脑干三叉神经诱发电位的特征及临床应用研究

目的　探讨正常人脑干三叉神经诱发电位 (BTEP)的波形特征及三叉神经系统病变时BTEP的变化。方法　对 3 0名正常成人进行BTEP检测 ,确定正常值标准 ,并与 2 5例确诊为三叉神经系统病变患者的BTEP检查结果进行比较。结果　 3 0名正常人均记录到清晰、稳定的BTEP反应波。病例组 2 5例中BTEP异常 14例 ( 5 6% ) ,其中双侧异常 6例。 9例有面部感觉障碍者中 8例BTEP异常 ,16例无面部感觉障碍者 6例异常。 5例经脑外科手术证实的脑桥小脑角肿瘤患者 4例异常。 7例行射频治疗者 ,手术前后BTEP无明显变化。周围性病变时 ,BTEP主要表现为T1、T2 波消失或潜伏期延长 ,T1～T3波波间潜伏期差值 (IPLD)延长。中枢性病变时T3、T5波消失或低波幅 ,T1～T5、T2 ～T5波IPLD延长。结论　用无伤害性刺激在正常人可引导出稳定的BTEP反应波。三叉神经系统周围神经和脑干中枢部分病变时 ,BTEP变化明显。BTEP为评价三叉神经周围结构和脑干中枢神经通路功能 ,提供了一个新的、可靠的电生理学方法。     

脑干听觉诱发电位对脑干缺血诊断价值的探讨

目的：探讨脑干听觉诱发电位对脑干缺血诊断价值。方法：对44例经颅多普勒检查（TCD）确定为椎基底动脉供血不足的眩晕患者（VBI组）进行脑干听觉诱发电位（BAEP）检查,并与52例经颅多普勒检查确定为脑血管痉挛的眩晕患者（对照组）脑干听觉诱发电位检查结果进行对照分析。结果：椎基底动脉供血不足的眩晕组BAEP异常率为52．27％,明显高于对照组（3．85％,P＜0．001）。VBI组BAEP各波潜伏期均长于对照组（P＜0．05）,BAEP的I波及V波波幅低于对照组（P＜0．05）。结论：脑干听觉诱发电位可作为评价脑干缺血及其程度的一个客观指标。     

三叉神经痛患者的三叉神经诱发电位探讨

目的:探讨三叉神经痛患者脑干三叉神经诱发电位(BTEP)的波形特征及其临床价值。方法:对50例三叉神经痛患者进行BTEP检测。结果:50例三叉神经痛患者,正常10例,异常40例.BTEP异常率80%。疼痛侧异常包括双侧异常37例,疼痛侧异常明显高于对侧。异常BTEP主要表现为T2、T3波形消失或分化欠佳,波幅低下,或峰潜伏期延长,IPLI)延长。BTEP的变化与病情相关,病情越重、病程越长BTEP异常越明显。结论:BTEP可作为检测三叉神经痛患者的一种电生理方法。     

多发性硬化脑干诱发电位I波异常21例分析

目的 研究多发性硬化（MS）患者听神经脱髓鞘损害。方法 对21例MS患者23例次脑干诱发电位（BAEP）I波异常进行分析,以及结合MRI表现探针听神经脱髓鞘损害部位。结果 AEP I波异常单侧17例,双侧4例,包括I波两耳潜伏期差（ILD）异常11例,I波消失单、双侧各2例,分化不清,潜伏期不稳定3例,潜伏期延长3例。其中单侧主观听力障碍2例。同时,BAEP显著脑干内损害10例。MRI显示脑干内病灶5例。结论 部分MS患者存在听神经远端脱髓鞘损害。主要表现为I波ILD异常,部分为BAEP I波替伏期延长,I波消失,较少部分听神经脱髓鞘严重可出现突聋。     

帕金森病脑干听觉诱发电位变化30例报告

目的 探讨脑干听觉诱发电位(BAEP)对帕金森病的诊断价值.方法 对30例帕金森病人进行脑干听觉诱发电位(BAEP)检查.结果 30例帕金森病人双耳听阈增高,Ⅰ～Ⅲ波潜期延长者13例,Ⅲ～Ⅴ波潜期延长者17例,Ⅰ～Ⅴ波潜期延长者9例,Ⅰ～Ⅴ波潜期不清楚5例.提示不同程度的听觉通路及脑干的损害.结论 脑干听觉诱发电位对帕金森病的诊治有临床应用价值,值得推广.     

