Jingjing Gong

The impact of leucoaraiosis on neurological function recovery in elderly patients with acute cerebral infarction: Clinical study involving 279 Chinese patients

Objective To explore the link between leucoaraiosis and recovery of neurological function in elderly patients with acute cerebral infarction. Methods The study included elderly patients, hospitalized with acute cerebral infarction. Magnetic resonance imaging examinations were performed before or within 5 days after admission; T1-weighted, T2-weighted, fluid-attenuated inversion recovery and diffusion-weighted imaging sequence data were collected. Using the Fazekas scale, leucoaraiosis (white matter hyperintensity [WMH]) was graded as 0 (absent), 1 (mild), 2 (moderate) or 3 (severe) for all participants. Results The study included 279 patients. WMH grades of 0, 1, 2 and 3 were seen in 27 (9.67%), 90 (32.26%), 104 (37.28%) and 58 cases (20.79%) respectively. Improvement on the National Institutes of Health Stroke Scale for neurological impairment was negatively associated with WMH grade. Patients with severe leucoaraiosis at hospital admission had worse neurological functional recovery and a higher rate of self-care incapability compared with those with mild or no leucoaraiosis. Conclusions The results suggest that severe leucoaraiosis in elderly patients with acute cerebral infarction is associated with poor prognosis and poor recovery of neurological function.

Factors influencing risky decision-making in patients with cerebral infarction

Numerous studies have found that the framing effect is common in medical scenarios, but few studies have examined the influence of the framing effect upon thrombolytic therapy for cerebral infarction. In this study, 1040 inpatients and outpatients in the department of neurology were recruited to explore whether there is a framing effect in decision-making within thrombolytic therapy, and if so, which factors influence that effect. The findings from Study 1 indicate that the framing effect occurred in patients both with and without cerebral infarction (χ2 = 7.90, p = .005; χ2 = 5.16, p = .023, respectively), with both groups displaying risk-seeking behavior (thrombolytic therapy) in the positive frame and no risk aversion or risk seeking in the negative frame. The results of Study 2 show that the patients preferred risk seeking in both collaborative and individual decision-making. In the collaborative decision-making group, the patients in the senior group showed the framing effect (χ2 = 5.35, p < .05), with the patients in the positive frame (G) showing more significant risk seeking than both those in the negative frame (H) and those in the other positive frame (A, C, and E). In summary, decision-making about thrombolytic therapy in patients with cerebral infarction is influenced by the framing effect, and some influencing factors should be attended in clinical practice. Further research is necessary to guide the treatment of cerebral infarction.

Frequent hemianesthesia as initial symptom of limbic encephalitis associated with LGI1 antibodies.

We report on a 59-year-old female who presented with sudden numbness on the right side of the body and face, lasting less than 3 s (10–20 times daily), and brain MRI scan was normal. She obtained a spontaneous remission after a month, which was followed by agitation, visual hallucinations, sleep disorder, and impaired short-term memory. Two months later, she began to suffer increasingly frequent stereotypical, involuntary clonic motions of her right arm, lasting less than 2 s (more than 10 times daily). Three and a half months later, the patient suddenly experienced a combination of right arm jerking, right face contorting, head-turning and eyes gaze to the right (faciobrachial dystonic seizures, FBDS), followed by generalized tonic– clonic seizures (about 3 min). Over the next 15 days, similar manifestation occurred three times, though treatment of anti-epileptic drugs (AEDs) was given for 2 weeks (carbamazepine, 0.2 g, b.i.d). The second MRI scan revealed hyperintense fluid-attenuated inversion recovery (FLAIR) signal in bilateral medial temporal lobe, insular lobe, and cingulate gyrus (Fig. 1a). Cerebrospinal fluid (CSF) was positive for 1-4-33 protein and antibodies against leucine-rich glioma inactivated-1 (LGI1) (in both serum and CSF). Interictal EEG was normal. F-fluoro-deoxyglucose-PET indicated hypometabolism in the left hippocampus and lenticular nucleus (Fig. 1d–e). The patient started treatment with IVIg (22.5 g daily) for 5 days, and 10 days after being hospitalized the patient was improved dramatically, and FBDS were significantly decreased with no generalized tonic–clonic seizures. However, the withdrawal of AEDs resulted in the patient’s increasingly frequent FBDS, and anti-epileptic medications were prescribed again and showed obvious efficacy. 6 weeks after treatment, the patient has remained well without mental/cognitive sequelae (Fig. 1b), but FBDS were triggered by high emotion for about 2–3 times. Follow-ups in 3 months found that the patient suffered depression and sleep disorder again without any other symptoms (Fig. 1c), which was misdiagnosed as a relapse at first. She was admitted in our department again, and blood test showed LGI1 was weak positive (improved). Psychological assessment showed that her intelligence scores were increased significantly, while Self-rating Depression Scale (SDS) indicated her moderate depression. 3 weeks later, her depression and insomnia were significantly relieved by antidepressant. LE can be caused by infections and autoimmune inflammation, the latter of which comprises LE correlating with antibodies against intracellular/nuclear antigens (mainly paraneoplastic), LE correlating with antibodies that target neuronal cell surface/synaptic antigens, ion channels (i.e., VGKC), and ligand-gated ion channels (i.e., & Yonghua Huang neurohuangyonghua@163.com

Correlation of retinopathy with leukoaraiosis in patients with anterior circulation infarcts

Although retinal and cerebral microvessels share similar embryological, anatomical and physiological characteristics, the correlation between retinopathy and leukoaraiosis (LA), a type of brain microvascular disease, is unclear. In the present study, the sample included 213 patients admitted to the department of neurology from January 2012 through October 2012. MRI and retinal photography were performed within 48hours of hospitalization, and patient demographics, comorbidities, preadmission medications and laboratory data were collected. MRI images were used to divide the patients into LA and non-LA groups. Using multivariate binary logistic regression, the effects of retinopathy on LA were investigated. Of the 213 patients enrolled, 168 were included in this study (LA, n=108; non-LA, n=60). Hypertension, coronary heart disease and carotid artery plaque were more common in the LA group, and these patients showed higher blood levels of C-reactive protein, homocysteine and triglycerides. The incidence of retinopathy was significantly increased in the LA group compared with the non-LA group, and there was a significant correlation between the severity of LA and incidence of retinopathy. Retinopathy is an independent risk factor for LA and can significantly increase the risk of LA when combined with age, coronary heart disease, C-reactive protein, carotid artery plaque or systolic pressure. Taken together, retinopathy is associated with LA in patients with anterior circulation infarcts. Retinopathy is an independent risk factor for LA and an increase the risk of LA, and thus facilitating the evaluation of LA.