, Neuromyelitis Optica, and Multiple Sclerosis

Background Brain stem lesions are common in patients with acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and multiple sclerosis (MS). Objectives To investigate comparative brain stem lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, NMO, and MS. Methods Sixty-five adult patients with ADEM (n = 17), NMO (n = 23), and MS (n = 25) who had brain stem lesions on MRI were enrolled. Morphological features of brain stem lesions among these diseases were assessed. Results Patients with ADEM had a higher frequency of midbrain lesions than did patients with NMO (94.1% vs. 17.4%, P<0.001) and MS (94.1% vs. 40.0%, P<0.001); patients with NMO had a lower frequency of pons lesions than did patients with MS (34.8% vs. 84.0%, P<0.001) and ADEM (34.8% vs. 70.6%, P = 0.025); and patients with NMO had a higher frequency of medulla oblongata lesions than did patients with ADEM (91.3% vs. 35.3%, P<0.001) and MS (91.3% vs. 36.0%, P<0.001). On the axial section of the brain stem, the majority (82.4%) of patients with ADEM showed lesions on the ventral part; the brain stem lesions in patients with NMO were typically located in the dorsal part (91.3%); and lesions in patients with MS were found in both the ventral (44.0%) and dorsal (56.0%) parts. The lesions in patients with ADEM (100%) and NMO (91.3%) had poorly defined margins, while lesions of patients with MS (76.0%) had well defined margins. Brain stem lesions in patients with ADEM were usually bilateral and symmetrical (82.4%), while lesions in patients with NMO (87.0%) and MS (92.0%) were asymmetrical or unilateral. Conclusions Brain stem lesions showed various morphological features among adult patients with ADEM, NMO, and MS. The different lesion locations may be helpful in distinguishing these diseases.

Comparison of deep gray matter lesions on magnetic resonance imaging among adults with acute disseminated encephalomyelitis, multiple sclerosis, and neuromyelitis optica.

Background: Deep gray matter lesions have been reported in patients with acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), and neuromyelitis optica (NMO). Objectives: The purpose of this study was to compare the features of deep gray matter lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, MS, and NMO. Methods: Ninety-five adult patients with ADEM (n=12), MS (n=60), and NMO (n=23) who had deep gray matter lesions on MRI were enrolled. Morphological features of deep gray matter lesions among these patients were assessed. Results: Putamen involvement was more common in patients with ADEM than in patients with MS and NMO. Differing from children, thalamus involvement might not be helpful in differentiating ADEM from MS in adults. Hypothalamus involvement was more common in patients with NMO than in patients with ADEM and MS. More importantly, bilateral hypothalamus involvement was more helpful in differentiating NMO from MS. The diameter of the thalamus lesions in patients with ADEM was larger than that in patients with NMO. Conclusions: Morphological features of deep gray matter lesions vary among adult patients with ADEM, MS, and NMO, and may be helpful in distinguishing these diseases.

Neuromyelitis optica spectrum disorders without and with autoimmune diseases

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) can coexist with non-organ-specific or organ-specific autoimmune diseases. The aim of this study was to investigate and compare the features between NMOSD without and with autoimmune diseases, and NMOSD with non-organ-specific and organ-specific autoimmune diseases.MethodsOne hundred and fifty five NMOSD patients without autoimmune diseases (n = 115) and with autoimmune diseases (n = 40) were enrolled. NMOSD with autoimmune diseases were divided by organ-specific autoimmune diseases. The clinical, laboratory and magnetic resonance imaging features between two groups were assessed.ResultsMotor deficit was less frequent in NMOSD patients with non-organ-specific autoimmune diseases (p = 0.024). Cerebrospinal fluid white blood cell and protein, serum C-reactive protein and immunoglobulin G were lower in NMOSD patients without autoimmune diseases, while several autoantibodies seropositivity and thyroid indexes were significantly higher in NMOSD patients with autoimmune diseases (p < 0.05). No difference was found in other clinical and laboratory characteristics between different NMOSD subtypes (p > 0.05). NMOSD patients with autoimmune diseases had higher brain abnormalities than NMOSD without autoimmune diseases (p < 0.001).ConclusionsThe characteristics between NMOSD without and with autoimmune diseases were similar. NMOSD with autoimmune diseases have high frequency of brain abnormalities.

Homocysteine and C-Reactive Protein Associated with Progression and Prognosis of Intracranial Branch Atheromatous Disease

