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1.
本文对80例椎—基底动脉供血不足(VBI)患者及60例健康对照组进行 ̄(99m)Tc—ECD—SPECT检查,SPECT诊断VBI的灵敏性为73,8%,特异性为78.3%,总符合率为75.7%。59例SPECT阳性者,出现相应临床症状者43例(72.9%)。VBI组缺血灶的缺血程度较对照组明显(P<0.01)。80例VBI患者均在距VBI最后一次发作16d内进行SPECT检查,3d以内与4d后检查的两组阳性率相差不明显(P>0.05)。  相似文献   

2.
脑供血不足的SPECT与BEAM比较   总被引:1,自引:0,他引:1  
报告42例临床诊断为脑供血不足病人的SPECT及BEAM,阳性率分别为86%及19%,二者有显著性差异(P〈0.01)。SPECT在RCBF低于正常1%时即可显示缺血性,面BEAM较易反映在脑半球功能变化,。SPECT能检出脑血流高于症状发生阈25ml/(100g.min)而低于生理阈值50ml/(100g.min)的潜在性缺血病灶,为临床提供超早期治疗依据。在脑供血不足缓解期检查SPECT,发现  相似文献   

3.
椎—基底动脉供血不足的SPECT与临床   总被引:4,自引:0,他引:4  
本文对80例椎-基底动脉供血不足(VBI)患者及60例健康对照组进行^99mTc-ECD-SPECT检查,SPECT诊断VBI的灵敏性为73.8%,特异性为78.3%,总符合率为75.7%,59例SPECT阳性者,出现相应临床症状者43例(72.9%),VBI组缺血灶的缺血程度较对照明显(P〈0.01)。80例VBI患者均在距VBI最后一次发作16d内进行SPECT检查,3d以内与4d后检查的两组  相似文献   

4.
多发性抽动症患者脑SPECT与CT/MR及EEG比较性研究   总被引:4,自引:0,他引:4  
目的探讨脑SPECT、CT/MR、EEG对多发性抽动症(TS)的临床诊断价值。方法对35例TS患者进行99m锝-双半胱乙酯(9mTc-ECD)脑SPECT显像,并于2周内行CT/MR和EEG检查。结果脑SPECT对TS诊断的灵敏性、特异性、准确性分别为714%、100%、8367%;EEG检查的阳性率486%,明显低于SPECT(P<005);CT仅发现1例侧脑室轻度增大。结论SPECT脑显像对确定TS的病变部位优于EEG和CT/MR。  相似文献   

5.
自发性脑出血SPECT研究   总被引:15,自引:1,他引:14  
报告30例自发性脑出血后脑血流改变的SPECT研究结果。结果发现全部患者SPECT显示脑血流量的下降区域均超过CT病灶范围,7例血流量下降局限于病灶区,余23例见广泛缺血,其中小脑失联络9例,基底节区出血对脑血流的影响超过脑叶出血,血流下降的范围与出血量有关,且与神经功能恢复程度有一定联系。本文提示脑出血在积极控制水肿的同时,应注意改善亚急性期和恢复期脑部低灌注。  相似文献   

6.
外伤性迟发性硬膜外血肿的临床特点与诊治   总被引:9,自引:0,他引:9  
目的 探讨外伤性迟发性硬膜外血肿(DEDH) 的发病规律、诊断及治疗。方法 经CT监测及临床观察确诊84例DEDH, 分析迟发性血肿与原发损伤的关系及治疗资料。结果 经2 次CT检查发现迟发性血肿70 例,经3 次CT检查确诊14 例;迟发性血肿多发生于伤后24 小时内(64-3% ) ,多见于颞顶部(59-5 %) ,且多有颅骨骨折(76-2% ) 。下述情况的GOSⅣ~Ⅴ级者占比例最高,其中额颞部血肿(18/20) ,GCS13 ~15 分(53/53),血肿量50 mL以下(55/55) ,手术清除血肿(45/54) ,提示具有这些情况的患者预后较好。结论 CT和颅内压(ICP) 监测有助于及时发现DEDH 和确定正确治疗方案,对部分小血肿病人可行保守治疗。  相似文献   

