Intracranial magnetic resonance venography in healthy individuals:normal anatomy and variations of the cerebral venous system

Objective:To evaluate the basic appearance and variation of the venous sinuses and veins in healthy individuals.Methods:Prospectively-recruited healthy volunteers completed a questionnaire and underwent magnetic resonance imaging plus contrast-enhanced magnetic resonance venography(CE-MRV)to measure their sinus diameters.Anatomical variations of cerebral venous sinuses were evaluated.Results:Fifty-eight individuals were included.The mean diameter of the left transverse sinus(LTS)(5.37±1.35 mm)was significantly smaller than that of the right transverse sinus(RTS)(6.65±1.57 mm)(P<0.001),and the average discrepancy was 19.2%.RTS dominance was noted in 55.1%of cases.Four superior sagittal sinus(SSS)anatomical variations were found.Type A was the most common and was present in 43 participants(74.1%).The SSS preferentially drained into the RTS in 32 patients(55.2%),and arachnoid granulation was observed in the transverse sinus(TS)and SSS in patients.According to our reclassification combined with Osborn’s previous research,we found that the SSS commonly drained into the RTS and that the straight sinus(StS)branched into both TSs.Conclusions:A 19%difference between the LTS and RTS provides a threshold for TS lateral dominance instead of a TS abnormality.Clinicians and radiologists should not ignore the influence of acquired pathology when the SSS drains in a non-RTS-dominant manner.Anatomical variations of the torcular herophili are frequent;the most commonly observed was the StS branching into both TSs,with the SSS draining into the RTS.

Cerebral venous sinus thrombosis presenting with subarachnoid hemorrhage and intracerebral hemorrhage:a case report

Objective:To explore the clinical and pathological characteristics of cerebral venous sinus thrombosis(CVST)with subarachnoid hemorrhage(SAH)and intracerebral hemorrhage(ICH),and to investigate the diagnosis,radiographic changes,and prognosis over the course of treatment.Methods:The clinical data and radiographic findings of a young male CVST patient,who presented with initial symptoms of SAH and ICH,were collected and analyzed.The relevant literature was also reviewed.Results:The patient had no specific clinical symptoms except for headache.The brain computed tomography(CT)scan revealed SAH,a high-density shadow in the right posterior fossa and cerebellar hemisphere,and ICH in the left frontal lobe.Magnetic resonance venography(MRV)further revealed bilateral thrombosis in the transverse and sigmoid sinuses.Conclusion:CVST with SAH and ICH is rare and difficult to diagnose.Careful radiological study and clinical analysis are important for the correct and early diagnosis of this condition.Anticoagulation therapy is considered the primary treatment for CVST.

A case of primary angiitis of the central nervous system diagnosed and treated based on HR-MRI

Objective:To summarize the clinical features,imaging manifestations,therapeutic options,and prognosis of the primary angiitis of the central nervous system(PACNS)and to explore the role of high-resolution magnetic resonance imaging(HR-MRI)in the PACNS diagnosis and treatment.Methods:One patient with PACNS treated by HR-MRI was retrospectively analyzed and summarized by combining relevant literature.Results:The patient was a young female who was hospitalized with progressive cerebral infarction and multiple intracranial arterial stenosis.HR-MRI indicated vasculitic changes.After excluding other diseases,hormone shock combined with immunosuppression was given,followed by long-term rehabilitation treatment.The patient’s condition tended to stabilize,and the prognosis was satisfactory.Conclusion PACNS is challenging to diagnose and is characterized by poor prognosis and easy recurrence.HR-MRI plays an important role in the clinical diagnosis and treatment adjustment for PACNS.

Intracranial arterial stenosis in young adults:risk factors,diagnosis and treatment

Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosis for individuals and a great burden to society.The etiology and risk factors of ICAS in youth differ from those of older patients,thus resulting in a difference in the progression and prognosis of the disease.Even though the diagnosis of ICAS is lumen-based,it is sometimes difficult to identify in young patients based on imaging alone.Notably,novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence.Moreover,pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients.Thus,considering the poor prognosis,there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.

