Migraine, with its high prevalence, ranks as the second leading cause of disability among neurological disorders. Chronic migraine, in particular, imposes a greater disease burden, leads to poorer quality of life for patients, and results in higher healthcare resource consumption. Current conventional oral preventive medications often suffer from inadequate efficacy, poor tolerability, and potential drug-drug interactions, which can contribute to the persistence of headaches. This makes chronic migraine a significant clinical challenge and public health issue. Botulinum toxin type A injection has gained widespread attention as an effective preventive treatment for chronic migraine. This expert consensus is developed based on domestic and international advances in diagnosis and treatment, combined with the actual situation in China, with the aim of guiding neurologists and other relevant clinicians in the standardized use of botulinum toxin type A for the management of chronic migraine.
Multiple system atrophy (MSA) is a rare neurodegenerative disorder with very low incidence and prevalence worldwide. Clinically, it presents as a heterogeneous combination of autonomic failure, Parkinsonism and cerebellar ataxia. This review synthesizes current evidence on the epidemiology, subtype distribution, natural history and prognostic modifiers of MSA, with particular emphasis on the prodromal phase (e.g., rapid eye movement sleep behavior disorder and pure autonomic failure), hallmark clinical milestones after diagnosis (e.g., recurrent falls, wheelchair dependence, dysphagia, and inspiratory stridor), and key determinants of disease progression (including age at onset, severity of autonomic involvement, motor subtype and levodopa responsiveness). The clinical features and prognostic contrasts between young-onset and late-onset MSA are examined, and the future priorities focusing on biomarker development, early diagnosis and prodromal detection, and optimization of multidisciplinary care strategies are highlighted, aiming to inform clinical practice and interventional research.
Objective To improve clinician's understanding of the clinicopathological and imaging features of primary central nervous system malignant melanoma. Methods The clinical diagnosis and treatment data of one patient with primary central nervous system malignant melanoma were retrospectively analyzed, including clinical symptoms, magnetic resonance imaging (MRI) and PET-CT findings, as well as cerebrospinal fluid cytology and brain biopsy pathology. The diagnostic and therapeutic approaches were discussed in conjunction with relevant literature. Results The patient in this paper was an elderly male presenting with rapidly progressive dementia and gait imbalance as the main clinical manifestations. Cranial MRI demonstrated hyperintensities on T1- and T2-weighted imaging with significant contrast enhancement in extensive cortical involvement, lesions in the right cerebellar hemisphere, and bilateral sulcal, along with supratentorial hydrocephalus. Cerebrospinal fluid cytology revealed the presence of atypical cells containing melanin granules, and the diagnosis of primary central nervous system malignant melanoma was finally confirmed through pathological examination of a brain biopsy. Conclusion Patients with primary central nervous system malignant melanoma, characterized by diffuse leptomeningeal involvement and hydrocephalus on imaging, may present with rapidly progressive dementia. The characteristic MRI findings and cerebrospinal fluid cytological changes serve as key clues for early diagnosis, while definitive confirmation still relies on pathological examination.
Vascular dementia (VaD), as the second most prevalent type of dementia after Alzheimer's disease, seriously affects the quality of life of patients. Although VaD is theoretically reversible, there is currently no definitive treatment available. Traditional Chinese Medicine (TCM) has been widely employed in VaD management due to its distinct advantages of proven efficacy, minimal adverse effects, cost-effectiveness, and multi-target intervention. The integration of TCM with modern medical approaches can better serve clinical practices. This article systematically reviews the main research advances in VaD over the past decade from both clinical treatment and basic research perspectives. It covers the current mainstream clinical interventions for VaD, along with exploratory findings regarding the mechanisms and potential targets of TCM in VaD treatment. Furthermore, considering the current trends in scientific and technological advancements, we provide insights and prospects on future research avenues and therapeutic development for VaD.
Vascular cognitive impairment (VCI) is the second most common type of cognitive disorder in the elderly population, ranking only after Alzheimer's disease, with its clinical spectrum encompassing the entire progression from mild cognitive impairment to vascular dementia. Inflammaging, a prevalent low-grade chronic inflammatory state during aging, is closely associated with various age-related diseases, and has been confirmed to play a pivotal role in the occurrence and progression of VCI. The neurovascular unit (NVU), a core structure for maintaining normal brain function, consists of neurons, glial cells, vascular endothelial cells, pericytes, and the basement membrane. Through a complex intercellular signaling network, the NVU collaboratively regulates cerebral blood flow, maintains blood-brain barrier integrity, and provides the metabolic support for neuronal activity. This review focuses on the NVU to systematically elucidate the mechanisms by which inflammaging contributes to the development of VCI, aiming to reveal the intrinsic relationship between inflammaging and VCI from an inflammatory perspective and provide a theoretical basis for a deeper understanding of the pathophysiological processes of VCI.