Background and Objectives C-reactive protein (CRP) is a biomarker of inflammation and a sensitive predictor of stroke, and high homocysteine (Hcy) is also associated with stroke. However, the roles of CRP and Hcy in the pathogenesis, progression and prognosis of branch atheromatous disease (BAD) and lipohyalinotic degeneration (LD) are largely unknown. We sought to determine the relation between them in Chinese patients. Methods According to the lesion presences shown by diffusion-weighted imaging (DWI), we retrospectively recruited a cohort of 308 patients with a diagnosis of BAD and LD from a total of 1458 consecutive patients with acute ischemic stroke. Progression was defined as worsening by > or  = 1-point in the NIHSS for motor function within the first 5 days. Good outcome was deemed as Modified Rankin Scale (mRS) ≤ 2 and poor outcome was mRS > 2 recorded at one month after onset. Results This study comprised a total of 179 patients with BAD and 129 patients with LD. Subjects in patients with LD significantly had an elevated Hcy (p = 0.030), a lower NIHSS score on admission (p<0.001) and mRS score at one month after ictus (p<0.001) than those in patients with BAD. Elevated Hcy (P = 0.004) and increased CRP (P = 0.025) were associated with progression in patients with BAD, and CRP (p = 0.006) and diabetes mellitus (p = 0.011) were found to be associated with poor outcome in patients with BAD. However, no association was observed in patients with LD on progression and prognosis. After multivariate logistic regression analysis, elevated Hcy (p = 0.002) remained the only independent predictor for the progression, and increased CRP (p = 0.027) and smoking (p = 0.012) became the independent predictors for the poor outcome in patients with BAD. Conclusions In patients with BAD, elevated Hcy and increased CRP may independently predict progression and prognosis, respectively.

A case of exacerbated multiphasic disseminated encephalomyelitis after interferon beta treatment

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system (CNS), which can be monophasic or with repeated episodes. Relapsing ADEM can be misdiagnosed as multiple sclerosis (MS). We describe here a 16-year-old female patient with multiphasic disseminated encephalomyelitis (MDEM), which was exacerbated after an interferon beta (INF-β) treatment. The patient presented with polysymptomatic and encephalopathic features at the first attack and was definitively diagnosed with ADEM. During the following 28months, she had two relapses, with the lesions spatially disseminated in time and space, but without encephalopathy. She was diagnosed with MS and started on treatment with IFN-β injection. A severe relapse occurred 5months after starting IFN-β treatment, with both the clinical and MRI characteristics worse than during the former 2 relapses, meeting the diagnostic criteria for MDEM. Treatment with IFN-β was halted, with no new relapses observed over the following 9months. These findings suggest that treating MDEM patients with IFN-β may exacerbate the disease, similar to that observed during IFN-β treatment of patients with neuromyelitis optica. Caution should be exercised when treating these patients with IFN-β.

Hemoglobin A1C is independently associated with severity and prognosis of brainstem infarctions

OBJECTIVE To assess the association of Hemoglobin A1C (HbA1c) with acute brainstem infarctions (BSIs) and to determine whether HbA1c is an independent risk factor in BSIs patients. METHODS 96 only BSIs patients were categorized into four groups according to HbA1c as <6%, ≥ 6% but <7%, ≥ 7% but <8%, or ≥ 8%, respectively. The association of the four HbA1c groups with diffusion-weighted imaging (DWI) infarct volumes (DIV), National Institutes of Health Stroke Scale (NIHSS), and follow-up modified Rankin Scale (FmRS) scores were analyzed. Patients also were categorized into two groups according to HbA1c<6% or ≥ 6%. Logistic regression analyses were performed to determine independent risk factors. RESULTS There was a significant correlation between HbA1c and DIV (Spearman ρ=0.339, P=0.001), NIHSS scores (ρ=0.292, P=0.004) and FmRS scores (ρ=0.315, P=0.002). The incidence of pons infarction was highest in BSIs and patients with HbA1c ≥ 6% showed significantly more frequent isolated pontine infarction. Logistic regression analyses showed that only HbA1c was independently associated with larger DIV (P=0.025) and FmRS scores (P=0.026). CONCLUSIONS These results suggest that elevated HbA1c level may be a potential serologic marker in the evaluation of the severity and prognosis of acute BSIs. There is an urgent need to study control of diabetes mellitus (DM) before and after BSIs.

Comparison of clinical characteristics between neuromyelitis optica spectrum disorders with and without spinal cord atrophy.

BackgroundSpinal cord lesions is one of the predominant characteristics in patients with neuromyelitis optica spectrum disorders (NMOSD). Interestingly, mounting evidence indicates that spinal cord atrophy (SCA) is one of common clinical features in multiple sclerosis (MS) patients, and correlates closely with the neurological disability. However, Clinical studies related to the SCA aspects of NMOSD are still scarce.MethodsWe retrospectively analyzed 185 patients with NMOSD, including 23 patients with SCA and 162 patients without SCA. Data were collected regarding clinical characteristics, laboratory tests, and magnetic resonance imaging findings.Results12.4% of patients had SCA in NMOSD. Patients with SCA had a longer disease duration and higher EDSS at clinical onset and last visit. More importantly, SCA patients were more prone to reach disability milestones (EDSS ≥ 6.0). Bowel or bladder dysfunction, movement disorders, and sensory disturbances symptoms were more common in patients with SCA. ESR and CRP were significantly higher in patients with SCA than those without SCA. Patients with SCA were more frequently complicated with cervical cord lesions. However, the ARR, progression index, seropositive rate of NMO-IgG and OCB were similar in the two groups. Futhermore, LETM did not differ significantly between patients with SCA and without SCA in NMOSD patients.ConclusionsPatients with SCA might have longer disease duration, more severe clinical disability, and more frequently complicated with cervical spinal cord lesions. SCA might be predictive of the more severe neurologic dysfunction and worse prognosis in NMOSD. Inflammation contributes to the development of SCA in NMOSD.

