神経学的障害

Slit ventricle syndrome is a rare complication of the treatment of hydrocephalus in infancy. Symptoms usually appear several years after the placing of the shunt system. They can cause diagnostic difficulties. The diagnosis is usually wrong or delayed. The authors describe a patient with SVS, the course of hospitalization and examinations performed.

Background: Movement disorders caused by Wernicke’s encephalopathy (WE) are very rarely reported, and involuntary hyperkinesia of the tongue as an initial manifestation of WE have not yet been reported. The study aimed to investigate the path mechanism and localization of involuntary lingual movement symptoms.

Methods: We present a patient with lingual hyperkinesia as an initial manifestation of WE, who had lesions of the periaqueductal area of the midbrain tectum and bilaterally medial thalami in Brain MRI. Patient’s lingual symptoms were observed and analyzed sequentially for localization of involuntary hyperkinetic movement of the tongue.

Results: Lingual hyperkinesia symptoms of the patient diagnosed in WE, occurred in advance and were more earlier improved by thiamine treatment before other brainstem symptoms.

Conclusion: The clinical and neuro-radiological results discussed here may provide support for the localization of lingual hyperkinetic movement disorders. In addition to brainstem lesion, thalamic lesion should be considered in cases of acute or subacute-onset, involuntary hyperkinetic movement of the tongue.

Aims and Objective: The aim of this study is to assess the caregiver’s knowledge regarding the symptoms of the stroke and their perception. We need to know about their perception before meeting any knowledge gaps. Methodology: This cross-sectional study was done at Fauji Foundation Hospital. The study’s duration was one year from March 2016 to February 2017. We enrolled total of 100 caregivers of consecutive stroke patients admitted in Medical Wards. A Stroke Patient was defined as a patient whose presenting complaints one of the predefined symptoms by National Institute of Neurological Disorder were lasting more than 24 hours with no apparent cause other than of vascular origin. The Care giver was defined as the person who was present next to the patient at the time of the event. The second part consists of an open-ended question about caregiver’s perception of stroke patient. When the answer to the question was stroke it was defined as correct response, rest of the answers were taken as incorrect response. Results: Out of 100 patients 32 (32%) were illiterate. The literate group was divided into three groups as follows; under matriculation (26), till matriculation (23), graduate and above (09). 11% of caregivers used the term stroke. In logistic regression, education plays a significant role on the correct diagnosis of stroke disease with coefficient of education 1.124 with p value=0.004 which is significant at 5% level of significance. Conclusion: Given the fact that in our region the average age of stroke is 10 years younger we need on emergency basis the required community outreach programs.

Moyamoya syndrome is an acquired idiopathic non-atherosclerotic vasculopathy that involves the terminal internal carotid artery and its branches. It is associated with numerous medical conditions such as hematologic abnormalities, autoimmune diseases, brain radiation, and tumors. These medical diseases cause chronic endothelial damage to cerebral vasculature resulting in both friability and stenosis of vessels, presenting as cerebral hemorrhage or infarction. There is an established link between moyamoya syndrome and hematologic diseases such as sickle cell and beta thalassemia. A few case reports of rare hemoglobin opathies have caused moyamoya syndrome; however, there are no reports of moyamoya due to hemoglobin C disease. This case report presents a patient with known hemoglobin C disease who presented with her second intracranial hemorrhage, found to have moyamoya syndrome.

Video games are widely popular their impacts on player addiction are thus intensively investigated. Considering the importance of reward in addiction, this study investigated whether high penalty feedback has a promoting effect on the maintenance of the reward value of the game stimulation. In Experiment 1, the characteristics of attentional bias of game stimulation were tested using the dot-probe task paradigm. In Experiment 2, changes in the heart rate of game players and non-game players during the game were compared to investigate the physiological activation state of the game players. In Experiment 3, the impacts of different penalties on the aggressive behavior of game players were analyzed. Our results showed that long-term game players exhibited attentional bias toward the game stimuli, which was mainly reflected in terms of the orientation characteristics of attention; during a game, the player’s high physiological activation helped the game stimulus to maintain the reward value in the habitual level. High intensity penalty feedback can maintain the reactive attack state of game players, which helped to maintain the players in a state of high physiological activation during the game. From the perspective of “learning in games” in the Confucian culture, the approach and content of video games must be actively improved.