脑干听觉诱发电位在听阈正常的语言发育迟缓患儿中的意义

目的 探讨脑干听觉诱发电位（BAEP）在听阈正常而语言发育迟缓患儿中的变化规律及应用价值.方法 分析100例听阈正常而语言发育迟缓患儿BAEP的变化规律;按年龄分组比较两个年龄段之间各波的延长时间.结果 （1）BAEP正常10例,异常90例,BAEP表现为Ⅰ、Ⅴ波潜伏期（PL）延长,Ⅲ~Ⅴ、Ⅰ~Ⅴ波峰间期（IPL）延长;（2）随着年龄增长,Ⅴ波PL与Ⅲ~Ⅴ波IPL延长时间越长.结论 Ⅰ波、Ⅴ波延长对早期诊断听阈正常而语言发育迟缓患儿具有一定的意义,说明即使听阈正常也可能存在听觉传导通路异常,且随着年龄增加,脑干上段受损越严重.     

糖尿病患者颅神经亚临床损害的瞬目反射及脑干听觉诱发电位研究

目的：探讨瞬目反射及脑干听觉诱发电位(BAEP)对糖尿病患者颅神经亚临床损害的诊断价值。方法：对150例糖尿病患者及50名健康志愿者进行双侧瞬目反射和BAEP检查。结果：瞬目反射和BAEP均检查200人、400侧次，两项检查在糖尿病患者中总的阳性率为31．3％，远高于临床症状、体征的阳性率(6％)。瞬目反射中R2、R2′潜伏期和R1-R2波间期延长最为明显，BAEP的异常则以V波潜伏期延长最常见。结论：瞬目反射与BAEP检查能够可靠的检测糖尿病患者颅神经和脑干受损的早期及亚临床损害。     

脑干听觉诱发电位对癫痫患儿检测的意义

目的探讨脑干听觉诱发电位在癫痫患儿检测中的意义。方法对2000—01～2008—01我院38例癫痫患儿BAEP的检狈5结果进行总结。结果BAEP正常15例（39．5％），异常23例（60．5％），其中21例BAEP改变形式多样，异常指标相混出现。结论癫痫患者存在脑干功能异常。     

36例高胆红素血症新生儿脑干听觉诱发电位异常的分析

目的：探讨高胆红素血症对新生儿的听觉和脑干功能的影响。方法：对36例高胆红素血症新生儿进行脑干听觉诱发电位（BAEP）检测。结果：BAEP异常的新生儿，以胆红素水平分两组，血总胆红素≤300umol/L为黄疸1组，其主要表现为：Ⅲ，Ⅴ波峰潜伏时延长，I－V，I－Ⅲ峰间潜伏时延长，血总胆红素＞300umol/L为黄疸2组，黄疸1组与黄疸2组比较，其主要表现为：I，V波峰潜伏时及Ⅲ-Ⅴ，Ⅰ-Ⅴ峰间潜伏时间延长。结论：高胆红素血症新生儿既可有中脑下丘的损害，也可有听神经损害。BAEP对了解新生儿早期听神经及脑干功能障碍有重要价值。     

儿童先天性外耳畸形38例脑干听觉诱发电位检测分析

观察先天性外耳畸形病儿的脑干听觉诱发电位（BAEP）变化特征及意义；对38例先天性外耳畸形病儿进行BAEP检测分析；38例病儿76耳中，畸形46耳，BAEP异常率达94．1％，无畸形30耳，BAEP异常率20％，异常多表现为Ⅰ波并伴余波峰潜伏期（PL）延长，提示传导阻滞部位主要在蜗前，其听力障碍以中度听力损失为主。结论BAEP检测先天性外耳畸形病儿的听力状况是敏感而有价值的，对指导治疗及评价预后也颇有意义。     

The value of serial auditory brainstem response in patients with subacute sclerosing panencephalitis

A total of 98 serial auditory brainstem responses from 17 patients (11 boys and 6 girls) with subacute sclerosing panencephalitis were compared with their clinical course and stages. These patients were exposed to measles early in life (at 1.8 +/- 1.4 years old) with the average onset of the disease at 8.8 +/- 0.7 years of age. The main abnormalities of their auditory brainstem responses were a prolongation of waves I, III, and V, and of the I to V interpeak interval. Wave V thresholds were also elevated. These effects on the auditory brainstem responses started 1 to 2 years after onset of neurologic signs. I to V interpeak latency became prolonged with the progress of clinical stages, especially in Jabbour's clinically advanced stage IV. In two patients with an acute progressive type of subacute sclerosing panencephalitis, very rapid deterioration with a distorted wave pattern of later components was observed. These findings suggest rostrocaudal progression in the central nervous system of both long-term and fulminant cases.     

