创伤性原发性脑室内出血

创伤性原发性脑室内出血(TPIVH)是一种较为罕见的颅内出血,以前须经手术或尸体解剖才能证实。自 CT 应用后,逐渐引起人们的重视。我院自1986年6月至1990年12月共收     

神经节苷脂GM1在创伤性颅脑损伤中应用的研究进展

神经节苷脂GM1是一种广泛存在于中枢神经系统的含唾液酸的神经鞘糖脂,参与神经系统的发育过程,并能通过血脑屏障与神经元细胞膜相互作用,拮抗兴奋性氨基酸、减少氧自由基的产生、防止Ca2+大量内流、抑制一氧化氮合成酶活性、增强营养因子作用、促进神经再生,在创伤性颅脑损伤的病理过程中能广泛的起到神经保护作用,减轻继发性脑损害,改善伤后运动和记忆功能障碍。本文重点就GM1在创伤性颅脑损伤的基础实验和临床应用的研究进展进行综述。     

颅脑外伤术后应用异丙酚镇静治疗临床回顾

目的探讨异丙酚用于颅脑外伤患者术后镇静的疗效。方法回顾分析715例颅脑外伤手术患者：对照组289例（1998年～2000年）,术后自然苏醒;治疗组426例（2001年-2005年）,术后给予异丙酚镇静治疗,比较两组颅内压、脑灌注压、术后低血压发生率、术后再出血率和术后6个月GOS等指标。结果两组病例术后6h颅内压存在显著差异（P〈0．05）,脑灌注压无显著差异（P=0．07）,低血压发生率无显著差异（P=0．19）,再出血发生率无显著差异（P=0．46）,两组术后6个月的GOS无显著差异（P=0．28）。结论异丙酚能够安全有效的完成颅脑外伤术后的镇静治疗。     

脑创伤模型大鼠脑组织中SBDP145和SBDP120的水平测定

目的检测大鼠重型颅脑损伤模型脑组织中SBDP140和SBDP120浓度,分析其在创伤急性期释放趋势。方法随机将70只成年雄性SD大鼠分为对照组(假手术组)10只,重型脑损伤组60只,于模型制作成功后处死小鼠,制备脑组织匀浆,所有标本均采用酶联免疫吸附剂测定分析方法进行检测SBDPS的浓度。结果 SBDP145和SBDP120浓度,在不同的时间点上实验组明显高于对照组,SBDP145在伤后6h就能够检测到明显变化,而SBDP120直到到伤后72h才有明显的升高。结论创伤性脑损伤脑组织中的SBDPS与脑损伤的严重性有关。     

小儿外伤性脑干及左丘脑梗塞一例

小儿外伤性脑干及左丘脑梗塞一例李铮，蔡琦，董方箴，杨钧，韩胜，李云林患儿，男９岁，由凳子上摔下，臀部及枕部着地．无原发昏迷，仅略感头育，无恶心呕吐．伤后半小时出现意识丧失并呕吐一次，为胃内容物．在当地治疗病情无缓解，５天后转至我院．查：浅昏迷，呼吸平...     

细胞周期机制在创伤性脑损伤中的研究进展

创伤性脑损伤后诱导继发性损伤,导致神经元凋亡、神经炎症和神经功能障碍,一个重要的损伤机制是细胞周期激活。细胞周期再进入机制可能是神经元凋亡性细胞死亡的共同通路,通路可能是p53依赖性或p53非依赖性的。创伤性脑损伤也导致星形胶质细胞和小胶质细胞中细胞周期激活。细胞周期抑制剂,在创伤性脑损伤后可以提供强有力的神经保护作用,为颅脑损伤的治疗提供新的研究靶点。     

创伤性颅脑损伤治疗新进展

一、颅脑损伤以及损伤机制创伤性颅脑损伤,仍是影响健康的主要问题。美国每年就诊病人达２００万以上,其中约７５００人致死,１２５０００人致残。英国每年达１００万以上,死亡率为９／１０万,占住院全部死亡数的１％;１５％～２０％的死亡者年龄,在５～３５岁之间...     

动脉内灌注罂粟碱治疗创伤性脑血管痉挛

颅脑损伤通常伴有一定程度的蛛网膜下腔出血及血管痉挛.自1996年5月～1998年7月,我们应用动脉内灌注罂粟碱治疗创伤性血管痉挛13例,现报告如下.     

创伤性颈静脉孔综合征延误诊断2例报告

例1：患者男必，26岁，因头部外伤后短暂神志不清，头晕，头痛1h余入院。查体：左侧枕部见一不规则，深达颅骨的头皮伤口，余神经系统检查未见明显异常，头颅CT扫描示：右额叶脑挫裂伤，左枕骨骨折，入院后予以卧床休息，镇静、止血，脱水及预防外伤性癫痫等处理。     

颅脑创伤后脑缺血性损伤研究进展

随着我国国民经济、交通、建筑等的快速发展,创伤性颅脑损伤（traumatic brain injury,TBI）的发病率也逐年上升,已成为威胁人们健康的主要原因之一。创伤性颅脑损伤发病率高、致残率高、死亡率高,长期受到世界各国科研工作者的重视。以往的研究重点多在出血性脑损伤、脑水肿的机制和防治等方面。Tawil等报道颅脑外伤患者中8％存在明确的外伤后脑梗死,其死亡率高达45％,合并影像学上脑血管钝性伤的占11．7％。近年来创伤后脑缺血性损伤的研究成为神经外科新的热点,研究主要集中于几个方面：脑血管的直接损伤、脑血管痉挛、脑血管血栓形成及损伤血管修复。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.     

The influence of comorbid depression on seizure severity

PURPOSE: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.     

Une phénoménologie de la dépendance à l'alcool. Une expérience primordiale de la « nostrité »

The phenomenological approach to alcoholism interestingly focuses on specific dynamics of interpersonal relationships displaying the founding of the Self from a primary “us” and its original basis in the human feast. Priorities for treatment intervention recommend to involve social setting and relationships of the patients, reaching their active participation to a motivational and long term group treatment, underlying the specific therapeutic effect of world exchanges. Biopsychosocial determination of alcoholism could be primarily based on components of interpersonal relationships. Regarding social background, drinking is one of the most famous supports for the achievement of the feast, a founding marker of present time. Taking an existential point of view, the feast appears as the heart of mankind because it presents a primary “us”, a plural state which indicates the beginning and founding of the Self from the others. During the feast, we regularly have to reach our Self from the “us” while avoiding two main dangers, drunkenness, an increase in the dizziness of upright verticality, and addiction, an opposite vertical surrender to alcohol and falling into in the alcoholic relapse, both situations imply a spatial domination and the disappearance of others. Treatment programs of alcohol addicts need to integrate the necessity of reaching the existential basic trust from the support of a group to the appropriation of the community which can be defined as an original “usness”.