关键词： 神经病学   疾病诊断   神经免疫性疾病   神经系统疾病   神经变性疾病   脑血管疾病   感染性疾病   神经电生理  

摘要： 本期神经疾病诊断专刊从策划、组稿到出版发行．历时近1年时间，凝聚了全国近10多位知名神经病学专家的临床诊疗实践和学术研究成果。专刊内容以我国当前严重危害人类健康的重大神经系统疾病——脑血管疾病、神经变性疾病、神经感染性疾病、神经免疫性疾病为中心，从影像学、体液抗体、病原体二代测序和基因检测、神经电生理以及神经病理等的角度．

关键词： PBL教学法   LBL教学法   神经病学   教学方法  

摘要： 目的探讨以问题为基础(PBL)教学法在神经病学见习教学中的应用效果。方法将该校2013级5年制临床医学专业29名学生随机分为观察组(n=15)采用PBL教学法,和对照组(n=14)采用传统讲授式教学法。两组均依照神经病学教学大纲进行出科考试及理论课考试,对两组平均成绩进行比较,客观评价教学效果。结果观察组学生出科考试成绩、理论课考试成绩均明显高于对照组,差异均有统计学意义(P<0.05)。结论 PBL教学法在神经病学见习教学中能取得良好的教学效果,且有助于理论课成绩的提高。

关键词： health beliefs   culture   illness causation   Saudi Arabia   health professionals  

摘要： Saudi society is one of many where supernatural explanations for neurological and psychiatric disorders are prevalent among lay persons. The frequency of such beliefs among health care professionals in this country, however, is unknown. The frequency of supernatural explanations for neurological and psychiatric disorders was assessed in 126 health care professionals at an academic medical center in Jeddah. A high frequency of belief in supernatural factors as a cause for neurological and psychiatric illness, including the evil eye, divine testing and punishment, and sorcery, was found. Younger age and more junior level of training were associated with a higher likelihood of belief in supernatural causation. A surprisingly high prevalence of supernatural explanations was found among these health care professionals, 80% of whom were attending physicians or physicians in training. Future studies should focus on the potential impact of these beliefs on clinical practice.

关键词： Delayed cerebral ischemia   Asymmetric dimethylarginine   Biomarker   Endothelium   Vasodilatation   Cerebrospinal fluid  

摘要： Delayed cerebral ischemia (DCI) is the major cause of lethality and neuronal damage in patients who survived the primary subarachnoid hemorrhage (SAH). Asymmetric and symmetric dimethylarginines (ADMA and SDMA) inhibit nitric oxide production from l-arginine via distinct mechanisms. Elevated ADMA levels are associated with vasospasm after SAH. We aimed to study the time course of ADMA and SDMA in plasma and ventricular cerebrospinal fluid (CSF) and their associations with DCI and outcome. We measured ADMA and SDMA in 34 SAH patients with an external ventricular drain at admission and on days 3, 6, 8, 12, and 15 and followed them up for clinical status and neurological outcome until 30 days post-discharge. DCI was defined as the appearance of new infarctions on cerebral computed tomography or magnetic resonance imaging. ADMA and SDMA plasma concentrations did not differ significantly at baseline between patients who suffered DCI (N = 14;41%) and not;however, plasma ADMA reached a peak on days 8 and 15 after hemorrhage in patients with DCI (0.81-0.91 A mu mol/l). Baseline plasma l-arginine/ADMA ratio was significantly lower in patients with DCI (57.1 [34.3;70.8] vs. 68.7 [55.7;96.2];p < 0.05). ADMA and SDMA concentrations in CSF were significantly higher in patients with DCI than without. In multivariable-adjusted linear regression models, CSF ADMA was negatively associated with the incidence of DCI (OR 0.03 [0.02-0.70];p = 0.04), whereas CSF SDMA on the day of hemorrhage predicted poor neurological outcome until 30 days after discharge (OR 22.4 [1.21-416.02];p = 0.04). Our study shows that ADMA and the l-arginine/ADMA ratio are associated with the incidence of DCI after SAH. By contrast, SDMA was associated with initial neuronal damage and poor neurological outcome after SAH. These data support the hypothesis that ADMA and l-arginine affect the pathophysiology of cerebral ischemia after SAH, while SDMA is a biomarker of neurological outcome after SAH.

