Two uncommon manifestations of leptospirosis:Sweet's syndrome and central nervous system vasculitis

To leptospirosis is the commonest spirocheatal infection in the tropical and temperate countries of Indian sub-continent and Africa and the most common zoonosis worldwide.The protean manifestation of this infectious disease is a challenge for practising clinicians across the world. In poor developing countries,at most clinical suspicion it is essential in the diagnosis of this disease.In this report,we are able to document two uncommon manifestations of leptospirosis, namely Sweet’s syndrome and central nervous system vasculitis.

Extracellular vesicles in the diagnosis and treatment of central nervous system diseases

Extracellular vesicles,including exosomes and microvesicles,play a fundamental role in the activity of the nervous system,participating in signal transmission between neurons and providing the interaction of central nervous system with all body systems.In many neurodegenerative diseases,neurons pack toxic substances into vesicles and release them into the extracellular space,which leads to the spread of misfolded neurotoxic proteins.The contents of neuron-derived extracellular vesicles may indicate pathological changes in the central nervous system,and the analysis of extracellular vesicle molecular content contributes to the development of non-invasive methods for the diagnosis of many central nervous system diseases.Extracellular vesicles of neuronal origin can be isolated from various biological fluids due to their ability to cross the blood-brain barrier.Today,the diagnostic potential of almost all toxic proteins involved in nervous system disease pathogenesis,specificallyα-synuclein,tau protein,superoxide dismutase 1,FUS,leucine-rich repeat kinase 2,as well as some synaptic proteins,has been well evidenced.Special attention is paid to extracellular RNAs mostly associated with extracellular vesicles,which are important in the onset and development of many neurodegenerative diseases.Depending on parental cell type,extracellular vesicles may have different therapeutic properties,including neuroprotective,regenerative,and anti-inflammatory.Due to nano size,biosafety,ability to cross the blood-brain barrier,possibility of targeted delivery and the lack of an immune response,extracellular vesicles are a promising vehicle for the delivery of therapeutic substances for the treatment of neurodegenerative diseases and drug delivery to the brain.This review describes modern approaches of diagnosis and treatment of central nervous system diseases using extracellular vesicles.

Accuracy of ultrasonography in diagnosis of fetal central nervous system malformation

BACKGROUND Prenatal examination is an important measure for the screening and diagnosis of fetal malformations.AIM To investigate the accuracy of ultrasonography in the diagnosis of fetal central nervous system(CNS)malformations.METHODS One hundred and thirteen pregnant women suspected of having fetal CNS malformations were examined at our hospital from December 2018 to October 2020 using two-dimensional ultrasonography and three-dimensional ultrasonography,respectively.RESULTS According to the pathological results,there were 79 cases of CNS malformations and 34 cases of non-CNS malformations among the 113 pregnant women suspected of having fetal CNS malformation.Fifty-one cases of CNS malformation and 26 cases of non-CNS malformation were detected by two-dimensional ultrasonography,and 73 cases of CNS malformation and 30 cases of non-CNS malformation were detected by three-dimensional ultrasonography.The diagnostic sensitivity(92.41%)and accuracy(91.15%)of three-dimensional ultrasonography were higher than those of two-dimensional ultrasonography(64.56% and 68.14%,respectively)(P=0.000).The specificity of three-dimensional ultrasonography(88.24%)was higher than that of two-dimensional ultrasonography(76.47%);however,the difference was not significant(P=0.203).CONCLUSION Three-dimensional ultrasonography has high application value in the diagnosis of fetal CNS malformations.In addition,the image quality is clear,and the diagnostic sensitivity and accuracy are high.