Auditory brainstem evoked potentials in early-treated congenital hypothyroidism

To evaluate the effect of early treatment of congenital hypothyroidism on central nervous system development, auditory brainstem evoked potentials were determined in 32 patients with hyperthyrotropinemia diagnosed during neonatal screening. The patients included 27 with congenital hypothyroidism and 5 with transient hypothyroidism. Abnormal auditory brainstem evoked potential tracings were found in 8 patients (congenital hypothyroidism in 7 and transient hypothyroidism in 1). Four of these patients had increased peripheral conduction time (wave I prolongation), and the other 4 had increased central conduction time (wave III or V prolongation). The patients with abnormal auditory brainstem evoked potentials did not show increased initial manifestations, yet 6 of them had lower initial thyroxine levels. Specific auditory brainstem evoked potential abnormalities were found in 25% of early-treated patients with congenital hypothyroidism. The possible causal relationship between deviant auditory brainstem evoked potential patterns and later neurodevelopment demands further clarification. This study suggests the usefulness of auditory brainstem evoked potential assessment to provide information about electrophysiologic deviation of the auditory pathway in patients with early-treated congenital hypothyroidism.     

脑干听觉诱发电位改变对Binswanger病的评估价值

目的用脑干听觉诱发电位方法检测Binswanger病的脑功能改变。方法对20例BD病患者、20例非痴呆脑血管病患者、20例老年健康人同时进行脑干听觉诱发电位（BAEP）检查。结果BAEP异常：BD病10例（50％），非痴呆脑血管病2例（10％），经统计学检查BD组BAEP与健康组、非痴呆脑血管病组有显著性差异，非痴呆脑血管病组与健康组无显著性差异。结论BAEP异常反应BD病患者有脑干功能受损和弥漫性脑功能障碍，并可作为BD病患者脑功能损害检查敏感指标，以及与非痴呆脑血管病患者鉴别诊断的一个辅助检查方法。     

Neurological and pathophysiological analyses of patients with absent auditory brainstem evoked response

Seventeen patients with no auditory brainstem evoked response (ABR) who suffered from various neurological disorders were reported. We evaluated the possibilities of co-existent brainstem lesions in addition to the peripheral impairment in the auditory pathway, by assessing neurological findings and other laboratory examinations, including cranial CT and electrically elicited blink reflex. Patients who showed cranial nerve symptoms other than that of the acoustic nerve or abnormal postural reflexes were suspected to have brainstem dysfunction. It was difficult, however, to exclude the influence from the dysfunction in the more central level CNS. Definite brainstem atrophy was revealed radiologically only in one case who was at the end stage of the degenerative disease. Blink reflex was studied in eleven cases, four of whom revealed abnormal responses, also suggesting brainstem dysfunction. All the five cases, consistent with these abnormal laboratory findings, had shown severe delay in motor development. Other five patients who showed rather good auditory behavior were considered to have 'desynchronization' response to ABR in the auditory pathway at the peripheral level. Many pathophysiological conditions may be involved in the phenomenon of absent ABR, which should be carefully evaluated from the viewpoints of clinical neurology.     

Diagnostic value of electroencephalography and brainstem auditory evoked potentials in dizziness

Electroencephalogram (EEG) and brainstem auditory evoked potentials (BAEP) were recorded from 142 dizzy patients. The results were compared with those obtained by other neurological examinations of the same patients. Thirty-three percent (N = 44) of the patients had an abnormal EEG: 21% (28) showed focal abnormality, 12% (16) irritative features, and 10% (13) generalized disturbance. There were no differences in the distribution of abnormal EEGs in different diagnostic categories of dizziness, but irritative findings were not found in the cases of peripheral vestibular or psychogenic disturbances. EEG findings in 3 patients suggested temporal epilepsy, correlating with the clinical picture. BAEPs were abnormal in 18% (N = 21) of the recordings. There were 3 cases of MS and 5 ischaemic lesions in the vertebro-basilar region. Twelve of the 13 other patients with abnormal BAEP showed evidence of CNS pathology with other methods. EEG abnormalities were mostly non-specific; however, the irritative findings suggested cerebral pathology, such as epilepsy. An abnormal BAEP offers reliable evidence for brainstem lesion and is thus a useful examination in dizziness.     

