颅脑创伤后植物状态磁共振影像36例分析

目的研究颅脑创伤后持续植物状态（PVS）的磁共振影像（MRI）特征。方法分析36例颅脑创伤后持续植物状态患者MRI资料，按病灶位置、性质大小进行统计处理。结果所有患者都有脑实质损害，共发现脑软化灶312处．平均每例8．67处，主要分布在大脑皮层、脑室旁白质、基底节、胼胝体、脑干。结论MRI检查对颅脑创伤后持续植物状态的诊治有重要意义。     

脑弥漫性轴索损伤125例临床分析

目的探讨脑弥漫性轴索损伤的发病机制、临床特点、诊断、治疗和预后。方法回顾性分析125例脑弥漫性轴索损伤患者的临床资料。结果伤后6个月根据格拉斯哥预后分级:恢复良好28例(22.4%)、中残32例(25.6%)、重残30例(24%)、植物生存11例(8.8%)、死亡24例(19.2%)。结论脑弥漫性轴索损伤是重型颅脑损伤患者死亡的主要原因,致残率高;意识障碍是其典型临床表现。其诊断MRI检查优于CT;大部分采取非手术治疗。格拉斯哥昏迷评分越低,患者昏迷持续时间越长,预后越差。     

多次颅脑创伤患者的临床特点及诊治

目的回顾性分析多次颅脑创伤患者的致伤原因、病程演变、头颅CT特点以及治疗方法和效果,提高对此类损伤的认识。方法以我院神经外科治疗的颅脑创伤患者为研究对象,统计既往有颅脑创伤史的53例患者的临床资料。结果多次颅脑创伤患者中有9例(17%)发生脑内血肿或脑室内出血,预后差;轻、中型患者后遗症发生率达74%。结论多次颅脑创伤是相对特殊的创伤类型,更为严重地危害患者的健康。     

动态脑电图监测对脑损伤后早期癫痫诊疗的意义

脑电图(EEG)作为脑功能直接的反映,能客观敏锐地窥知脑的功能状态.脑电图监测具有无创、安全、便捷及可动态监测等优点,易于推广应用,脑电图在临床上的应用越来越广,尤其在癫痫的辅助诊断方法中,脑电图是最重要、最有价值和最方便的手段之一.笔者通过对142例急性颅脑创伤(TBI)患者的诊治和随访,探讨动态脑电图监测在急性颅脑创伤患者伤后癫痫诊断和治疗的应用价值.     

创伤后应激障碍患者创伤暴露后不同时期静息脑功能初探

目的:探讨创伤后应激障碍(PTSD)患者在创伤后不同时期静息态脑功能连接的变化,旨在进一步了解PTSD的发病机制。方法:12例PTSD确诊患者在创伤后2天和6个月后分别行静息态脑功能MRI检查,运用DPARSF软件进行以后扣带回为种子点的脑功能连接分析,采用配对t检验,P<0.05(AlphaSim校正)为差异有统计学意义。结果:与创伤暴露后2天比较,6个月后PTSD患者双侧内侧前额叶皮层/前扣带回、右侧前扣带回、左侧额上回和右侧额中回与后扣带回的功能连接显著降低(P<0.05)。结论:创伤暴露后内侧前额叶皮层、前扣带回与后扣带回的功能连接随着时间推移而降低,这一变化对于PTSD的发病可能有重要意义。     

颅脑创伤血管痉挛的CT血管造影评价

目的 :探讨CT血管造影 (CTA)在评价颅脑外伤性血管痉挛中的应用。材料和方法 :对 19例颅脑外伤患者和 10例对照组患者采用多层螺旋CT增强扫描获得原始图像 ,用最大强度投影 (MIP)和容积显示 (VR)技术进行三维重建CTA观察和分析。结果 :所有患者均成功获得良好的CTA图像 ,9例患者发现脑血管痉挛 16处 ,其中 13处出现在大脑中动脉 ,并大多呈串珠样改变。VR显示血管改变最佳 ,可充分显示血管痉挛 ;结合横断面图像可全面评价脑创伤情况。结论 :外伤后脑血管痉挛大多呈串珠样改变 ,CTA VR可充分显示血管痉挛 ,有助于研究外伤后脑血管的变化。     

