100例多发性硬化的发作性症状临床分析

目的 探讨多发性硬化中发作性症状的发生率、临床特点、发病机制和治疗。方法 对我院18年来100例多发性硬化住院患者进行回顾性分析，对具有发作性症状的MS患者根据其临床特点分类，分析影像学、电生理特点，总结其异同点。结果 多发性硬化中发作性症状的发生率27%，临床表现不一，其中以痛性强直发作占37.0%、Lhermitte症占44.4%、发作性感觉异常占44.4%、癫痫占37.0%最为常见，其发病机制近似相同。结论 MS发作症状共同点：突发突止，刻板重复，历时短暂；予抗癫痫药治疗有效。     

多发性硬化的发作性症状

发作性症状作为多发性硬化（MS）的特点之一，包括痛性强直发作、Lhermitte征、感觉异常、短暂的肢体无力、复视、视力障碍、共济失调、三叉神经痛、瘙痒，特别在MS早期，有的可以是MS的首发症状，有的提示MS复发和病情加重，其共同特点是突发突止，发作频繁，刻板重复，现将我们近3年观察的76例MS进行分析，发现具有发作性症状的患21例，现报道如下。     

26例多发性硬化患者的临床与鉴别诊断

目的 分析26例临床确诊的多发性硬化(multiple sclerosis，MS)患者的临床资料。方法 回顾性总结临床确诊MS患者的临床表现、实验室检查以及影像学表现。结果 26例MS患者最常见的临床症状为肢体无力和感觉异常，其次为肌肉痉挛性疼痛、视力障碍、尿便异常、共济失调，个别患者可有周围神经改变。实验室检查示：脑脊液蛋白水平和IgG量增高最常见。磁共振(MRI)异常率高达90．9％。结论 MS是一种临床表现复杂、累及中枢神经系统白质多部位、病程表现多时相的自身免疫性疾病。但临床有周围神经症状及MRI发现皮层病灶也并非是排除MS的绝对标准。在诊断MS时，尤其对于单病灶或多病灶、单时相病程患者应从临床和影像学方面注意与脑梗死、脊髓疾病相鉴别。     

多发性硬化的发作性症状分析

目的 探讨多发性硬化中发作性症状的临床特点、发病机制和治疗方法.方法 对15例具有发作性症状的MS患者根据不同临床特点分类,分析影像学、电生理特点,总结其异同点.结果 多发性硬化中发作性症状的发生率、临床表现不一,其中以痛性强直发作、发作性感觉异常、Lhermitte征和癫最为常见.结论 MS发作症状共同点为突发突止,刻板重复,时间短暂,可能的发病机制是由于中枢神经系统脱髓鞘损害,使神经纤维间的冲动发生横向扩散所致,卡马西平等抗癫药治疗有效.     

多发性硬化的临床特点分析

目的探讨多发性硬化(MS)的临床表现特点。方法回顾性分析2007-01—2010-06于我院确诊的68例多发性硬化病例,总结其一般资料、临床表现、病变部位、重要辅助检查及治疗转归等。结果 68例患者中,首发症状以肢体无力(28例,41.2%)最常见;肢体无力、感觉障碍、视觉损害是MS患者最常见的症状;MS好发于青壮年,以急性和亚急性起病为主;视、听、体感诱发电位(VEP、BAEP、SEP)有助于发现亚临床病变;脑脊液(CSF)检查可有异常;磁共振(MRI)检查阳性率高;临床定位以大脑半球、脊髓和视神经受累最多见。糖皮质激素及免疫球蛋白治疗有效。结论根据临床特点,结合神经电生理脑脊液及影像学等检查能大大提高MS的临床确诊率。     

多发性硬化伴发作性瘙痒20例临床分析

目的 探讨多发性硬化(MS)伴发作性瘙痒的临床特点.方法 回顾性分析20例MS伴发作性瘙痒患者的临床资料.结果 本组19例(95.0%)患者为女性,12例(60.0%)发作性瘙痒出现在首次病程,3例为MS的首发症状.瘙痒以头颈为主,突发突止,持续时间短,反复发作,瘙痒区域均伴有其他感觉障碍.MRI显示病灶位于延髓10例(头颅MRI检查15例)、颈髓11例(脊髓MRI检查14例).卡马西平等治疗后发作性瘙痒消失.结论 MS伴发作性瘙痒多为女性,发作性瘙痒有共同的临床特征,可能与延髓、颈髓病变有关,卡马西平治疗有效.     

