1263例急性脑卒中心电图分析

目的：探讨急性脑卒中心电图改变、机制及临床意义。方法：对1 263例急性脑卒中病人心电图结合其它临床资料进行回顾性分析。结果：脑梗死与脑出血心电图异常分别为87.2%与64.37%,差异明显（P〈0.001）,丘脑出血心电图异常达89.28%明显高于其它部位出血与梗塞的心电图改变（P均〈0.01）,72例脑出血死亡与29例脑梗死死亡心电图异常分别为84.5%与75%,差异明显（P〈0.01）。结论：急性脑卒中心电图改变可能与脑卒中类型及病变部位有关,机制可能与脑卒中直接或间接导致植物神经中枢功能失调及神经体液功能紊乱等有关。心电图改变影响预后,应予以重视并积极治疗。     

急性脑血管病致脑心综合症心电图改变分析

目的:分析急性脑血管病对心脏的影响.方法:回顾性分析自2006-01～2011-12间126例急性脑血管病患者心电图(ECG)的变化.结果:126例患者中有89例心电图显示有异常改变,占总数的71.4%,其中脑梗塞异常为65.7%,脑出血异常为75.5%,蛛网膜下腔出血异常为83.3%.心电图异常以心律失常最多.结论:急性脑血管病可以引起心脏损害,病情越重,心脏损害发生率越高,心电图的改变越严重.     

79例脑出血患者与141例脑梗塞患者心电图分析

目的：探讨急性脑血管病心电图分析及临床意义。方法分析2011年10月～2014年10月入住的220例经CT、MRI确诊为急性脑血管疾病患者的临床资料,其中脑出血组患者数79例,脑梗塞数141例。分析两组患者心电图异常率、脑出血部位与心电图异常分类情况、脑梗塞部位与心电图异常分类情况。结果（1）脑出血组79例患者中,心电图异常率为88．61％;脑梗塞组141例患者中,心电图异常率为84．09％;（2）脑出血部位为基底节、丘脑及脑干患者心电图异常率为97．96％,显著高于脑叶、小脑部位（73．33％）（P＜0．05）;（3）脑梗塞部位为基底节、丘脑及脑干患者心电图异常率为92．16％,显著高于脑叶、小脑部位（53．85％）（ P＜0．05）。结论急性脑血管病心电图异常与脑出血及脑梗塞发病部位有关,且心电图对急性脑血管的临床诊疗中具有十分重要的指导意义与价值。     

高海拔地区32例脑出血患者心电图分析

急性脑血管病引起的心脏功能改变或心电图变化,临床上称之为“脑心综合征”。为探索研究高海拔地区脑出血患者心电图改变情况,本文对我院(海拔2800m青藏高原)1994～1996年间32例脑出血患者的心电图改变进行分析如下。     

脑出血患者QTd及心肌酶谱的变化及意义

 目的探讨脑出血时心电图QT离散度(QTd)及血清心肌酶谱变化,客观评价脑出血病情及继发心脏损害的危险性。方法对54例脑出血患者及46例健康者的心电图QTd及血清谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CK)等心肌酶谱进行检测,并作了对照分析。结果脑出血患者QTd明显增加,心肌酶谱各项检测指标显著异常,与对照组比较,P＜0.01或P＜0.05,并与脑出血量多少相关。QTd增加与心肌酶谱多项指标升高呈正相关。结论脑出血患者心电图QTd及心肌酶谱显著异常。对QTd及心肌酶谱检测有助于判断脑出血病情及心脏受累程度,有利于脑源性猝死的预防。     

脑出血急性期的心电图改变52例分析

急性脑血管病与心脏的关系 ,既脑心综合征也受到临床医生的关注 ,它可以引起心电图改变及心律失常 ,我们收集本院从 1996年 6月至 2 0 0 0年 12月的资料完整病人共 5 2例分析脑出血量、出血部位与心电图改变及心律失常的关系 ,现报告如下 :1　对象与方法1.1　临床资料　一般资料本组 5 2例 ,其中男性 3 2例 ,女性 2 0例 ,年龄在 3 8-80岁 ,患者均在发病 2天内收住院 ,并在此期间记录心电图加以分析。心电图表现　出血量小于 5 0ml者 45例 ,心电图有改变 (包括ST段、T波异常、Q -T间期延长 )者 2 6例 ,有心律失常 4例(其中房性心律失常 2例…     

