RESUMEN

Objective To summarize the epidemiological and clinical features of infectious diseases of the central nervous system(CNS)by a single-center analysis.Methods A retrospective analysis was conducted on the data of 1247 cases of CNS infectious diseases diagnosed and treated in the First Medical Center of PLA General Hospital from 2001 to 2020.Results The data for this group of CNS infectious diseases by disease type in descending order of number of cases were viruses 743(59.6％),Mycobacterium tuberculosis 249(20.0％),other bacteria 150(12.0％),fungi 68(5.5％),parasites 18(1.4％),Treponema pallidum 18(1.4％)and rickettsia 1(0.1％).The number of cases increased by 177 cases(33.1％)in the latter 10 years compared to the previous 10 years(P<0.05).No significant difference in seasonal distribution pattern of data between disease types(P>0.05).Male to female ratio is 1.87︰1,mostly under 60 years of age.Viruses are more likely to infect students,most often at university/college level and above,farmers are overrepresented among bacteria and Mycobacterium tuberculosis,and more infections of Treponema pallidum in workers.CNS infectious diseases are characterized by fever,headache and signs of meningeal irritation,with the adductor nerve being the more commonly involved cranial nerve.Matagenomic next-generation sequencing improves clinical diagnostic capabilities.The median hospital days for CNS infectious diseases are 18.00(11.00,27.00)and median hospital costs are ￥29,500(￥16,000,￥59,200).The mortality rate from CNS infectious diseases is 1.6％.Conclusions The incidence of CNS infectious diseases is increasing last ten years,with complex clinical presentation,severe symptoms and poor prognosis.Early and accurate diagnosis and standardized clinical treatment can significantly reduce the morbidity and mortality rate and ease the burden of disease.

RESUMEN

Sporadic Creutzfeldt-Jakob disease(sCJD)is a prion-caused degenerative disease of the central nervous system,with the typical clinical manifestation of rapidly progressive dementia.The course of disease is less than 1 year in most patients and more than 2 years in only 2% to 3% patients.We reported a case of sCJD with expressive language disorder and slow progression in this paper.By summarizing the clinical manifestations and the electroencephalograhpy,MRI,and pathological features,we aimed to enrich the knowledge about the sCJD with slow progression.

Asunto(s)

RESUMEN

Objective To explore the effect of intracranial Cryptococcus neoformans (Cr.neoformans) infection on the function of fluconazole transport by breast cancer-resistance protein (BCRP),a kind of efflux transporter on the blood-brain barrier (BBB).Methods Twenty-four male Sprague-Dawley rats were randomly divided into 4 groups (6 each):normal rats received 20mg/kg fluconazole by intravenous injection (Group A),normal rats received 20mg/kg fluconazole with co-administration of pantoprazole (a kind of BCRP inhibitor) by intravenous injection (Group B),rats with intracranial Cr.neoformans infection received 20mg/kg fluconazole (Group C),and infected rats received 20mg/kg fluconazole with co-administration of pantoprazole (Group D).Microdialysis probes were implanted into the rats' striatum to continuously collect brain extracellular fluid (ECF) after the intravenous infusion of fluconazole with or without BCRP inhibitor pantoprazole.High-performance liquid chromatography (HPLC) was applied to measure the fluconazole concentrations in blood and brain ECF.The area under the concentration-time curves of fluconazole and the penetration of fluconazole passing though BBB were then calculated.Results Meningoencephalitis rat model was successfully established by intracerebral inoculation of Cr.neoformans.The infection significantly increased the penetration of fluconazole passing through BBB (P＜0.05).Pantoprazole did not alter the distribution of fluconazole in normal rat's brain,but significantly increased the penetration of fluconazole passing through BBB of the infected rats (P＜0.05).Conclusion Cr.neoformans infection can reduce the BBB resistance to fluconazole,and induce the efflux transport of fluconazole from the brain ECF back into the blood by BCRP.

