低血糖性脑损害研究进展

低血糖性脑损害是由于多种原因引起的血葡萄糖浓度过低(血糖低于2.8mmol/L),引起的中枢神经系统损害,严重者可致昏迷。本文将就低血糖性脑损害的临床表现、影像及电生理检查、生化及病理改变做一综述。1低血糖症的病因和临床表现引起低血糖的常见病因有:肝源性、肾脏疾病、饥饿     

老年患者低血糖脑病误诊急性脑血管病的原因分析与护理措施

目的探讨老年患者低血糖脑病误诊为急性脑血管病的原因与护理措施。方法对福州总医院干部病房2006-03—2015-10收治的老年低血糖脑病患者97例进行回顾性分析。结果首诊时被误诊为急性脑血管病18例,误诊率为18.6%,其中急性脑梗死14例,短暂脑缺血3例,脑出血1例。确诊后即给予静注50%葡萄糖注射液40~100mL,而后继续静滴10%葡萄糖注射液24~48h,给予吸氧、脑细胞营养剂,所有患者静滴葡萄糖液15~30min后症状消失,神经体征在意识清楚后2~3h消失。监测血糖5~7d正常后予以出院。无1例死亡。结论低血糖脑病易误诊为急性脑血管病,老年糖尿病患者一旦发生昏迷,应及时测定血糖、补充葡萄糖,预后良好。     

脑动脉瘤破裂所致蛛网腆下腔出血急性期患者的诊断和治疗

蛛网膜下腔出血(CAK)的诊断和治疗是神经内、外科的中心问题之一。其患病率为11～20/10万。其病因51%是脑动脉瘤破裂所致。常可引起脑积水和血管痉挛等复杂的病理生理改变。其中血管痉挛在CAK首发患者占29%,复发者占80%。无生命功能障碍的CAK患者70%予后良好,如出现意识障碍直至昏迷者85%死亡。60?K患者头10天内复发者预后险恶,死亡率达50～100%。为此作者对101例15～60岁的动脉瘤破裂所致CAK(男29例、女72例)急性期患者的诊断和治疗分析如下: 一、诊断首先对刚入院的CAK患者进行心血     

免架测量定位排空器治疗高血压性脑内血肿

采用脑内血肿排空器及颅骨钮技术.以 CT片为依据免架测量定位行高血压性脑内血肿排空治疗Ⅲ例共112次;壳核区83例.丘脑4例.皮质下20例.小脑2例.胼胝体膝、纵裂各1例: 体积21～50ml 51例51～100 ml 42例.101～150 ml12例.>150ml 4例.以上共有27例同时破入脑室;2例小脑血肿<20ml.排空率>81%者73次、61%～80%者29次,51%～60%者10次: 手术病死率按病情统计.Ⅲ级为3%.Ⅳ级为12. 5%.Ⅴ级为69;Ⅲ、Ⅳ级合计为9.2%.Ⅲ、Ⅳ、Ⅴ级合计为16.2% 病死率按手术与发病时间分别统计为6h内含者62.5%.7～12h者25%.13～24h者10%.2～3d者11.6%.4～14d者11%.76例术后随访2～6O个月.2例呈植物状态.17例因其它原因死亡,57例恢复良好.     

卒中样低血糖脑病

目的提高对低血糖脑病的认识,降低误诊率。方法回顾性总结分析15例以卒中起病的低血糖脑病的临床资料。结果14例入院诊断为“大面积脑梗死或脑干梗死”,1例诊断为“昏迷原因待诊,病毒性脑炎可疑”的患者,均给以相应治疗无明显疗效后急查血糖示偏低而确诊。确诊后给予推注高渗葡萄糖和持续静点葡萄糖后,大部分患者有立竿见影的效果。结论出现卒中后常规急诊测血糖,极早诊断和治疗低血糖脑病,能最大限度降低患者中枢神经系统不可逆性损害的发生。     

