Excellent cognitive performance despite massive cerebral white matter changes

Marked cerebral white matter changes are a frequent finding in the daily routine of magnetic resonance imaging of elderly patients. These findings are often equated with a decrease of cognitive function. Here we present a case of massive white matter changes but excellent cognitive performance, to avoid the automatism of drawing conclusions on intellectual ability by just interpreting the imaging data of elderly patients.     

脑白质疏松症的核磁共振成像及临床探讨

为探讨脑白质疏松症核共振成像和临床特征以及与脑梗塞的关系，本文收集１９９５～１９９７年脑白质疏松症５３例进行探讨分析，发现智力下降，肌张力升高，肌力下降，脑萎缩在脑白质疏松伴脑梗塞患者较多见，而在单纯脑白质疏松患者却无明显神经局灶表现，仅与智力下降及中央性脑萎缩有关，本病的起病方式及病程有规律性，提示脑白质疏松与脑栓塞有密切关系，均与血管性疾病有关。     

脑白质稀疏症的CT与临床分析

脑白质稀疏症(LA)是指CT上白质部位出现边缘不清的斑片状低密度病变。本文通过对201例脑血管病的临床及CT资料分析,得出了国人在脑血管病中LA的发生率为52％(106/201),统计结果还显示LA的发生与年龄、脑血管病类型及血压水平(尤其是平均收缩压水平)有关系。     

轻度血管性认知损害患者血浆同型半胱氨酸浓度变化的临床研究

目的探讨轻度血管性认知损害（mild vascular cognitive impairment,MVCI）与血浆同型半胱氨酸浓度间的关系。方法对46例MVCI患者及38例认知功能正常对照组的老年人进行血浆同型半胱氨酸（homocysteine,Hcy）测定,比较组间血浆Hcy浓度。结果MVCI组血浆总Hcy浓度（23.41±1.49μmol/L）显著高于对照组（17.01±2.48）μmol/L（t=14.61,P〈0.001）;结论增高的血浆Hcy浓度可能通过引起脑内小动脉硬化及神经细胞毒性作用而参与VMCI的患病。     

脑白质疏松症的相关因素分析──与脑梗塞和脑萎缩的异点探索

笔者对277例脑白质疏松症、脑梗塞和脑萎缩的住院病人进行CT与临床出院诊断的回顾性对比分析，比较三者临床疾病伴随车的异同点。结果表明；三者的伴随疾病谱相似，但脑白质疏松症高血压、动脉粥样硬化和心脏病的伴随车分别为58．3～75％，66．7％和41．7～60％均明显高于脑梗塞和脑萎缩组（P＜0．05）。而高粘血症、高脂血症、糖尿病、颈椎病、肺气肿和痴呆的伴随率三者间无显著差异。本文讨论了三者病因与发病机理的异同．并提出一新的假说。     

慢性酒精中毒性脑病的MRI表现

目的分析慢性酒精中毒性脑病的MRI表现。方法搜集18例经临床诊断慢性酒精中毒性脑病患者,行MRT1WI、T2WI和FLAIR检查,分析其MRI表现。结果18例中,12例表现为脑白质稀疏症,4例表现为胼胝体变性,2例合并桥臂异常信号灶,MRI上病变主要呈T1WI稍低、T2WI和FLAIR序列高信号。结论MRI能清楚显示慢性酒精中毒性脑病的病变范围,有助于临床诊断及预后疗效观察,是较可靠的影像学检查方法。     

White matter lesion in the elderly

The advent of neuroimaging has brought medical attention to the frequency of unsuspected white matter lesions in the brains of elderly people. In 1987 Hackinski suggested the term “leuko-araiosis” to identify such white matter abnormalities detected by computed tomography and magnetic resonance imaging to emphasize that their etiology and clinical relevance require clarification. Since then, leuko-araiosis has been recognized among approximately ten percent of apparently normal, elderly people over age sixtyfive. The severity and frequency of leuko-araiosis increases with advancing age, risk factors for stroke, history of strokes particularly of the lacunar type and dementia of both the vascular and Alzheimer type. Current concepts concerning the pathogenesis and neurological concomitants of leuko-araiosis are reviewed. The etiology of leuko-araiosis may be heterogeneous but is most likely ischemic in nature. However, as white matter lesions progress among the elderly they are likely to become associated with cognitive impairments and motor dyspraxias presumably resulting from cortico-subcortical disconnections, particularly involving the frontal cortex and basal ganglia and may themselves be considered a radiological “risk factor” or precursor for dementia.     

脑白质疏松与脑梗塞和脑萎缩之间关系的探讨

目的：探讨脑白质疏松，脑梗塞与脑萎缩合并或独立发生的规律，原因和临床意义，材料与方法：对２５６例头颅ＣＴ显示三合并或单独存在的住院病人进行回顾性分析，同时找出脑白质疏松和脑萎缩发现率与年龄增长的关系。结果：在脑白质疏松，脑梗塞与脑萎缩中，一病与二病合并率分别为８９．６％，６５．８％和６１．６％，脑白质疏松与脑萎缩合并出现时，轻，中，重程度同步的占５３．２％二的发现率与年龄增长呈高度正相关，γ值     

Apolipoprotein E-4 gene dose in clinically diagnosed Alzheimer's disease: prevalence,plasma cholesterol levels and cerebrovascular change

Summary The prevalence of the apolipoprotein E-4 allele (ApoE-4) was significantly higher in a referral population of 40 patients with clinically diagnosed Alzheimer's disease than in a sample of non-demented elderly controls (P<0.01). The highest plasma cholesterol levels were found in demented patients homozygotic for Apo E-4, but no significant increases of glucose, triglycerides and thyroxine or of leuko-araiosis and brain infarcts were verified in this preliminary study.