RESUMEN

<p><b>BACKGROUND</b>It is important to choose an appropriate antiepileptic drug (AED) to manage partial epilepsy. Traditional AEDs, such as carbamazepine (CBZ) and valproate (VPA), have been proven to have good therapeutic effects. However, in recent years, a variety of new AEDs have increasingly been used as first-line treatments for partial epilepsy. As the studies regarding the effectiveness of new drugs and comparisons between new AEDs and traditional AEDs are few, it is determined that these are areas in need of further research. Accordingly, this study investigated the long-term effectiveness of six AEDs used as monotherapy in patients with partial epilepsy.</p><p><b>METHODS</b>This is a retrospective, long-term observational study. Patients with partial epilepsy who received monotherapy with one of six AEDs, namely, CBZ, VPA, topiramate (TPM), oxcarbazepine (OXC), lamotrigine (LTG), or levetiracetam (LEV), were identified and followed up from May 2007 to October 2014, and time to first seizure after treatment, 12-month remission rate, retention rate, reasons for treatment discontinuation, and adverse effects were evaluated.</p><p><b>RESULTS</b>A total of 789 patients were enrolled. The median time of follow-up was 56.95 months. CBZ exhibited the best time to first seizure, with a median time to first seizure of 36.06 months (95% confidential interval: 30.64-44.07). CBZ exhibited the highest 12-month remission rate (85.55%), which was significantly higher than those of TPM (69.38%, P = 0.006), LTG (70.79%, P = 0.001), LEV (72.54%, P = 0.005), and VPA (73.33%, P = 0.002). CBZ, OXC, and LEV had the best retention rate, followed by LTG, TPM, and VPA. Overall, adverse effects occurred in 45.87% of patients, and the most common adverse effects were memory problems (8.09%), rashes (7.76%), abnormal hepatic function (6.24%), and drowsiness (6.24%).</p><p><b>CONCLUSION</b>This study demonstrated that CBZ, OXC, and LEV are relatively effective in managing focal epilepsy as measured by time to first seizure, 12-month remission rate, and retention rate.</p>

Asunto(s)

RESUMEN

Objective To investigate the diagnostic values of interleukin-8 (IL-8), matrix metalloproteinase-9 (MMP-9) and interferon gamma (INF-γ) levels in patients with tuberculous meningitis and viral meningitis by detecting the contents of these biomarkers in the cerebrospinal fluid (CSF). Methods Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of IL-8,MMP-9 and INF-γ in the CSF of patients with tuberculous meningitis (n=20),viral meningitis (n=15) and noninfectious neurologic diseases (n=20) who admitted to our hospital from August 2010 to November 2011. Results The IL-8,MMP-9 and INF-γlevels in the samples from the tuberculous meningitis patients were significantly higher than those from either viral meningitis or noninfectious neurologic diseases (P＜0.05).The contents of IL-8 and MMP-9 in patients with viral meningitis were significantly higher than those in patients with noninfectious neurologic diseases (P＜0.05),while that of INF-γ showed no significant difference between the 2 groups (P＞0.05). Conclusion Detection of IL-8,MMP-9 and INF-γ in CSF is useful in the diagnosis of tuberculous meningitis; IL-8 and MMP-9 participate in the progress of viral meningitis; the detective value of high concentration of INF-γ in CSF is more significant in diagnosis of tuberculous meningitis than that of IL-8 and MMP-9.