关键词： Lyme neuroborreliosis   Borrelia garinii   Borrelia afzelii   Facial palsy   Guillain-Barre syndrome-like  

摘要： Objective. To describe clinical cases with neurological manifestations associated with Borrelia burgdorferi infection in a large cohort of children and adults from Mexico. Material and Methods. Patients with neurological manifestation (cranial neuritis, radiculoneuritis, meningitis and encephalomyelitis) were recruited in one pediatric and two general hospitals, during January 2006 December 2015. Blood and cerebrospinal fluid (CSF) samples were drawn from each patient at inclusion. IgM and IgG antibodies against B. burgdorferi were detected using a commercial ELISA test, and confirmed by Western-Blot test (WB) using three different antigens from Borrelia burgdorferi complex. Following CDC criteria were considered true cases with both positive tests. Results. Of 606 patients recruited, 403 (66.5%) were adults and 203 (33.4%) children, 50.5% were male. B. burgdorferi infection was diagnosed in 168 patients (27.7%), 97 adults, mean age 42 +/- 14.7 years and 71 children, mean age 9.6 5 years;early disseminated disease occurred in 130 cases (77.4 %) and chronic stage in 38 (22.6 %). A previous tick bite was reported by 21% cases, and 5% recalled an erythema migrans lesion. Polyradiculoneuropathy and encephalomyelitis were the most common manifestations, whereas 14.8% presented an initial Guillain-Barre Syndrome. B. burgdorferi sensu stricto was identified in 142 (84%) cases, B. garinii in 14 (8%), B. afzelii in three, and nine cases presented coinfection with two species. Conclusion. Lyme neuroborreliosis is a frequent condition in patients with neurological diseases in Mexico. (C) 2018 IMSS. Published by Elsevier Inc.

关键词： clinical examination   neurology service   feedback   technology  

摘要： The neurological examination remains the essence of neurology. It allows symptoms to be assessed, diagnoses to be made, and dynamic functions to be followed. Skill in the neurological examination has faced increasing challenges from the encroachment of diagnostic imaging, but has maintained its clinical utility. It has also encountered the battle for the precious time within a medical curriculum. This review considers how the neurological examination can best be taught into the future. It does so by considering factors related to the examination, the learner, the teacher, and the modern clinical environment.

关键词： Colloid cyst   Cyst size   Female   Headaches   Hydrocephalus   Neurologic deterioration   Sudden death  

摘要： Colloid cysts have been associated with acute neurologic deterioration and sudden death. However, the low incidence of associated sudden deaths has meant that factors influencing outcome in patients who present with acute neurological deterioration have not been extensively published. A PubMed literature search was performed to identify reported patients who presented with acute neurological deterioration with radiographic or histopathologic diagnosis of a colloid cyst. Demographic data, presenting symptoms, physical exam, surgical interventions, and outcomes were recorded. Analysis included 140 patients. Mean cyst size was 2.12 cm in males and 1.59 cm in females (p = 0.155), and 1.64 cm in patients who survived and 2.05 cm in patients who died (p = 0.04). Minimum cyst size was 0.4 cm in females and 0.8 cm in males. All patients without surgical intervention died, versus 48% with surgical intervention (p < 0.0001). Patient age was not significantly associated with outcome. Patients with hydrocephalus who have symptomatic colloid cysts are at extremely high risk for acute neurological deterioration and sudden death. Larger cyst size was associated with higher mortality, regardless of intervention. Prompt surgical intervention in extremis can lead to survival in approximately half the patients. Females, even with smaller cyst sizes, may be more likely to die before any intervention and may therefore benefit from more aggressive treatment approaches. (C) 2018 Elsevier Ltd. All rights reserved.

关键词： Cerebral injury   Functional deficit   Neuroprotection   Ischemic stroke   Ocimum basilicum extract   Phenolic acids  

摘要： Oxidative stress is strongly implicated in the pathogenesis of stroke. Strategies using antioxidants to improve neurological functions after stroke have, thus, gained significant attention. Ocimum basilicum L. is used traditionally to treat CNS disorders. Its antioxidant capacity is well established. Our laboratory has reported protective effects of pre-treatment with O. basilicum in experimental stroke, but its curative (post-treatment) effects in ischemic stroke have not been documented. Hence, the present study was aimed to evaluate the effect of O. basilicum leaf extract (OBLE) on functional outcomes following cerebral injury in mice. Cerebral injury was induced in the experimental animals by bilateral common carotid artery occlusion (BCCAO) followed by reperfusion. OBLE treatment (200 and 400 mg/kg;orally, once daily) was given for 7 days after BCCAO. Cognitive outcomes and sensorimotor disturbances were evaluated with Morris Water Maze, Elevated Plus Maze and neurological severity score, respectively. TTC (2,3,5-triphenyltetrazolium chloride) staining was used to measure cerebral infarct size. Thiobarbituric acid reactive substances, reduced glutathione levels and superoxide dismutase activity in mice brain homogenate were estimated to elucidate the neuroprotective mechanism of OBLE. Treatment with OBLE resulted in marked improvement in memory and motor coordination. OBLE also decreased cerebral infarct size and oxidative stress in mice. The extract was standardised with respect to total phenol content;an HPLC-PDA analysis showed the presence of eight phenolic acids in OBLE. It is concluded that treatment with OBLE improves functional outcomes after ischemic stroke and this may be developed as a neuroprotective drug.