Noninvasive tools based on immune biomarkers for the diagnosis of central nervous system graft-vs-host disease:Two case reports and a review of the literature

BACKGROUND Central nervous system graft-vs-host disease(CNS-GVHD)is a rare cause of CNS disorders after allogeneic hematopoietic stem cell transplantation.Currently,establishing a diagnosis of CNS-GVHD is challenging because the diagnostic criteria and diagnostic methods are not well defined and many confounding factors need to be ruled out.CASE SUMMARY Here,we present two patients with CNS-GVHD.Both patients with a history of acute GVHD or chronic GVHD developed neurological symptoms that could not be explained by other causes,and had abnormal cerebrospinal fluid(CSF)studies as determined by CSF and blood immune biomarker examinations,suggestive of suspected CNS-GVHD.Due to the lack of specific magnetic resonance imaging abnormalities and the rapid clinical deterioration of the patients,we did not attempt to perform a brain biopsy,but prompted the initiation of empirical immunosuppressive therapy.In view of the rapid and favorable response to local and systematic immunosuppressive treatment and the aforementioned neurologic manifestations together with CSF abnormalities and other negative findings,a final diagnosis of CNS-GVHD was made.CONCLUSION CSF and blood immune biomarker examinations facilitated the diagnosis of CNSGVHD,which are particularly suitable for patients who are critically ill and require urgent treatment and for those who are unsuitable for invasive diagnostic procedures.

Clinical Studies on Primary Central Nervous System Lymphoma:A Report of 31 Cases

OBJECTIVE To analyze the clinical manifestations, neuroimaging and pathological characteristics of primary central nervous system lymphoma （PCNSL） with a normal immunity, and to explore the methods of treatment and diagnosis. METHODS The clinical, laboratory, imaging data and pathological findings and therapeutic efficacy of 31 cases with pathologically proved PCNSL, during a period from July 1995 to June 2006, were analyzed retrospectively. The method of surgery, used in combination with chemotherapy and radiotherapy, was evaluated in 18 cases versus a simple surgical procedure used in 5. Among the total cases, a CHOP regimen was employed in 11 and Teniposide （VM26） plus Semustine （me-CCUN） was used in 7 cases. RESULTS PCNSL had a variety of clinical features, so that its misdiagnosis rate was high. The main clinical findings of PCNSL included intracranial hypertension and （focal） neurologic impairment. No positive result was found in the CSF cellular examination. All of the 31 cases were B-cell lymphoma. Twenty-four of the 31 cases were followed-up, with a follow-up period from 6 to 98 months. The median period of survival of the group who underwent surgery in combination with chemotherapy and radiotherapy was 20 months, while the group with simple surgical therapy was 10 months. CONCLUSION Specific clinical manifestations were usually absent in the patients with PCNSL, giving an uncertain preoperative diagnosis and a poor prognosis. Pathological examination is the only reliable method for a final diagnosis of the disease. The main objective of surgical therapy is to relieve the intracranial hypertension caused by the tumor. Recurrence may occur in a short period following the simple operation. Therefore combined therapy, i.e. surgery plus additional radiotherapy and chemotherapy, should be adopted. This is the key point for extending survival time and improving the quality of life.

Clinical analysis of primary central nervous system lymphoma with non-immune deficiency in 17 patients

Objective: The aim of this study was to investigate the clinical manifestations of primary central nervous system lymphoma (PCNSL) with non-immune deficiency and explore effective methods for its diagnosis and treatment. Methods: The clinical, imaging and pathological data from 17 cases with PCNSL in our hospital from March 2006 to April 2009 were analyzed. The immunologic function test for all 17 cases was confirmed as normal. Four of them received stereotactie brain biopsy while the other patients were given full or partial resection. Fifteen of them were given both radiotherapy and chemotherapy after surgery. High-dose Methotrexate (HD-MTX) (2.0g/m2) was used via intravenous infusion once per week for three times. From week 4, patients began radiotherapy. Six cases with abnormal cerebrospinal fluid were given whole central nervous system radiotherapy, and 9 cases with normal cerebrospinal fluid were given only whole brain radiotherapy. Two of them were without any additional treatment after surgery. Sixteen of 17 cases were followed up for 9-48 months. Therapeutic efficacy, toxic and side effect were investigated. Results: Six cases, who were given HD-MTX chemotherapy and whole central nervous system radiotherapy, had grade 3 leukopenia, but other toxic and side effect above grade 3 were not observed. Two patients having no chemotherapy and radiotherapy recurred in one month, but there was only one recurred case in three months among 15 cases who had both chemotherapy and radiotherapy. One of them lost fellow-up. The 2-year survival rate was 69.2%. Conclusion: There is no specific clinical manifestation for PCNSL. The pathological examination is a reliable method to confirm PCNSL. Recurrence may occur after surgery alone, however, the combination of HD-MTX chemotherapy and radiotherapy is an effective and safe therapeutic option, which might improve the treatment efficiency and survival rate.