西宁地区364例高血压脑出血患者心电图分析

目的:分析西宁地区364例高血压脑出血患者心电图特点。方法:对我院1998年—2005年资料较为完整的364例高血压脑出血住院患者的心电图进行整理分析、研究以探讨其特点。结果:西宁地区高血压脑出血心电图发生异常与高原特殊环境无明显相关,与平原地区高血压脑出血心电图发生异常基本相同,可能与脑损害部位有关。结论:通过西宁地区364例高血压脑出血患者心电图特点变化分析,总结西宁地区与平原地区高血压脑出血心电图的特点。     

肿瘤患者化疗前后血清心肌酶学临床分析

目的观察恶性肿瘤患者化疗前后血清心肌酶学的改变及其临床意义。方法对641例恶性肿瘤患者分别在化疗前后检测血清心肌酶浓度的改变，同时行常规心电图及超声心动图检查。结果641例恶性肿瘤患者在接受首次化疗前有238例患者存在血清心肌酶学异常，主要表现为AST和LDH的异常；化疗后新增异常45例，主要表现为CK和CK—MB的异常。化疗前血清心肌酶学异常和肿瘤的类型、病情进展情况有关；化疗后血清心肌酶学升高和化疗药物的器官损害有关。结论观察化疗前后血清心肌酶学的改变对提示预后、疗效、化疗心脏毒性具有一定的参考价值。     

糖尿病酮症酸中毒合并假性前壁心肌梗死1例

<正>糖尿病酮症酸中毒(diabetic ketoacidosis, DKA)是糖尿病常见的急性并发症之一，以高血糖、酮症和酸中毒为主要表现，并伴有严重脱水。部分严重的DKA也可合并器官损伤表现，如急性心肌损伤，临床上表现为心肌酶升高、心电图异常改变等，很难与血管病变所致急性心肌梗死鉴别，为临床治疗带来困惑。本文报道1例严重DKA患者疑似典型的急性前壁心肌梗死，但冠脉造影正常的案例。1 病例报告患者，男，41岁，     

急性一氧化碳中毒的颅脑CT观察(附100例分析)

分析了100例急性一氧化碳中毒及迟发脑病患者的颅脑CT改变。在未出现迟发脑病68例(A组)及出现迟发脑病的32例(B组)中,各有28例发现颅脑CT异常,异常率分别为41.2％、87.5％。两组CT异常主要表现为双侧大脑皮层下白质及苍白球或内囊大致对称的密度减低区,后期出现脑室扩大或脑沟增宽。对CT改变与病理特点、昏迷时间、检查时间,以及与神经系统症状体征间的关系进行了分析与讨论,指出颅脑CT对重度急性CO中毒及迟发脑病具有辅助定位诊断与鉴别诊断、判断病情及预后的作用。     

急性脑血管意外后深静脉血栓形成(附18例报告)

目的：对急性脑血管意外后并发的深静脉血栓进行临床分析，加深对此病的认识。方法：对18例急性脑血管意外后深静脉血栓形成患者的原始资料进行回顾性分析。结果：同期脑卒中病人并发有症状的深静脉血栓的发生率为4．3％；原发病为脑栓塞9例，脑血栓形成5例，脑出血3例，蛛网膜下腔出血1例；伴发疾病中糖尿病和心房纤颤常见；继发肺栓塞5例，3例死亡。结论：深静脉血栓易致急性肺栓塞，死亡率很高，且易漏诊，应对高龄的、卧床的有深静脉血栓形成倾向的脑卒中病人给予必要的预防。     

COVID-19相关急性脑损伤的临床及影像学表现

目的:探讨新型冠状病毒病(COVID-19)相关急性脑损伤的临床及影像学特征.方法:回顾性分析9例COVID-19合并急性脑损伤患者的临床及影像资料,9例患者均行胸部和头颅CT检查,其中1例行MRI检查.所有患者COVID-19鼻咽拭子核酸和血清特异性抗体均为阳性.记录患者发生急性脑损伤最近时间点的超敏反应C蛋白、血沉...     

