Abstract:Objective To estimate the application value of head-neck CT angiography（ CTA） and whole brain CT perfusion（ CTP） in patients with chronic cerebral ischemia by the correlation comparison study of head-neck CTA and brain CTP. Methods A total of 150 patients' CTA and CTP were analyzed for their correlations with the distribution of perfusion region， responsible blood vessels and perfusion abnormalities. Results The responsible vessels of 98.72% perfusion abnormal region were moderate vascular stenosis. With the aggravation of the degree of the stenosis of the responsible vessels， the proportion of abnormal region of perfusion was significantly increased. The degree of responsible vascular stenosis was moderately positively correlated with the staging of CTP in the pre-infarction stage. Conclusions Combined with the results of headneck CTA and whole brain CTP， the degree of chronic ischemia in patients with chronic cerebral ischemia can be comprehensively evaluated， which is more conductive to the selection of clinical treatment.

Abstract:Objective To explore the characteristics of comorbidity of chronic insomnia disorder（ CID） and restless legs syndrome（ RLS）. Methods A consecutive case series of CID were enrolled into the study. The patients' general information， etiological subtype， RLS symptoms investigation and RLS symptom severity scale were recorded. All patients were divided into CID with RLS group（ CID+RLS） and CID without RLS group（ CIDRLS）， and the distribution of etiological subtype was compared between two groups. Results 117 cases of CID were enrolled from 122 consecutive cases， the other 5 cases were eliminated because of unable cooperation. 50 cases（ 42.7%） comorbided two or more etiological subtypes. The incidences of insomnia due to mental disorders， insomnia due to medical disorders， psychological physiology insomnia were 50（ 42.7%） ，41（ 35.0%） and 32（ 27.4%） respectively. Insomnia due to other sleep disorder were 33（ 28.2%）， 30 cases of which（ 25.6%） were for RLS. Compared with the CID-RLS group， CID+RLS group had insomnia more due to medical disorders （40.0% vs 12.6%， P=0.001）， CID+RLS group had insomnia less due to poor sleep hygiene， physiologic insomnia， and unspecified（ 3.3% vs 18.4%， P=0.044； 0% vs 13.8%， P=0.032）. Conclusions In the Neurological outpatients， nearly half comorbid two or more kinds of subtypes. It is more common to have insomnia due to mental disorders， medical disorders and psychological physiology insomnia among CID outpatients. The subtypes of two groups are significantly different.

Abstract:Objective To explore the clinical features of children's head shotgun injury at long distance by pellet and its neurosurgical treatment. Methods The clinical data of 12 children with skull shotgun wounds by pellet at distance， who were consecutively admitted in our hospital from January 2000 to January 2017 were retrospectively analyzed. The differences between children's head shotgun injury and general firearm injury in adults were studied. The neurosurgical treatment of children's head shotgun injury at long distance by pellet was summarized. Results There were three cases of local debridement， seven cases of craniotomy， two cases of stereotactic surgery and one case of re-craniotomy for the metal foreign bodies. There were six cases of metal foreign body residues after operation， two cases of postoperative infection， one case of postoperative epilepsy and one case of permanent neurological dysfunction. Conclusions Children's head shotgun injury at distance seems to have a better outcome compared to adults gunshot wounds， with considerable postoperative longterm effects. A relatively conservative debridement is suggested for this kind of gunshot injury， so as to avoid aggravating neurological damage. There is no significant increase in the incidence of postoperative infection and epilepsy with the presence of residual metal in the cerebral.

Abstract:Anti-N-methyl-D-aspartate receptor encephalitis is a kind of autoimmune encephalitis of central nervous system. The clinical symptoms are complex. The clinical manifestations are characterized by mental and behavioral abnormalities， involuntary movements， seizures and disturbance of consciousness. The difference of mental disorder caused by anti N-methyl-D-aspartate receptor encephalitis and functional disease and the role and significance of electroencephalogram in its diagnosis are discussed in combination with two cases.

Abstract:Cerebral vasospasm is considered as the main cause of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Its pathogenesis is not clear yet， and its curative effect is not good. Recent studies have demonstrated that cerebral vasospasm following subarachnoid hemorrhage is influenced by many factors， including cerebral vascular dysfunction， oxidative stress， cortical depolarization， immune response， and so on. This is to review the possible pathogenesis and prevention and treatment of cerebral vasospasm after subarachnoid hemorrhage.

Abstract:Maladaptive daydreaming（ MD）， also called the excessive daydreaming or compulsive fantasy， is a fantasy activity described as a behavioral addiction for vivid fanciful imagery， which interferes human interaction and/or interferes with academic， interpersonal， or vocational functioning. Based on previous research， this paper synthesizes the current status of research on maladaptive daydreaming， including the concept， measurement， structured clinical interview， as well as the comorbidity on attention deficit hyperactivity disorder（ ADHD）， obsessive-compulsive disorder（ OCD） and other mental disorders in Diagnostic and Statistical Manual of Mental Disorders（ DSM-5）. This paper also introduces the antecedents， features， maintenance factors and results of MD. Future research should expand the sample to explore MD in the Chinese context， and further study the antecedents and comorbidity of MD， so as to develop treatment models and early intervention methods.

Abstract:Growth differentiation factor-15（ GDF-15） is a new divergent member of the transforming growth factor-β（ TGF-β） superfamily. Research on GDF-15 is currently focused on its anti-inflammatory， anticell proliferation， and inhibition of tumor growth. In the nervous system， researchers found that GDF-15 is a protective factor for nigral dopaminergic neurons， a new trophic factor for motor and sensory neurons， a predictor of cerebrovascular disease and brain damage. Recent studies have shown that GDF-15 also has the function of modulating the expression of neuronal ion channels and affecting the function of synaptic transmission. This review summarizes the biological characteristics of GDF-15 and its recent advances in neurological diseases.

Abstract:Obsessive-compulsive disorder（ OCD） is a refractory mental illness with complicated etiology. The application of imaging technology in mental illness is more extensive， and plays an increasingly important role in exploring the pathogenesis of OCD. Studies have found abnormal functional connectivity in the prefrontal cortex and subcortical structures of patients with OCD through functional magnetic resonance imaging（ fMRI）. OCD is a heterogeneous disease， therefore different neural circuits may mediate different obsessive compulsive symptoms. This paper is to analyze the research progress of OCD in recent years from the perspective of the pathogenesis of the brain， and to review he current research on the pathogenesis of OCD and its correlation with clinical symptoms.