Inflammatory myofibroblastic tumor of the central nervous system:A case report

BACKGROUND An inflammatory myofibroblastic tumor(IMT)occurring in the central nervous system is very rare,and thus its pathogenesis is unknown.This case report and literature review aimed to explore the pathogenesis,clinical features,imaging findings,pathological characteristics,immunohistochemical characteristics,diagnoses,treatments,and risks of postoperative recurrence of IMT in the central nervous system.CASE SUMMARY A 67-year-old woman was admitted to the hospital with an exophthalmic protrusion and double vision in the left eye that had persisted for 3 mo.Magnetic resonance imaging(MRI)showed a 2.4 cm×1.3 cm heterogeneous large mass in the bottom of the left anterior cranial fossa,which was closely related to the dura mater.Before surgery,we suspected the mass to be meningioma.The entire mass was successfully removed under neuronavigation and electrophysiological monitoring,and postoperative pathology indicated an IMT with extensive infiltration of chronic inflammatory cells and scattered multinucleated giant cells.Head MRI at the 3-mo follow-up showed that the tumor at the bottom of left anterior cranial fossa had been completely resected without recurrence.CONCLUSION From the histological,immunohistochemical,and genetic analyses,the present case suggests that the pathogenesis of IMT-CNS is related to autoimmunity.

Primary isolated central nervous system acute lymphoblastic leukemia with BCR-ABL1 rearrangement:A case report

BACKGROUND BCR-ABL1 fusion gene is associated with a poor prognosis and a high incidence in central nervous system(CNS)leukemia.CNS invasion which detected at the initial diagnosis is commonly with bone marrow infiltration.It is uncommon for the leukemia cells to be located primarily in the CNS without bone marrow involvement.CASE SUMMARY We here report the rare initial presentation of CNS-restricted BCR-ABL-positive acute lymphoblastic leukemia in a 30-year-old female patient who clinically manifested with leukemic meningitis,with no involvement in peripheral blood or bone marrow.Identification of abnormal phenotypes of blast cells,and BCR-ABL1 rearrangement in the cerebrospinal fluid alone established the diagnosis of primary CNS-isolated acute lymphocytic leukemia.The patient received a combination of intrathecal therapy and high-dose chemotherapy.But the benefits of the treatments were short-lived and she experienced recurrence.CONCLUSION Flow cytometry in combination with molecular genetic analysis improved diagnostic accuracy.New approaches that may enhance the efficacy of the existing therapies and cure CNS leukemia are required.

Primary central nervous system lymphoma:status and advances in diagnosis,molecular pathogenesis,and treatment

Primary central nervous system lymphoma(PCNSL)is a rare group of extra-nodal non-Hodgkin lymphoma which is confined to the central nervous system or eyes.This article aims to present a brief profile of PCNSL diagnosis and treatment in immunocompetent patients.The authors retrieved information from the PubMed database up to September 2019.The annual incidence of PCNSL increased over the last four decades.The prognosis of PCNSL has improved mainly due to the introduction and wide-spread use of high-dose methotrexate,which is now the backbone of all first-line treatment polychemotherapy regimens.Gene expression profiling and next-generation sequencing analyses have revealed mutations that induce activation of nuclear factor-kB,B cell antigen receptor,and Janus kinases/signal transducer and activator of transcription proteins signal pathways.Some novel agents are investigated in the treatment of relapsed PCNSL including immunotherapy and targeted therapy.In particular,lenalidomide and ibrutinib have demonstrated durable efficiency.Treatment of PCNSL has evolved in the last 40 years and survival outcomes have improved in most patient groups,but there is still room to improve outcome by optimizing current chemotherapy and novel agents.

