后循环缺血性单发性眩晕的研究进展

由于椎-基底动脉供血不足(VBI)存在概念和标准含糊不清等问题,近年来国际上有以后循环缺血(PCI)性单发性眩晕取代VBI的倾向。PCI性单发性眩晕作为PCI的常见首发症状,有助于其早期诊断和治疗,预防更为严重的脑血管病的发生。现对PCI性单发性眩晕的国内外研究进展综述     

脑干听觉诱发电位在孤立性眩晕患者中的临床应用

眩晕是椎-基底动脉系统缺血及内耳病变的常见症状,对伴发后循环缺血的眩晕患者,通常诊断为椎-基底动脉供血不足(VBI),但对于一些仅表现为孤立性眩晕的患者,对其诊断上有一定的困难。2002年1月至2003年3月我科收治的孤立性眩晕患者35例,结合BAEP及相关检测,对其进行分析。     

前列地尔治疗椎基底动脉供血不足疗效观察

椎基底动脉供血不足(vertebro-basic arterial ischemia,VBI)常见于中老年人,由于小脑及脑干依靠椎基底动脉的供血,当椎基动脉发生病变时,脑部血流不畅,供血不足,常出现眩晕、恶心、呕吐等症状,严重影响患者生活质量.我科2009-11～2010-08应用前列地尔与红花注射液治疗50例VBI患者,取得良好效果,现报告如下.     

血管源性眩晕的临床与眼震图特征

发作性眩晕是椎基底动脉缺血的常见症状。若眩晕与其它椎基动脉供血不足(VBI)的症状同时出现,或伴脑干和/或小脑梗塞症状时,诊断多无困难。当仅出现孤立性眩晕发作时,往往与累及内耳的良性疾病难以鉴别。作者分析1974至1978年间神经耳科门诊84例血管性眩晕患者的资料,着重探讨孤立性眩晕的发生机理及与梗塞的关系。84例患者均进行神经耳科检查、定量前庭功能试验及限震图检查。部分患者行CT 及MRI 检查。16例进行后循环动脉造影,7例表现为与梗塞相关的     

不宜诊断椎基底动脉供血不足

国内“椎基底动脉供血不足（Vertebrobasilar insufficieney，VBI）”的诊断太泛，对哪些仅表现为眩晕或头昏的患者，在没找到引起眩晕或头昏的原因时临床上往往诊断VBI。用“椎基底动脉供血不足”在CHKD期刊全文数据库进行题名检索，仅2000年-2006年期间就可检索出931篇。那么用“VBI”这个诊断合适吗？     

椎一基底动脉轻微供血不足眩晕的诊断问题

椎一基底动脉供血不足所致眩晕相当多见。当椎一基底动脉梗塞症状明显时,诊断不难,已有不少报导。但当眩晕作为轻微椎一基底动脉供血不足特别是TIA的主诉时,由于缺少明确的、完整的诊断依据,常造成诊断困难。为此我们自1981年以来有目的地观察了一批患者,筛选其中资料完整、诊断及病因明确的187例TIA 154例对其临床特征总结如下,作为临诊参考。     

"椎-基底动脉供血不足"的概念过时了吗?

自20世纪60年代，椎-基底动脉供血不足（vertebrobasilar insufficiency，VBI）的概念首先被神经科接受和使用，并逐渐在普通内科、心血管科、骨科、五官科、老年科以及中医科广泛运用，许多患都因头晕或眩晕而被冠之以椎-基底动脉供血不足。然而，在大多数情况下椎-基底动脉供血不足的临床诊断缺乏标准，对之处理更是杂乱无章，毫无规范可言，导致大量医疗资源浪费，而真正的患又未得到正确的防治。因此，澄清椎-基底动脉供血不足的相关概念、规范诊断治疗标准，具有十分重要的意义。     

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。     

椎基底动脉供血不足的临床诊断

本文分析了137例椎基底动脉供血不足(VBI),并针对诊断学方面的若干问题进行了讨论。137例VBI中,临床确诊的51例(37％),临床不典型,但经过眼震电图、经颅多普勒超声等特殊检查确诊的20例(15％);其它66例均拟诊为VBI。本文还对VBI的病因诊断进行了分析和讨论。     

