卒中后癫痫发作的临床研究

目的 研究卒中后癫痫发作的患病率、临床表现与卒中后癫痫的危险因素.方法 对华山医院神经内科自2003年9月1日至2006年2月1日因卒中住院的患者445例进行同顾性研究并对其进行随访.结果 本研究中约9.1%(40例)卒中患者出现卒中后癫痫发作.脑出血、蛛网膜下腔出血、皮层病灶、病灶范围大于一个脑叶的卒中患者更容易出现卒中后癫痫发作(P相似文献   

老年卒中后癎性发作75例临床分析

目的通过对75例老年卒中后性发作的临床资料分析,探讨老年卒中后性发作的相关因素,以实施有效的防治。方法分析75例老年卒中后性发作的类型、病灶部位、神经功能缺损程度、性发作发生的时间和诱发因素。结果出血性卒中、额叶、颞叶、顶叶皮质病变,神经功能缺损严重的性发作的发生率高,迟发性性发作要高于早发性性发作,感染为明显的诱发因素。结论卒中后性与卒中类型、卒中部位、卒中后神经功能缺损程度及合并感染密切相关。     

老年卒中后癎性发作75例临床分析

目的通过对75例老年卒中后癎性发作的临床资料分析,探讨老年卒中后癎性发作的相关因素,以实施有效的防治.方法分析75例老年卒中后癎性发作的类型、病灶部位、神经功能缺损程度、癎性发作发生的时间和诱发因素.结果出血性卒中、额叶、颞叶、顶叶皮质病变,神经功能缺损严重的癎性发作的发生率高,迟发性癎性发作要高于早发性癎性发作,感染为明显的诱发因素.结论卒中后癎性与卒中类型、卒中部位、卒中后神经功能缺损程度及合并感染密切相关.     

卒中后癫痫合并低钠血症一例

正卒中后癫痫是指卒中前无癫痫病史,在卒中后一定时间内出现的癫痫发作并排除脑部和其他代谢性病变,一般脑电监测到的痫性放电与卒中部位具有一致性,又分为卒中后早发性癫痫和迟发性癫痫~([1])。绝大部分早发性痫性发作随着原发病的缓解和病程的进展会自动缓解,而迟发性则绝大多数会反复发作,且需要抗癫痫药物(antiepileptic drugs,AEDs)的长期干预~([2])。卒中后癫痫持续状态占卒中人群的     

卒中后癫痫危险因素的病例对照研究

目的通过了解卒中后癫痫的临床特征,探讨影响卒中后癫痫发生的危险因素。方法本研究采用病例对照研究设计,选择确诊的脑卒中后发生癫痫的患者80例为病例组;脑卒中未发生癫痫患者80例为对照组。收集两组年龄、性别、高血压史、糖尿病史、脑卒中类型、脑卒中部位、心电图检查结果和血清学检查结果等资料,分析卒中后癫痫的危险因素。资料录入采用Epidata3.2,统计分析采用SPSS 13.0。计量资料采用t检验,计数资料采用χ2检验,检验标准α=0.05。采用Logistic回归模型对卒中后癫痫的危险因素进行单因素和多因素回归分析。结果单因素Logistic回归分析结果显示:房颤、卒中部位累及皮质、颞叶、血清钠值、氯值与卒中后癫痫的发生有关(P<0.05);多因素Logistic回归分析结果表明,卒中部位累及皮质(OR=3.53,P=0.002,95%CI=1.62~7.69)、卒中位于颞叶(OR=3.06,P=0.015,95%CI=1.28~7.35)和血清氯值(OR=1.21,P=0.012,95%CI=1.04~1.40)是卒中后癫痫的危险因素。结论卒中部位累及皮质、位于颞叶和血清氯是卒中后癫痫的危险因素,应采取针对性的措施进行干预。     

