类固醇激素在防治微血管减压术后迟发性面瘫中的作用

目的通过对在我科行微血管减压术（MVD）的145例面肌痉挛术后患者进行随访,研究类固醇激素在面肌痉挛患者接受微血管减压术后防治迟发性面瘫（DFP）中的作用。方法 2009年4至6月和2010年4至5月这两段时期,面肌痉挛行微血管减压术的病例145例,随访时间为6～18个月。全部由同一组医师实施手术。术前均予以检测单纯疱疹病毒（HSV）IgG、IgM。病例分为两组：A组93人,术后未应用类固醇激素。B组52人,自术后当天开始应用类固醇激素,持续4 w。对比分析迟发性面瘫发生率。结果 A组有5例发生迟发性面瘫（5/93,5.38%）,持续（56.6±37.7）d,按House-Brackmann分级,1例为Ⅳ级,2例为Ⅲ级,另2例为Ⅱ～Ⅲ级。B组有3例发生迟发性面瘫（3/52,5.77%）,持续（29.3±1.2）d,3例均为II级。两组病例迟发性面瘫发生率（P=0.2895）及面瘫持续时间（P=0.2711）无显著性差异。结论类固醇激素不能防止面肌痉挛微血管减压术后迟发性面瘫的发生,但是能有效减轻迟发性面瘫程度,缩短其病程（样本少,统计学差异不显著）。     

急性一氧化碳中毒患者迟发性脑病的临床治疗观察

目的 观察一氧化碳中毒后迟发性脑病的临床治疗情况.方法 本院急诊科2009年11月～2012年11月共收治急性一氧化碳中毒迟发性脑病患者38例,对其临床资料进行回顾性分析.结果 38例DEACMP患者临床症状均有不同程度的改善,其中18例基本痊愈（47.4％）,显效12例（31.6％）,8例好转（21.1％）.结论 一氧化碳中毒迟发性脑病患者有多种临床表现,影像学检查有助于临床诊断,一旦确诊,应立即给予对症治疗,早期、足疗程高压氧治疗能提高患者的生存质量,减轻社会和家庭的经济负担.     

面肌痉挛微血管减压术后迟发性面瘫危险因素及预后研究

目的评价面肌痉挛微血管减压术后迟发性面瘫发生的概率、风险因素、以及预后和恢复时间。方法回顾性连续纳入2012年6月至2017年6月四川大学华西医院神经外科经微血管减压术治疗的面肌痉挛患者256例,手术后门诊或电话随访,评价迟发性面瘫发生及恢复情况。分类变量采用卡方检验或Fisher确切概率法分析;连续变量采用独立样本t检验分析;迟发性面瘫的风险因素采用多因素逻辑回归分析。结果 256例患者平均随访24±4.5个月(8～60个月),18例(7%)患者出现迟发性面瘫。除1例患者发展成为永久性面瘫,另外17例患者自行痊愈。迟发性面瘫发生时间平均为术后10.4±1.6天(2～30天),除去1例永久性面瘫,面瘫持续时间平均为57.6±6.4天(7～220天)。高血压与迟发性面瘫发生有相关性(优势比4.228,95%置信区间1.078～15.489,P=0.035)。结论迟发性面瘫可能是一种自愈性疾病,绝大多数患者在没有任何特殊治疗的情况下可完全康复。此外,高血压与迟发性面瘫发生存在相关性。     

面肌痉挛显微血管减压术后迟发性面瘫

目的 探讨面肌痉挛显微血管减压术(MVD)后迟发性面瘫的病因、治疗及预后.方法 随访我院同一个术者自2007年1月至2009年11月行MVD治疗的415例面肌痉挛患者中术后出现迟发性面瘫者,研究面瘫的发生时间、持续时间及预后情况.结果 415例患者中20例术后出现迟发性面瘫,发病率4.8%.面瘫发生时间为术后5～14 d(平均10.7 d),持续时间为14～150 d(平均49.7 d);不论是否经过治疗,所有出现迟发性面瘫的患者均能够临床治愈.结论 MVD术后迟发性面瘫并不少见,发病原因尚不明确,可能与疱疹病毒感染有关,具有临床自愈性,预后佳.     