RESUMEN

<p><b>OBJECTIVE</b>To improve the differential diagnosis of tuberculous meningitis (TBM) and reduced potential misdiagnosis of TBM.</p><p><b>METHODS</b>The clinical data of 47 misdiagnosed cases of TBM between January, 1994 and June, 2009 were investigated retrospectively. The clinical presentations and causes for the misdiagnoses were analyzed.</p><p><b>RESULTS</b>The 47 patients with misdiagnosed TBM included 28 male and 19 female patients with a mean age of 36.84∓16.41 years. Eight patients had an acute onset, 10 had a subacute onset, and 29 had chronic disease. The initial symptoms, in the descending order of their frequencies, included fever and headache (87.2%), anergia and dyskinesia (27.7%), cerebral nerve damage (23.4%), decreased level of consciousness (14.9%), and urinary and fecal incontinence (2%). Meningeal irritation was present in 25 cases and positive Babinksi sign was found in 19 cases. Elevated intracranial pressure occurred in 51.1% of the cases, and 16 cases showed papilloedema. Non-purulent CSF with elevated protein was found in 86.7%, decreased glucose in 50%, and decreased chlorinate in 53.3% of the cases. Eight out of 23 cases showed a positive result of PPD test. MRI identified abnormitis with meningeal enhancement in 15 cases, hydrocephalus in 7 cases and infarction in 14 cases. Tuberculoma was found in 2 cases, and spinal cord lesions were found 4 cases. All the patients received anti-tuberculosis therapy, which resulted in symptomatic improvement in 39 cases, fluctuated condition in 2 cases; 5 patients discontinued the treatment and 1 died.</p><p><b>CONCLUSION</b>Early TBM often presents with atypical features and its differential diagnosis can be difficult. CSF monitoring and careful inspection of the radiographic data can be helpful in the diagnosis of suspected cases, for which early anti-TB treatment is an important means to reduce misdiagnosis.</p>

Asunto(s)

RESUMEN

<p><b>OBJECTIVE</b>To assess the diagnostic value of tumor markers in the cerebrospinal fluid (CSF) for meningeal carcinomatosis (MC).</p><p><b>METHODS</b>Twenty-one MC patients (including 13 adenocarcinoma and 8 non-adenocarcinoma patients), 72 patients with tuberculous meningitis (TBM) and 23 with primary intracerebral tumors (PIT) were enrolled in this study. Blood and CSF tumor markers including CEA, CA125, CA15-3, CA19-9, CA72-4, CYFRA21-1, AFP and NSE were measured by Roche E170 electrochemiluminescence analyzer and sandwich assay.</p><p><b>RESULTS</b>CSF tumor markers CEA, CA125, CA199 and CYFRA21-1 and the serum tumor markers CEA, CA125, CA153, CA199 and AFP were significantly higher in MC group than in the other two groups. CSF CEA and CA15-3 were significantly higher in adenocarcinoma MC than in non-adenocarcinoma MC patients, but no significant differences were found in the serum tumor markers between the two groups (P>0.05). CSF tumor markers including CEA, CA125, CA15-3, CA72-4 and CYFRA21-1 were positively correlated to the serum tumor markers (P<0.05). CA199 was positively correlated to the disease course (P<0.05), and age was not correlated to any of the indexes (P>0.05).</p><p><b>CONCLUSION</b>Detection of the tumor markers in the CSF, especially CEA, CA125, CA19-9 and CYFRA21-1, may help in the early diagnosis of MC. CEA and CA15-3 can serve as indicators for differential diagnosis of adenocarcinoma and non-adenocarcinoma.</p>

Asunto(s)

RESUMEN

Objective To study the discharges regularity of ambulatory electroencephalogram (ambulatory,EEG,AEEG)during sleep and hyperventilation(HV)-induced EEG. Methods Features of epileptiform discharges of AEEG and HV-induced EEG were evaluated comparatively in 65 cases with frontal lobe epilepsy. Results The epileptiform discharge rate of HV-induced EEG was evidently lower than that of AEEG during the shallow sleep period (non-rapid-eye-movement phase 1 and 2,NREM phase 1 and 2),which had statistical significance(P＜0.01);however,the rate of HV-induced EEG had no significant difference from that of AEEG during the awake period and deep sleep period(NREM phase 3 and 4)(P＞0.05). Conclusions The epileptiform discharge rate of AEEG during the shallow sleep period is obviously higher than that of HV-induced EEG in patients with frontal lobe epilepsy,and thus sleep EEG is helpful to enhance the diagnostic rate of epileptiform discharges in these patients.