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IntroductionThe primary objective was to investigate the value of the fluid attenuated inversion recovery (FLAIR) signal intensity ratio (SIR) in identifying stroke within 4.5 h. The secondary objective was to ascertain whether large vessel occlusion (LVO) mediated the relationship between the SIR and stroke within 4.5 h.MethodsWe analyzed 633 acute stroke patients within 24 h of clear symptom onset. The SIR and DWI-FLAIR mismatch were evaluated. First, we determined whether demographic variables, vascular risk factors and LVO were related to stroke within 4.5 h with multivariate logistic regression analyses and stratified regression analysis. Next, we used mediation analysis to determine whether LVO explained the association between SIR and stroke within 4.5 h. Finally, we used receiver operating characteristic (ROC) analysis to assess the value of SIR, independent variable, and multiparameter models in identifying stroke within 4.5 h and compared with DWI-FLAIR mismatch.ResultsHyperlipemia, LVO and SIR were associated with stroke within 4.5 h. Mediation analysis revealed that LVO partially mediated the relationship between SIR and stroke within 4.5 h (p

BackgroundThe presence of fluid attenuated inversion recovery (FLAIR)-hyperintense lesions in anti-myelin oligodendrocyte glycoprotein (MOG) antibody-associated cerebral cortical encephalitis with seizures (FLAMCES) was recently reported. However, the clinical characteristics and outcome of this rare clinico-radiographic syndrome remain unclear.MethodsThe present study reported two new cases. In addition, cases in the literature were systematically reviewed to investigate the clinical symptoms, magnetic resonance imaging (MRI) abnormalities, treatments and prognosis for this rare clinico-radiographic syndrome.ResultsA total of 21 cases were identified during a literature review, with a mean patient age at onset of 26.8 years. The primary clinicopathological characteristics included seizures (100%), headache (71.4%), fever (52.3%) and other cortical symptoms associated with the encephalitis location (61.9%). The common seizure types were focal to bilateral tonic-clonic seizures (28.6%) and unknown-onset tonic-clonic seizures (38.1%). The cortical abnormalities on MRI FLAIR imaging were commonly located in the frontal (58.8%), parietal (70.6%) and temporal (64.7%) lobes. In addition, pleocytosis in the cerebrospinal fluid was reported in the majority of the patients (95.2%). All patients received a treatment regimen of corticosteroids and 9 patients received anti-epileptic drugs. Clinical improvement was achieved in all patients; however, one-third of the patients reported relapse following recovery from cortical encephalitis.ConclusionsFLAMCES is a rare phenotype of MOG-associated disease. Thus, the wider recognition of this rare syndrome may enable timely diagnosis and the development of suitable treatment regimens.

目的 利用半自动化分析软件对脑白质疏松患者不同区域白质损伤进行定量，并对其与认知功能评 分进行偏相关分析。 方法 2011年1月-2017年1月在北京天坛医院进行健康体检的50～85岁社区“健康”人群63例，对 其进行认知功能评价[简易精神状态量表（mi ni -mental state examination，MMSE）、蒙特利尔认知量表 （Montreal cognitive assessment，MoCA）]及影像学数据采集，基于液体衰减反转恢复序列定量计算全脑、 侧脑室旁及深部皮层下脑白质受损体积，将认知功能评分与以上白质受损体积进行偏相关分析，探 索白质受损在认知障碍发生发展过程中所起的作用。 结果 控制年龄、性别、文化程度后，全脑白质体积与MMSE评分、MoCA评分有偏相关性（R’=-0.428， P =0.001）（R’=-0.539，P＜0.001），尤其是侧脑室旁白质体积（R’=-0.427，P =0.001）（R’=-0.559，P ＜0.001），与深部皮层下白质也存在偏相关性（R’=-0.365，P =0.004）（R’=-0.447，P＜0.001）。 结论 全脑、侧脑室旁、深部皮层下脑白质损伤体积增大，认知功能评分随之下降；MMSE评分、 MoCA评分与侧脑室旁白质损伤之间的相关性较深部皮层下白质损伤更大。 Abstract: Objective To analyze white matter hyperintensity (WMH) in different brain regions in patients with cerebral leukoaraiosis using semi-automatic quantitative analysis software, and analyze the partial correlation of WMH and cognitive impairment. Methods A total of 63 ‘healthy’ community subjects (50-85 years) who had a physical examination in Beijing Tiantan hospital from January 2011 to January 2017 were included in this study. The cognitive function of all subjects were assessed using mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). We quantitatively analyzed the WMH in the whole brain, periventricular and deep cortex on fluid attenuated inversion recovery (FLAIR) sequence, which represented white matter lesion, and made a partial correlation analysis of the volume of white matter lesion and cognitive function score, to investigate the role of white matter lesion in the development of cognitive impairment. Results After adjusting for age, gender and education level, the volume of whole brain white matter lesion still had a partial correlation with MMSE and MoCA scores (R’=-0.428, P =0.001; R’=-0.539, P