Treatment of neurosurgical intensive care patients infected with multidrug resistant (MDR) or extensive drug resistant (XDR) Acinetobacter baumannii presents significant challenges and is associated with high mortality rates. Sulbactam has long been an effective treatment for MDR Acinetobacter baumannii, particularly due to its ability to penetrate the inflamed blood-brain barrier, making it highly suitable for use in severe neurosurgical cases. However, in recent years, increasing resistance to sulbactam among Acinetobacter baumannii strains has become a concern. There is a lack of standardized guidelines regarding the dosage, administration methods, routes and combination therapy strategies for sulbactam in the treatment of these resistant infections. Thus, Chinese Neurosurgical Intensive Care Management Collaborative Group has developed the "Chinese expert consensus on the use of sulbactam to treat patients infected with Acinetobacter baumannii in the neurosurgical intensive care unit", through a thorough review of relevant evidence-based medical literature and extensive discussion and revision. This consensus includes 28 recommendations aimed at providing scientific and feasible clinical guidance for the application of sulbactam in the management of neurosurgical intensive care patients.

Alzheimer's disease (AD) is the most common type of dementia in the elderly. The ApoE ε4 gene is the main genetic risk factors for sporadic AD, and is associated with the changes in the amyloid β-protein (Aβ) and tau protein, the core pathological features of AD. ApoE ε4 has great potential as a genetic biomarker for AD. Clinical studies have shown the important role of peripheral blood ApoE ε4 in AD risk assessment and disease detection. But in the current clinical practice, there are many weak points of insufficient understanding and insufficient attention about the clinical use of ApoE ε4. The importance of ApoE ε4 is highlighted especially with the development of high-quality clinical drug trials or the arrival of clinical drug therapy targeting Aβ for AD. So far, there is still a lack of Chinese expert consensus on the standardized application of ApoE ε4 in AD. Given that, this article systematically summarizes the current domestic and international research on the application of ApoE ε4 in AD. The consensus is written and aimed to fully reflect the clinical application value of ApoE ε4 in AD, and improve the diagnosis and treatment level of AD, and guide further clinical research.

Objective: To analyze the clinical features and prognostic factors of herpes simplex virus type 1 (HSV-1) encephalitis. Methods: A total of 51 patients with HSV-1 encephalitis hospitalized in He'nan Provincial People's Hospital from January 2018 to September 2023 were selected, and their clinical data, laboratory and imaging examination results were recorded. The modified Rankin Scale (mRS) was used to evaluate the prognosis of patients and the recovery of neurological function after brain injury. Univariate and multivariate stepwise Logistic regression analyses were screened for risk factors of adverse prognosis of HSV-1 encephalitis. Results: The main symptoms of 51 cases were fever and headache. The serological examination results showed increased white blood cell count (14 cases), increased neutrophil count (14 cases), decreased lymphocyte count (8 cases), and decreased serum sodium level (17 cases). Cerebrospinal fluid (CSF) examination by lumbar puncture showed increased CSF pressure (18 cases), increased white blood cell count (28 cases), increased protein (32 cases), and increased glucose (15 cases). There were 48 patients who underwent head MRI examination, and 43 patients (89.58%) showed obvious brain region involvement on head MRI, among which 35 patients (72.92%) with positive MRI showed typical unilateral or bilateral temporal and frontal lobe involvement, and 8 cases (16.67%) with increased cerebral pia mater enhancement. 66.67% (34/51) of the patients recovered completely within 6 months after discharge, 21.57% (11/51) of the patients had sequelae, and the fatality rate was 11.76% (6/51). There were 34 (66.67%) patients with good prognosis and 17 (33.33%) patients with adverse prognosis. Multivariate Logistic regression analysis showed age increased (OR = 1.090, 95%CI: 1.020-1.200; P = 0.023) and increased CSF glucose level (OR = 23.800, 95%CI: 23.800-1250.000; P = 0.030) were risk factors for adverse prognosis in HSV-1 encephalitis patients. Conclusions: Increased aging and CSF glucose level are risk factors for the adverse prognosis in HSV-1 encephalitis patients. In clinical practice, it is necessary to master the clinical characteristics of patients with HSV-1 encephalitis, so as to achieve early detection, diagnosis and treatment.

With the rapid development of society and economy and the acceleration of population aging, the global disease spectrum has undergone profound changes. Neurological diseases, especially brain functional disorders, have become major threats to human health. Neuromodulation technique, as a critical means to address this challenge, has opened new avenues for the treatment of brain functional disorders and has become one of the three innovative technologies in modern neurosurgery. This paper systematically elaborates on the concept, classification, and technological evolution of neuromodulation, focusing on the clinical application progress of invasive neuromodulation technique. It analyzes their efficacy and potential in the fields of movement disorders, epilepsy, pain, cognitive impairment, and neurorehabilitation. Additionally, it explores the integration trend between neuromodulation and brain-computer interface (BCI), pointing out that closed-loop neuromodulation has become an important component of BCI, providing new approaches for precise treatment and individualized modulation. Finally, it proposes future development directions in the field of neuromodulation, including expanding new indications, innovating target exploration models, updating treatment concepts, and conducting high-quality evidence-based medical research. Looking ahead, Chinese neuromodulation endeavors should seize current opportunities, achieve a leap from following to leading through continuous exploration and innovation, and make greater contributions to global brain health.

Objective: To analyze the clinical characteristics of anti-neuronal antibody positive paraneoplastic neurological syndrome related to immune checkpoint inhibitors (ICI-PNS). Methods and Results: A total of 5 patients with anti-neuronal antibody positive ICI-PNS in Peking Union Medical College Hospital from January 2012 to March 2024 were included. Tumor types included small cell lung cancer (2 cases), malignant melanoma (one case), Hodgkin lymphoma (one case) and cervical cancer (one case). Immune checkpoint inhibitors (ICIs) included programmed death 1 (PD-1) inhibitors (3 cases), programmed cell death ligand 1 (PD-L1) inhibitors (one case) and bispecific PD-1/cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitors (one case). All 5 patients presented with high-risk neurologic phenotypes of paraneoplastic neurological syndrome (PNS), of which 4 presented with limbic encephalitis and one presented with rapidly progressive cerebellar syndrome. Anti-neuronal antibodies detected in serum and/or cerebrospinal fluid of patients included anti-Hu, γ-aminobutyric acid receptor type B (GABA_BR), sex-determining region of Y chromosome-related high mobility group box 1 (SOX1), metabotropic glutamate receptor 5 (mGluR5) and Yo antibodies. Neurological syndromes occurred within 2 weeks after receiving ICIs in 4 patients. The modified Rankin Score (mRS) of 4 patients was 3 at peak of illness, and one patient was 5 at peak of illness. The Common Terminology Criteria for Adverse Events (CTCAE) was grade 3 in all 5 patients. After withdrawal of ICIs and treatment with glucocorticoids and intravenous immunoglobulin (IVIg), the neurological symptoms of the patients were improved. Conclusions: High/intermediate-risk anti-neuronal antibodies are diagnostic markers of ICI-PNS. Evaluation of ICI-PNS clinical phenotypes and CTCAE grading are important for immunotherapy. Discontinuation of ICIs, administration of glucocorticoids and IVIg can improve the prognosis of patients.