多发性硬化42例临床分析

目的 探讨多发性硬化(MS)的临床特点、诊断和治疗.方法 分析42例多发性硬化患者的一般资料、病变部位、主要症状、重要辅助检查及其治疗方法和效果.结果 42例MS患者中青壮年女性多见,以急性、亚急性起病为主,首发症状以肢体无力最常见,病变部位以脊髓和视神经最常见,实验室检查以脑脊液蛋白水平和IgG指数增高常见.MRI异常率高达85.96%.结论 MS是一种临床表现复杂、累及中枢神经系统白质,多部位、多时相的自身免疫性疾病.根据临床特点、神经电生理、脑脊液免疫学及磁共振成像检查能提高临床确诊率,激素治疗对大多数病人有效.     

10例多发性硬化伴癫痫发作与MRI相关性分析

目的:探讨多发性硬化(MS)伴癫癎发作患者的临床特点与MRI所示病灶的相关性。方法:回顾性分析121例确诊为MS住院患者中10例(8.29%)伴癫癎发作的临床特点及MRI表现。结果:癫癎在MS其他症状或体征之前出现2例;癫癎发作为MS复发时唯一症状的1例;癫癎发作时已伴MS其他症状或体征者7例。10例患者头颅MRI均示双侧半球的深部白质、侧脑室旁数个斑块病灶,其中5例伴皮质-皮质下斑块病灶,2例伴局灶性皮质萎缩。5例癫发作与皮质-皮质下斑块病灶有相关性。结论:癫癎可以是MS的首发症状或复发时唯一临床表现,MS患者癫癎发作与皮质-皮质下斑块病灶相关。     

顶叶癫癎的临床和脑电图特征分析

目的分析和总结顶叶癫癎的临床特征、发作间歇期和发作期的脑电图特点。方法对46例顶叶癫癎患者的临床和实验室资料进行分析,并对部分患者进行随访观察。结果 46例患者,首发年龄8个月至75岁,其中首发年龄≤14岁者29例,占 63％。症状性32例,其中肿瘤、脑外伤和皮质发育异常是最常见病因,隐源性14例。顶叶癫癎临床发作形式主要为躯体感觉性发作且多表现为麻木,继发全身化多见,局灶运动发作、视觉症状、复杂部分性发作伴自动症等表现提示发作向顶叶以外部位传导,顶叶发作缺乏明确的时间分布规律,脑电图也表现为在清醒、睡眠中均出现异常放电。对其中37例患者进行了6个月至5年的随访,大部分临床得到很好控制,仅5例有难治性趋势(均为症状性)。结论顶叶癫癎是一组临床表现复杂多样具有特征性的综合征,正确认识临床特征和脑电图特点是诊断和治疗的关键。     

颞叶癫(癎)发作期临床表现及脑电图特点分析

目的 探讨颞叶癫(癎)患者发作期临床特征、脑电图特点及其临床意义.方法 对14例患者的46次发作的临床特点及脑电图进行分析.结果 46次发作中,16次为单纯部分性发作,30次为复杂部分性发作,2次继发全面性发作,单纯部分发作频率高而持续时间短,复杂部分发作持续时间长但发作频率低并常见发作后朦胧状态.发作时脑电图表现以中高波幅慢波起始最多见,10例患者可以得到定侧.4例患者通过分析临床表现及脑电图改变定侧后进行手术,术后癫(癎)完全控制.结论 颞叶癫(癎)是一组部分性症状性癫(癎)综合症,多表现为复杂部分发作,临床医生通过监测到临床发作可以更好明确诊断.同时,临床发作及同步脑电图改变可以为术前评估提供很大帮助.     

Bibliography of officers of department of mental hygiene

Psychiatric Quarterly -     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.     

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.     

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.