颅脑损伤合并迟发性面瘫临床诊治

目的探讨颅脑损伤合并迟发性面瘫的发病机理、诊断及治疗方法。方法回顾分析24例颅脑损伤合并迟发性面瘫的临床资料。结果24例中22例采取非手术治疗，21例有效，有效率87．5％，1例无效；2例手术治疗，均有效。结论外伤性迟发性面瘫可在伤后3d时出现；颅脑CT对颞骨骨折所致迟发性面瘫的诊断有重要参考价值；治疗早期采取保守治疗，两个月无效可行经乳突后鼓室切开、上鼓室进路面神经膝状神经节减压术治疗。     

中颅底骨折相关并发症的临床分析

目的探讨中颅底骨折及相关并发症的临床特点及治疗经验。方法本组61例中颅底骨折患者中伴有脑脊液漏的患者41例,除1例采用开颅修补硬脑膜,其余采用保守治疗;相关脑神经损伤31例,对于伤后即刻出现的面瘫,早期采用面神经管减压;颈内动脉海绵窦漏(CCF)3例,采取介入手术治疗。结果脑脊液漏患者均得到治愈,脑神经损伤患者有不同程度的好转,CCF患者均治愈;死亡2例。结论绝大多数中颅底骨折致脑脊液漏患者通过保守治疗能得到治愈,不需要开颅修补硬脑膜;对于伤后立即出现的面瘫,根据薄层CT扫描确定损伤部位,早期面神经管减压有助于面神经恢复;早期发现CCF并及时处理对患者病情恢复有重要意义。     

一氧化碳中毒继发癫痫97例的临床分析

目的：探讨一氧化碳（CO）中毒继发癫痫的临床特点,方法：对851例CO中毒者中的97例继发癫痫患者进行回顾分析。结果：癫痫发生率为11．4％,其中早期癫痫发作68例（70．1％）多于迟发性癫痫29例（29．9）（P＜0．01）。发作形式以强直－阵挛发作和强直性发作最多（60例,61．9％）,早期癫痫发作和迟发性癫痫均以中老年多见,分别为69．1％和79．3％。26例（26．8％）需长期服用抗癫痫药治疗,其中19例（19．6％）为迟发性癫痫。迟发性癫痫疗效远低于早期癫痫发作（P＜0．01）。结论一氧化碳中毒后癫痫以早期癫痫发作为主,多见于强直－阵挛性发作和强直性发作,早期癫痫发作预后良好,而迟发性癫痫较差。     

中西医结合治疗有机磷中毒迟发性神经病58例临床分析

有机磷中毒迟发性神经病(OPIDN)是严重的中毒性神经病，多在中毒症状缓解后2-3周出现，由于疗程长，恢复慢，给患者带来诸多不便，有的可致永久性肢体瘫痪，严重影响患者生活质量。1998年5月前我科采用营养神经、改善微循环、针灸等传统疗法治疗OPIDN，有效率达58％。自1998-06—2003-08，在传统疗法基础上，采用早期应用激素及联用中药治疗58例OPIDN，取得满意疗效．现报告如下。     

中西医结合治疗有机磷中毒迟发性神经病58例临床分析

有机磷中毒迟发性神经病(OPIDN)是严重的中毒性神经病,多在中毒症状缓解后2~3周出现,由于疗程长,恢复慢,给患者带来诸多不便,有的可致永久性肢体瘫痪,严重影响患者生活质量。1998年5月前我科采用营养神经、改善微循环、针灸等传统疗法治疗OPIDN,有效率达58％。自1998-06~2003-08,在传统疗法基础上,采用早期应用激素及联用中药治疗58例OPIDN,取得满意疗效,现报告如下。1 临床资料     

颅内压监测在颅脑外伤术后早期发现迟发性血肿中的价值

目的探讨颅内压监测在颅脑外伤术后早期发现迟发性血肿中的价值。方法收集郑州大学第二附属医院2011-09—2017-09 80例颅脑外伤术后迟发性血肿并再次手术者,随机数字表法分为观察组和对照组各40例,对照组给予传统方法测定患者颅内压,观察组给予连续性颅内压监测,比较2组患者迟发性血肿发现时间和治疗效果。结果在12h内发现迟发性血肿例数观察组多于对照组,差异具有统计学意义(P0.05);观察组治疗效果优于对照组,差异具有统计学意义(P0.05)。结论采用颅内压监测可以早期发现颅脑外伤术后迟发性血肿,有利于患者及时治疗,值得临床推广。     

Comparative study of thyrotoxic periodic paralysis from idiopathic hypokalemic periodic paralysis: An experience from India

Objective:

There is paucity of reports on thyrotoxic periodic paralysis (TPP) from India. We report the patients with TPP and compare them with idiopathic hypokalemic periodic paralysis (IHPP).