Diagnosis, treatment, and misdiagnosis analysis of 28 cases of central nervous system echinococcosis

Background:To explore central nervous system(CNS)involvement in this disease,from the perspectives of diagnosis,treatment,and misdiagnosis Methods:Twenty-eight patients with CNS echinococcosis were included in this retrospective study,including 18 males(64.3%)and 10(35.7%)females.The average age of all the patients were 23.5 years(ranged 4–60 years).Twenty-three(23)patients(82.1%)received the first surgical resection in our hospital.Five(5)patients(17.9%)gave up surgical treatment for multiple-organ hydatidosis and previous surgery history at other hospitals,and albendazole was applied for a long-term(3–6 months)adjunct therapy for the 5 patients.The average follow-up time was 8 years.Results:For the 28 patients,23 cases received surgical treatments,and the diagnosis was confirmed by pathological examinations.The diagnosis of 4 cases of brain echinococcosis and 2 cases of spinal cord echinococcosis could not be confirmed,resulting in a misdiagnosis rate of 21.4%(6/28).For the pathological examination,a total of 17 cases were infected with Echinococcus granulosus(including 2 cases of spinal cord echinococcosis),and 6 cases were infected with Echinococcus alveolaris.Conclusion:The diagnosis should be specifically considered in endemic regions.The clinical features of CNS hydatidosis were intracranial space-occupying lesions.For the treatment,the surgical removal of cysts should be necessary.In addition,the adjuvant therapy with drug and intraoperative prophylaxis is also suggested.The misdiagnosis may have resulted from atypical clinical features and radiographic manifestations,as well as the accuracy of hydatid immunologic test.

中枢神经系统血管炎的MRI诊断及鉴别诊断

目的 分析中枢神经系统血管炎 (CNSV)的MRI、MRA表现 ,提出诊断及鉴别诊断要点。资料与方法 对6例怀疑CNSV的病例进行常规MRI及MRA扫描 ,分析常规MRI病灶的大小、分布、信号特点、强化特征及MRA血管情况。结果 6例临床怀疑的脑部血管炎 ,5例临床仅表现头痛症状 ,无语言及肢体运动障碍 ,体检无明显神经系统阳性体征。 1例有左侧上肢乏力 ,体检左侧上肢肌力Ⅲ°。MRI显示 2例病灶位于双侧 ,病变涉及灰白质。 4例病灶位于单侧 ,主要位于白质内 ,分布以额顶叶为主。T1WI呈略低信号 ,T2 WI呈略高信号 ,增强后 2例双侧病变有斑点状或斑片状强化 ,1例单侧病灶显示轻微斑片状强化 ,强化灶模糊。MRA 4例单侧病变显示病侧相应供血动脉的闭塞及分支减少。结论 联合常规MRI及MRA成像 ,可以确定脑内病变的血管性起源。结合临床表现 。

