正常压力脑积水的研究——低中压分流的随机比较

正常压力脑积水(NPH)分流管压力选择一直是引起广泛争论的话题,没有人对各种压力分流管之疗效行随机分组研究。作者对此进行了前瞻性研究。 96例NPH患者随机分为两组:低压组49例,中压组47例。低压(40±10mmH_2O),中压(100±10mmH_2O),依NPH评分标准评定病人步态障碍和痴呆程度,用mRS(modified Rankin Scale)标准评定伤残水平。所有病人CT显示均为交通性脑积水,Evan′s指数≥0.3,脑室指数>0.8。且步态障碍,痴呆分类评分至少12分,伤残水平至少二级。病人手术前及术后1、3、6、9、12个月行疗效随访。由术前和最后NPH评分及mRS分级判定最初疗效,用术前NPH评分及mRS分级,随访平均分     

特发性正常压力型脑积水患者行手术和保守治疗的预后对比

目的对比行脑室-腹腔分流术(VPS)与保守治疗特发性正常压力型脑积水(i NPH)患者的预后,探索影响预后的可能因素。方法队列纳入109例i NPH患者,其中67例(61.5%)行VPS(VPS组),42例(38.5%)未行任何手术(保守治疗组)。VPS后1年,61.2%患者症状改善,其中步态障碍改善58.2%(39/67例),认知功能障碍改善50.8%(30/59例),尿失禁改善56.1%(23/41例)。VPS组和保守治疗组的5年整体生存率分别为(76.5±6.0)%和(68.0±9.1)%(P=0.313)。8/67例(11.9%)术后发生并发症,包括硬膜下积液4/67例(6.0%),血肿2/67例(3.0%),远端导管感染1/67例(1.5%),头痛1/67例(1.5%)。结论 VPS可以改善i NPH临床症状,至少术后5年内各项症状可以得到不断的改善,步态障碍的改善可能会好于认知功能障碍和尿失禁,但同时具有一定的术后并发症风险。     

正常颅压脑积水的诊断与治疗

<正>一、概述正常颅压脑积水(normal pressure hydrocephalus,NPH)是为数不多的、可治的导致痴呆的疾病之一。其定义是虽有脑室扩大,但脑脊液压力正常。主要表现为步态障碍、痴呆和尿失禁,分流术后其症状可得以改善。1965年Hakim和Adams第一次描述了NPH的"三主征":步态不稳、尿失禁和痴呆。但是"三主征"在不同的患者并非同时存在或有不同组合,其     

去骨瓣减压术后脑积水性脑膨出的临床治疗分析

目的探讨重度脑损伤去骨瓣减压术后脑积水性脑膨出的临床治疗方法及疗效。方法顾性分析航空总医院脑脊液病神经外科2012年01月至2014年01月之间收治的49例重度脑损伤去骨瓣减压术后脑积水性脑膨出患者的临床及影像学资料,均行脑室腹腔分流术和(或)颅骨修补术,并运用格拉斯哥预后评分(GOS评分)方法进行预后评估。结果脑室腹腔分流术后患者意识及神经功能障碍均有不同程度好转者39例(79.6%),无明显变化甚至恶化死亡者共10例(20.4%)。其中恢复良好者10例(20.4%),中度残疾者8例(16.3%)、重度残疾者5例(10.2%)、植物生存者23例(47.0%)、死亡者3例(6.1%)。结论创伤后脑积水诊断延误或治疗方法不当易造成脑膨出,导致缺血缺氧性脑软化、脑萎缩,影响患者预后。脑室腹腔分流术是治疗创伤后脑积水合并脑膨出患者的有效方法,有助于改善患者意识及神经功能。     

特发性正常压力脑积水的临床治疗进展

正常压力性脑积水(normal pressure hydrocephalus,NPH)是一种特殊类型的交通性脑积水,主要表现为步态障碍、认知障碍和尿失禁"三联征";影像学检查主要表现为脑室扩大,Evan’s指数>0.3,侧裂池增宽,部分病人脑室旁白质可见低密度影;脑脊液压力测定在70~200 mmH2O的一组临床综合征。NPH临床分为两类:一类是继发性NPH(secondary normal pressure hydrocephalus,sNPH),常继发于有明确发病原因的颅脑损伤、高血压性脑出血、蛛网膜下腔出血、颅内感染、脑炎等。     