Materials and Methods:

Patients with hypokalemic periodic paralysis (HPP) treated during the past 11 years were evaluated retrospectively. Their demographic parameters, family history, clinical features, precipitating factors, severity of weakness, laboratory parameters and rapidity of recovery were recorded. The demographic, clinical and laboratory parameters of TPP and IHPP were compared.

Results:

During the study period, we managed 52 patients with HPP; nine (17.3%) of whom had TPP and 27 (52%) had IHPP. The demographic, precipitating factors, number of attacks and severity of limb weakness were similar between the TPP and IHPP groups, except in the IHPP group, bulbar weakness was present in four and respiratory paralysis in six, needing artificial ventilation in two patients. Serum potassium was significantly lower in TPP (2.21 ± 0.49) compared with IHPP (2.67 ± 0.59, P = 0.04). Four patients with TPP had subclinical thyrotoxicosis and two had subclinical hyperthyroidism. Rebound hyperkalemia occurred in both TPP and IHPP (three versus eight patients). The recovery was faster in IHPP (26.7 ± 15.4 h) compared with TPP (34.0 ± 14.0 h), but was statistically insignificant.

Conclusion:

TPP constitutes 17.3% of HPP, and absence of clinical features of thyrotoxicosis and subclinical hyperthyroidism in TPP is not uncommon. Clinical features, demographic profile and rebound hyperkalemia are similar in both TPP and IHPP. The serum potassium level is significantly low in the TPP compared with the IHPP group.     

The Assessment of the Phenomenology of Sleep Paralysis: The Unusual Sleep Experiences Questionnaire (USEQ)

Previous research has found a relationship between sleep paralysis (SP) and anxiety states and higher rates have been reported among certain ethnic groups. To advance the cross-cultural study of SP, we developed a brief assessment instrument (which can be self-administered), the Unusual Sleep Experiences Questionnaire (USEQ). In this article, we report on a pilot study with the USEQ in a sample of 208 college students. The instrument was easily understood by the participants, with one quarter reporting at least one lifetime episode of SP. As in previous studies, SP was associated with anxiety (in particular, panic attacks).     

Locked-in syndrome with bilateral ptosis: combination of bilateral horizontal pontine gaze paralysis and nuclear oculomotor nerve paralysis

Summary A patient with a classical locked-in syndrome is described, in whom bilateral ptosis was observed on the 2nd day. On the 4th day, ophthalmoplegia was complete with the exception of a voluntary downward movement of the right eye. The syndrome can be explained by the association of bilateral horizontal pontine gaze palsy and a unilateral nuclear oculomotor nerve palsy, and approximates the total locked-in syndrome.     

Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients

Background:

Hypokalemic paralysis is characterized by episodes of acute muscle weakness associated with hypokalemia. In this study, we evaluated the possible etiological factors in patients of hypokalemic paralysis.

Materials and Methods:

We reviewed the records of 29 patients who were admitted with a diagnosis of hypokalemic paralysis. Modified Guillain-Barre´ Syndrome disability scale was used to grade the disability.

Results:

In this study, 15 (51.7%) patients had secondary causes of hypokalemic paralysis and 14 patients (42.3%) had idiopathic hypokalemic paralysis. Thyrotoxicosis was present in six patients (20.6%), dengue infection in four patients (13.7%), distal renal tubular acidosis in three patients (10.3%), Gitelman syndrome in one patient (3.4%), and Conn''s syndrome in one patient (3.4%). Preceding history of fever and rapid recovery was seen in dengue infection-induced hypokalemic paralysis. Approximately 62% patients had elevated serum creatinine phosphokinase. All patients had recovered completely following potassium supplementation. Patients with secondary causes were older in age, had significantly more disability, lower serum potassium levels, and took longer time to recover.