The mechanisms that regulate neuronal pyroptosis in cerebral ischemia-reperfusion injury:current theories and recent advances

Early or ultra-early pharmacological thrombolysis together with mechanical thrombectomy are key treatments for ischemic stroke,and both are aimed at vascular recanalization and improved collateral circulation.While these methods enhance tissue perfusion in the ischemic penumbra,they also trigger complex neurotoxic reactions,including apoptosis,acidosis,ion imbalance,oxidative stress,and pyroptosis,exacerbating cerebral ischemia-reperfusion injury(CIRI).Pyroptosis,a recently discovered form of programmed cell death driven by inflammation,plays a significant role in neuronal death during CIRI.This study reviews the regulatory mechanisms of pyroptosis in CIRI.

Function and mechanism of traditional Chinese medicine in the prevention and treatment of Parkinson＇s disease

Parkinson’s disease （PD） was frst discovered 200 years ago. The current gold standard of clinical treatment is still mainly levodopa replacement therapy. Traditional Chinese medicine is the foundation of traditional medicine in China. Chinese herbs and acu-puncture both exhibit remarkable effcacy in the treatment of PD. Clinical studies on the treatment of PD using Chinese herbs have confrmed that the combined use of Chinese herbs and the levodopa formulation can signifcantly increase the treatment effect and reduce toxic side effects. Basic studies further confrmed that various Chinese herbs and their monomeric substances can protect dopaminergic neurons in PD models. The major mechanisms include anti-infammation, anti-oxidant, anti-apoptosis, neuroprotection, mitochondrial function protection, and regulation of gut microbiota. The function of acupuncture in the treatment of PD has also gradually received extensive attention in China and other countries. Acupuncture not only has peculiar advantages in the improvement of symptoms of PD patients, but also can attenuate adverse drug reactions, delay disease progression, and increase the quality of life of patients. Basic studies further confrmed that acupuncture can improve many motor symptoms in animal models of PD and has cumulative effects and follow-up effects. The major mechanisms include dopamin-ergic neuron protection functions, anti-infammation and anti-oxidant effects, and the regulation of related neuro-transmitters and neural circuits. The clinical application of acupuncture and Chinese herbs still requires strict ran-domized, double-blind, controlled design, multi-centre and large-sample size evidence-based clinical studies and follow-up observations of long-term effcacy to support the effect. In addition, the multi-target and multi-pathway therapeutic mechanisms need further studies.

Phosphorylation of group I metabotropic glutamate receptors in drug addiction and translational research

Protein phosphorylation is an important posttranslational modification of group I metabotropic glutamate receptors （ mGluR1 and mGluR5 subtypes, mGluR1/5 ） which are widely distributed throughout the mammalian brain. Several common protein kinases are involved in this type of modification, including protein kinase A, protein kinase C, and extracellular signal-regulated kinase. Through constitutive and activity-dependent phosphorylation of mGluR1/5 at specific residues, protein kinases regulate trafficking, subcellular/subsynaptic distribution, and function of modified receptors. Increasing evidence demonstrates that mGluR1/5 phosphorylation in the mesolimbic reward circuitry is sensitive to chronic psychostimulant exposure and undergoes adaptive changes in its abundance and activity. These changes contribute to long-term excitatory synaptic plasticity related to the addictive property of drugs of abuse. The rapid progress in uncovering the neurochemical basis of addiction has fostered bench-to-bed translational research by targeting mGluR1/5 for developing effective pharmacotherapies for treating addiction in humans. This review summarizes recent data from the studies analyzing mGluR1/5 phosphorylation. Phosphorylation-dependent mechanisms in stimulant-in-duced mGluR1/5 and behavioral plasticity are also discussed in association with increasing interest in mGluR1/5 in translational medicine.