中脑、中脑-间脑结合部损伤与植物生存

植物生存状态 (ｖｅｇｅｔａｔｉｖｅｓｔａｔｅ) ,俗称植物人 ,临床上多发生于重型颅脑损伤、脑疝、脑干原发或继发性损伤、高血压脑出血、脑血管畸形出血、ＣＯ中毒等病例。笔者分析了 2 5 1例持续昏迷 2周以上病人的颅脑ＣＴ、ＭＲＩ片 ,发现 31例长期昏迷 (1个月以上 )并发展成植物生存状态的病例 ,其ＣＴ、ＭＲＩ片均显示有中脑、中脑 -间脑结合部灶性或片状损害。现将临床资料报告如下。临　床　资　料1.一般资料 :男性 2 5例 ,女性 6例 ;年龄 5～ 6 3岁。病因 :脑外伤 2 3例 (枪伤 1例 ,交通伤 15例 ,坠落伤、跌伤 4例 ,打击伤 3例 )…     

高压氧综合治疗持续植物状态280例

目的 探讨高压氧(HBO)综合治疗持续植物状态(PVS)的疗效以及影像学在PVS诊断中的意义.方法 对280例PVS患者进行了HBO综合血液磁极化治疗、药物治疗以及影像学等检查.结果 本组治愈85例,占30.4%;好转148例,占52.8%;未脱离PVS 43例,占15.2%,但全身状况改善;死亡4例占1.6%.280例PVS患者脑CT显示多种异常征象;76例MRI检查尚可见到中脑、脑干萎缩;32例脑(SPECT)显像显示脑不同部位血流灌注减低.随PVS的恢复,接受HBO综合治疗20～50次后影像学复查明显好转.结论 HBO综合治疗PVS的治疗方案疗效满意.脑SPECT显像可与CT、MRI互补,并可作为HBO综合治疗PVS判断疗效及预后的指标.     

中、重型颅脑创伤患者的癫痫易感性研究

创伤后癫痫(posttraumatic epilepsy,PTE)是颅脑创伤后最严重的并发症之一[1],不仅增加了患者和家庭的精神心理负担和经济负担,同时亦增加了社会经济负担.中、重型颅脑创伤患者病情重,死亡率高,同时PTE的发生率亦较高.目前为止,国内尚未见基于人群或临床的有关中、重型颅脑创伤患者癫痫易感性的大规模流行病学调查资料.现就我院脑系科中心2004年9月-2007年9月好转出院的290例中、重型颅脑创伤患者进行回顾性分析和随访,以了解中、重型颅脑创伤后癫痫的发生率和危险因素.现报告如下.     

呼吸睡眠暂停低通气患者脑功能的功能性MRI诊断

目的:探讨静息状态下呼吸睡眠暂停低通气((SAHS)患者脑功能是否发生异常及经持续正压通气(CAPP)治疗后脑功能的改变情况.方法:搜集25例中重度OSAHS患者(患者组)及25例健康志愿者(对照组).患者CAPP治疗前后及健康志愿者均进行MRI平扫及血氧依赖水平功能性磁共振成像(BOLD-fMRI)检查.结果:与对照组相比,患者组治疗前右侧额中回等脑区的局部一致性减低,右侧岛叶等脑区的低频振幅(ALFF)值减低,右侧额下回等脑区的低频振幅比率(fALFF)值减低.与对照组相比,患者组治疗后右侧小脑半球等脑区的局部一致性减低,右侧楔叶等脑区的ALFF减低,右侧额下回等脑区的fALFF减低.与治疗前相比.患者组治疗后右侧颞下回等脑区的局部一致性明显增高,右侧小脑半球等脑区的ALFF增高,左侧枕中回等脑区的fALFF增高.结论:静息状态下OSAHS患者脑功能状态存在异常,经CAPP治疗后脑功能异常的脑区可部分逆转.功能性MRI对呼吸睡眠暂停低通气患者脑功能的诊断具有重要价值.     