Parkinson's disease (PD) is a common neurodegenerative disease in clinical practice. Patients with PD are usually accompanied by non-motor symptoms (NMS) such as gastrointestinal dysfunction, hyposmia, sleep disorders, depression, pain and hallucinations, which seriously reduce the quality of life. Recent studies have found that PD patients were accompanied by diffuse pathological changes in non-dopaminergic system such as progressive degeneration of 5 -hydroxytryptamine (5-HT) ergic neurons, and 5-HT plays an important role in the regulation of emotion, cognitive function, pain and other neural functions, and is closely related to non-motor symptoms of PD. This article reviews the correlation between 5-HT and non-motor symptoms of PD and its research progress, in order to further clarify the pathogenesis of non-motor symptoms of PD and provide a theoretical basis for the treatment of PD.

Objective: To report and analyze the clinical features of the first documented case in China of anti-neurofilament heavy chain (NfH) antibody-associated encephalitis. Methods and Results: A 63-year-old female presented with cognitive impairment, recurrent epileptic episodes, and aphasia. Head MRI showed multiple abnormal signals in bilateral frontal and parietal lobes, and slight swelling in some gyri, dilatation of the supratentorial ventricular system and brain atrophy, especially in bilateral temporal lobes and hippocampus. ¹⁸F-DPA714 PET/MRI showed abnormal uptake in multiple brain regions in the frontal, temporal, parietal and occipital lobes, suggesting neuroinflammation in the brain. EEG showed frequent epileptiform discharges. Cerebrospinal fluid white cell count and glucose were elevated. Serum and cerebrospinal fluid antibodies related to autoimmune encephalitis were negative. Serum tissue-based indirect immunofluorescence assay showed cerebellar neurofilament-like fluorescence surrounding Purkinje cells, further detection of neurofilament protein-related antibodies, it suggested high titer of serum NfH-IgG (1∶1000). The patient was diagnosed with anti-NfH antibody-associated encephalitis. After treatment with intravenous immunoglobulin and methylprednisolone, the prognosis was improved. Conclusions: Anti-NfH antibody-associated encephalitis is a rare and clinically complex condition. The myriad of symptoms complicates early diagnosis and differential identification. Early initiation of immunomodulatory therapy may offer prognostic advantages.

Objective: To investigate the rehabilitation effects of vestibular rehabilitation in acute brainstem infarction patients with subjective visual vertical (SVV) tilting, and the correlation between the SVV, balance confidence, dizziness/vertigo and walking function. Methods: All 45 acute brainstem infarction patients with SVV tilting who were hospitalized in Tianjin Huanhu Hospital from July 2022 to July 2023 were collected. Patients were divided into vestibular rehabilitation group (n = 25) and general rehabilitation group (n = 20), Bucket Test was used to test SVV tilting angle, Activities - Specific Balance Confidence Scale (ABC) was used to evaluate balance confidence, Visual Analog Scales (VAS) was used to evaluate dizziness/vertigo and Functional Ambulation Category Scale (FAC) was used to evaluate walking function before and after 2 weeks of treatment. Results: The SVV tilting angle (F = 4.356, P = 0.043), ABC score (F = 4.389, P = 0.042), dizziness/vertigo VAS score (F = 4.138, P = 0.048) were significantly different between vestibular rehabilitation group and general rehabilitation group. After treatment, the SVV tilting angle (t = - 2.139, P = 0.038) and the dizziness/vertigo VAS score (t = - 2.952, P = 0.005) in vestibular rehabilitation group were lower than those in general rehabilitation group, and the ABC score was higher than that in general rehabilitation group (t = 2.920, P = 0.006). SVV tilting angle (F = 196.923, P = 0.000), ABC score (F = 89.050, P = 0.000), dizziness/vertigo VAS score (F = 81.803, P = 0.000), FAC grade (F = 72.866, P = 0.000) were statistically significant. The SVV tilting angle (t = 0.763, P = 0.000; t = 0.972, P = 0.000) and dizziness/vertigo VAS score (t = 8.815, P = 0.000; t = 5.107, P = 0.000) after treatment were lower than those before treatment of 2 groups, and the ABC score (t = 0.689, P = 0.001; t = 0.703, P = 0.001) and FAC grade (t = - 6.721, P = 0.000; t = - 5.772, P = 0.000) were higher than those before treatment of 2 groups. Correlation analysis showed a positive correlation between SVV tilting angle and dizziness/vertigo VAS score in acute brainstem infarction patients with SVV tilting (r = 0.627, P = 0.000). Conclusions: Vestibular rehabilitation can effectively improve the SVV tilting, balance confidence and dizziness/vertigo symptoms of acute brainstem infarction patients with SVV tilting, and the SVV tilting angle is closely related to the degree of dizziness/vertigo.

Objective: To investigate the efficacy and neuromyelitis optica spectrum disorders (NMOSDs). Methods: The clinical data of 25 patients with NMOSDs hospitalized in The First Affiliated Hospital of Zhengzhou University from April 2022 to March 2023 and treated with ofatumumab were retrospectively analyzed. They were divided into 2 groups, Group A with 12 cases receiving regular medication, and Group B with 13 cases receiving medication based on the percentage of CD19⁺B lymphocytes. Annual relapse rate (ARR), the number of relapses, the frequency and time of relapses, and the symptoms of relapses were calculated before and at one year of medication. The neurological function was assessed by Expanded Disability Status Scale (EDSS) before and at one year of medication. The adverse drug reactions were recorded during medication. Results: After one year treatment with ofatumumab, 3 patients (12%) experienced recurrence. One patient in Group A experienced recurrence twice, one month and 5 months after treatment, respectively. At the second recurrence, the percentage of CD19⁺B lymphocytes was 2.80%. Two patients in Group B experienced recurrence, one patient relapsed twice at 2 and 6 months after medication. The percentage of CD19⁺B lymphocytes was 0.80% and 0.21%, respectively; another patient relapsed once at 2 months after medication. At the time of recurrence, the percentage of CD19⁺B lymphocytes was 0.70%. There was a statistically significant difference in ARR before and after one year treatment (F = 29.061, P = 0.000). After one year's treatment, the ARR of Group A (t = 13.215, P = 0.001) and Group B (t = 19.259, P = 0.000) was decreased than before. There were 8 cases of the injection site pain, 3 cases of fever after injection, and one case of headache after injection. There were no serious adverse reactions such as disability and death, and EDSS scores were not increased. Conclusions: Continuous administration of ofatumumab every 3 months or based on the percentage of CD19⁺B lymphocyte can reduce recurrence. Combination with corticosteroids should be alert to the risk of infection.