Computational fluid dynamics modeling in intracranial atherosclerotic disease

Intracranial atherosclerotic disease(ICAD)is an important cause for ischemic stroke and transient ischemic stroke(TIA)throughout the world,especially in Asians,which is not fully appreciated,partly due to its inaccessibility and limitations of current neuroimaging methods.The computational fluid dynamics(CFD)modeling technique provides a novel approach to reveal the hemodynamic characteristics in ICAD,e.g.,the distributions of pressure,wall shear stress and flow velocity.In this review article,we aim to provide an overview of the general methodology of CFD modeling in arterial stenotic diseases,the established application of this technique in coronary artery disease,and more importantly,perspectives and challenges of this technique in the investigation of ICAD.Promising findings of preliminary studies using a CFD model for hemodynamic analysis in ICAD warrant verifications.Further studies in this area will help rectify loopholes in the current secondary prevention strategy,and inform individualized treatment for ICAD patients in the near future.

Research progress of localization technique assisted neuroendoscopy for cerebral hemorrhage

Neurosurgeons who perform intracere-bral hemorrhage(ICH)evacuation procedures have lim-ited options for monitoring hematoma evacuation and intraoperatively assessing residual-hematoma burden.In recent years,neuroendoscope-assisted,minimally inva-sive surgery for spontaneous ICH is simple and effective and becoming increasingly common.Many methods are applied in neuronavigation-assisted surgery for ICH evac-uation,such as neuroendoscopy,three-dimensional(3D)reconstruction,intraoperative ultrasound,and stereotac-tic craniotomy.Compared with a traditional craniotomy operation,hematoma removal(using methods of accurate localization)can reduce iatrogenic damage,protect white matter,and shorten patients’recovery time.This paper mainly outlines the treatment of basal ganglia-cerebral hemorrhage with neuroendoscopy assistance using local-ization techniques.

Cognitive deficits in schizophrenia:from pharmacology to neurocognitive models

Schizophrenia is a typical mental disorder characterized by cognitive,social,and emotional impairments and by psychotic symptoms.For nearly a century,there have been ongoing discussions on the anatomical-functional connections between brain abnormalities and symptoms in patients with schizophrenia.Neuroimaging studies in such patients show abnormalities in the prefrontal cortex(PFC),a brain region that acts as an executive center in cognition processing.The disrupted brain connectivity between PFC and other brain structures(such as the limbic system,basal ganglia and thalamus)results in faulty information processing and cognition deficits.Dopamine receptors,which have historically acted as vital targets in schizophrenia therapies,have complex roles in cognition.Here we reviewed dopamine's role as a widespread neurotransmitter mediating the PFC-cognitive system.The imbalance of brain dopamine level,especially the abnormal D1/D2receptors ratio,leads to dysfunctions in brain connectivity in patients with schizophrenia.Recent neurocognitive modeling studies suggest the imbalance of dopamine receptors affects the internal noise within brain networks,which may lead to reduced signal-to-noise ratio in the PFC neuron populations.Going forward,more researches focusing on the relationship between pharmacology and neurocognitive models are needed,in an effort to identify more effective and efficient ways to treat cognitive impairment in patients with schizophrenia.

Research progress for microRNA in the pathological mechanism of brain injury after stroke

Ischemic stroke is a leading cause of death and disability.Despite extensive research,treatment for ischemic stroke is limited to thrombolytic therapy and symptom management.Identifying and testing new therapeutic targets is therefore critical for future clinical-ly viable stroke therapies.Noncoding RNAs,especially microRNAs(miRNAs),are one of many classes of mole-cules that cause functional changes before,during,and af-ter ischemic stroke.Current research finds that expression levels of many miRNAs are altered in the blood and brain of rodents and humans after stroke.In addition,miRNA can be regulated by external factors to improve functional outcomes after ischemic stroke.In certain studies,induction of ischemic tolerance by preconditioning(PC)also altered the levels of many miRNAs.This review focuses on miRNAs that modulate stroke-related risk factors and pathologic mechanisms of post-stroke brain injury.

Latest progress in the research of protein kinase C(PKC)isoform-specific signaling and PKC-modulated autophagy in ischemic stroke

Ischemic stroke is a major cause of morbidity and mortality,and currently there is no effective treatment.The family of protein kinase C(PKCs)could phosphorylate serine or threonine residues of its substrate proteins and play a key role in the ischemia/reperfusion injury.Autophagy is essential for maintaining cell homeostasis under physiological condition and acts as a double-edged sword in the process of ischemic neuronal death.In this article,we reviewed the PKCs isoform-specific signaling pathways and PKC-modulated autophagy in ischemic stroke.