血浆同型半胱氨酸浓度对老年脑卒中的临床预警价值

 目的 探讨血浆同型半胱氨酸（homocysteine, HCY）浓度对老年脑卒中病的临床预警价值。方法 2010-01至2012-07我院收治老年脑卒中患者143例, 分为脑梗死组和脑出血组, 并选择同期的老年健康体检者371例作为对照组, 所有受检者均于清晨空腹采取静脉血, 采用酶化学法测定HCY浓度。结果 脑梗死组患者的血浆HCY浓度显著高于健康对照组, 差异具有统计学意义（P<0.05）;脑出血组患者的HCY浓度显著高于健康对照组, 差异有统计学意义（P<0.05）。脑梗死组和脑出血组的HCY浓度相近, 差异无统计学意义（P>0.05）。结论 HCY浓度与老年脑梗死和脑出血的发生有密切联系, 检测老年人HCY浓度对脑卒中病的发生有重要的预警价值;HCY的浓度不能作为脑梗死和脑出血之间区分判定的依据。     

重型颅脑损伤急性上消化道出血并顽固性膈肌痉挛24例临床分析

目的 探讨重型颅脑损伤急性上消化道出血并顽固性膈肌痉挛的临床特点,总结其发病机制及治疗方法。方法 总结分析我院1995年1月-2000年12月期间收治的220例重型颅脑损伤患者中24例合并急性上消化道出血、顽固性膈肌痉挛病例的临床资料。结果 本组220例患者中24例并发急性上消化道出血、顽固性膈肌痉挛,发病率10．9％,治愈21例(87．5％),死亡3例(12．5％)。结论 重型颅脑损伤后急性上消化道出血并不少见,而合并顽固性膈肌痉挛则病情更重,死亡率更高,应引起足够的重视。     

Clinical and Angiographic Features and Stroke Types in Adult Moyamoya Disease

BACKGROUND AND PURPOSE:This study was conducted to elucidate the association between clinical and angiographic characteristics and stroke types in adult Moyamoya disease that has been rarely evaluated.MATERIALS AND METHODS:We analyzed the clinical and radiologic data obtained from a retrospective adult Moyamoya disease cohort with acute strokes, which were classified into 7 categories: large-artery infarct, hemodynamic infarct, perforator infarct, deep intracerebral hemorrhage, lobar intracerebral hemorrhage, intraventricular hemorrhage, and SAH. With conventional angiography, which was performed in the hemispheres with acute strokes, the Suzuki angiographic stage, intracranial aneurysm, major artery occlusion, and collateral vessel development were confirmed within 1 month of stroke onset.RESULTS:This study included 79 patients with acute ischemic stroke and 96 patients with acute hemorrhagic stroke. The angiographic stage had a strong tendency to be more advanced in the hemorrhagic than the ischemic patients (P = .061). Intracranial aneurysms were more frequently found in the hemorrhagic than ischemic or control hemispheres (P = .002). Occlusions of the anterior cerebral artery and development of fetal-type posterior cerebral artery were more frequently observed in the hemorrhagic than the ischemic (P = .001 and .01, respectively) or control hemispheres (P = .011 and .013, respectively). MCA occlusion (P = .039) and collateral flow development, including the ethmoidal Moyamoya vessels (P = .036) and transdural anastomosis of the external carotid artery (P = .022), occurred more often in the hemorrhagic than the ischemic hemispheres. Anterior cerebral artery occlusion occurred more frequently in patients with deep intracerebral hemorrhage or intraventricular hemorrhage than with lobar intracerebral hemorrhage (P = .009).CONCLUSIONS:In adult Moyamoya disease, major artery occlusion and collateral compensation occurred more often in the hemorrhagic than in the ischemic hemispheres. Thus, anterior cerebral artery occlusion with or without MCA occlusion and intracranial aneurysms may be the main contributing factors to hemorrhagic stroke in adult patients with Moyamoya disease.

