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1.
Ictal Single Photon Emission Computed Tomography in Occipital Lobe Seizures   总被引:5,自引:5,他引:3  
Summary: Purpose: Ictal single photon emission computed tomography (SPECT) has been evaluated as an adjunctive localizing technique in temporal lobe epilepsies and, to a lesser degree, in some extratemporal epilepsies. The purpose of this study was to determine whether occipital lobe seizures are associated with distinctive ictal cerebral blood perfusion (rCP) patterns.
Methods : SPECT was used with the tracer 99mTc HMPAO to image ictal rCP in 6 patients in whom clinical, EEG, and imaging data indicated occipital lobe seizures.
Results : Two patterns of rCP were seen. Four patients had hyperperfusion that was restricted to the occipital lobe, and two patients had hyperperfusion of the occipital lobe and the ipsilateral mesial temporal lobe, with hypoperfusion of the lateral temporal lobe. The latter 2 patients had clinical and surface EEG evidence of temporal lobe involvement in the seizure discharge.
Conclusions : Ictal rCP patterns in occipital lobe seizures are distinct from those in temporal lobe seizures and may vary according to whether or not ipsilateral temporal lobe structures are involved in the ictal discharge.  相似文献
2.
抗癫痫药物长期控制特发性癫痫异常灌注灶的修复   总被引:3,自引:0,他引:3       下载免费PDF全文
Epileptic seizure control and the disappearance of epileptiform discharge are not indicative of the absence of abnormal perfusion foci.Perfusion abnormalities are a major cause of epileptic discharge,and the existence of abnormal perfusion foci implies possible relapse.Very little is known about perfusion abnormality repair in epilepsy.The present study selected 43 cases of idiopathic epilepsy under antiepileptic drug control for an average of 24 months.Comparisons between interictal single-photon emission CT(SPECT)images and long-term electroencephalogram(EEG)pre-and post-treatment showed that cases of normal SPECT increased by 48%(12/25)following treatment,with a total number of 15 reduced foci(36%,15/41).Perfusion foci,i.e.,region of interest,were altered following treatment.These changes included:normal to abnormal in 3 cases(7%,3/43;2 hyperperfusion and 1 hypoperfusion);abnormal to normal in 14 cases(32%,14/43;10 pre-treatment hypoperfusion and 4 hyperperfusion);abnormal to abnormal in 7 cases(16%,7/43;hyperperfusion to hypoperfusion in 5 cases,hypoperfusion to hyperperfusion in 2 cases).Long-term EEG revealed in an increase in the number of normal cases by 20(40%,20/39),and there were 25 fewer cases with epileptiform discharges(66%,25/38).These findings demonstrate that long-term control of anti-epileptic drugs partially repaired cerebral perfusion abnormalities and reduced epileptiform discharges in idiopathic epilepsy.  相似文献
3.
支架术治疗症状性MCA狭窄的围手术期并发症及其管理   总被引:3,自引:0,他引:3  
目的观察支架术治疗症状性MCA狭窄的围手术期并发症,探讨规范的围手术期管理在并发症防治中的意义。方法对26例症状性MCA狭窄患者行支架术,手术患者均实施规范的围手术期管理,观察围手术期并发症及其发生率。结果手术成功率92.4%(24/26),术后造影显示MCA狭窄程度由术前的78%下降至不到10%。围手术期有5例患者出现并发症,血管痉挛1例,血管破裂致蛛网膜下腔出血1例,大脑中动脉急性闭塞1例,高灌注综合征1例,支架内血栓形成死亡1例。其中血管急性闭塞、支架内血栓形成与围手术期管理不善有关。结论支架术治疗大脑中动脉狭窄手术成功率高,疗效确切;规范化围手术期管理对于防治支架术治疗大脑中动脉狭窄的并发症具有重要意义,可以避免绝大多数并发症的发生,使手术更安全。  相似文献
4.
目的 对比研究重度颈动脉狭窄患者稳定与易损动脉粥样硬化斑块间的脑灌注情况,探讨斑块性质与脑灌注的关系。方法 利用磁共振成像技术检测颈动脉动脉粥样硬化性病变,并筛选单侧颈内动脉狭窄程度为70%~99%患者30例。对30例患者行动态磁敏感对比增强磁共振成像,测定患侧与健侧大脑半球、额叶、顶叶、半卵圆中心、皮质分水岭前区、皮质分水岭后区的平均通过时间(MTT)、相对脑血流量(rCBF)、相对脑血容量(rCBV)比值。将颈动脉粥样硬化斑块的纤维帽是否完整、斑块表面是否有大片钙化、其内是否有近期出血及是否有较大的脂质中心作为易损斑块诊断标准,分为稳定和易损斑块两组,比较两组患者脑血流动力学参数的差异。结果 与稳定斑块组比较,易损斑块组在皮质分水岭前区和后区的MTT值明显延长(t =1.561,P =0.042和t =1.227,P =0.038),rCBF和rCBV无统计学差异。上述两组在其余部位的血液动力学参数比值无统计学差异。结论 颈动脉粥样硬化斑块的稳定性和相应皮质分水岭供血区域灌注情况有关,易损斑块容易导致同侧皮质分水岭区低灌注,MTT是最敏感的指标。  相似文献
5.