Massive subdural hematoma misdiagnosed as delayed encephalopathy of carbon monoxide poisoning: a case report and literature review

Subdural hematoma is often secondary to brain trauma and other diseases.The onset is hidden and the condition is critical.Timely detection and early treatment are particularly important.The patient denied a history of trauma,but had a history of consciousness loss after charcoal burning.The clinical symptoms were progressive cognitive impairment.The initial diagnosis was delayed encephalopathy caused by carbon monoxide poisoning.However,computed tomography(CT)scan of the brain showed a large area of subdural hematoma on the left side and the formation of a cerebral hernia,which was life-threatening.The patienfs symptoms gradually improved after an emergency operation.

Research progress on the relationship between proBDNF and alcohol dependence and its related cognitive impairment

Brain-derived neurotrophic factor(BDNF)plays an important role in the growth,develop-ment,differentiation,injury,repair,survival and apoptosis of nerve cells.Precursor of BDNF(proBDNF)is an im-portant regulator of neurodegeneration,long-term hippo-campal inhibition and synaptic plasticity.Alcohol depen-dence syndrome(ADS)is a group of chronic recurrent diseases with unknown etiology.Current studies believe that proBDNF plays an important role in the occurrence,development and outcome of ADS.Alcohol dependence patients,like other neurodegenerative diseases,will also have different degrees of cognitive impairment.This arti-cle reviews the research progress on the relationship be-tween BDNF,proBDNF,alcohol dependence and cogni-tive impairment.

Why sex differences in schizophrenia？

Clinical observation shows that men and women are different in prevalence, symptoms, and responses to treatment of several psychiatric disorders, including schizophrenia. While the etiology of gender differences in schizophrenia is only partially understood, recent genetic studies suggest significant sex-specific pathways in the schizophrenia between men and women. More research is needed to understand the causal roles of sex differences in schizophrenia in order to ultimately develop sex-specific treatment of this serious mental illness. In the present review, we will out-line the current evidence on the sex-related factors interaction with disease onset, symptoms and treatment of schizophrenia, and discuss the potential molecular mechanisms that may mediate their cooperative actions in schizophrenia pathogenesis.

Mechanistic roles of the subthalamic nucleus and internal globus pallidus:evidence from local field potentials and deep brain stimulation

Deep brain stimulation (DBS) has become an effective therapeutic option for neurological and psychiatric disorders such as Parkinson’s disease (PD), dystonia, and obsessive-compulsive disorder. The subthalamic nucleus (STN) and internal globus pallidus (GPi) are by far the most commonly used targets for DBS in the treatment of PD. However, STN/GPi stimulation sometimes causes side effects, including motor fluctuations, cognitive declines, and worse emotional experience, which affect patients’ postoperative quality of life. Recent invasive electrophysiological studies are driven by the desire to better understand the mechanisms of therapeutic actions and side effects of STN/GPi stimulation. These studies investigated the function of the STN and GPi in motor, cognitive and affective processes by recording single- neuron firing patterns during the surgery or local field potentials after the surgery. Here we review the relevant studies to provide an integrative picture of the functional roles of the STN and GPi within the basal ganglia loops for motor, cognition, and emotion. Previous studies suggested that STN and GPi gamma oscillations encode the strength and speed of voluntary movements (execution), whereas beta oscillations reflect the effort and demand of potential movements (preparation). In the cognitive domain, oscillatory beta activity in the STN is involved when people have to stop an inappropriate action or to suppress salient but task-irrelevant information, whereas theta/delta activity is associated with the adjustment of decision thresholds and cost-benefit trade-off. In the affective domain, STN activity in the alpha band may represent the valence and arousal of emotional information.