Objective: To summarize the clinical characteristics of peripheral nerve hyperexcitability syndrome (PNHS). Methods and Results: Ten patients with PNHS were admitted to He'nan Provincial People's Hospital from October 2018 to April 2022, with the clinical phenotypes of Morvan syndrome in 5 cases, Issacs syndrome in 4 cases, and cramp-fasciculation syndrome (CFS) in one case. There were 10 cases with clinical manifestations of muscle twitching, 8 of dysautonomia, 7 of central nervous system symptoms, 7 of limb weakness, 6 of sensory deficits, and 2 of cramping and muscle stiffness. Five cases were positive for autoimmune antibodies. Two cases had MRI abnormalities located in the brainstem, left occipital lobe and right thalamus. Ten cases had EMG abnormalities, including afterdischarges of F-wave in 10 cases, unit potential of spontaneous motion abnormalities in 10 cases, fasciculation potentials in 10 cases, myokymic discharges in 8 cases, and neuromyotonic and myokymic discharges in 3 cases. Three cases underwent only symptomatic therapy, and 7 cases underwent symptomatic therapy and immunomodulatory treatments. Except for one case who lost of follow-up, 5 cases had a good prognosis, 2 cases with poor prognosis, and 2 cases died. Conclusions: PNHS is a heterogeneous group of clinical manifestations. Electrophysiological appearance of afterdischarges may be a sensitive indicator for the diagnosis of PNHS.

Objective: To analyze the risk factors for dismal prognosis in patients with cryptococcal meningitis and construct a prediction scoring system Nomogram model. Methods: A total of 100 patients with cryptococcal meningitis who treated with anticryptococcal therapy admitted to Affiliated Hospital of Zunyi Medical University from January 2010 to August 2022 were selected. The patients were divided into favorable prognosis group (n = 19) and dismal prognosis group (n = 81) according to the results of cerebrospinal fluid (CSF) cryptococcal culture during hospitalization and clinical symptoms and signs at the time of discharge. Risk factors were screened by using univariate and multivariate stepwise Logistic regression analyses. A Nomogram model was constructed based on the risk factors, the receiver operating characteristic (ROC) curve and calibration curves of the model were plotted, and Hosmer-Lemeshow goodness-of-fit test was performed. Results: The proportion of patients in the dismal prognosis group with Nutritional Risk Screening 2002 (NRS 2002) score (Z = -3.898, P = 0.000), CSF pressure > 250 mm H₂O (χ² = 9.512, P = 0.002) and duration of antifungal treatment < 14 d (χ² = 17.847, P = 0.000) on admission were higher than those in the favorable prognosis group, and the blood routine red blood cell count (t = -2.802, P = 0.006) and lymphocyte count (Z = -2.878, P = 0.004), plasma albumin (t = -4.332, P = 0.000), and the proportion of amphotericin B application (χ² = 4.597, P = 0.032) were lower than those in the favorable prognosis group. Logistic regression analysis showed the admission high NRS 2002 score (OR = 3.258, 95%CI: 1.337-7.940; P = 0.009), CBF pressure > 250 mm H₂O (OR = 0.108, 95%CI: 0.018-0.659; P = 0.016), and the duration of antifungal treatment < 14 d (OR = 0.092, 95%CI: 0.011-0.742; P = 0.025) were risk factors for dismal prognosis of cryptococcal meningitis. A Nomogram model was constructed based on the above 3 risk factors, and the area under the ROC curve was 0.927 (95%CI: 0.873-0.980, P = 0.000), which predicted a cut-off value of 53.50 points for dismal prognosis in cryptococcal meningitis; the calibration curve (with good consistency), and the Hosmer-Lemeshow goodness-of-fit test (χ² = 2.694, P = 0.912) indicated that the model had good discrimination, calibration and stability. Conclusions: Patients with cryptococcal meningitis with a high NRS 2002 score, CSF pressure > 250 mm H₂O, and antifungal treatment < 14 d had a dismal prognosis, and the Nomogram model constructed accordingly has a high predictive value of dismal prognostic risk.

Since 2017, human encephalitis caused by pseudorabies virus (PRV) has been reported in 28 cases in China. The clinical symptoms include fever, headache, seizures, focal neurological loss, disturbance of consciousness, etc.. This disease has the high disability rate and fatality rate. PRV is mainly transmitted through close contact with infected pigs or their excrement, or spread via blood - borne. Patients are mostly practitioners in the live pig industry chain. Early diagnosis and treatment are critical to the prognosis of patients. Therefore, this article reviews the progress on diagnosis and treatment of human encephalitis caused by PRV, in order to improve the clinical diagnosis and treatment of this disease.

Objective: To summarize the clinical characteristics of Vogt-Koyanagi-Harada syndrome (VKHS) combing with meningitis/encephalitis patients. Methods and Results: The clinical data of the inpatients of Beijing Tongren Hospital, Capital Medical University from January 2009 to December 2022 with VKHS combing with meningitis/encephalitis were retrospectively analyzed. A total of 23 patients were included in the study, of which 20 patients (86.96%) had neurological symptoms, with headache being the most common (19 cases, 82.61%), 11 patients (47.83%) had increased cerebrospinal fluid (CBF) pressure, 14 patients (60.87%) had increased CBF white blood cells, and 11 patients (47.83%) had increased CBF protein. The brain MRI mainly showed white matter demyelination (8/14 cases). Optic nerve MRI showed inflammatory lesions of optic nerve and optic papilla (12/14 cases). The visual evoked potential (VEP) mainly showed prolonged latency (10/16 cases). The optical coherence tomography (OCT) showed retinal exudation (8/15 cases) and retinal neurocortical detachment (7/15 cases). The main results of fundus photography were disc edema (17/18 cases). The main manifestation of fundus fluorescein angiography (FFA) was uveitis (9/15 cases). After intravenous hormone and intravenous immunoglobulin (IVIg) treatment, 14 patients were followed up, and neurological symptoms were completely relieved, 11 patients had good visual prognosis, and 3 patients had no obvious visual improvement. Conclusions: VKHS might present with meningitis/encephalitis symptoms, and the CSF characteristics of these patients were similar to those of viral meningitis. For those with early suspicions of VKHS, CBF examination and imaging examination might assist in early diagnosis and treatment.