卒中后癫癎发作时间分布及影响因素的研究

目的 分析卒中后癫癎发作时间分布特点,并对其影响因素进行研究.方法 将122例卒中后癫癎发作患者分为早发性癫癎发作组(卒中后2周内出现癫癎发作)60例;晚发性癫癎发作组(卒中2周后出现癫癎发作)62例.进行单因素及多因素分析,研究患者的基础情况,卒中的危险因素、卒中的类型、癫癎发作的类型、发作频次、治疗等情况与早发及晚发的关系.结果 性别、年龄、卒中危险因素以及脑电图改变在两组间无差异.缺血性卒中出血转化是卒中后癫癎发作早发的危险因素;早发性癫痫发作倾向于表现为全面性强直阵挛发作,晚发性癫癎发作倾向于表现为部分性发作;颞叶病变是卒中后癫癎发作晚发的危险因素;晚发性癫癎发作倾向于复发.早发性癫癎发作患者接受短期治疗的比例较高,晚发性癫癎发作患者接受长期治疗的比例较高.Logistic多元回归提示糖尿病是卒中后癫癎发作早发的危险因素(OR=2.664,95%CI=1.143～6.210,P=0.259).结论 糖尿病和缺血性卒中出血转化为卒中后癫癎发作早发的危险因素;而颞叶病变是卒中后癫癎发作晚发的危险因素,且晚发性癫癎发作更倾向于复发.     

卒中后癫发作时间分布及影响因素的研究

目的 分析卒中后癫发作时间分布特点,并对其影响因素进行研究。 方法 将122例卒中后癫发作患者分为早发性癫发作组（卒中后2周内出现癫发作）60例;晚发性癫发作组（卒中2周后出现癫发作）62例。进行单因素及多因素分析,研究患者的基础情况、卒中的危险因素、卒中的类型、癫发作的类型、发作频次、治疗等情况与早发及晚发的关系。 结果 性别、年龄、卒中危险因素以及脑电图改变在两组间无差异。缺血性卒中出血转化是卒中后癫发作早发的危险因素;早发性癫发作倾向于表现为全面性强直阵挛发作,晚发性癫发作倾向于表现为部分性发作;颞叶病变是卒中后癫发作晚发的危险因素;晚发性癫发作倾向于复发。早发性癫发作患者接受短期治疗的比例较高,晚发性癫发作患者接受长期治疗的比例较高。Logistic多元回归提示糖尿病是卒中后癫发作早发的危险因素（OR＝2.664,95%CI=1.143～6.210,P=0.259）。 结论 糖尿病和缺血性卒中出血转化为卒中后癫发作早发的危险因素;而颞叶病变是卒中后癫痫发作晚发的危险因素,且晚发性癫发作更倾向于复发。     

青壮年卒中后癫痫89例临床分析

卒中是癫痫的常见原因之一，但对青壮年卒中与癫痫的关系报道较少。现收集我院1989年5月～1999年8月间住院的青壮年卒中后癫痫 89例，分析报道如下。1 临床资料1.1 一般资料 男52例，女37例。年龄 20～ 59岁，平均47岁。20～29岁 12例， 30～39岁20例，40～49岁27例，50～59岁30例。1.2 CT及MRI检查 全部病例均行CT或 MRI检查，显示缺血性病变48例，出血性病变41例。额叶21例，顶叶13例，颞叶7例，枕叶4例，额顶叶5例，额颞叶4例，顶颞叶2例，内囊基底节13例，丘脑3例，脑干2例，蛛网膜下腔15例。其中多发病灶6例。 1.3 发作类型 根据1…     

脑卒中后癫痫160例临床分析

目的 探讨脑卒中后癫痫的临床特征及发病机制。方法 对1860例脑卒中患中的160例继发癫痫的临床资料进行回顾性分析。结果 卒中后癫痫总发生率为8．6％，其中早发型癫痫占64％，迟发型癫痫占36％。早发型癫痫多见于脑出血，而迟发型癫痫多见于脑梗死。卒中后癫痫的发生率因病灶部位(皮质／皮质下)的不同存在显性差异。皮质病灶中,位于额叶、颞叶、顶叶好发癫痫。皮质下区病灶在基底节、内囊易发生癫痫。结论 脑卒中后癫痫以早发型为多,早期癫痫多见于脑出血,而迟发型癫痫多见于脑梗死。病灶位于皮质发生癫痫的危险性高,皮质下结构在癫痫活动的调节中也起着重要的作用。     

卒中后癫痫的临床与机理探讨（附148例报告）

对１４８例卒中后癫痫的临床及发病机理与卒中类型进行分析研究，结果为卒中后癫痫的发生率为６．４％，早期癫痫发作４．３％，迟发性癫痫２．１％。卒中后癫痫的发生率与病灶部位（皮质／皮质下）有明显的相关性（Ｐ＜０．０１），与卒中类型无明显差异（Ｐ＞０．０５）。脑水肿是早期癫痫发作的重要致痫因素，迟发性癫痫可因胶质疤痕形成癫痫灶所致。     