低血糖脑病的临床及脑部磁共振特征

目的探讨低血糖脑病的临床及脑部磁共振特征。方法回顾分析69例低血糖昏迷患者的临床、脑磁共振（MRI）成像资料。结果低血糖昏迷诱因较为复杂,常见的为进食减少、腹泻、上呼吸道感染、降糖药物应用不当等。临床表现复杂多样,除意识障碍外,还可表现为偏瘫、四肢瘫、凝视麻痹等,多数伴有Babinski征。69例患者中有18例出现脑MRIDWI异常高信号病灶,病灶主要累及海马、基底节、大脑皮质以及皮质下白质,多为对称性损害。3个月后随访,不伴有脑部MRI损害的患者预后良好率明显高于伴有脑部MRI损害的患者（94．12％对22．22％;P=0．0011）。伴有脑部MRI损害者有10例患者预后不良,其中9例（90％）发生于皮质受累患者。结论低血糖脑病临床表现不具有特异性,对于昏迷患者,应当考虑到低血糖的可能。降糖药物应用不当为低血糖脑病的主要诱发因素。脑部MRI要优于脑部CT检查,其中DWI序列对于检测低血糖所致的脑部损害有着非常重要的意义。皮质受累者预后不良。     

酷似脑血管病的低血糖危象(附3例报告)

临床上典型的低血糖症较易诊断,而非典型低血糖症,尤其是低血糖危象,表现为突然偏瘫、昏迷、血压高为首发症状者诊断较困难。现报告三例如下:例1,女,58岁,因昏迷5小时以脑血管意外收入院。查:深昏迷,Bp21.3/13.3kPa,右瞳孔2.0mm,左瞳孔3.0mm,对光反应消失;右下肢呈外旋位,双侧 Babinski 氏征阳性。立即静注20%甘露醇250ml,病情未见好转,又静注50%葡萄糖100ml,20分钟后患者神志转清,两瞳孔等大,四肢活动自如,病理反射消失。此时方考虑到低血糖的可能,急检血糖为3.     

CT定位下颅内血肿清除术60例临床分析

我院于1999-10～2002-10对60例脑出血患者CT定位下采用YL-l型颅内血肿粉碎穿刺针行微创清除术,取得较好疗效,报道如下。1临床资料1.1一般资料男38例,女22例,年龄45～79岁。有高血压病史48例,病史1～6年。出血部位:基底节区出血35例,脑叶出血17例,脑室出血8例。出血量:10～15ml9例,25～35ml24例,35～60ml16例,60ml以上11例,均为脑室出血。意识清楚14例,嗜睡26例,昏迷20例(浅昏迷12例,中度昏迷5例,深昏迷3例)。手术时间:6h内18例,6～24h12例,24～48h30例。1.2治疗方法在CT室根据血肿的大小、位置、形态等确定穿刺靶点,并在患者相应位置上标…     

低血糖性脑病28例分析

低血糖性脑病是指由低血糖（〈2．8mmol·L^-1）引起的脑损害和一系列神经精神症状的一种临床综合征。老年糖尿病患者在治疗过程中，由于各种原因，可出现低血糖反应。临床表现貌似急性脑血管病。本文收集了温州市第三人民医院神经内科2002年1月至2007年1月收治的低血糖昏迷患者28例分析如下。     

糖尿病病人低血糖昏迷20例临床分析

目的 探讨糖尿病患者低血糖昏迷的原因.方法 将20例糖尿病病人昏迷时急查血糖变化.结果 20例患者血糖均低于正常水平.结论 糖尿病病人应用降糖药物时注意监测血糖;防止低血糖的发生.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -     

Summary of legislation of 1941 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -     

Asymmetry of on- and off-pathways of blue-sensitive cones of the retina of macaques

Macaque retinal ganglion cells whose receptive-field center recieves input from blue-sensitive cones show an overt asymmetry of the frequency of ON-center and OFF-center varieties, an asymmetry not present in ganglion cells whose center receives input from the other two cone types. A similar asymmetry of ON/OFF responses is found in the local electrotetinogram (d-wave) mediated by signals from blue-sensitive cones. ‘Blue-ON-center’ ganglion cells have larger receptive-field centers and shorter conduction latencies than other opponent-color varieties, suggesting an appreciable degree of receptor convergence and presumably large cell bodies. Intracellular stainings of these neurons with Procion Yellow show that they correspond to diffuse stratified (Parasol) ganglion cells whose flat-topped dendritic arborization stratifies in the sclerad half of the inner plexiform layer. In view of the known characteristics of macaque bipolar cells and of the ON/OFF asymmetry, it is proposed that these ganglion cells are postsynaptic to cone-specific flat bipolars possibly mediating sign-inverting synaptic contacts. The results also indicate a reversal, for the blue-cone pathway, of the ON/OFF lamination of the inner plexiform layer that has recently been described in other species.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.