Objective: To evaluate the reliability, validity and diagnostic accuracy of the Canadian Longitudinal Study on Aging Epilepsy Algorithm (CLSA - EA) questionnaire (Chinese version) in screening Chinese adult epilepsy. Methods: From August to October 2022, a total of 384 subjects and patients were included, who were respectively screened from urban and rural communities in Chengdu, Sichuan, and Department of Neurology of West China Hospital, Sichuan University. The CLSA - EA questionnaire (Chinese version) was used for the survey. Epilepsy was diagnosed according to 2014 International League Against Epilepsy (ILAE) criteria. Kappa coefficient and Cronbach's α coefficient were used to evaluate test- retest reliability and internal consistency, respectively. Construct validity was used to test validity. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic consistency κ value were calculated by confusion matrix method to evaluate the effect of screening. Results: Finally, 348 questionnaires were obtained, including 190 epileptic cases (54.60%) and 158 non-epileptic cases (45.40%), of which 244 were retested subjects, including 123 epileptic cases (50.41%) and 121 non-epileptic cases (49.59%). Retest reliability analysis in epileptic cases showed that the consistency of items Q3a, Q3b ⅲ, Q3b ⅳ, Q4a and Q4b in CLSA - EA questionnaire (Chinese version) had moderate consistency (0.400 ≤ κ < 0.750; P = 0.000, for all). Items Q1, Q2, Q3bⅰ, Q3bⅱ, Q3bⅴ, Q3bⅵ and Q3bⅶ had poor consistency (0.000 ≤ κ < 0.400;P < 0.05, for all). In non-epileptic cases, the consistencies of items Q2, Q3a, Q3bⅰ, Q4a and Q4b were moderate (P = 0.000, for all), Q3bⅴ and Q3bⅵ were poor (P = 0.000, for all), and no consistencies of Q3b ⅱ, Q3b ⅲ and Q3b ⅳ were found (P > 0.05, for all). The internal consistency evaluation in epileptic cases showed that the internal consistency of all items and the sum of all items in the CLSA -EA questionnaire (Chinese version) were poor (Cronbach's α coefficient < 0.700). The internal consistency of items Q4a and Q4b for non-epileptic patients was also poor, but other items and the sum of all items were acceptable (Cronbach's α coefficient 0.700-0.800). The structural validity analysis showed that the cumulative variance contribution rate of the four factors was only 43%, and items Q1 and Q3a were not incorporated into the factors. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and consistency of CLSA - EA2 epilepsy determination algorithm were higher (> 0.900, for all). Conclusions: The CLSA - EA questionnaire (Chinese version) has high sensitivity and specificity, which can guide the preliminary screening of epilepsy in China. However, the applicability, reliability and validity still need to be further considered.

Neuromyelitis optica spectrum disorders (NMOSDs) are most common in anti -aquaporin 4 (AQP4) antibody positive NMOSDs, which are characterized by recurrent episodes of optic neuritis and myelitis, etc., and severely reduce the quality of life. In recent years, new insights into the diagnostic techniques, diagonstic markers, and immunotherapy of anti-AQP4 antibody positive NMOSDs have continued to emerge, and here we focus on synthesizing new advances in the diagnostic techniques and diagonstic markers of anti-AQP4 antibody positive NMOSDs and the most recent recommendations for its treatment, in hopes of summarizing to promote the understanding and application of new diagnostic and therapeutic techniques for anti-AQP4 antibody positive NMOSDs in China, and to explore more possible clinical diagnostic and therapeutic approaches.

Autonomic nerve dysfunction is a common non-motor symptom of Parkinson's disease (PD). It has a high incidence and involves multiple organ system disorders with various manifestations, seriously affecting the quality of life. Autonomic nerve dysfunction can be a major symptom of advanced PD and a major cause of disability. Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced PD, and its improvement of motor symptoms in PD patients has been widely recognized. However, the effect of STN-DBS on the symptoms of autonomic nerve dysfunction in PD patients is still unclear. Here, the efficacy of STN-DBS on PD autonomic nerve dysfunction is briefly reviewed. Therefore, we should pay more attention to the symptoms of autonomic nerve dysfunction in PD patients, and conduct preoperative evaluation of DBS in PD patients, so as to comprehensively consider the postoperative efficacy, target selection, stimulus parameter setting, drug adjustment, develop an individualized treatment plan.

Myasthenia gravis (MG) treatment has entered an era of targeted therapies. Different targeted therapies take effect in various aspects of pathogenic mechanisms in MG. For a steady long-term control of MG symptoms, immunotherapies that reduce the production of pathogenic autoantibodies should be used. The glucocorticosteroid acts on multiple aspects of pathogenic mechanisms relevant to autoantibody production and regulation of the immune network, which renders glucocorticosteroid the basis of MG therapy. A definite therapeutic target has been established in MG. Glucocorticosteroid can be used alone or in combination with traditional immunosuppressants or targeted therapies at different stages of the treat-to-target process. Based on the evaluation of the beneficial characteristics of patients using the traditional glucocorticosteroid escalation strategy, the implementation of the glucocorticosteroid-based and treat-to-target-oriented individualized treatment helps to obtain better long-to-term efficacy.

Stroke can lead to long-term motor disorders and reduced quality of life. Despite advances in conventional rehabilitation, many patients are still faced with limited efficacy of rehabilitation. Neuromodulation techniques have shown breakthrough therapeutic potential. The purpose of this article is to provide an overview of the mechanism of poststroke neuroplasticity, to explore the mechanism of dentate nucleus deep brain stimulation (DN-DBS) to improve poststroke motor function, and to summarize the progress of the study, in order to provide a scientific basis and a new therapeutic perspective for clinical practice of DN-DBS.

