肝性脑病患者的EEG、CT和MRI研究

目的 描述肝性脑病患者的临床表现及脑电图(EEG)、颅脑CT、MRI特点,评价EEG、CT、MRI对该病的诊断价值.方法 总结17例各种原因引起的肝性脑病患者的临床表现、血氨水平,对全部病例进行EEG、颅脑CT、MRI检查.结果 17例肝性脑病患者EEG异常15例,主要表现为:基本节律慢化;中波～高波幅θ活动;散在的δ波、三相波.MRI检查阳性14例,主要特点为双侧苍白球(14/17)、豆状核(4/17)、中脑被盖(7/17)T1WI高信号,T2WI等信号,T2FLAIR序列可见大脑半球白质区双侧对称性高信号.CT检查在同一部位未见异常信号.结论 肝性脑病患者EEG、颅脑CT和MRI检查各具有特征性,可为临床诊断提供重要信息.     

Interictal regional cerebral blood flow and electrical source analysis in patients with complex partial seizures

BACKGROUND: Recently, new methods of EEG source analysis have been developed. Dipole modeling and brain distributed source analysis localize in three-dimensions the origin of the electrical source of spikes registered in EEG. With single photon emission computed tomography (SPECT), it is possible to detect hypo- and hyperperfusion zones. Our aim in this study is to compare the regions where the electrical sources are detected, with the hypoperfusion regions in patients with complex partial seizures (CPS). METHODS: The concordance of localization with dipole analysis, brain distributed source analysis and regional cerebral flow blood in patients with CPS was studied. The hypoperfusion zones detected with interictal SPECT were compared with electrical sources localized with brain electric source analysis (BESA) and brain distributed source analysis with variable resolution electromagnetic tomography (VARETA). RESULTS: Hypoperfusion zones were found to localize with the origin of dipoles in 18 cases (90%), between lobes in 17 (85%) and between mesial or lateral regions in the temporal lobe in 12 cases (60%). With VARETA, agreement between side of hypoperfusion and electrical current source localization was found in 18/20 cases (90%), with lobes in 17 (85%) and with mesial or lateral regions of the temporal lobe only in 2 cases (10%). CONCLUSIONS: Hypoperfusion zones in interictal SPECT of patients with CPS are in agreement with the origin of dipoles in 85% of the cases, but in specifics zones of temporal lobe the agreement falls to 60%. The concordance of hypoperfusion zones was better with dipole analysis than with VARETA.     

减压后脑体积肿大的病理生理基础

36只家猫按脑缺血(EEG平坦),(CBF为0)时间(25分钟、15分钟、5分钟)分为三组。每组均为12只,其中6只减压后注入2％Evans蓝(4mg/kg),另6只用于组织学检查。Evans蓝染色:急性脑肿大脑干及下血脑重度着色,而迟发性脑肿大大脑半球重度着色。组织学改变:急性脑肿大以脑干和下丘脑损伤、血管充血性扩张为主要改变、迟发性脑肿大以大脑半球水肿为主要改变。结论、脑干和下丘脑损伤而致脑血管麻痹性扩张,脑血容量增多即脑肿胀是急性脑肿大的主要病理生理基础。而缺血性脑水肿是迟发性脑肿大的主要病理生理基础。     

Protective action of phenytoin on cerebral ischemia in rats]

In order to study and modify the ischemic brain lesions, protecting the reversible damage of neurons, and limiting the ischemic damage both models of cerebral ischemia--focal cerebral ischemia induced by photochemically, and brain reperfusion after ligation of common carotid arteries bilateral in Wistar rats were used to investigate the protective effect of diphenylhydantoin (DPH) on cerebral ischemia. Two groups of rats received DPH 10 mg/kg and 30 mg/kg respectively were compared with those having received normal saline immediately after cerebral ischemia. The effects of DPH on the changes of EEG, biochemical marker and pathologic lesion in focal cerebral ischemia in rats were evaluated. The results showed that the degree of restoration of EEG in the group treated with DPH was better than in the group with normal saline, the content of water in ischemic cerebral tissue was decreased significantly (P < 0.05), the activity of Na-K-ATPase and antioxidant was increased significantly (P < 0.01, P < 0.05, respectively), and the percentage of necrotic neurons in periischemic area was decreased markedly (P < 0.001) in groups treated by DPH. The results suggest that there is a definite protective effect of DPH on cerebral ischemia.     

227例颅内肿瘤的脑电图分析

本文227例经手术和病理证实的颅内肿瘤中,幕上肿瘤脑电图160例,除1例误诊为正常外,余均为不正常脑电图.其中局灶性慢波122例(76.2%),患侧慢波18例(11.2%),即140例(87.4%)有定位定侧诊断意义.19例为弥散性异常,而其中18例为中线深部肿瘤.67例颅后凹肿瘤脑电图,除18例桥小脑角肿瘤中的11例正常外,余56例均为广泛不正常.这说明半球肿瘤脑电图多为局灶性慢波,而弥散性慢波以颅后凹或中线深位肿瘤为主.桥脑小脑角肿瘤脑电图50%以上为正常.     

