双侧中线旁丘脑梗死5例致残特点及生存期调查

Background:Bilateral thalamus infarction near median line is uncommon in clinic.Reports concerned with this conditions were more less.It is characterized by conscious disorder and Korsakoff syndrome.The main caused may be the injury of intralaminar nuclei,dorsomedial nuclei,and injury of cortical matter,mammalillary bodies,fasciculus thalamicus around cerebral chamer III.Comprehensing the disability characteristics in pateints with bilateral thalamus infarction near median line is important for direction of rehabilitation.While study of survival time will improve evaluation of prognosis. Design:Patients recruited from June 1997～ October 2000 were analyzed. Unit:Intraneural Department of First People's Hospital of Yunnan Province. Subjects:55 subjects with MRI proved bilateral thalamus infarction near median line entered study.These patients included 3 women,2 men(age ranging from 50 to 77 years old,mean age:68.6 years).The period from onset to admission ranged from 5 hours to 2 days.All subejcts experienced acute bilateral thalamus infarction near median line.All had hypertension previously,1 had diabetes,2 had auricular fibrillation. Intervention:All patients received management which was conducted according to protocol for treatment of ischemic cerebrovascular diseases. Patients clinical characteristics were summari-zed and analyzed.Follow up was conducted to determine the survival period. Main evaluation indexes:Survival time and conscious disorder were evaluated. Result:All patients showed different level of conscious disorder.3 cases developed thalamic dementia,2 developed vision numb,In 1 case,condition progressively deteriorated manifesting as moderate coma progressed to deep coma,and bilateral mydriasis.Finally,this patients died of central respiratory and circulatory failure after 8 days.4 cases with favorable prognosis discharged,3 out of them died within 1 year after discharge.Survival subject suffered from reduced memory was followed up till now. Conclusion:Concious or cognitive disorder ,vision bumb are common among patients with bilateral thalamus infarction near median line.Their prognosis are poor.In the current study,the number of case was samll,so further study is needed.     

头痛患者的定量感觉研究

目的:探讨定量感觉检测(QST)对头痛患者的诊断意义。方法:用定量感觉检测仪对对照组40例及头痛组71例(A组继发性头痛36例,B组功能性头痛35例),用Limit法测定耳前面颊部及耳后乳突处的冷觉(CS)、温觉(WS)、冷痛觉(CP)、热痛觉(HP)阈值,比较并分析。结果:头痛A组有32例出现QST异常,表现为阈值增高,感觉减退;头痛B组32例异常,表现为阈值降低,感觉过敏。结论:继发性及功能性头痛者表现出相反的QST异常结果,对于阈值增高的头痛患者应高度警惕存在头颈部的器质性病变。     

急性脑梗死患者血清白介素-6的变化及其临床意义

目的观察脑梗死患者急性期血清中白介素 6 (IL 6 )的含量变化及其临床意义。方法采用双抗体夹心ELISA法测定 4 2例急性脑梗死患者血清中IL 6的含量 ,并与 18例健康者进行对照。结果脑梗死患者急性期血清中IL 6的含量明显高于正常对照组 (P <0 .0 1) ;其含量与病灶大小呈正相关 (P <0 .0 5)。结论IL 6在脑梗死急性期的发病过程中起重要作用 ,测定血清IL 6含量有助于急性脑梗死的早期诊断、判断病灶大小及估计预后     

血钠异常对脑损害的预警价值

目的探讨中枢性尿崩症致血钠代谢异常对脑损害预后的判断意义。方法回顾性分析32例中枢性尿崩症患者的病因、血钠值、格拉斯哥昏迷评分（GCS）分值与临床表现及病死率的关系。结果血钠增高组的GCS分值显著低于血钠降低组，其病死率明显高于血钠降低组。结论中枢性尿崩症患者的血钠异常可视为判断预后的一个因子。     

Investigation of survival time and disability characteristics in 5 subjects with bilateral thalamus infarction near median line

Background：Bilateralthalamusinfarctionnearmedianlineisuncommoninclinic．Reportsconcernedwiththisconditionsweremoreless．ItischaracterizedbyconsciousdisorderandKorsakoffsyndrome．Themaincausedmaybetheinjuryofintralaminarnu－clei，dorsomedialnuclei，andinjuryofcorticalmatter，mammalillarybodies，fasciculusthalamicusaroundcerebralchamerII－I．Comprehensingthedisabilitycharacteristicsinpateintswithbi－lateralthalamusinfarctionnearmedianlineisimportantfordirec－tionofrehabilitation．Whilestudyo…     