Objective: Summarize the clinical and genetic characteristics of atypical Rett syndrome and developmental epileptic encephalopathy caused by IQSEC2 gene variation. Methods and Results: From May 2020 to April 2022, Anhui Provincial Children's Hospital diagnosed and treated 4 children with atypical Rett syndrome and developmental epileptic encephalopathy caused by IQSEC2 gene variation, including 2 males and 2 females were a pair of identical twins. They all had comprehensive developmental delay before onset. At the age of 2 years, all cases gradually exhibited clinical manifestations of atypical Rett syndrome, such as frequent clapping, biting, sleep disorders (increased sleep or difficulty falling asleep), and grinding teeth, followed by developmental regression and seizures. The initial age of epilepsy was from 2 years and 2 months to 2 years and 10 months. All cases started with generalized tonic-clonic seizure, with epileptic spasm occurring between 2 and 11 months of course. Case 2, Case 3 and Case 4 were also accompanied by focal seizures. Four cases with VEEG background of 4-6 Hz θ wave, the VEEG during the interictal phase was a broad multifocal sharp slow complex wave. In Case 2, Case 3 and Case 4, MRI was abnormal, mainly with increased depth of cerebral hemispheric sulcus and gyrus. The whole exome sequencing suggested pathogenicity and possible pathogenic variations in the IQSEC2 gene, Case 1 and Case 2 were frameshift mutations of c. 608dup (p. Gln204Profs*35), while Case 3 and Case 4 were nonsense mutations of c. 2231C > A (p. Ser744Ter) and c. 2521C > T (p. Gln841Ter), respectively. The four mutation sites have not been reported domestically or internationally. All cases received treatment with multiple antiepileptic seizure medicine. The last follow-up age was from 4 years and 3 months to 6 years and 3 months. All cases were unable to walk alone and had no active language. There were no seizures in Case 1 for 3 years, occasional seizures in Case 2 and Case 4, and frequent seizures in Case 3. Conclusions: IQSEC2 gene variation can manifest as atypical Rett syndrome, which can be accompanied by refractory epileptic spasms. Both males and females have severe phenotypes, and the severity of clinical phenotypes at the same mutation site varies. Our report enriches the variation spectrum and clinical phenotype spectrum of the IQSEC2 gene, expands the genetic spectrum of Rett syndrome and developmental epileptic encephalopathy, and provides value for the clinical diagnosis, treatment and subsequent research of this disease.

Objective: To investigate the effect of cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) in diagnosis and treatment of intracranial infection. Methods: A retrospective analysis of 117 patients with intracranial infection were admitted to Shenzhen Second People's Hospital from January 2020 to December 2022. Before initiating empirical broad-spectrum antibiotic treatment, CSF samples were collected for microbial culture (conventional culture group, n = 58) and/or mNGS (mNGS group, n = 59). The results were used to adjust the antibiotic treatment plan, and the study compared the pathogen detection rates and result reporting times of the two testing methods, as well as the antibiotic intensity grading, the intensive care unit (ICU) stay, total hospital stay, and mortality rate. Results: A total of 65 pathogens were detected from the CSF samples of all the patients through microbial culture and/or mNGS, with viruses being the most prevalent, accounting for 49.23% (32/65), followed by Gram-negative bacteria (24.62%, 16/65), Gram-positive bacteria (18.46%, 12/65) and fungi (7.69%, 5/65). The pathogen detection rate of CSF mNGS was higher than that of CSF microbial culture (χ² = 22.781, P = 0.000), and the results were reported earlier (t =-32.588, P = 0.000). Based on the results, 20 cases (33.90%) in the mNGS group adjusted antibiotic treatment plan, with 5 cases downgrading and 15 cases upgrading the intensity of antibiotic application. In the conventional culture group, 30 cases (51.72%) adjusted their antibiotic treatment plan, with 17 cases downgrading and 13 cases upgrading the intensity of antibiotic application. There was no significant difference between the 2 groups (Z =-1.917, P = 0.055). And there was no statistically significant difference in ICU stay (Z =-0.716, P = 0.474), total hospital stay (Z =-0.933, P = 0.351) and mortality rate (Fisher's exact probability: P = 0.496) between the 2 groups. Conclusions: The application of mNGS can effectively improve the detection rate of intracranial infection pathogens, which may shorten the duration of antibiotic use and reduce the intensity of broad-spectrum antibiotics, so as to help clinical effective judgment and treatment decision.

Objective: To report 3 cases of Guillain-Barré syndrome (GBS) caused by heat stroke (HS) and review the relevant literatures, and summarize the clinical characteristics of GBS caused by HS. Methods and Results: The three patients were all diagnosed and treated by The Second Affiliated Hospital of Nanchang University in August 2022. The clinical manifestations were mainly weakness of limbs and dysarticulation after recovery of consciousness disorder of HS, disappearance of tendon reflex as shown by physical examination, extensive peripheral nerve damage mainly caused by axonal damage and motor nerve involvement as shown by EMG. Cerebrospinal fluid protein cell segregation phenomenon was present in Case 1 and Case 2, and the clinical diagnosis was GBS caused by HS. The muscle strength was better than before after immunotherapy, but obvious neurological dysfunction was still found after one year follow-up. Conclusions: GBS caused by HS is a severe condition, often appearing within 3 weeks after HS. Immunotherapy leads to varying degrees of improvement in muscle strength; however, significant neurological dysfunction still persist, resulting in a poorer prognosis compared to general GBS.

Background: Para-infectious encephalopathy is an acute inflammatory encephalopathy secondary to a systemic infectious disease, including acute necrotizing encephalopathy (ANE) and mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). This paper reports on 3 cases of SARS-CoV-2 related to para-infectious encephalopathy diagnosed and treated in The Ordos Central Hospital of Inner Mongolia Autonomous Region from December 2022 to February 2023, and reviews relevant literature to summarize the clinical characteristics of the disease. Methods and Results: The 3 patients with SARS-CoV-2 related to para-infectious encephalopathy, including 2 cases of SARS-CoV-2 related to ANE and one case of SARS-CoV-2 related to MERS were reported. Three patients developed consciousness disorder 2-4 d after fever, and still had aphasia, mental abnormality, convulsions, etc.. SARS-CoV-2 throat swab was positive. Head MRI showed one abnormal signal of brain stem and bilateral thalamus, one abnormal signal of bilateral thalamus, and one abnormal pressure of corpus callosum. All received hormone shock therapy and (or) intravenous immunoglobulin. One died, and 2 cases were recovered. Conclusions: SARS-CoV-2 related to para-infectious encephalopathy including SARS-CoV-2 related to ANE and MERS and other clinical subtypes, the former has rapid progress, severe disease, high disability rate and fatality rate and poor prognosis, while the latter has relatively mild symptoms and better prognosis.