7.
SPECT脑血流灌注显像在眩晕患者中的初步应用   总被引:3,自引:1,他引:2  
目的评价乙撑双半胱氨酸二乙酯(^99mTc-ECD)SPECT脑血流灌注显像对眩晕患者的诊断价值。方法对19列眩晕患者和20例正常对照者进行SPECT脑血流灌注显像。结果突发性耳聋组和诊断未明确组的患者全部出现局部脑血流量下降,且多数分布在颞叶;梅尼埃病患者组则较少出现局部脑血流量下降(40%,2/5);正常对照组未发现局部脑血流量下降。结论^99mTc-ECDSPECT脑血流灌注显像有助于眩晕患  相似文献   

8.
目的:研究急性一氧化碳中毒后迟发性脑病(DEACMP)患者的诱发电位(EP)、CT和脑电图(EEG)。方法:对46例DEACMP患者进行EP、CT和EEG检查,结果:异常率体感诱发电位(SEP)83%、视觉诱发电位(VEP)63%,脑士听觉诱发电位(BAEP)30%,CT71%,EEG100%。SEP中的P40、N50,P60和N75峰潜伏期(PL)比正常对照组显著延长,VEP的P100PL较对照  相似文献   

9.
改善血肿周围缺血对高血压性脑出血预后的初步报告   总被引:19,自引:0,他引:19  
目的:观察改善血肿周围缺血对脑出血血肿和水肿及神经功能的影响。方法:21例脑出血患者随机分组,观察血肿、水肿体积和神经功能缺失评分。结果:(1)低右、血栓通组第10天血肿体积明显缩小;(2)低右组第4、10、21天水肿体积缩小;(3)ESS/CSS评分与血肿体积显著相关,与水肿体积中度相关;(4)低右组改善治疗后第4、10、21天的ESS/CSS;血栓通组的第21天ESS/CSS改善。结论:低右和血栓通能改善血肿周围缺血、促进血肿吸收、促进水肿的消退,改善临床神经功能。  相似文献   

10.
对46例枕叶脑卒中患者和40例正常人进行视觉诱发电位(VEP)检查,同时133Xe吸入法测定脑血流量。结果发现脑卒中组VEP异常31例(67.4%);对照组异常3例(7.5%),两组比较χ2=29.6,P<0.01。脑卒中组枕叶脑血流量平均43.2±6.1ml.100g-1/min,对照组49.8±7.8ml.100g-1/min,t=4.4,P<0.01。VEP异常与枕叶脑血流量呈负相关,r=-0.387,P<0.01。伴有视野缺损VEP异常率高。结果提示:VEP对诊断视中枢损伤价值较大,尤其伴有视野缺损者意义尤大,VEP异常与枕叶脑血流量呈负相关。  相似文献   

11.
Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.  相似文献   

12.
Diagnostic Difficulties and Treatment Implications   总被引:1,自引:0,他引:1  
Robert J. Gumnit 《Epilepsia》1987,28(S3):S9-S13
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.  相似文献   

13.
Cognitive Dysfunction Associated with Antiepileptic Drug Therapy   总被引:7,自引:5,他引:2  
Eileen P.G. Vining 《Epilepsia》1987,28(S2):S18-S22
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.  相似文献   

14.
B. J. Wilder 《Epilepsia》1987,28(S2):S1-S7
Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.  相似文献   

15.
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.  相似文献   

16.
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.  相似文献   

17.
Hepatic Considerations in the Use of Antiepileptic Drugs   总被引:5,自引:4,他引:1  
Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.  相似文献   

18.
Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity   总被引:5,自引:1,他引:4  
G. Trube  R. Netzer 《Epilepsia》1994,35(S5):S62-S67
Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.  相似文献   

19.
Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.  相似文献   

20.
Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.  相似文献   

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