基于体素的形态学测量的重症肌无力患者脑结构改变研究及其与认知功能障碍的相关性分析

目的分析重症肌无力(MG)患者是否存在认知功能障碍及脑结构改变, 从脑结构角度探讨MG认知功能损害的可能机制。方法选择苏州大学附属第一医院神经内科自2019年7月至2021年12月收治的28例MG患者作为MG组, 选择MG患者家属或同期于医院体检中心体检的健康体检者共30例作为健康对照组。采用神经心理学测试评估受试者的认知功能;采用基于体素的形态学测量(VBM)方法分析受试者结构磁共振成像(sMRI)上脑结构的改变, 采用相关性分析检验MG组患者差异脑区的灰质体积与认知功能的相关性。结果与健康对照组比较, MG组患者的简易智力状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、画钟测验(CDT)评分、词语流畅性测验(VFT)评分、Rey听觉词语学习测验(RAVLT)即刻记忆评分和延迟记忆评分均降低, 而连线测验A部分(TMT-A)耗时、汉密尔顿抑郁量表(HAMD)评分和汉密尔顿焦虑量表(HAMA)评分均增高, 差异均有统计学意义(P<0.05);与健康对照组比较, MG组患者左侧眶部额上回、右侧眶部额中回、右侧三角部额下回、左侧脑岛、左侧额中回、右侧缘上回、右侧前...     

正常压力脑积水的临床特征和手术治疗

目的探讨正常压力脑积水(NPH)的临床特征和手术治疗效果。方法 NPH患者32例,其中17例应用中压分流管、15例用可调压分流管行脑室-腹腔分流术治疗。结果应用可调压分流管分流者的症状改善率为86.7%(13/15),应用中压分流管者为41.2%(7/17),两者相差显著(P<0.01)。结论应用可调压分流管行脑室-腹腔分流是治疗NPH的有效方法。     

脑室-腹腔分流术治疗外伤性脑积水32例

目的讨论外伤性脑积水手术治疗的临床疗效及相关因素。方法回顾性分析2003年至2008年脑室-腹腔分流术治疗的32例高颅内压及正常颅内压外伤性脑积水患者的临床资料。结果32例患者脑室-腹腔分流术后出现意识障碍的9例患者中,7例有不同程度好转,其中5例分流效果良好,有效率55.5%（5/9）,随访6个月-1.5年,头痛头晕症状改善者9例,有效率64.3%（9/14）,5例患者智力障碍及步态不稳症状改善明显,恢复正常生活,有效率71.4%（5/7）,2例尿失禁患者的症状均明显改善。结论脑室-腹腔分流术是治疗外伤性脑积水的有效方法,但必须严格掌握手术指征,术前进行综合评估,特别是对正常压力脑积水的患者,以提高疗效。     

可调压式分流管治疗正常压力脑积水的临床应用及护理体会

采用可调压式分流管治疗24例正常压力脑积水患者,根据影像学检查结果 和临床症状.术后分别调压0～6次,平均(1.88±1.52)次,患者临床症状得到明显改善,尤以步态障碍为首发症状者效果最佳.证明可调压式分流管能够缓解正常压力脑积水患者临床症状,尤其适用于病程短之继发性正常压力脑积水.     

老年人特发性正常压力脑积水的临床研究(附35例报道)

目的 探讨脑室腹腔分流术在老年人特发性正常压力脑积水治疗中的临床疗效.方法 回顾性总结沧州市中心医院神经外科自2006年5月至2010年5月收治的35例老年人特发性正常压力脑积水患者的病史、CT和(或)MR影像资料、腰椎穿刺放液试验等临床资料,分析以上因素对脑室腹腔分流手术效果的影响. 结果 本组35例患者术后均得到6～12月随访,其中显效16例,有效12例,无效7例;智能障碍患者的术后有效率为58.0％,步态不稳患者的术后有效率为85.0％,尿失禁患者的术后有效率为81.5％.33例患者影像学复查见脑室系统均有不同程度缩小. 结论 脑室腹腔分流术是目前治疗老年人特发性正常压力脑积水的最有效方法.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

The organization of the connections between the cortex and the claustrum in the monkey

The distribution of labelled cells and of extracellular granules in the claustrum has been studied after injections of horseradish peroxidase in several areas of the neocortex. The frontal and parietal lobes are related to the anterior and posterior halves respectively of the claustrum, and the occipital and temporal cortex to the posterior and inferior margins. Parts of the claustrum related to areas of the cortex in the frontal lobe overlap considerably in the antero-posterior dimension with parts related to widely separated but interconnected areas of the parieto-temporal cortex. Areas of cortex within one lobe which are interconnected are related to parts of the claustrum which overlap in the dorsoventral dimension.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.