Conclusion:

In conclusion, more than half of patients had secondary causes responsible for hypokalemic paralysis. Dengue virus infection was the second leading cause of hypokalemic paralysis, after thyrotoxicosis. Presence of severe disability, severe hypokalemia, and a late disease onset suggested secondary hypokalemic paralysis.     

钾敏感型周期性麻痹一个家系研究

目的　探讨正常血钾型家族性周期性麻痹的临床、病理特点及可行的治疗方法。方法　对一个血钾正常的周期性麻痹患者家系进行临床及病理研究。结果　该家系 4代 1 8名有血缘关系的家庭成员中 ,共有 8名男女成员患病 ,符合常染色体显性遗传方式。受累成员均在 1 0岁前发病 ,表现为发作性四肢无力 ,持续 1～ 2周后逐渐恢复。间歇期基本正常。儿童期发作频繁 ,为每月数次 ,不能上学。青春期后发作减少 ,约每年数次。常见诱因有饥饿、寒冷、兴奋、剧烈运动后休息及进食西瓜等。发作时及发作后血钾均正常。钾负荷试验诱发出典型全身无力发作 ,静脉滴注葡萄糖及胰岛素能迅速缓解。肌电图检查支持周期性麻痹诊断。肌肉活检未发现明显病理学改变。使用已报道的治疗方法均不能有效缓解生活因素诱发的肌无力。结论　血钾正常的钾敏感型周期性麻痹很可能是高钾型周期性麻痹的变异型 ,但与已报道的家系又有诸多不同 ,需进一步研究其分子缺陷及离子通道特性。     

甲亢性周期性瘫痪18例临床分析

目的　分析甲亢性周期性瘫痪。方法　回顾 18例甲亢性周期性瘫痪临床资料。结果　青壮年男性多发。其中 8例误诊为非甲亢性周期性瘫痪 ,发作时均有低血钾 ,T3 、T4 均高于正常。补钾治疗迅速有效 ,甲亢控制不好易复发。结论　青壮年男性患低血钾瘫痪 ,在积极补钾同时要注意查T3 、T4 ,确诊甲亢性周期性瘫痪 ,抗甲亢治疗 ,是防止复发的关键。     

甲亢性周期性麻痹94例临床分析

目的：探讨甲亢性周期性麻痹(TPP)的临床特点。方法：对94例TPP临床资料进行回顾性分析和总结。结果：中国北方人TPP发生率占同期住院甲亢患者的5．8％,男女比例93：1,21～40岁为发病高峰年龄,肌无力发作期97．6％(80／82)的病例血钾低于正常。结论：中国北方人住院甲亢患者了PP发生率为5．8％,98．9％7PP为男性青年;低钾性周期性麻痹是其最常见临床类型。     

Lifetime prevalence rates of sleep paralysis: a systematic review

Objective

To determine lifetime prevalence rates of sleep paralysis.

Data sources

Keyword term searches using “sleep paralysis”, “isolated sleep paralysis”, or “parasomnia not otherwise specified” were conducted using MEDLINE (1950–present) and PsychINFO (1872–present). English and Spanish language abstracts were reviewed, as were reference lists of identified articles.

Study selection

Thirty five studies that reported lifetime sleep paralysis rates and described both the assessment procedures and sample utilized were selected.

Data extraction

Weighted percentages were calculated for each study and, when possible, for each reported subsample.

Data synthesis

Aggregating across studies (total N = 36,533), 7.6% of the general population, 28.3% of students, and 31.9% of psychiatric patients experienced at least one episode of sleep paralysis. Of the psychiatric patients with panic disorder, 34.6% reported lifetime sleep paralysis. Results also suggested that minorities experience lifetime sleep paralysis at higher rates than Caucasians.

Conclusions

Sleep paralysis is relatively common in the general population and more frequent in students and psychiatric patients. Given these prevalence rates, sleep paralysis should be assessed more regularly and uniformly in order to determine its impact on individual functioning and better articulate its relation to psychiatric and other medical conditions.     

丘脑出血的眼征

对50例丘脑出血患者的眼征进行了临床观察和病理机制探讨,发现Horner征者10例(占20％);各种类型垂直性注视麻痹者18例(36％),其中双眼上视麻痹者最多9例,上视和下视联合麻痹者5例,垂直性一个半综合征2例,单眼上视或下视麻痹者各1例;水平侧视麻痹14例(28％)。