中枢神经系统血管炎与线粒体脑肌病的诊断与鉴别诊断

目的:比较中枢神经系统血管炎(central nervous systemvasculitis,CNSV)与线粒体脑肌病(MELAS型)临床及影像学特点,分析二者的鉴别诊断特点。方法:回顾性分析我科收治的7例CNSV患者和5例线粒体脑肌病(MELAS型)患者的临床资料,比较二者临床表现、实验室检查指标、影像学表现及组织学分析的特点,筛选二者的鉴别诊断要点。结果:CNSV患者和线粒体脑肌病(MELAS型)患者头颅MRI检查均为多发病灶。CNSV临床表现以头痛、肢体无力及变态反应改变为主;线粒体脑肌病(MELAS型)以癫发作、血清乳酸升高为主要特点。两组疾病的脑电图均异常:CNSV患者以弥漫损害为主,伴局限性改变;线粒体脑肌病患者可捕捉到性放电证据,与临床表现基本一致。结论:CNSV和线粒体脑肌病的临床鉴诊较影像学更有意义,CNSV表现为血管病损害和炎症反应,线粒体脑肌病表现为能量代谢障碍,脑灰质损害更为突出,最终诊断依赖于实验室和组织学检查。

原发性中枢神经系统血管炎与结核性脑膜/脑炎的头颅MRI对比分析

目的探讨原发性中枢神经系统血管炎(PACNS)与结核性脑膜/脑炎的头颅MRI的差别。方法回顾性收集32例PACNS患者和34例结核性脑膜/脑炎患者(结核组)病历资料。对比两组患者的MRI表现。结果PACNS顶叶病灶明显多于结核组(P<0.05),其他病变部位无区别;PACNS的病灶强化中的条索样强化多于结核组(P<0.05),其余病灶强化类型无区别;PACNS的脑底池脑膜铸型强化少于结核组,脑底池脑膜非铸型强化多于结核组(P<0.01)。PACNS出现脑积水比率少于结核组,未出现脑积水比率明显多于结核组(P<0.01)。脑出血形式差异无统计学意义(P>0.05)。结论PACNS的病灶在顶叶较多见,病灶条索样增强较多见,脑底池脑膜非铸型强化多见;出现脑积水比率少见。通过上述表现可助于两病的鉴别。

累及中枢的系统性血管炎与结核性脑膜/脑炎的头颅MRI对比分析

目的:探讨中枢神经受累的系统性血管炎与结核性脑膜和(或)脑炎的头颅M R I的差别。方法:回顾性收集32例中枢神经系统血管炎,34例结核性脑膜和(或)脑炎。对比两组患者的M R I表现。结果:中枢神经系统血管炎顶叶病灶明显多于结核组(P<0.05),其他病变部位无区别;中枢神经系统血管炎的病灶强化中的条索样强化多见于结核(P<0.05),其余病灶强化类型无区别;中枢神经系统血管炎的脑膜强化连续性的少于结核组,非连续性的强化多于结核组(P<0.01)。脑出血形式差异无显著性。结论:中枢神经系统性血管炎的病灶在顶叶较结核多见,病灶条索样增强较多见,脑膜强化多为非连续性的,通过上述表现可帮助鉴别两病。

Neurological Involvement in Systemic Lupus Erythematosus (SLE): Our Recent Experience