脑卒中部位与认知功能障碍的相关分析

目的观察不同部位脑卒中所致认知功能障碍的特点,探讨脑卒中部位与认知功能障碍之间的关系。方法采用中文版蒙特利尔认知评估量表(MOCA)对100例脑卒中患者(脑梗死63例,脑出血37例;卒中部位:额叶15例,顶叶15例,颞叶12例,枕叶8例,丘脑14例,基底节20例,小脑8例,脑桥8例)进行测试,将脑卒中患者的CT/MRI定位与MOCA的7个分项目[(定向力(ORT)、视空间与执行功能(EF)、命名(NAM)、记忆(MEM)、注意(ATT)、语言功能(LANG)包括复述与流畅性、抽象概括(ABS)]的测试结果进行相关分析。结果(1)额叶、顶叶、颞叶、枕叶、丘脑、基底节卒中与认知功能障碍的发生相关(均P<0.05)。小脑、脑桥卒中与认知功能障碍无关。(2)额叶卒中损害ORT、EF、MEM、ATT;顶叶卒中损害EF、NAM、MEM、ATT;颞叶卒中损害EF、MEM、LANG,枕叶卒中损害EF;丘脑卒中损害MEM、LANG;基底节卒中损害EF、MEM、LANG。结论脑卒中患者认知功能障碍的发生与卒中部位有关,不同部位脑卒中损害的认知功能障碍也不同。     

热射病导致的脑梗死或脑出血的诊治分析

目的 探讨热射病导致的脑梗死或脑出血的影像学表现、治疗方法及其效果。方法 回顾性分析2012～2022年收治的20例热射病导致的脑出血或脑梗死的临床资料。结果 2例出现微出血病灶,部位为右额叶及左顶叶;18例出现缺血样改变,包括放射冠、基底节、额叶、颞叶、顶叶、枕叶、皮层下白质、胼胝体、海马,其中2例伴有明显脑水肿。出院时,11例恢复正常,未遗留明显肢体活动障碍、言语障碍及逻辑思维能力障碍;2例出现认知功能减退,主要存在语言表达能力障碍、遵嘱动作较差、小脑共济失调（轮替试验阳性、Romberg阳性）;3例深度昏迷,GCS评分3～4分;4例死亡。结论 热射病导致的脑梗死或脑出血,临床少见,多数病人保守治疗预后良好。建议早期进行康复治疗,以减少神经功能障碍。     

Acute post-stroke restless legs syndrome: the body of caudate nucleus considerations

ObjectivesTo investigate the relationship between the lesion location and post-stroke restless legs syndrome (RLS).MethodsA total of 376 patients with acute cerebral infarction were recruited from Tangshan Gongren Hospital, Department of Neurology between May 2016 and May 2017, all of whom were evaluated for RLS. Established RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG) in 2012. Neurological functions were assessed according to the National Institutes of Health Stroke Scale (NIHSS). The lesion location was evaluated with magnetic resonance imaging (MRI). The associations between the lesion location and post-stroke RLS were then analyzed by logistic regression.ResultsA total of 49 patients (13.03%) had RLS. The multivariate logistic regression model adjusting for post-stroke RLS risk factors including gender, age, history of hypertension, history of diabetes, history of stroke, smoking, drinking, body mass index (BMI), NIHSS, hemoglobin, platelet and homocysteine determined that body of caudate nucleus and pontine were significantly associated with post-stroke RLS with odds ratio (OR) of 26.26 (95% confidence interval (CI): 9.41–73.28,p < 0.001) and OR of 4.37 (95% CI: 1.24–15.34, p = 0.021). The stepwise logistic regression model with temporal lobe, parietal lobe, occipital lobe, frontal lobe, callosum, body of caudate nucleus, thalamus, lenticulo capsule, corona radiata, centrum semi-ovale and pontine as potential predictors yielded a predictor mode. The stepwise logistic regression predictor mode indicated that body of caudate nucleus and pontine predicted post-stroke RLS with similar OR to multivariate models of 23.61 (95% CI: 9.53–58.51, p < 0.001) and 4.46 (95% CI: 1.38–14.4, p = 0.012).ConclusionsThe ischemic infarcts located in body of caudate nucleus, pontine are significantly associated with post-stroke RLS. Body of caudate nucleus acute infarcts may play a role in the development of post-stroke RLS.     