The central release of both oxytocin and vasopressin within the septum and dorsal hippocampus in response to suckling was studied in conscious, freely-behaving lactating rats. Three consecutive 30-min push-pull perfusions were carried out before, during and after suckling (suckled group) or without suckling (control group). As compared to control levels, suckling resulted in a significantly increased oxytocin release within both limbic brain areas (septum: to 140%, dorsal hippocampus: to 1,600%). After removal of the suckling pups, the oxytocin concentration in the final perfusates remained at the stimulation level (septum) or tended to return to control values (dorsal hippocampus). In contrast to oxytocin, the vasopressin perfusate levels did not differ significantly between unsuckled and suckled rats.  相似文献
6.
延髓血管母细胞瘤47例报告   总被引:2,自引:2,他引:27  
目的 进一步了解延髓血管母细胞瘤的特点, 确定治疗方法, 改进手术技巧, 预防并发症及降低死亡率。方法 回顾性地分析自1987 年2 月至1998 年12 月显微手术治疗的47 例延髓血管母细胞瘤的临床资料。结果 39 例单发的血管母细胞瘤分布在延髓脑桥背部 (5 例) 、延髓背部(22例) 及延髓颈髓背部或髓内(12 例) ; 8 例为多发的血管母细胞瘤。974 % 单发血管母细胞瘤的 M R I上可见肿瘤周边低信号的囊肿形成, 并可分成以实质肿瘤为主体和以囊肿为主体两类。 D S A 及 M R A可以显示主要的供血动脉和浓厚的肿瘤染色。39 例单发的血管母细胞瘤皆被整个摘除, 术后615 % 病人的症状显著进步; 2 例与术前相似; 11 例恶化, 其中8 例经治疗后好转, 2 例死亡。结论 延髓血管母细胞瘤在 M R I及 D S A 上有其特点, 可在术前准确地作出诊断。对这种肿瘤切忌作活检或分块切除。小的实质性的或者囊性的肿瘤手术是比较安全的; 脑干背侧大的实质性肿瘤手术后会出现病情恶化, 我们认为这是正常灌注压突破( N P P B) 现象所致; 正确地掌握这种肿瘤的手术技巧, 预防及减轻 N P P B 是降低手术死亡率的关键。  相似文献
7.
PURPOSE: To characterize perfusion patterns of periictal single-photon emission tomography (SPECT) in patients with unilateral temporal lobe epilepsy (TLE) and to determine their relationship to the epileptogenic zone (EZ). METHODS: We studied periictal SPECT scans of 53 patients after anterior mesial temporal lobectomy who had good seizure outcome after surgery. Ictal SPECT scans were performed during video-EEG monitoring. Typical SPECT patterns consisted of ipsilateral ictal hyperperfusion or ipsilateral postictal hypoperfusion. Atypical ictal patterns included normal scans, bilateral temporal hyperperfusion, or contralateral patterns. These perfusion patterns were retrospectively analyzed searching for concordance rate with the EZ. RESULTS: We obtained 51 ictal and two early postictal scans. In the typical group, 40 (75.4%) patients had ipsilateral ictal temporal lobe hyperperfusion, and one (1.9%) patient had ipsilateral postictal temporal lobe hypoperfusion. Twelve (22.7%) patients exhibited atypical perfusion patterns: seven (13.2%) patients had bitemporal ictal hyperperfusion (four cases showed asymmetric temporal lobe changes), four (7.6%) patients had contralateral hyperperfusion, and one (1.9%) patient had a normal SPECT scan. All four patients with bitemporal asymmetric hyperperfusions showed greater perfusion lateralized to the side of the EZ. Three of the four patients who had contralateral hyperperfusion also had a complex postictal-like pattern in the ipsilateral temporal lobe consisting of anteromesial hyperperfusion with adjacent lateral hypoperfusion. CONCLUSIONS: This study analyzed typical and atypical perfusion patterns in unilateral TLE, and suggested that not only typical, but also some atypical perfusion patterns may contribute to the lateralization of EZ.  相似文献
8.