Introduction: The central, psychiatric and peripheral neurological manifestations of lupus are among the most severe visceral disorders and are grouped under the general term of “neuro-psychiatric systemic lupus erythematosus” (NPSLE). We conducted a cross-sectional observational study within our Department of Internal Medicine aimed at describing the clinical and evolutionary aspects of central neurological disorders of SLE, excluding lupus myelopathy. Patients and Methods: This was a retrospective and observational cross-sectional study carried out from 1 January 2015 to 31 October 2017, in the Department of Internal Medicine of Aristide le Dantec University Hospital in Dakar (Senegal). All patients hospitalized during this period who met the 1997 ACR classification criteria of SLE and who presented with a central neuropsychiatric syndrome attributable to SLE (as defined by ACR 1999) were included. Patients with isolated headache, acute myelitis or secondary neurological involvement attributable to a toxic, metabolic, infectious or tumour-related cause were excluded from our study. Results: During the study period, 10 patients with neuropsychiatric lupus involvement were treated at our institution, including 9 women and 1 man;the median age was 29 years (20 - 55 years). Neurological involvement occurred during the course of lupus evolution in 9/10 cases. The median time to SLE evolution was 18 months (0 - 60 months). Neuropsychiatric syndromes as defined by the 1999 ACR were commonly associated and more than half of our patients had multiple neuropsychiatric syndromes. There were 5 cases of confusion syndrome and coma, 4 cases of seizure, 3 cases of psychosis, 2 cases of acute cerebrovascular disease and 1 case of aseptic meningitis. Among the extra-neurological manifestations of SLE, haematological and dermatological involvements were common. Renal involvement affected half of the patients. The other manifestations were: polyarthritis in 3 patients, serositis in 2 patients, 5 cases of fever, 4 cases of deterioration of the general state, and one isolated case of ophthalmological involvement. Therapeutically, 8 patients received a bolus of methylprednisolone and 3 patients received a bolus of cyclophosphamide. Oral corticosteroids and hydroxychloroquine were administered to all patients, and azathioprine was administered in 2 patients. The evolution was favorable in 4 patients, other 2 patients maintained neurological sequelae and 2 patients were transferred to intensive care. Death was recorded in 4 patients. Conclusion: Neuropsychiatric manifestations of lupus are rare and sometimes severe, potentially life-threatening. In our patients, we have identified some of the most severe neurological syndromes according to the ACR nomenclature. The neurological involvement is exceptionally revealing, as these syndromes are often associated and integrated into a systemic context of lupus. The evolution is rapidly unfavorable and requires early diagnosis and optimal management.

Intraocular lymphoma

Intraocular lymphoma （IOL） is a rare lymphocytic malignancy which contains two main distinct forms. Primary intraocular lymphoma （PIOL） is mainly a sub- type of primary central nervous system lymphoma （PCNSL）. Alternatively, IOL can originate from outside the central nervous system （CNS） by metastasizJng to the eye. These tumors are known as secondary intraocular lymphoma （SlOL）. The IOL can arise in the retina, uvea, vitreous, Bruch＇s membrane and optic nerve. There are predominantly of B-cell origin; however there are also rare T-cell variants. Diagnosis remains challenging for ophthalmologists and pathologists, due to its ability to masquerade as noninfectious or infectious uveitis, white dot syndromes, or occasionally as other metastatic cancers. Laboratory tests include flow cytometry, immunocytochemistry, interleukin detection （IL-10： IL-6, ratio 〉1）, and polymerase chain reaction （PER） amplification. Methotrexate-based systemic chemotherapy with external beam radiotherapy and intravitreal chemotherapy with methotrexate are useful for controlling the disease, but the prognosis remains poor. Therefore, it is important to make an early diagnose and treatment. This review is focused on the clinical manifestations, diagnosis, treatment and prognosis of the IOL.

Recognition of moyamoya disease and its hemorrhagic risk using deep learning algorithms:sourced from retrospective studies

Although intracranial hemorrhage in moyamoya disease can occur repeatedly,predicting the disease is difficult.Deep learning algorithms developed in recent years provide a new angle for identifying hidden risk factors,evaluating the weight of different factors,and quantitatively evaluating the risk of intracranial hemorrhage in moyamoya disease.To investigate whether convolutional neural network algorithms can be used to recognize moyamoya disease and predict hemorrhagic episodes,we retrospectively selected 460 adult unilateral hemispheres with moyamoya vasculopathy as positive samples for diagnosis modeling,including 418 hemispheres with moyamoya disease and 42 hemispheres with moyamoya syndromes.Another 500 hemispheres with normal vessel appearance were selected as negative samples.We used deep residual neural network(ResNet-152)algorithms to extract features from raw data obtained from digital subtraction angiography of the internal carotid artery,then trained and validated the model.The accuracy,sensitivity,and specificity of the model in identifying unilateral moyamoya vasculopathy were 97.64±0.87%,96.55±3.44%,and 98.29±0.98%,respectively.The area under the receiver operating characteristic curve was 0.990.We used a combined multi-view conventional neural network algorithm to integrate age,sex,and hemorrhagic factors with features of the digital subtraction angiography.The accuracy of the model in predicting unilateral hemorrhagic risk was 90.69±1.58%and the sensitivity and specificity were 94.12±2.75%and 89.86±3.64%,respectively.The deep learning algorithms we proposed were valuable and might assist in the automatic diagnosis of moyamoya disease and timely recognition of the risk for re-hemorrhage.This study was approved by the Institutional Review Board of Huashan Hospital,Fudan University,China(approved No.2014-278)on January 12,2015.