烟雾病脑卒中部位的分布特征及其机制

目的 分析烟雾病脑卒中的好发部位,提高对烟雾病的认识,以减少漏诊.方法 分析我院神经内科1998年1月至2008年12月的32例烟雾病患者,对其脑卒中部位进行总结分类,并计算各构成比.结果 32例病例中男性14例,女性18例,男女比例为1:1.28,发病年龄7～47岁,缺血性脑卒中5例(15.6%),平均年龄24岁,出血性脑卒中21例(65.6%),平均年龄33岁,同时患缺血性脑卒中和出血性脑卒中者6例(18.8%),平均年龄32岁.出现梗死部位共20处,常见部位依次为额顶叶12次(60%)、颞枕叶4次(20%)及基底节区4次(20%),发生出血共28次,常见部位依次为脑室旁11次(42.8%)、脑室11次(39.2%)、颞枕叶3次(10.8%)及蛛网膜下腔2次(7.2%),小脑和脑干无脑卒中发生.结论 成人烟雾病多以颅内出血发病;无脑卒中危险因素成人出现脑室或脑室旁出血、额顶叶梗死以及青少年颅内出现缺血性病变合并癫痫者需高度警惕烟雾病.     

The localizing value of ictal EEG in focal epilepsy.

OBJECTIVE: To investigate the lateralization and localization of ictal EEG in focal epilepsy. METHODS: A total of 486 ictal EEG of 72 patients with focal epilepsy arising from the mesial temporal, neocortical temporal, mesial frontal, dorsolateral frontal, parietal, and occipital regions were analyzed. RESULTS: Surface ictal EEG was adequately localized in 72% of cases, more often in temporal than extratemporal epilepsy. Localized ictal onsets were seen in 57% of seizures and were most common in mesial temporal lobe epilepsy (MTLE), lateral frontal lobe epilepsy (LFLE), and parietal lobe epilepsy, whereas lateralized onsets predominated in neocortical temporal lobe epilepsy and generalized onsets in mesial frontal lobe epilepsy (MFLE) and occipital lobe epilepsy. Approximately two-thirds of seizures were localized, 22% generalized, 4% lateralized, and 6% mislocalized/lateralized. False localization/lateralization occurred in 28% of occipital and 16% of parietal seizures. Rhythmic temporal theta at ictal onset was seen exclusively in temporal lobe seizures, whereas localized repetitive epileptiform activity was highly predictive of LFLE. Seizures arising from the lateral convexity and mesial regions were differentiated by a high incidence of repetitive epileptiform activity at ictal onset in the former and rhythmic theta activity in the latter. CONCLUSIONS: With the exception of mesial frontal lobe epilepsy, ictal recordings are very useful in the localization/lateralization of focal seizures. Some patterns are highly accurate in localizing the epileptogenic lobe. One limitation of ictal EEG is the potential for false localization/lateralization in occipital and parietal lobe epilepsies.     

脑卒中后认知损害与影像学分型的相关研究

目的探讨不同部位缺血性脑卒中急性期患者认知功能损害的特点。方法收集230例脑梗死急性期（1～14 d）患者,包括额叶31例,颞叶27例,顶叶26例,枕叶21例,基底节47例,丘脑35例,小脑23例,脑干20例;采用中文版蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）对受试者进行认知功能测评。结果 （1）各病变部位认知障碍的发生率不同;额叶组、颞叶组及丘脑组MoCA总分低于其他各组（P〈0.05）,顶叶组、枕叶组MoCA总分与基底节组、小脑组和脑干组比较有显著性差别（P〈0.05）;（2）额叶组在视空间及执行功能、注意认知域及MoCA总分值低于其他各组（P〈0.05）;颞叶组在命名、延迟回忆认知域分值低于其他各组,MoCA总分与顶叶组、枕叶组、基底节组、小脑组、脑干组有显著性差异（P〈0.05）;顶叶组及枕叶组MoCA总分低于基底节、小脑、脑干组（P〈0.05）;丘脑组在视空间及执行功能、注意认知域及MoCA总分低于顶叶、枕叶、基底节、小脑和脑干组,语言及定向认知域分值低于其他各组（P〈0.05）。结论不同部位脑梗死患者认知障碍的发生率及认知损害的特点不同。     