Adult brainstem glioma is a rare and deadly disease, and optimal treatment has not yet been fully established. Biopsy or surgery is not always possible therefore radiation therapy is the standard treatment. We operated multisession CyberKnife stereotactic radiosurgery for 2 patients of adult brainstem glioma. Both cases have enabled surviving for significantly long terms, and without relapse, for 48 months and 21 months. One of them achieved Complete Remission (CR) and the other achieved Partial Remission (PR). Multisession CyberKnife stereotactic radiosurgery has successfully demonstrated to be substantially beneficial for such a devastating disease.

Objective: Mild cognitive impairment patients and normal elderly people were selected in this research. EEG complexity (Lempel-Ziv Complexity, LZC) and P300 value of the two groups were compared in two statuses (quiet eyes closed, cognitive load), The brain functional characteristics of different cognitive states were explored, it was expected to construct a simple and objective cognitive function evaluation approach to provide criteria for early diagnosis of cognitive dysfunction and disease evaluation.

Methods: The clinical data was from 50 MCI patients in Neurology department of the 8th People’s Hospital. 45 normal elderly people with corresponding sex, age and education level was chosen as control group. 5 minutes EEG signals were recorded and measured with P300 for both groups with quiet eyes closed and cognitive load states. Due to smooth baseline and inconspicuous artifacts, 2048-point EEG (about 8s) were selected to perform LZC analysis and complexity calculation in Mat tab.

Results: 1. Normal elderly people showed higher LZC than MCI patients. Moreover, LZC was higher in those complex brain function areas such as temporal and frontal areas. 2. With the reduction of cognitive function, the value of EEG complexity was reduced accordingly. 3. The cognitive related brain areas showed more obvious degradation than other brain areas. 4. Under the cognitive load status, the complexity value in cognitive related brain areas of MCI patients decreased significantly. 5. The prolongation of P300 latency and LZC decrease of the MCI patients indicated that LZC could reflect the decrease of cognitive function.

Discussion: In this study, P300 latencies of MCI group was delayed, we could deduce that because of the decline in brain function and brain areas of fibers connecting, the reduction in information processing performance could indicate that the delay of P300 latent period. These were identical with another study where the complexity of EEG is testified that. Based on these, we could infer, from the perspective of nonlinearity, EEG complexity reveals the changes of brain function in patients with cognitive impairment.

Conclusion: The brain electrical LZC value in normal elderly people group was higher than that in cognitive impairment group, those brain areas with more complex functions like frontal area and temporal area had highest LZC, which illustrated the degree distribution differences in complex brain regions. The prolonged latency of P300, these results of cognitive impairment in patients could also predict the degree of cognitive decline.

The cerebral hernia is usually caused by intracranial hematoma, tumor, abscess. Here, we report a rare case of cerebral hernia caused by severe epidural hygroma. The patient was a 51-year-old male, with a large, right-sided skull defect and severe scalp depression, who had received a decompressive craniectomy for traumatic brain injury and a lumboperitoneal shunt for secondary hydrocephalus 6 months earlier. A cranioplasty with titanium mesh was performed after admitted. Unfortunately, he suffered from a complication of epidural fluid collection. Through repeated local treatment of the hygroma, the patient was not better but rather became more and more serious, and developed to cerebral hernia eventually. However, after finding out the root cause, the patient got dramatically improvement just by elevating the valve pressure of the lumboperitoneal shunt. The case and literature review are instructive to the treatment of patients with skull bone defect associated with hydrocephalus.