急性对称性脑出血6例临床分析

急性脑出血大多为单侧性 ,双侧性少见 ,而双侧对称部位同时出血较为罕见。现对我院自 1996年以来收治的 6例急性对称性脑出血患者的临床表现分析如下。1　临床资料1.1　一般资料　本组 6例中男 4例 ,女 2例 ,年龄 2 7～76岁 ,平均 5 2岁。有高血压病史或入院后血压高者 5例 ,占83 .3 3 % ,发病时血压在 160～ 2 10 / 95～ 13 0 m m Hg。活动状态起病 4例 ,安静状态下起病 2例。 60岁以下 4例 ,3例为高血压 ,1例病因不清 ;60岁以上 2例 ,均有高血压。起病时头痛 3例 ,意识障碍 2例 (1例浅昏迷 ,1例嗜睡 )。四肢瘫 3例 ,偏瘫 1例 ,偏身感觉障…     

嗜酸性脑膜炎31例分析

现将我院2005-01～2006-06收治的嗜酸性脑膜炎31例分析如下。     

躯体形式障碍患者定量感觉检查的研究

目的 用定量感觉检查的方法了解躯体形式障碍患者的感觉改变.方法 用定量感觉仪对27名躯体形式障碍患者,分别用Limit法和Level法测定四肢的冷觉(CS)、温觉(WS)、热痛觉(HP)、冷痛觉(CP)、振动觉(WT)阈值,并与19名正常人的CS、WS、HP、CP、WT阈值进行对比.结果 Limits法显示躯体形式障碍组与对照组间除左上肢的冷痛觉、振动觉、右上肢的冷痛觉、右下肢的冷觉、冷痛觉阈值差异无显著性外,其余15项定量感觉值均差异有显著性[左上肢的热痛觉分别为(39.79±1.29)℃,(43.17±1.10)℃],t=9.2835,P＜0.01,左下肢的热痛觉分别为[(16.46±3.41)℃,(14.72±1.10)℃,t=2.1410,P＜0.05].其中11个定量感觉阈值为躯体形式障碍组明显低于正常对照组,而仅4个定量感觉阈值为躯体形式障碍组明显高于正常对照组,躯体形式障碍组的阈值降低率为55%,高于20%的升高率,差异有显著性(x2=5.2267,P＜0.05).Levels法显示2组间除右下肢的冷觉差异无显著性外,其余各定量感觉阈值亦差异有显著性[右下肢的振动觉分别为(1.07±0.13)Hz,(1.33±0.03)Hz,t=8.5327,P＜0.01]左下肢的冷觉分别为[(28.73±0.69)Hz,(28.08±0.63)Hz,t=3.2587,P＜0.01].且其中8个定量感觉阈值为躯体形式障碍组明显低于正常对照组,而仅3个定量感觉阈值为躯体形式障碍组明显高于正常对照组,躯体形式障碍组的阈值降低率为67%,高于25%的升高率,差异有显著性(x2=4.1958,P＜0.05).Limits法和Levels法阈值降低或升高率差异无显著性(P＞0.05).结论 Limits和Level法的定量感觉检查均提示躯体形式障碍出现感觉阈值下降、感觉敏感性增加的可能性较大;躯体形式障碍所产生的感觉障碍可能与周围和中枢神经敏感性均增高有关.     

度洛西汀治疗持续性躯体形式疼痛障碍临床研究

目的观察度洛西汀治疗持续性躯体形式疼痛障碍临床疗效和药物不良反应。方法78例持续性躯体形式疼痛障碍患者按给药时间的不同，分为治疗组30例和对照组48例。治疗组给予度洛西汀；对照组给以氟西汀加小剂量阿米替林治疗。分别于治疗的2、4、6周评定对比2组的疼痛量表（MOSPM）、汉密尔顿抑郁量表（HAMD）和不良反应量表（TESS），观察疗效及其药物不良反应。结果2组患者在治疗的2、4、6周MOSPM疼痛缓解率和HAMD评分差异无统计学意义（P〉0．05）。治疗组于治疗的2、4周TESS评分明显低于对照组，差异有统计学意义（P〈0．01）。结论度洛西汀治疗持续性躯体形式疼痛障碍疗效相似于氟西汀加小剂量阿米替林，但药物不良反应明显降低。     

奥氮平与氯氮平治疗巴金森病精神症状的对照

目的:对比奥氮平和氯氮平治疗巴金森病中精神症状的疗效与不良反应。方法:对27例奥氮平和25例氯氮平治疗的存在精神症状的巴金森病患者,在治疗的0、2、4、6周分别评定简明精神病评定量表(BPRS)、治疗中出现的症状量表(TESS)、锥体外系副反应量表(RSESE),对比两组间疗效与不良反应的差别。结果:2周时两组BPRS评分均较治疗前有显著性降低(P均<0.05)。两组间BPRS、RSESE评分在不同时间差异均无显著性(P均>0.05)。2、4、6周时奥氮平组的TESS评分明显低于氯氮平组,两组间差异有显著性(P<0.05)。结论:奥氮平和氯氮平对治疗巴金森病中精神症状的疗效相似,均未明显增加巴金森病的锥体外系反应。奥氮平的不良反应低于氯氮平。