脑再灌流对大鼠脑水肿的影响

使用大鼠4—动脉阻断模型,观察脑缺血30min,再灌15、30、60和180min各组动物脑含水量,伊文思蓝血管外渗和超微结构的改变。结果发现脑含水量增加,再灌流时较单纯缺血明显。单纯缺血和再灌流15min为细胞性脑水肿,再灌30～180min时,细胞性和血管源性脑水肿同时存在。     

当归与阿魏酸钠对促进局灶性脑缺血再灌注后神经功能恢复作用的比较

目的:研究当归及其主要成分阿魏酸钠(SF)对促进脑缺血再灌注后神经功能恢复的作用,并将两者进行比较。方法:雄性Wistar大鼠60只,改良线栓法制作大脑局灶性脑缺血再灌注模型后(n=45),分别分为当归组、SF组和对照组,每组15只,假手术组(n=15)线栓仅插入1 cm,各组动物分别取2,7,14 d 3个时间点,观察神经功能恢复、脑梗死体积、脑含水量。结果:当归组Bederson评分在术后第7天开始优于对照组(P<0.05),SF组在第2,7天均优于对照组(P<0.05)。SF组横木行走测试评分在各时间点均高于对照组(P<0.05),当归组与对照组相比无显著性差异。SF组足失误测试评分在术后2,14 d低于对照组(P<0.05),当归组与对照组相比无显著性差异。SF组脑梗死体积在各时间点均明显小于对照组,且在14 d小于当归组(P<0.05),当归组只在术后2,14d小于对照组(P<0.05)。除SF组外,各组脑含水量均呈逐渐上升趋势,SF组在术后2 d高于其它各组,术后14 d低于其它各组(P<0.05)。当归组在术后7,14 d低于对照组(P<0.05)。结论:当归和SF都能改善脑缺血再灌注后的神经功能,减小脑梗死体积,减轻脑水肿,但在促进神经功能恢复方面,SF可能发挥早期作用,减小脑梗死体积和减轻脑水肿的功能的作用强于当归,SF可能是当归治疗脑缺血再灌注损伤的主要有效成份。     

脑伤宁对大鼠脑缺血再灌注损伤的保护作用

目的观察脑伤宁对大鼠脑缺血再灌注脑损伤的保护作用。方法凝闭大鼠双侧椎动脉4~5 h后,夹闭颈总动脉30 min,再灌注90 min,造成大鼠脑缺血再灌注损伤模型,观察脑伤宁对脑组织中生化指标及脑电图的影响。结果缺血再灌注造成脑组织严重损伤,脑组织中水、Na 、Ca2 含量及丙二醛(MDA)含量较对照组明显增高,而超氧化物歧化酶(SOD)活力较对照组降低,并伴有脑电图异常和脑组织结构病理性改变。夹闭颈总动脉前30 m in腹腔注射脑伤宁能降低脑组织中水、Na 、Ca2 含量及MDA含量,并提高SOD活力,对组织学检查及脑电图也有所改善。结论脑伤宁对脑缺血再灌注损伤具有保护作用。     

血管性痴呆大鼠的记忆行为改变与突触结构参数的关系

目的：研究大鼠在慢性脑灌注不足状态下的记忆行为改变以及大脑皮层和海马的突触结构参数改变，探讨记忆行为改变和突触结构参数的关系。方法：采用老年大鼠持久双侧颈总动脉结扎造成慢性脑缺血动物模型，分为正常对照组，缺血2月组，缺血4月组，电脑控制穿梭箱系统观察大鼠记忆行为改变，电镜下观察突触超微结构改变，应用体视学方法和图像分析，对突触结构参数（突触数密度，突触活性带长度，圆盘面积、表面密度）进行分析，并分析两者关系，结果：电脑控制穿梭箱系统观察大鼠主动回避反应（AAR）及被动回避反应（PAR）在缺血2月及4月组均下降，皮层及海马在缺血2月组，缺血4月组突触数密度（Nv)均明显下降，海马在缺血2月组，缺血4月组突触活性带长度（L），突触连接带圆面积（S）及突触表面密度（Sv)均下降，皮层在缺血2月组，缺血4月组未见明显改变。结论：在慢性脑灌注不足状态下的突触数密度下降，突触活性长度减小与记忆行为改变有关。     

Serum testosterone and electroencephalography spectra in developmental male rhesus Macaca mulatta monkeys