Perspectives on mechanisms underlying remote ischemic conditioning against ischemic stroke

Ischemic stroke is a major neurological disease with limited effective therapeutic options except for thrombolysis and thrombectomy. Remote ischemic conditioning (RIC) is an approach that promises an alternative to the current treatment portfolio. As an easy-handled, non-invasive regimen, it takes advantage of transient ischemia (currently often made through inflation and deflation of limb blood pressure cuff) to enhance the tolerance of vital organs to ischemia. RIC can be executed before, during and after the onset of stroke. The mechanisms of action of RIC employed at different stroke stages are similar and may involve humoral, neurological and inflammatory pathways. As new mechanisms underlying RIC-induced neuroprotection continue to be revealed, we review in this article some of the latest development in this field, including:① RIC and RIC-induced fundamental change, hypoxia, as well as the role of hypoxia inducible factors against stroke;② Potential role of RIC-induced extracellular vesicles in neuroprotection;③ RIC-induced metabolic changes in tissue protection;④ Potential effect of RIC on red blood cells (RBC) oxygen delivery;and ⑤ RIC and its anti-inflammatory potential.

Clinical characteristics and treatment strategies of acute ischemic stroke with internal carotid artery occlusion: a case report

Acute ischemic stroke has the characteristics of high disability,lethality and recurrence rate,which seriously threatens the health of middle-aged and elderly people.This article describes the acute ischemic stroke with internal carotid artery occlusion as the main clinical feature and discusses its treatment strategy.Treatment remedies:clinical diagnosis was carried out based on the present medical history,physical examination and craniocerebral CT(computed tomography).Neurological function was improved by intravenous thrombolysis,cerebrovascular angiography was used to clarify cerebrovascular occlusion,cerebral blood supply was identified by CT perfusion,and neurological function recovery was followed up.After intravenous thrombolysis,the patient’s consciousness turned clear and the right limb muscle strength recovery was not obvious,but the patient did not receive bridging therapy.Cerebral angiography showed about 90%stenosis at the beginning of the left internal carotid artery,and the blood flow terminated at the C7 segment.Cerebral CT perfusion imaging showed decreased perfusion in the left cerebral hemisphere,but the patient did not receive carotid endarterectomy and vascular bypass treatment.Post treatment evaluating:follow-up showed that NIHSS(National Institute of Health stroke scale)score was significantly decreased and limb function was significantly restored.Conclusion:early intravenous thrombolytic therapy can help reduce the area of ischemic penumbra and improve long-term prognosis.Severe vascular stenosis can stimulate vascular compensation,significantly reduce the range of ischemia when thrombus occurs,and effectively reduce the disability rate without bridging therapy.Whether vascular stenosis and occlusion are treated by vascular bypass,etc.,individualized plans should be made according to vascular compensation.

Animal models and molecular mechanism of major depressive disorder

Major depressive disorder(MDD)has been a devastating neurological problem in modern history.However,therapeutic strategies to relief the disease are inadequate.The limit in understanding of the molecular mechanism of MDD has been holding back discovery of new therapies.Behind this problem is the establishment of animal models to truly reflect human MDD pathology.In this review,we discuss our current understanding of the molecular mechanism of MDD and the strength and weakness of rodent models of depression.Developing new models of MDD and finding new drugable targets are still important steps to discover new therapies against MDD.

Advances in research on neuromyelitis optica spectrum disorders and its clinical heterogeneity

Neuromyelitis optica spectrum disorders(NMOSD)is a demyelinating disease mainly involving the optic nerve and spinal cord.It has recurrent and aggravating attacks and high disability rate.Most patients have a stepwise progression,resulting in complete blindness or paraplegia.NMOSD lesions contain not only the optic nerve and spinal cord,but also other neurological and non-neurological symptoms,which has clinical heterogeneity.The discovery of aquaporin-4-immunoglobulin G(AQP4-IgG)attributed it to autoimmune ion-channel disease,and rituximab(RTX)has achieved good clinical efficacy in the treatment of NMOSD.Myelin oligodendrocyte glycoprotein(MOG)antibodies have been found in some AQP4-IgG-negative NMOSD patients,which have different clinical and immunological features,posing new challenges to the diagnosis and treatment of NMOSD,which may require re-design and testing of new immune-targeted drugs.