椎基动脉供血不全的外科治疗

椎基动脉供血不全综合征(VBI)现已为人们熟悉的疾病,表现为脑干、小脑和/或枕叶皮质一时性缺血发作.继1947年Kubik与Adams对椎基动脉闭塞的临床和病理表现进行深入论述之后,许多作者已注意到后组脑循环的—时性缺血和使用抗凝治疗.虽然在颅外动脉手术方面已取得某些早期经验,但大多数VBI病人仍采用内科治疗,常不作血管造影.这与前组脑循环的暂时性缺血发作(TIAs)相反,前组脑循环TIAs的血管造影诊断和颈内动脉内膜切除术的外科治疗已     

"Objective" methods and "subjective" experiences

Current psychiatric research and practice emphasize measurement of operationalized variables, quantification, and rigorous hypothesis testing. The fact that mental states can be subjectively experienced and that thoughts can refer to things and events outside the mind suggests that such objectifying methods alone may not provide a complete approach to mental life. Other complementary but systematic methods can be described which stress that (1) words are often natural expressions, not labels, of experiences; (2) usefulness, not agreement with observation, can sometimes validate psychological expressions; (3) some data can only be gathered by interactive involvement, not dispassionate observation; (4) a goal of inquiry can be interpretation, not hypothesis testing; and (5) understanding may require a holistic approach which expands rather than constricts the realm of relevant data.     

Knowing "what" and knowing "when"

The ability to situate autobiographical memories accurately in the "time-line" of one's own life is a particular aspect of retrograde memory that has received little attention in well-controlled, systematic studies. Here, we addressed this issue by testing the hypothesis that patients with basal forebrain damage would be impaired in their ability to place various autobiographical memories accurately on a 'time-line' of their life. Seven such subjects were contrasted with 11 medial temporal lobe subjects, 8 brain-damaged comparison subjects, and 18 normal comparison subjects, using a procedure in which subjects placed autobiographical events on a time-line of their life. The basal forebrain group was very impaired in this task, relative to the other groups, and on average, misplaced events by more than five years. Although the basal forebrain group was also impaired in retrieving the contents of autobiographical memory, they did not differ statistically from the medial temporal lobe group in this regard (and the medial temporal lobe group did not have impaired time placement of memories). The results indicate an intriguing dissociation between "knowing what" and "knowing when," and suggest that the basal forebrain contains structures that are especially important for "knowing when." Our findings are compatible with the view that the basal forebrain participates critically in retrieval strategies important for memory chronology, which contrasts with the medial temporal lobe's critical role in relational memory per se.     

The "forty-nine" and "seventeen" problems]

The single most common age of murderers in Japan is 49. Individuals aged between 45 and 54 are, however, likely to commit not offences but suicides comparing with other generations. One factor behind this phenomenon is the trend toward company downsizing, which is thought to affect the mental attitude of workers. This trend is destroying the Japanese lifetime employment system and undermining worker's loyalty to the company. On the other hand, in the broader category of felony crimes (assault, burglary, arson, murder), offenders aged 17 are the most common in Japan. This is thought to be partly due to the effect of so-called "school collapse" (school system failure) on the mental attitude of students. "School collapse" implies dysfunction of educational practice as a result of chattering, bullying and violence in the classroom. It is the reflection of students' dissatisfaction with the group-oriented school system. Therefore, students are unable to find any purposes in school and exhibit aggressive behaviours. In terms of mental health for both middle-age and teenage generations, it is necessary to devise new strategies whereby people can break away from the pressure of loyalty to the group. For both "normal" and "disabled" workers, rights of recuperations, adequate unemployment benefits policy, and support system for occupational change should be established. Simultaneously, for both "normal" and "disabled" students, reform of the school system under the concepts of diversity of education, rights of selection, and rights of refusal is urgently necessary. With respect to forensic psychiatry, without the provision of social supports, labeling of conduct disorder as well as other disorders should be avoided. In particular, instead of introducing security hospitals, drastic improvements of medical reformatories and medical prisons are necessary to provide adequate medical and social supports for offenders with psychiatric disorders.