Background: Multi-modal neuroimaging examinations play a crucial role in the diagnosis and treatment of functional neurosurgery. However, there is currently a lack of effective management for these complex data in clinical practice. This study attempts to establish a feasible multi- modal neuroimaging data information management system and evaluate its application effects. Methods: By standardizing clinical diagnosis and treatment processes, analyzing the nodes where imaging data were generated, and streamlining data flow routes, establishing storage naming conventions, setting up storage servers, and training specialized personnel, we designed and applied a multi-modal neuroimaging data information management system. The primary evaluation indicators were the archiving rates of 5 types of data: structural sequences, other preoperative images, postoperative electrode CT, electrode reconstruction, and postoperative CT/MRI. The secondary evaluation indicators included the total man-hours consumed for data archiving and the average man-hours consumed per case. Results: Without multi-modal neuroimaging data information management (control group, n = 64), the total manpower consumption was 192 man-hours, with an average of 3 man-hours per case. With multi-modal neuroimaging data information management (data management group, n = 50), the total manpower consumption was 84 man-hours, with an average of 1.68 man-hours per case. The data management group had higher archiving rates compared to the control group: structural sequences [100% (50/50) vs. 32.81% (21/64); χ² = 11.383, P = 0.001], other preoperative images [96% (48/50) vs. 26.56% (17/64); χ² = 13.839, P = 0.000], postoperative electrode CT [96% (48/50) vs. 32.81% (21/64); χ² = 10.409, P = 0.001], electrode reconstruction [96% (48/50) vs. 32.81% (21/64); χ² = 10.409, P = 0.001], postoperative CT/MRI [96% (48/50) vs. 15.63% (10/64); χ² = 22.169, P = 0.000]. Conclusions: Designing a multi-modal neuroimaging data information management system that aligns with clinical practice and reasonably setting data collection and archiving nodes can effectively improve data archiving rates, save manpower resources, ensure the complete storage of clinical data, and ensure the smooth operation of clinical tasks, and enhance clinical diagnosis and treatment levels.

Objective: To investigate and compare the efficacy of endoscopic-assisted hematoma evacuation and burr hole hematoma drainage combined with urokinase in the treatment of septated chronic subdural hematoma (CSDH). Methods: A total of 38 patients with septated CSDH who were admitted in Peking Union Medical College Hospital and received endoscopic-assisted hematoma evacuation (endoscopy group, n = 19) or burr hole drainage combined with urokinase (burr hole group, n = 19) from January 2022 to December 2023. The change rate of the hematoma cavity was calculated, the modified Rankin Scale (mRS) and Barthel Index (BI) were used to evaluate neurological function prognosis and abilities of daily living. In addition, postoperative drainage time, postoperative hospitalization time, total hospitalization cost and incidence of cerebrospinal fluid leakage were recorded. Results: The two treatment modalities did not show differences in the change rate of the hematoma cavity (t = 0.858, P = 0.396). Both endoscopy group (Z =-4.116, P = 0.000) and burr hole group (Z =-4.195, P = 0.000) had lower mRS scores on discharge than on admission, while the difference between the 2 groups on discharge was not significant (Z =-0.502, P = 0.616). The endoscopy group (Z =-1.557, P = 0.119) and burr hole group (Z =-0.091, P = 0.928) had no significant difference in BI scores on discharge versus on admission, and the difference in BI scores between the 2 groups on discharge was also not statistically significant (Z =-0.853, P = 0.394). Postoperative drainage time was longer in the endoscopy group (t =-2.488, P = 0.018), but postoperative hospitalization time was longer in the burr hole group (t =-3.894, P = 0.000). Total hospitalization cost in both 2 groups (t = 1.175, P = 0.248) and the incidence of cerebrospinal fluid leakage (Fisher's exact probability: P = 0.313) were not statistically significant. Conclusions: Both neuroendoscopic surgery and burr hole drainage combined with urokinase treatment are safe and effective in treating septated CSDH. They can clear the hematoma and improve neurological function; neuroendoscopic surgery can faster improve the neurological function and shorter postoperative hospitalization time.

The concept of subjective cognitive decline (SCD) is currently receiving much attention, as SCD has a high risk of transitioning to mild cognitive impairment (MCI) and dementia.The ATN biomarker diagnostic framework can accurately diagnose SCD as preclinical Alzheimer's disease (AD), which is an important window for precise prevention and treatment of AD.Based on the present diagnostic paradigms of clinical diagnosis and biomarker diagnosis for SCD, it is important to have fine management during the diagnostic process and precise communication and support after diagnosis for SCD patients, including diagnostic management specification, interpretation and recommendation diagnostic of biomarker disclosure, patients health management, and possible treatment for specific underlying causes.Previous studies have shown heterogeneity between clinical research and practice, and many doctors still feel unfamiliar with the concept of SCD and lack a systematic understanding.SCD diagnosis can provide patients with a certain degree of certainty, but it may also bring uncertainty about the expected risk of disease, and there is an urgent need to provide guidance to clinical doctors.So far, there is still a lack of Chinese expert consensus on diagnostic management specification, biomarker disclosure, and patient management of SCD.Based on the systematic summary of the current domestic and international research on the SCD, the consensus is written and aimed to improve the diagnosis and treatment level of SCD, guide high-quality preclinical AD research and lay the foundation for further clinical translation.