BACKGROUND: The main objectives in this work were to determine whether the relationship between serum testosterone concentration and electroencephalography (EEG) develop mental change observed in human males is also present in Macaca mulatta and, if so, to determine which frequency bands are involved and which regions change in pre-pubertal monkeys as a function of serum testosterone concentration. METHODS: Nine healthy monkeys were divided into three groups according to age. Serum testosterone was measured using immunoenzymatic chemiluminescent assay. EEG results were processed using Fast Fourier transform; average relative spectral power analysis was calculated and separated into delta and theta bands. RESULTS: The main findings were higher delta relative power in temporal area of the youngest group. Significant positive correlations were observed between serum testosterone levels and theta relative power across the entire scalp, and between theta relative power at frontal and temporal locations and in negative direction between delta relative power in temporal areas. Partial correlations controlling for cephalic perimeter remained significant between testosterone and total theta relative power and theta relative power in temporal areas. Partial correlations remained significant for theta relative power controlling for age at temporal locations. CONCLUSIONS: Our data show that testosterone may be a significant covariate in EEG development in Macaca mulatta males.     

中风康对局灶性脑缺血大鼠脑水肿的影响

目的 探讨中风康对局灶性脑缺血大鼠脑水肿的影响。方法 采用线栓法复制局灶性脑缺血大鼠模型，以步长脑心通为对照，于脑缺血6、12、24、48h动态观察中风康对局灶性脑缺血大鼠脑水肿的影响。结果 与假手术组比较，大鼠局灶性脑缺血6h，模型组出现明显脑水肿（P〈0．01），随缺血时间延长，水肿逐渐进展，至24h水肿达到高峰（P〈0．01），与同时点模型组比较，各治疗组脑水肿均有不同程度减轻，以中风康高剂量组减轻最为显著（P〈0．01）。结论 中风康可减轻脑水肿，有效维护血脑屏障的完整性，减轻局灶性脑梗死引起的缺血性损伤。     

小檗碱对实验性脑缺血的改善作用

小檗碱５、１０、２０ｍｇ／ｋｇ腹腔注射，可显著延长双侧颈总动脉结扎臻脑缺血小鼠的存活时间。自颅外阻断大鼠大脑中动脉造成局灶性脑缺血模型，小檗柘２０、４０ｍｇ／ｋｇ于术前，能缩小缺血２小时造成的梗塞范围，减轻神经功能障碍。小檗碱４０ｍｇ／ｋｇ能提高大鼠急性脑缺血３０分钟时的血浆，海马及皮层脑组织的超氧化物岐化酶活力，降低丙二醛含量。结果表明，小檗碱对缺血脑组织有保护作用，其机理推测与其抗氧自由基损伤     

脑表面大体摄影评价小鼠局灶性脑缺血后脑水肿变化

目的：建立脑表面大体摄影评价小鼠局灶性脑缺血后脑水肿变化的新方法。方法：采用大脑中动脉阻塞法诱导小鼠持续性局灶性脑缺血，于缺血后10、30min，1、3、6、12、24h取脑，用数码相机作脑顶面及侧面摄影；然后切成6片1mm厚的脑片进行摄影；最后，恒温烤干脑组织测定脑含水量。以MedBrain-2软件计算脑表面及脑片面积，评估脑水肿程度。结果：脑表面摄影测定面积的方法显示小鼠局灶性缺血后1h开始，缺血侧的脑面积明显增加，与脑含水量的结果一致。该方法测量脑水肿与脑含水量及脑片体积测量有较好的相关性。结论：脑表面大体摄影法是客观、定量评价局灶性脑缺血后脑水肿变化方法的一种补充，具有简便、敏感、不需前处理等优点。     

Senile dementia of the Binswanger type. A vascular form of dementia in the elderly

Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnection most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia.     

灯盏花素冰片注射液对实验性脑缺血的保护作用

目的:研究灯盏花素冰片注射液(SBI)对大鼠局灶性脑缺血和小鼠缺血缺氧性损伤的保护作用。方法:采用大鼠急性不完全性脑缺血实验,以大脑皮层含水量为指标初步筛选组方剂量。采用大鼠局灶性脑缺血再灌注损伤模型(MCAO)对模型大鼠进行神经症状和行为学评分,测定大脑皮层含水量,计算脑梗死区百分比,组织病理切片观察海马损伤程度,并测定脑组织内总抗氧化能力(T-AOC),丙二醛(MDA)和乳酸(LD)含量以及超氧化物歧化酶(SOD)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、Na -K -ATP酶、Ca2 -Mg2 -ATP酶、总ATP酶(T-ATP)活力等生化指标;采用小鼠急性不完全性脑缺血实验和小鼠常压耐缺氧实验,测定其存活时及对耐缺氧能力的影响。结果:灯盏花素12mg/kg与冰片0.48mg/kg配伍对模型大鼠降低其脑含水量作用最为显著。与模型对照组比较,SBI组尾静脉注射能使动物的神经行为学评分,脑梗死率和脑含水量显著降低,能显著改善海马区神经元的形态,同时还能明显增强MCAO后大鼠脑组织内T-AOC能力,增加脑组织SOD,显著减少脑组织内MDA含量,同时对于脑组织内CK活力、LDH活力也有显著的增加作用,还能显著减少MCAO后大鼠脑组织LD含量,显著增加Na -K -ATP酶、Ca2 -Mg2 -ATP酶及T-ATP酶活力。结论:SBI高剂量组可以极显著延长急性不完全性脑缺血小鼠存活时间和耐缺氧能力。结论:SBI对实验性脑缺血具有保护作用。     