颅脑伤后持续性植物状态100例脑组织的核磁共振变化

目的：为了明确创伤性持续性植物状态（PVS）脑损伤的部位、性质和脑组织结构的变化特征。方法：采用MRI对创伤性PVS患者100例进行病灶的定位、定性断定，且进行统计。结果：100例PVS患者中，发现病灶1154处（出血性462处，非出血性692处），每例5－19处，平均约12处病灶。弥漫性脑白质轴索损伤和胼胝体损伤94例，脑干背侧损伤87例，基底节和丘脑损伤分别为52例和32例，大脑皮层伤50例（以额、颞叶居多），海马旁伤47例。结论：创伤性PVS主要是由于弥漫性轴索损伤。统计结果表明，临床与MRI密切结合对确诊脑外伤后PVS有重要意义。     

溴隐停及美多巴联合治疗脑外伤后迁延性植物生存状态的临床观察

目的研究溴隐停及美多巴联合治疗创伤性脑外伤（TBI）后迁延性植物生存状态（PVS）的临床价值及使用范围。方法对一组连续46例在常规治疗的基础上加用澳隐停及美多巴治疗的PVS病人的一般临床特点和CT特征与治疗结果进行观察分析。结果TBI后的PVS最多见于交通事故性脑外伤。除大脑皮质的损伤外,弥漫性轴素损伤（DAI）、深部核团的损伤、脑干上部的损伤、以及伤后包括基底节在内的弥漫性脑萎缩是PVS的主要病理类型。运用澳隐停及美多巴后,73．9％的PVS病人的意识状态及运动功能得到改善。结论在没有广泛大脑皮质损伤,主要表现DAI和脑深部核团损伤的PVS病人,增强大脑多巴胺系统的功能对PVS病人具有治疗作用。     

HIV 阴性的隐球菌性脑膜脑炎的 MRI 表现及临床意义

目的：评价磁共振成像(MRI)在人类免疫缺陷病毒(HIV)阴性的隐球菌性脑膜脑炎(CM)的表现及预后判断。方法回顾性分析2000—2013年于本院由脑脊液墨汁染色及脑脊液细菌培养确诊的19例 HIV 阴性的 CM 的 MRI 表现及临床预后,采用格拉斯哥结局评分量表进行预后判断：1分=死亡,2分=永久植物状态,3分=严重残疾,4分=中度残疾,5分=恢复良好。1~3分归为预后差,4~5分为预后良好。结果84.2%(16/19)的 MRI 检查异常,84.2%(16/19)表现为脑膜强化,31.6%(6/19)为脑肿胀,47.4%(9/19)为脑实质病变,5.2%(1/19)为血管炎。平均随访时间3.5年,9例 MRI 证实脑实质病变中5例(5/9,44.4%)出现预后不良。结论 HIV 阴性的 CM 的 MRI 表现多样,当出现脑实质病变可能提示预后不良。     

MR imaging, single-photon emission CT, and neurocognitive performance after mild traumatic brain injury

BACKGROUND AND PURPOSE: Mild traumatic brain injury (mTBI) (Glasgow Coma Scale = 14-15) is a common neurologic disorder and a common cause of neurocognitive deficits in the young population. Most patients recover fully from mTBI, but 15% to 29% of patients have persistent neurocognitive problems. Although a partially organic origin is considered likely, little brain imaging evidence exists for this assumption. The aims of the present study were to establish the prevalence of posttraumatic lesions in mTBI patients on MR images and to assess the relation between these imaging findings and posttraumatic symptoms. Secondly, we explored the value of early posttraumatic single-photon emission CT (SPECT) for the evaluation of mTBI. METHODS: Twenty-one consecutive patients were included in the study. Patients underwent MR examination, technetium-99m hexamethylpropylene amine oxime SPECT, and neurocognitive assessment within 5 days after injury. Neurocognitive follow-up was conducted 2 and 6 months after injury, and MR imaging was repeated after 6 months. Lesion size and brain atrophy were measured on the MR studies. RESULTS: Twelve (57%) of 21 patients had abnormal MR findings, and 11 (61%) of 18 had abnormal SPECT findings. Patients with abnormal MR or SPECT findings had brain atrophy at follow-up. The mean neurocognitive performance of all subjects was within normal range. There was no difference in neurocognitive performance between patients with normal and abnormal MR findings. Patients with abnormal MR findings only showed significantly slower reaction times during a reaction-time task. Seven patients had persistent neurocognitive complaints and one patient met the criteria for a postconcussional syndrome. CONCLUSION: Brain lesions are common after mTBI; up to 77% of patients may have abnormal findings either on MR images or SPECT scans, and these lesions may lead to brain atrophy. The association between hypoperfusion seen on acute SPECT and brain atrophy after 6 months suggests the possibility of (secondary) ischemic brain damage. There is only a weak correlation between neuroimaging findings and neurocognitive outcome.     