320排CT在短暂性脑缺血发作中的应用价值初探   总被引:2,自引:0,他引:2  
目的 初步探讨320排容积CT在短暂性脑缺血性发作(TIA)的应用价值. 方法 在11例TLA患者发作间隙期应用320排容积CT进行一站式CT扫描,收集患者的头颅平扫、CT血管造影(CTA)及全脑灌注的信息,对影像资料进行综合分析.观察TIA患者的脑血管及其组织单元的病变情况. 结果 11例患者头颅CT平扫均未发现明确的责任病灶,3例行MRI无阳性发现;CTA结果显示,10例患者责任病灶区域内脑血管网明显稀疏,8例发现有相对应的血管明显变细,2例血管栓塞同时存在代偿血管形成.11例全脑灌注图像显示与临床症状相对应的灌注区达峰时间、平均通过时间延迟,5例脑血流量下降,3例脑血容量轻度增加. 结论 320排容积CT灌注成像可以通过一次对比剂注射,获得常规CT扫描、全脑灌注、CTA的数据,实现对缺血性脑血管病的全面评估.
Abstract:
Objective To explore the application value of 320-slice volume CT in detecting the cerebral transient ischemic attack (TIA). Methods One-stop CT scan was performed at intermission of onset on 11 patients with cerebral TIA; the data of plain CT scans, CT angiography (CTA) and whole brain perfusion on these patients were collected. Analysis by synthesis was performed on these imaging data. Results No lesions responsible for the attack were found in the brains of 11 patients with TIA under plain CT scan; 3 of them performed MRI did not have positive results. CTA indicated that the vascular networks in 10 patients were obviously sparse in the region of lesions responsible for the attack;the corresponding vessels in 8 of them became thin; both vascular thrombosis and compensatory angiogenesis occurred in 2 patients. The cerebral perfusion indicated that perfusion areas corresponding to clinical symptoms displayed delayed mean transit time and time to peak level in these 11 patients.Decreased regional cerebral blood flow was noted in 5 patients and regional cerebral volume increased mildly in 3 patients. Conclusion The 320-slice-volume CT perfusion imaging can obtain the information about whole brain perfusion, routine CT scan and CTA by injecting a kind of contrast medicament for only one time, thus can assess the ischemic cerebrovascular disease comprehensively.  相似文献
9.
短暂性脑缺血发作的动态CT灌注成像与缺血再发作的关系   总被引:2,自引:0,他引:2  
目的 探讨短暂性脑缺血发作(transient ischemic attack,TIA)患者CT灌注成像(CT perfusion,CTP)的变化,为预防TIA再发提供判断依据.方法 经临床确诊的TIA患者20例于急性期先行常规16排螺旋CT横断面平扫,然后根据累及的动脉系统,选择感兴趣平面行脑CT灌注扫描,同时行CT血管造影.1个月后复查脑CT灌注.结果 20例患者中,在急性期大部分患者患侧局部脑血流(regional cerebral blood flow,rCBF)呈轻到中度异常,患侧局部脑血容量(regional cerebral blood volume, rCBV)呈正常或轻度下降.1个月后复查CT脑灌注结果 显示有12例患者未发现异常,8例患者rCBF呈轻到中度下降,患侧rCBV呈正常或轻度下降,随访1年,14例未复发.6例两次CT灌注均有异常者在1年内有5例TIA再发,1例发展为脑梗死.结论 对于脑灌注量降低严重而且持续时间长的TIA患者,提示可能出现TIA再发或进展为脑梗死,应及时强化抗缺血治疗.  相似文献
10.
单侧大脑中动脉狭窄的脑磁共振灌注成像研究   总被引:2,自引:0,他引:2  
目的探讨大脑中动脉(MCA)不同狭窄程度时的脑磁共振灌注加权成像(PWI)表现。方法对31例经DSA诊断为单侧MCA狭窄或闭塞患者行脑磁共振PWI检查,并对不同程度MCA狭窄状态下患侧和健侧大脑半球的脑灌注参数局部脑血流量(rCBF)、局部脑血容量(rCBV)、局部平均通过时间(rMTT)、局部达峰时间(rTTP)进行定量分析。结果31例患者中,DSA诊断单侧MCA轻中度狭窄14例,其中脑灌注异常11例;患侧大脑半球rTTP较健侧显著延长(P〈0.01)。MCA重度狭窄或闭塞17例,均出现异常灌注;患侧大脑半球rTTP较健侧显著延长(P〈0.01),而患侧rCBF较健侧明显减少(P〈0.05),患侧rMTT健侧亦显著延长(P〈0.05)。结论通过脑灌注成像参数综合分析,磁共振PWI能准确评估MCA狭窄程度和脑组织血供情况,可为脑缺血的临床诊断提供重要价值。  相似文献
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