急性缺血性脑血管病的脑电变化分析

目的：对急性缺血性脑血管病患者的脑电图进行动态分析,以评价脑电图在该病的应用价值。方法：采用ＳＷ－ＪＨ２０００ＡＲ智能脑电监护仪,对４２例急性脑梗死治疗前后进行ＥＥＧ监测,按冯应琨《临床脑电图学》的诊断标准进行分析。结果：脑电图基本节律异常４１例,病侧慢波优势３１例,早期脑电图异常较ＣＴ敏感。脑电图异常程度与病变部位、病灶大小及病情轻重呈相关关系。结论：脑电病理波的出现及改变程度有助于急性缺血性脑     

丹参黄芪合剂对大鼠实验性脑缺血的保护作用

目的 观察丹参黄芪合剂(SQHJ)对缺血性脑水肿及SOD活力的影响,探讨其对实验性脑缺血的保护作用.方法 分别以丹参黄芪合剂小剂量(0.8 g/kg)、中剂量(1.6 g/kg)、大剂量(3.2 g/kg)对大鼠进行灌胃给药,并结扎大鼠双侧颈总动脉,形成急性实验性、不完全性脑缺血模型,3 h后,断头取脑,检测脑含水量和...     

颈动脉推注甘露醇对兔脑缺血所致脑水肿的作用

目的：研究缺血性中风脑水肿时,颈动脉推注２０％甘露醇对减轻脑水的机理及效果,方法：建立兔急性不完全性脑缺血模型,随机分为对照组,非推注组及推注组（颈动脉推注２０％甘露醇）,通过测定脑含水量及观察脑组织病理变化,评价脑水肿程度,结果：推注组脑组织含水量显著低于非推注组,其脑组织病理变化亦明显轻于非推注组。结论：颈动脉推注甘露醇可明显减轻缺血性脑水肿。     

脑低灌注触发脑内tau过度磷酸化和胆碱能神经损害

目的 探讨脑低灌注对脑内tau蛋白的过度磷酸化和胆碱能指标变化的影响.方法 40只SD大鼠随机分为低灌注组和假手术组,永久性阻断双侧颈总动脉制作脑低灌注模型;应用Y迷宫检测大鼠学习记忆能力,用免疫组化法检测大脑皮质和海马组织色氨酸404位点tau蛋白过度磷酸化(Pser404-Tau)和胆碱乙酰转移酶(ChAT)的表达,用考马斯亮蓝法检测海马组织乙酰胆碱酯酶(AChE)活性.结果 脑低灌注术后14 d和21 d,大鼠学习记忆能力明显减退,与假手术组相比差异有统计学意义(P＜0.01);大脑皮质和海马组织Pser404-Tau阳性细胞数较假手术组明显增加(P＜0.01);大脑皮质和海马组织ChAT阳性细胞计数较假手术组明显减少(P＜0.01);海马组织AChE活性较假手术组明显降低(P＜0.01).结论 脑低灌注后出现认知功能障碍,可能与脑缺血导致脑内tau蛋白过度磷酸化、损害胆碱能神经功能有关.     

完全性脑缺血引起家兔颌内静脉血气、血细胞及脑形态学的变化

夹闭家兔双侧颈总动脉与锁骨下动脉复制完全性脑缺血模型,研究缺血时间与从脑回流的静脉血液中 pH、血气、白细胞及血小板计数变化的关系,并观察了缺血5分钟后脑组织形态学的变化。结果显示:在脑缺血5′内,PvCO_2随缺血时间的延长而逐渐升高,而 pH、PrO_2、SO_2%、HCO_3~-及 CO_2 CT 却随着缺血时间延长而下降,尤以 pH、HCO_3~-、CO_2 CT 的变化迅速而规则;血液中的白细胞数和血小板数也逐渐减少;缺血5′后,大脑皮质,海马组织出现水肿,部分细胞发生核溶解,少数细胞崩解,这些组织的毛细血管扩张,淤血,小脑除出现水肿外,无其它特殊变化。