Objective: To summarize the clinical features of infection-associated autoimmune encephalitis (IAE) with different antibodies in Xinjiang region, and to explore the diagnostic value of relevant laboratory indicators for IAE. Methods: A total of 47 patients with IAE diagnosed and treated in People's Hospital of Xinjiang Uiger Autonomous Region from January 2018 to October 2023 were enrolled, including 18 cases (38.30%) of anti-leucine-rich glioma-inactivated 1 (LGI1) antibody-associated encephalitis, 16 cases (34.04%) of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, 8 cases (17.02%) of anti-myelin oligodendrocyte glycoprotein (MOG) antibody- associated encephalitis, and 5 cases (10.64%) of anti-γ-aminobutyric acid receptor type B (GABA_BR) encephalitis. Social demographic data, clinical manifestations, laboratory and other examinations were collected, and receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of relevant laboratory indicators for IAE. Results: The age of onset (χ² = 9.500, P = 0.023), myasthenia (χ² = 9.967, P = 0.019), vision loss (χ² = 9.967, P = 0.019) and seizures (χ² = 8.046, P = 0.045), cerebrospinal fluid (CSF) white blood cell count (χ² = 15.237, P = 0.002) and chloride (F = 4.156, P = 0.011) in patients with anti-LGI1 antibody-associated encephalitis, anti-NMDAR encephalitis, anti-MOG antibody-associated encephalitis and anti-GABA BR encephalitis were statistically significant. The age of onset in patients with anti-LGI1 antibody- associated encephalitis was larger than that in patients with anti-NMDAR encephalitis (Z =-2.384, P = 0.017) and anti- MOG antibody-associated encephalitis (Z =-2.420, P = 0.016). The CSF white blood cell count in patients with anti-NMDAR encephalitis was higher than that in patients with anti-LGI1 antibody-associated encephalitis (Z =-3.307, P = 0.001) and anti-MOG antibody-associated encephalitis (Z =-2.835, P = 0.005). CSF chloride was higher in patients with anti-NMDAR encephalitis (t = 3.159, P = 0.007) and anti-GABA_BR encephalitis (t =-4.592, P = 0.007) than in patients with anti-LGI1 antibody-associated encephalitis. ROC curve showed that the area under the curve (AUC) of age of onset for diagnosis of anti-LGI1 antibody-associated encephalitis was 0.722 (95%CI: 0.569-0.875, P = 0.012), the sensitivity was 0.556, the specificity was 0.821, and the cut-off value was 54.50 years old. The AUC of CSF white blood cell count in the diagnosis of anti-LGI1 antibody-associated encephalitis was 0.706 (95%CI: 0.558-0.855, P = 0.019), the sensitivity was 0.889, the specificity was 0.571, and the cut- off value was 4.50 × 10⁶/L. The AUC in the diagnosis of anti-NMDAR encephalitis was 0.790 (95%CI: 0.643-0.937, P = 0.002), the sensitivity was 0.600, the specificity was 0.967, and the cut-off value was 13.50 × 10⁶/L. The AUC of CSF chloride for the diagnosis of anti-LGI1 antibody-associated encephalitis was 0.748 (95%CI: 0.598-0.898, P = 0.005), with a sensitivity of 0.722 and a specificity of 0.714, and a cut- off value of 122.70 mmol/L. Conclusions: IAE with different antibodies in Xinjiang region has specific clinical features. Age of onset, CSF white blood cell count and chloride have important value in the diagnosis of anti-LGI1 antibody-associated encephalitis, and CSF white blood cell count has important value in the diagnosis of anti-NMDAR encephalitis.

As a mature neuromodulation technique, deep brain stimulation (DBS) has been widely used in the treatment of various neurological and psychiatric disorders. Parkinson's disease (PD) is one of the earliest indications for DBS and has received the most treatment so far. It has attracted extensive attention and in-depth research from the academic community for a long time, and has made remarkable progress in multiple fields. This review highlights the optimization of DBS for PD, focusing on two key directions: surgical technology innovation and neural circuit mechanism research. It explores the surgical technology innovation, equipment innovation, and programming strategy improvement of DBS, as well as the recognition and application of neural circuit markers. These studies not only significantly improve the efficacy of PD treatment, but also provide valuable ideas and scientific basis for the future development of neuromodulation technique.

Objective: To investigate the changes of retinal nerve fiber layer (RNFL) thickness and superficial vascular density in patients with Parkinson's disease (PD), and analyze the correlation between the changes and disease severity. Methods: Total 43 patients (76 eyes) with PD admitted to the Affiliated Hospital of North Sichuan Medical College from June 2021 to March 2022, and 45 patients (90 eyes) with normal neurological and visual functions from their family members were recruited as the control group. Optical coherence tomography angiography (OCTA) was used to measure RNFL thickness, retinal blood vessel length density and perfusion density, and the area and circumference of foveal avascular zone (FAZ). Disease severity was evaluated by modified Hoehn-Yahr staging, and motor function was evaluated by Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ) in PD group. Pearson and partial correlation analyses were used to investigate the correlation between retinal parameters and PD severity. Results: Comparison of OCTA related parameters between the 2 groups: RNFL thickness (t =-6.424, P = 0.000), central length density (t =-3.629, P = 0.000), inner ring length density (Z =-2.846, P = 0.004) and central perfusion density (Z =-2.703, P = 0.007) in the PD group were lower than those in the control group. Correlation analysis showed that RNFL thickness was negatively correlated with UPDRSⅢ score (r =-0.625, P = 0.000). Conclusions: RNFL thickness may be a potential indicator for early diagnosis and evaluation of the severity of PD.

Neurosurgical critical care is playing an increasingly pivotal role in the advancement of neurosurgery. It not only provides perioperative life support for neurosurgical patients but also addresses the treatment of severe cerebrovascular diseases and traumatic brain injury. Over the past two decades, major tertiary hospitals in China have established subspecialties dedicated to neurosurgical critical care. However, at the county level and other grassroots hospitals, the adoption of neurosurgical critical care concepts require further promotion. This paper reviews the development history of the neurosurgical critical care specialty and proposes measures to enhance the diagnostic and treatment capabilities of grassroots hospitals. These measures include standardizing core professional competencies, implementing high -quality multi-disciplinary team, and improving essential hardware configurations, with the goal of achieving standardized diagnosis and treatment in neurosurgical critical care.

Glioma is often recurred after standard treatment due to its complex biological characteristics and the presence of glioma stem cells (GSCs). High-mobility group box 1 (HMGB1) can regulate the malignant progression of glioma through a variety of ways as an oncogene. This article reviews the relationship between HMGB1 gene and the prognosis of glioma patients, tumor pathological grading, GSCs, and the ways including non coding RNA pathway, autophagy pathway, tumor microenvironment, etc., in which HMGB1 gene regulates glioma, so as to provide the reference for the treatment of glioma.

Objective: To explore the factors influencing the severity of acute phase and short-term prognosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and search for potential indicators for assessing disease severity and predicting prognosis. Methods: A total of 60 patients with anti-NMDAR encephalitis admitted to West China Hospital, Sichuan University from January 2020 to July 2023 were included. According to the modified Rankin Scale (mRS) during the acute phase, they were divided into mild group (mRS ≤ 3 score, n = 25) and severe group (mRS > 3 score, n = 35), as well as good outcome group (mRS ≤ 3 score, n = 32) and poor outcome group (mRS > 3 score, n = 28) based on the mRS score after one month of treatment at our hospital. Univariate and multivariate Logistic regression analyses were used to determine the risk factors of anti-NMDAR encephalitis with severe condition during the acute phase and poor short-term prognosis. Results: Logistic regression analysis showed consciousness disorder (OR= 8.975, 95%CI: 2.048-39.327; P = 0.004) and high level of neutrophil percentage-to-albumin ratio (NPAR; OR= 5.004, 95%CI: 1.138-22.011, P = 0.033) were the risk factors of anti-NMDAR encephalitis with severe condition during the acute phase, while high level of serum IgE was the protective factor (OR= 0.994, 95%CI: 0.989-0.999; P = 0.026). Female (OR= 4.380, 95%CI: 1.205-15.929; P = 0.025), consciousness disorder (OR= 5.493, 95%CI: 1.535-19.657; P = 0.009) and high level of NPAR (OR= 2.949, 95%CI: 1.010-8.612; P = 0.048) were the risk factors of anti-NMDAR encephalitis with poor short-term prognosis. Conclusions: Consciousness disorder, low serum IgE level and high NPAR are risk factors of anti-NMDAR encephalitis with severe condition during the acute phase, while female, consciousness disorder and high NPAR are risk factors of anti-NMDAR encephalitis with poor short-term prognosis. NPAR is a potential biological indicator for assessing disease severity during the acute phase and predicting short-term prognosis of patients with anti-NMDAR encephalitis.