Vascular dementia (VaD) is the second most common type of dementia after Alzheimer's disease, and its pathogenesis is closely related to chronic cerebral ischemia, neuroinflammation, and neuronal apoptosis. Recent studies have indicated that endoplasmic reticulum stress (ERS) plays a critical role in the pathological process of VaD. Cerebral ischemia and hypoxia can lead to the accumulation of unfolded/misfolded proteins in the endoplasmic reticulum lumen, triggering the unfolded protein response (UPR). Persistent ERS excessively activates core signaling pathways such as protein kinase RNA-like endoplasmic reticulum kinase (PERK)-eukaryotic translation initiation factor 2A (eIF2α)-activating transcription factor (ATF)4-C/EBP homologous protein (CHOP), inositol-requiring enzyme 1 (IRE1)α-X-box binding protein 1 (XBP1), and ATF6, ultimately inducing neuronal apoptosis. This article reviews the mechanism of ERS in VaD and focuses on the potential strategies of traditional Chinese medicine (TCM) for preventing and treating VaD. Research has shown that various TCM compound formulations (e.g., Taohong Siwu Decoction, and Buyang Huanwu Decoction) and TCM extracts (e.g., crocin, and tetrahydroxystilbene glucoside) can effectively inhibit ERS through multi-target and multi-pathway synergistic effects, alleviate oxidative stress and neuroinflammation, reduce neuronal apoptosis, and thereby improve cognitive function. Targeting the regulation of ERS provides a new direction for VaD treatment. In-depth research into the specific molecular mechanisms of TCM in preventing and treating VaD via the ERS pathway holds significant theoretical value and clinical translation prospects.
Vascular cognitive impairment (VCI) refers to a clinical syndrome primarily characterized by cognitive dysfunction caused by damage to brain tissue due to cerebrovascular disease. Its etiology is complex and diverse, encompassing underlying diseases, genetics, immunology, environmental factors, and other aspects. Most cases of VCI exhibit a chronic, insidious, and progressive onset, involving multiple clinical stages. Currently, modern medicine primarily focuses on treating individual etiologies, with considerable research on stroke prevention and treatment. Clinically, it is advisable to follow modern medical methods, control controllable risk factors, and intervene and treat early to achieve better primary or secondary prevention effects and delay disease progression. Regarding the cognitive impairment associated with VCI, modern medicine has not yet discovered effective therapeutic drugs. However, ancient Chinese medical texts contain treatment plans for corresponding conditions. Therefore, combining basic western medical treatment with traditional Chinese medicine (TCM) for the prevention and treatment of this disease has become a current research hotspot. This paper aims to explore the advancements in the prevention of VCI by collating preventive measures for VCI in ancient Chinese medical literature and combining them with modern medical methods, providing a reference for clinical practice.
Objective To enhance the efficiency of medical visits for patients with cognitive and emotional issues and the productivity of physicians, Longhua Hospital, Shanghai University of Traditional Chinese Medicine and Mental Health Center Affiliated to Shanghai Jiao Tong University School of Medicine have jointly established an outpatient clinic for the integrated traditional Chinese and western medicine diagnosis and treatment of amnesia and emotional management disorders. This article aims to explore the clinical value of this outpatient clinic, providing important clinical practice templates and preliminary data support for future in-depth mechanistic research and efficacy verification. Methods A retrospective descriptive analysis was conducted on the outpatient settings and visits to the outpatient clinic for amnesia and emotional management disorders treated with integrated traditional Chinese and western medicine from August 16, 2023, to October 29, 2025. Results The outpatient clinic for amnesia and emotional management disorders treated with both traditional Chinese and western medicine received a total of 540 patients, including 236 males (43.70%) and 304 females (56.30%); 368 adults (68.15%) and 172 minors (31.85%). The patient return visit rate was 20.00%, and the overall patient satisfaction rate was 89.45%. The most common disease treated was Alzheimer's disease (31.11%), followed by depression (23.15%), anxiety disorders (20.93%), and insomnia disorders (11.48%). Bipolar affective disorder (2.78%) and schizophrenia (3.15%) were less common. The most common treatment approach was the combination of traditional Chinese and western medicine (57.59%), followed by pure western medicine treatment (13.07%) and the combination of western medicine with traditional Chinese medicine and psychological therapy (11.67%). Conclusion The outpatient clinic for amnesia and emotional management disorders treated with integrated traditional Chinese and western medicine features a wide age distribution of patients (6-89 years old), a variety of diseases, high patient satisfaction, and a steady increase in outpatient volume. This study provides a reproducible operational blueprint for peers by integrating the application of traditional Chinese medicine's syndrome differentiation and Western psychiatry within the bio-psycho-social medical model, offering valuable reference for optimizing clinical services.
Cervical dystonia (CD) is the most common type of adult-onset focal dystonia, which can significantly impair patients' self-care ability and quality of life. Current mainstream therapeutic approaches include botulinum toxin therapy, pharmacotherapy, surgical treatment, physical therapy, psychological therapy, and characteristic therapies of traditional Chinese medicine (TCM). This paper conducts a literature review on the existing therapeutic modalities for CD and summarizes the efficacy, safety and limitations of different interventional measures. It is found that the existing therapies exert definite effects in managing the motor symptoms of CD, whereas obvious deficiencies remain in the efficacy evaluation and clinical attention to non-motor symptoms such as depression and anxiety. Future research should focus on exploring multimodal individualized treatment regimens integrating pharmacotherapy, surgery, rehabilitation and psychological intervention, so as to achieve precise matching of patients' treatment needs and comprehensive improvement of their quality of life.
Through a case report of Creutzfeldt-Jakob disease (CJD) featuring the cortical ribbon sign on cranial MRI, this article reviews the pathophysiological mechanism of this specific neuroimaging sign. It proceeds to explore the sign's association with a range of neurological diseases and its significance in diagnosis and differential diagnosis.