Spinal dural arteriovenous fistula 8 years after lumbar discectomy surgery: A case report and review of literature

BACKGROUND Spinal dural arteriovenous fistula(SDAVF)is an extremely rare vascular malformation of the central nervous system that is often confused with degenerative spinal disorders due to similar early symptoms and clinical features.Here,we report a case of SDAVF recurrence 8 years after lumbar spine surgery and summarize relevant literature.CASE SUMMARY A 54-year-old male was admitted to our hospital complaining of lower back pain,numbness in both lower extremities and intermittent claudication.Subsequent imaging identified lumbar spinal stenosis.Following surgical treatment,the patient’s symptoms significantly resolved,and he was able to perform daily activities.However,similar symptoms appeared 8 years later,followed by confirmation of SDAVF diagnosis.The patient underwent neurosurgery 7 mo after symptom onset.The follow-up period lasted 14 mo,and the patient remains with marginal neurological symptoms.CONCLUSION This case highlights the importance of prompt SDAVF diagnosis.Due to its nonspecific clinical presentation,the clinical experience of the surgeon and definitive imaging examination are indispensable.Additionally,timely neurosurgery is effective and may significantly improve patient outcomes.

A new paradigm for diagnosis of neurodegenerative diseases: peripheral exosomes of brain origin

Neurodegenerative diseases are a heterogeneous group of maladies, characterized by progressive loss of neurons. These diseases involve an intricate pattern of cross-talk between different types of cells to maintain specific signaling pathways. A component of such intercellular cross-talk is the exchange of various types of extracellular vesicles (EVs). Exosomes are a subset of EVs, which are increasingly being known for the role they play in the pathogenesis and progression of neurodegenerative diseases, e.g., synucleinopathies and tauopathies. The ability of the central nervous system exosomes to cross the blood-brain barrier into blood has generated enthusiasm in their study as potential biomarkers. However, the lack of standardized, efficient, and ultra-sensitive methods for the isolation and detection of brain-derived exosomes has hampered the development of effective biomarkers. Exosomes mirror heterogeneous biological changes that occur during the progression of these incurable illnesses, potentially offering a more comprehensive outlook of neurodegenerative disease diagnosis, progression and treatment. In this review, we aim to discuss the challenges and opportunities of peripheral biofluid-based brain-exosomes in the diagnosis and biomarker discovery of Alzheimer’s and Parkinson’s diseases. In the later part, we discuss the traditional and emerging methods used for the isolation of exosomes and compare their advantages and disadvantages in clinical settings.

浅谈MRI诊断在中枢神经系统血管炎患者中的应用

目的对于MRI诊断在中枢神经系统血管炎患者中的应用进行探讨。方法 2007年12月至2010年12月某医院收治的中枢神经系统血管炎患者,共选取10例,男6例,女4例,年龄为20～40岁,平均年龄为31.25岁,10例均行常规MRI平扫、增强及MRA检查。结果 10例均有异常MRI表现。其中6例为单侧病变,4例为双侧病变。结论 MRI诊断为临床诊断和观察疗效提供可靠依据,对治疗和估计预后亦有重要价值,对临床疑有中枢神经系统血管炎的患者,MRI可成为常规及首选检查方法。