Auditory brainstem-evoked response in childhood brainstem glioma

Auditory brainstem-evoked responses were recorded from 14 children with clinical and radiological evidence of brainstem glioma. Responses were abnormal in all cases. The findings were consistent with intrinsic brainstem lesions in all except one case with a glioma, which was shown to be located predominantly in the medulla oblongata. Seven of the children had more than one test and changes in the responses paralleled clinical changes in all except the case with glioma of the medulla. The usefulness of auditory brainstem-evoked responses as an aid in diagnosing and monitoring changes in brainstem gliomas is discussed.     

Miller-Fisher综合征和Bickerstaff脑干脑炎的临床特点及鉴别诊断

目的 探讨Miller-Fisher综合征(MFS)和Bickerstaff脑干脑炎(BBE)的临床特点及鉴别诊断.方法 回顾性分析12例MFS和15例BBE患者的临床资料.结果 MFS组表现为视物成双12例,瞳孔对光反射消失3例,周围性面瘫7例,饮水呛咳1例,四肢无力6例,感觉障碍4例,共济失调10例;BBE组表现为视物成双11例,中枢性面瘫4例,耳鸣4例,饮水呛咳6例,四肢无力10例,感觉障碍2例,共济失调10例,嗜睡或昏迷5例,病理征9例.脑脊液检查MFS组和BBE组各有10例表现为蛋白升高;MFS组脑脊液白细胞升高2例,BBE组6例.MFS组3例、BBE组1例肌电图出现神经源性损害.BBE组有6例CT或MRI检查异常,主要部位为脑干、丘脑等.两组患者治疗后预后良好.结论 MFS和BBE有相似特点,临床表现可以相互重叠,提示这两种疾病密切相关并形成一个连续的疾病谱;主要鉴别点是BBE患者可以有意识障碍、病理征和影像学异常.     

Auditory brainstem response and somatosensory evoked potential in Machado-Joseph disease in Japanese families

To clarify physiological aspects of Machado-Joseph disease (MJD), we studied auditory brainstem response (ABR) and somatosensory evoked potential (SEP) in 17 clinically diagnosed patients with MJD aged 32-64 in Japanese families. ABR was recorded in 13 patients. In 8 patients, ABR were abnormal. In 5 patients, the latency of I wave was normal, but other waves could not be evoked. In the other 3 patients, I-III interpeak latency was prolonged. SEP was recorded in 15 patients. In SEP of median nerve, 11 patients had abnormal findings, and SEP of posterior tibial nerve revealed abnormal findings in all 15 patients. In all patients, responses from Erb's point and popliteal fossa were normal in latency, but other peaks were low in amplitude or absent, and the latency and central conduction time (CCT) were prolonged. The result of ABR indicated the involvement of the brainstem auditory pathways in MJD, and the result of SEP suggested that somatosensory pathways, particularly central pathways, would be involved in the disease process. ABR and SEP can be potential diagnostic methods for detection of subclinical abnormality in MJD patients.     

Effect of vigabatrin (gamma-vinyl-GABA) on visual, brainstem auditory and somatosensory evoked potentials in epileptic patients

Visual (V), somatosensory (S) and brainstem auditory (BA) evoked potentials (EPs) were determined in 22 epileptic patients, mostly with partial seizures, who received add-on treatment with vigabatrin (1-3 g/day, stratified according to body weight) and placebo, each given for 7 weeks according to a double-blind, randomized cross-over design. At pretreatment assessment, BAEPs and SEPs were found to be within normal limits in most of the patients tested, while for VEPs several abnormal responses were found, including a marked prolongation of P100 latency values in the majority of cases. None of the EP parameters examined was significantly influenced by vigabatrin treatment. These results support the evidence that enhancement of GABA-ergic transmission does not substantially affect the functional state of afferent sensory pathways as assessed by EP analysis. The significance of these findings with respect to the safety of vigabatrin therapy is discussed.     

三叉神经痛微血管减压术后神经传导功能的恢复

目的 评价三叉神经痛(TN)微血管减压术(MVD)前后三叉神经的功能恢复.方法 本文研究了38例经磁共振三维层析血管成像术(MRTA)证实有神经血管接触的TN患者,在MVD过程中,通过术前、中、后记录早期头皮诱发电位监测三叉神经传导功能;同时从三叉神经出脑干区(REZ)直接记录诱发电位作为对照研究.结果 所有病例的术前头皮诱发电位均显示三叉神经根部的传导功能损害.头皮诱发电位和根部直接记录电位证实MVD后32例患者三叉神经传导功能迅速恢复,所有患者术后疼痛均缓解.结论 MVD后TN的改善常与神经生理学数值恢复正常有关,提示神经传导功能的恢复.MVD后电生理数值的迅速恢复和疼痛缓解均证明这两种现象与髓鞘再生无关.