Risk factors and etiological subtype analysis of brainstem infarctions

OBJECTIVE To evaluate the features of risk factors and etiological subtypes of brainstem infarctions (BSIs) patients in China. METHODS One hundred and ninety-nine cerebral infarction patients with brainstem involvement were categorized into five groups according to Trial of Org 10172 in Acute Stroke Treatment classification: large artery disease (LAD), cardioembolism (CE), small vessel disease (SVD), stroke of other determined etiology (SOE) or stroke of undetermined etiology (SUE). The risk factors and percentage of the different etiological subtypes were assessed. RESULT A total of 199 patients were enrolled in this study. The number and percentage of patients in SVD, LAD, SUE, CE and SOE were 77 (38.7%), 74 (37.2%), 25 (12.6%), 23 (11.6%) and 0, respectively. There were significantly different incidences of hypertension, diabetes and coronary heart disease (CHD) without atrial fibrillation (AF) among different stroke subtypes (P=0.006, P=0.002, P=0.016, respectively). Hypertension was more prevalent in LAD than in SVD and CE (P=0.001 and P=0.039, respectively) while the incidence of diabetes in LAD was higher than those in SVD and CE (P<0.001 and P=0.015, respectively). CHD without AF was more prevalent in CE than in SVD and LAD (P=0.044 and P=0.012, respectively). LAD was significantly associated with hypertension (OR=3.18, P=0.009) and diabetes (OR=2.84, P=0.003) in BSIs. CONCLUSION The pattern of etiological subtypes of BSIs in China has its own characteristics. It might result from the features of risk factors in Chinese patients.

Risk factors, topographic patterns and mechanism analysis of intracranial atherosclerotic stenosis ischemic stroke.

Background: The association between topographic patterns, risk factors and stroke mechanisms of ICAS in first-ever stroke remains unknown. Methods: A large sample sized retrospective study was performed on first-ever ICAS ischemic stroke using DWI and MRA. Results: Hypertension (60.92%), cigarette smoking (26.82%), MCA (76.65%) and multiple vessels (65.37%) stenosis, were the major factors favoring different mechanisms. Subcortical lesions were the most occurring topographic patterns (41.4%). The common mechanism was LBO (66.3%). Statistical analysis showed a significant relationship between lesion patterns and mechanisms (r = 0.384, P = 0.001). Single mechanism had the higher apoB/apoAI ratio (P = 0.005) and levels of plasma apoB (P = 0.007) compared with multiple mechanisms. The anterior circulation stroke were more multiple mechanisms as compared to the posterior circulation stroke (P = 0.001). LBO was more prevalent in posterior circulation stroke than in anterior circulation stroke (P = 0.001). Conclusions: The topographic patterns of ischemic lesions is helpful in early identification of different mechanisms of ICAS. Monitoring apoB and apoB/apoA1 may help to predict the mechanism of stroke with ICAS. The prevalence of mechanisms differ between anterior and posterior circulation stroke with ICAS.

Baicalein improves behavioral dysfunction induced by Alzheimer’s disease in rats

Background Alzheimer’s disease (AD) is considered to be a neurodegenerative disorder that is characterized by increased oxidative stress. Medicinal plants, with their antioxidant properties, have been used to cure several human diseases. The aim of the current study was to explore the protective and therapeutic effect of baicalein on AD-induced rats. Materials and methods Swiss Wistar rats were used in the study. The rats were divided into five groups. Group I: normal control group treated with water; Group II: disease control treated with AlCl3 to induce the mimicking AD for 4 successive weeks (SW); Group III: normal control group treated with baicalein (5 mg/kg) for 2 SW followed by combination of baicalein and AlCl3 for 4 SW; Group IV: normal control group treated with baicalein (10 mg/kg) for 2 SW followed by combination of baicalein and AlCl3 for 4 SW; Group V: normal control group treated with rivastigmine (0.3 mg/kg) for 2 SW followed by combination of rivastigmine and AlCl3 for 4 SW. Moreover, the therapeutic groups are as follows: Group VI: AD disease control treated with AlCl3 for 4 SW and serving as the therapeutic positive group; Group VII: AD disease control + baicalein (5 mg/kg) for 12 SW; Group VIII: AD disease control + baicalein (10 mg/kg) for 12 SW; Group IX: AD disease control + rivastigmine (0.3 mg/kg) for 12 SW. Behavioral test, T-maze, and rotarod test were also performed before and after the treatment. At the end of the experimental study, all the rats were sacrificed and their brains were removed and divided into two portions. The first portion was homogenated for estimating the level of acetylcholinesterase (AchE) and acetylcholine (Ach). Another portion was used for histopathological evaluation. Results The current investigation showed that baicalein significantly reduced the duration of revolving on the rotarod, cage activity, and T-maze activity in a dose-dependent manner compared with the AD control group rats. It also altered the AchE and Ach levels in the brain homogenates. The histopathology study also provides strength to the protective effect of baicalein. Conclusion The current study showed that baicalein significantly (P<0.05) improved the biochemical and histopathological condition of AD in rats.