脑部剪裂伤的CT与MRI诊断(附19例报告)

目的 评价CT和MRI对脑部剪裂伤的诊断功效。方法 回顾性分析了19例脑深部剪裂伤的CT和MRI影像表现和特点。结果 CT显示3个病灶，MRI显示了30个损伤灶，19例全部经MRI确诊，CT的敏感性只有MRI的10%。结论 MRI检查尤其是高场强MRI在颅脑剪裂伤的诊断中具有重要意义。比CT检查有显的优越性，随着MRI设备的普及，对颅脑损伤的病人行MRI检查应作为常规。     

Neuroimaging after coma

Following coma, some patients will recover wakefulness without signs of consciousness (only showing reflex movements, i.e., the vegetative state) or may show non-reflex movements but remain without functional communication (i.e., the minimally conscious state). Currently, there remains a high rate of misdiagnosis of the vegetative state (Schnakers et. al. BMC Neurol, 9:35, 8) and the clinical and electrophysiological markers of outcome from the vegetative and minimally conscious states remain unsatisfactory. This should incite clinicians to use multimodal assessment to detect objective signs of consciousness and validate para-clinical prognostic markers in these challenging patients. This review will focus on advanced magnetic resonance imaging (MRI) techniques such as magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI (fMRI studies in both “activation” and “resting state” conditions) that were recently introduced in the assessment of patients with chronic disorders of consciousness.     

持续植物状态99Tcm-ECD脑SPECT显像

目的：观察持续植物状态（PVS）患者脑血流灌注情况及其对高压氧配合药物治疗疗效和预后判断的意义，方法：用99Tc^m－双半胱乙酯（ECD）局部脑血流（rCBF）显像方法对26例不同病因所致的PVS患者进行了检测，9例进行了动态观察。结果：26例PVC患者脑血流灌注均显著, 部位可与脑CT或MRI检查相符或不符，随病情恢复，脑血流灌注亦恢复正常。结论：99Tcm-ECD脑SPECT显像观察rCBF可反映PVS患者脑血流灌注情况，并可作为高压氧配合药物治疗PVS疗效及预后判断的指标。     

MR of hypoxic encephalopathy in children after near drowning: correlation with quantitative proton MR spectroscopy and clinical outcome.

BACKGROUND AND PURPOSEQuantitative MR spectroscopy has a proved role in the investigation of hypoxia caused by near drowning. To date, no studies have addressed the MR imaging changes that may also accompany this condition. The purpose of this study was to describe the MR imaging findings in children with hypoxic encephalopathy caused by near drowning and to compare these findings with the results of qualitative and quantitative proton MR spectroscopy and clinical outcome.METHODSTwenty-two children (6 months to 11 years old) admitted to the pediatric intensive care unit after near drowning incidents underwent cerebral MR imaging and quantitative proton MR spectroscopy. Clinical and imaging studies were reviewed retrospectively, and subjects were grouped according to outcome: good result, persistent vegetative state, and death. Images were scored for edema, basal ganglia changes, and cortical changes, and were compared with MR spectra and outcome at days 1 to 2, 3 to 4, and 5 or more.RESULTSSix patients had a good outcome, four remained in a persistent vegetative state, and 12 died. Generalized/occipital edema correlated with poor outcome. Indistinct lentiform nuclei margins on T1-weighted images were a frequent finding (78%). Basal ganglia T2 hyperintensity correlated with poor outcome, progressing from a patchy/peripheral distribution to diffuse high intensity. Patchy high T2 signal in the cortex or subcortical lines were specific but insensitive for poor outcome, as were brain stem infarcts.CONCLUSIONMR images in children with hypoxic encephalopathy after near drowning show a spectrum of changes. The most sensitive prognostic result may be achieved by combining MR imaging with qualitative and quantitative MR spectroscopic data.