继发性癫痫患者68例临床特征分析

目的 探讨脑卒中继发癫痫患者的临床特征.方法 冀中能源峰峰集团有限公司总医院神经内科自2002年6月至2008年12月共收治经CT证实的脑卒中住院患者1082例,其中继发癫痫患者68例,回顾性分析脑卒中继发癫痫患者的临床资料,总结癫痫发作的主要类型、部位及其与脑卒中的类型和病灶部位的关系.结果 脑卒中继发癫痫患者癫痫发作部位主要位于中颞叶、类型以单纯部分性发作较多,脑出血患者继发癫痫的发病率高于脑梗死和蛛网膜下腔出血患者,差异有统计学意义(P＜0.05).脑卒中病灶部位在脑叶的患者继发癫痫的发病率高于其他部位,差异有统计学意义(P＜0.05).结论 脑卒中患者中脑出血、病灶累及脑叶者易继发癫痫,继发性癫痫病灶主要位于中颞叶,发病类型以单纯性部分发作较多.

Abstract：

Objective To explore the clinical features of epilepsy after stroke. Methods One thousand and eighty-two patients with stroke, admitted to our hospital from June 2002 to December 2008,were chosen. The clinical data of 68 of these patients having epilepsy after stroke were collected; the clinical characteristics, seizure types and locations were summarized; the relations between epilepsy and both the stroke types and the locations of stroke lesions were analyzed. Results In patients with secondary epilepsy, the lesion of seizure mainly located in the temporal lobe with simple partial seizure as its main seizure type; patients with epilepsy secondary to cerebral hemorrhage had a higher prevalence as compared with those secondary to cerebral infarction and subarachnoid hemorrhage (P＜0.05). Patients with secondary epilepsy having their lesions in the lobes had a higher prevalence as compared with those having their lesions in other locations (P＜0.05) Conclusion Stroke patients having cerebral hemorrhage and lesions in the lobes are likely to have secondary epilepsy; the lesion mainly locates in the middle of the temporal lobe; simple partial seizure is common.     

A network approach to investigate the bi-hemispheric synchrony in absence epilepsy

ObjectiveOur objective was to unravel the dynamics underlying spike-and-wave discharges (SWDs) characteristic for childhood absence epilepsy.MethodsSWDs were recorded for a cohort of 28 children using magnetoencephalography. Non-linear association analyses and a graph theoretical metric of local connectedness (LoC) were utilized in a sliding window starting one s before till four s after ictal onset.ResultsA focal pattern of bilateral frontal and parietal areas with high LoC during the spikes alternated by generalized patterns during the waves was found for all children studied during generalization of the SWDs. In the interval preceding the generalization a focal parietal region was most often (16/28) encountered and less often an occipital (4/28), temporal (5/28) or frontal (3/28) region. 55% of the children with a parietal/occipital focal onset became seizure free after the administration of two anti-epileptic drugs, and only 12.5% with a temporal/frontal focal onset.ConclusionsThe transition from the interictal to the ictal state is for some of the children characterized by dominant LoC at either the parietal/occipital and for others at the frontal/temporal region.SignificanceThe focal onset of the SWDs varies in location among the children with a clinical similar profile, who, however, seemingly are differing with regard to seizure control.     

Secondary brain stem hemorrhage in stroke

The occurrence of secondary brain stem hemorrhage was studied in 435 autopsies from patients with recent cerebral hemorrhage, infarction or ruptured cerebral aneurysms. The frequency of secondary brain stem hemorrhage was found to be 45% in cerebral hemorrhage, 15% in cerebral infarction, and 36% in ruptured aneurysms. In the majority of cases the secondary brain stem hemorrhage occurred a few days after the onset of cerebral hemorrhage or infarction. Ruptured aneurysms showed a more widespread temporal distribution of secondary brain stem hemorrhage. The median survival time was 2 days in cases of cerebral hemorrhage, 4 days in ruptured aneurysm and 4 days in cerebral infarction. The frequency of secondary brain stem hemorrhage was significantly lower in patients younger than 20 years. No significant difference was found in its distribution between the sexes. Secondary occipital lobe infarction was present in 3.5% of the patients. It is concluded that secondary brain stem hemorrhage is a common major contribution to the cause of death in stroke.