Background: Central nervous system aspergillosis is clinically rare. We present one case of central nervous system aspergillosis diagnosed by pathology, analyze its clinical features, review the literature, and summarize key diagnostic and therapeutic points. Methods and Results: The patient, a 50-year-old woman, presented clinically with progressive weakness in limbs, epileptic seizures, and cognitive decline. Systemic inflammation-immune markers and cerebrospinal fluid (CSF) analysis showed no significant abnormalities. Head MRI revealed abnormal signals in both frontal and parietal lobes with patchy and ring-enhancing lesions and meningeal enhancement. Neuropathology suggested vasculitis and brain tissue necrosis with hemorrhage. Periodic acid methenamine staining revealed fungal hyphae with apparent septation and branching at 45° angles. The final diagnosis was central nervous system aspergillosis. Following antifungal and other symptomatic treatments, the patient's symptoms improved, and follow-up brain MRI showed reduction in lesion size. Conclusions: Patients with central nervous system aspergillosis may not have a clear underlying immunodeficiency, and clinical manifestations are lack of specificity. CSF may show no inflammatory changes, and metagenomic next-generation sequencing (mNGS) may be negative. Brain biopsy is the primary diagnostic method. Early, adequate and full-course antifungal treatment with voriconazole can improve the prognosis.

With the progress of medical and health conditions, the incidence and mortality of encephalitis and meningitis caused by traditional pathogens have decreased. However, due to the change of pathogen spectrum of neurological infection, the improvement of detection methods of neurological infection pathogens and the emergence of new evidence of pathogens causing neurodegenerative diseases, it is necessary to rethink the clinical characteristics and diagnosis and treatment of neurological infectious diseases (NID). At the same time, post-infectious/para-infectious nervous system diseases (PPINDs) that do not directly enter the central nervous system are increasing after the SARS-CoV-2 epidemic. Therefore, we propose to attach importance to the disciplinary characteristics and discipline construction of Infectious Neurology with NID and PPINDs as the two major themes, and to improve the diagnosis and treatment of NID and PPINDs through multi-disciplinary cooperation and specialized training.

Objective: To explore effective treatments and prognostic factors for diffuse intrinsic pontine glioma (DIPG). Methods: Clinical and imaging information and survival data of 14 DIPG patients, treated with radiotherapy combined with temozolomide and nitolizumab or radiotherapy combined with ACT001, were retrospectively analysed at Beijing Tiantan Hospital, Capital Medical University from April 2021 to January 2024. The median progression free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier survival curves, and multifactorial Cox regression analysis was used to investigate the effects of different factors on PFS and OS. Results: The objective response rate (ORR) was 10/14, and the median PFS and OS were 7.83 and 8.30 months, respectively. Multfactorial Cox regression analysis identified the absence of enhancement on baseline imaging as a good prognostic variable for both PFS (RR = 0.052, 95%CI: 0.006-0.416; P = 0.005) and OS (RR = 0.046, 95%CI: 0.005-0.413; P = 0.006), while male (RR = 0.085, 95%CI: 0.009-0.764; P = 0.028), older age (RR = 0.631, 95%CI: 0.423-0.942; P = 0.024), and the absence of symptoms of cranial nerve involvement at the onset (RR = 0.116, 95%CI: 0.017- 0.781; P = 0.027) were also good prognostic variables for OS. Conclusions: Female, younger age at diagnosis, cranial nerve involvement at the onset, and enhancement on baseline imaging are risk factors for the survival of children with DIPG.

Objective: To summarize the clinical characteristics of patients with anti-contactin-associated protein 2 (CASPR2) antibody-associated encephalitis. Methods and Results: Total 13 patients diagnosed and treated for anti-CASPR2 antibody-associated encephalitis at The Third Affiliated Hospital, Sun Yat-Sen University from August 2017 to August 2022 were collected. Initial manifestations: 9 patients exhibited limbic system symptoms, 2 patients presented with peripheral nerve symptoms (both with limb pain), one patient had cerebellar ataxia, and one patient had limb weakness. Anti-CASPR2 antibody detection: all the 13 patients underwent serum anti-CASPR2 antibody testing, which was positive in all cases; 10 patients underwent cerebrospinal fluid (CSF) anti-CASPR2 antibody testing, with 5 cases testing positive; 3 patients had other concomitant positive autoimmune antibodies. Head MRI examination: among the 13 patients, 2 patients head T₂-FLAIR showed hyperintensity in the medial temporal lobes either unilaterally or bilaterally; 2 patients had cerebral microbleeds. Treatment: 2 patients were treated only with steroids, 4 patients received only intravenous immunoglobulin (IVIg), 5 patients were treated with steroids and IVIg, one patient received rituximab only, and one patient received a combination of IVIg, steroids, protein A immunoadsorption and rituximab. Follow-up: follow-up ranged from 1-5 years, with 2 patients lost to follow-up; one patient relapsed after self-discontinuation of medication and achieved a modified Rankin Scale (mRS) score of 0 after treatment; of the remaining 10 patients, one patient showed no symptom improvement, one patient had some symptoms preventing normal life, 6 patients had normal life, 2 patients died. Conclusions: Anti-CASPR2 antibody-associated encephalitis has complex clinical characteristics, and serum antibody testing is crucial for diagnosis.

Objective: To report 4 cases of intracranial arterial stenosis stenting via radial artery approach and summarize the experience of treatment. Methods and Results: The clinical data and treatment process of 4 patients with ischemic stroke treated by intracranial arterial stenosis stenting via radial artery approach in The Affiliated Hospital of Qingdao University were reviewed in 2022. The stenoses were located in the initial segment of left internal carotid artery (ICA), the initial segment of right vertebral artery (VA), the V4 segment of left VA, and the junction of V4 segment of left VA and the basilar artery, respectively. All the 4 patients underwent transradial approach stenting for ICA stenosis. The surgery was successful and the stenoses were recanalized. No adverse reactions were observed during and after the surgery. Conclusions: Intracranial arterial stenosis stenting via radial artery approach is safe and effective in the treatment of ischemic stroke.