Moyamoya disease (MMD) is a chronic, progressive cerebrovascular disorder with bilateral stenosis or occlusion of the supraclinoid ICA and its major branches at the surrounding area of the circle of Willis.¹ MMD exhibits diverse symptoms, such as TIA, recurrent TIAs, cerebral infarct, intracranial hemorrhage, headache, seizure, cognitive decline, ataxia, or choreiform movements; it can also be asymptomatic. In adult MMD, approximately half of the patients have intracranial hemorrhage, and the rest of the patients have TIA or cerebral infarct.^2,3 Recently, MMD was reported to exhibit a bimodal peak of symptom onset in the ischemic type and a unimodal peak in the hemorrhagic type.⁴ However, the cause of differential onset and the distinct presentation in MMD are not completely understood. Although angiographic factors causing intracranial hemorrhage in adult MMD, such as dilation and branch extension of the anterior choroidal artery or posterior communicating artery have also been reported,^5–7 direct comparison studies on the angiographic features according to stroke type in adult MMD have been limited.We hypothesized that there may be differences in major artery occlusion and collateral patterns according to stroke type. Because understanding differences in the angiographic characteristics of ischemic and hemorrhagic stroke types may be helpful to prevent future strokes and make a good prognosis in adult patients with MMD, this study aimed to compare the angiographic features of adult MMD with ischemic and hemorrhagic stroke.     

Clinical features of relative focal hyperfusion in patients with intracerebral hemorrhage detected by contrast-enhanced xenon CT.

BACKGROUND AND PURPOSEThe prevalence and clinical features of relative focal hyperperfusion were investigated in 165 consecutive patients with intracerebral hemorrhage.METHODSContrast-enhanced xenon CT was used to observe regional cerebral blood flow in all patients (86 men and 79 women ranging in age from 25 to 89 years; mean age, 66 years). The clinical data of patients with and without relative focal hyperperfusion were compared to define distinguishing characteristics.RESULTSRelative focal hyperperfusion was observed in 24 (23.5%) of 102 patients in the acute stage but in no patient in the subacute or chronic stages. Relative focal hyperperfusion was associated significantly more often with putaminal and subcortical hemorrhage than with thalamic and cerebellar hemorrhage. We found that patients with relative focal hyperperfusion had a lower mean age than those without it; a male dominance; and a more common history of intracerebral hemorrhage.CONCLUSIONRelative focal hyperperfusion occurs in the acute stage after intracerebral hemorrhage and does not persist for more than 30 days. The most common locations are the putamen and subcortical areas. Risk factors include male sex and previous bleeding in the same area.     

急性脑血管病血流变学改变的临床研究

目的观察急性脑血管病患者血流变性及血小板的改变。方法选择急性脑血管意外病例,检测其血液流变学及血小板指标并作统计学处理。结果血液流变学4项指标,脑出血组三项指标均明显高于对照组和脑梗塞组：脑梗塞组三项指标均高于对照组,脑出血和脑梗塞组血小板计数均低于对照组。结论急性脑血管病患者血流变学指标有明显改变,血液的流变性障碍。     

烟雾病的临床表现及CT、DSA分析

目的:探讨烟雾病的临床特点、头颅CT及DSA表现。方法:对54例烟雾病患者的临床症状、头颅CT及DSA表现行综合分析。结果:54例患者中,发病前29例曾有不同程度脑缺血症状,25例无明显临床症状和体征;CT显示脑出血患者46例,其中原发性脑室出血21例,颅底及脑叶多发梗塞灶7例,1例CT未见异常;DSA表现所有患者双侧颈内动脉末端及大脑前、中动脉起始端狭窄或闭塞,颅底及基底节区异常增生血管网,颈内、外侧支循环血管建立,脑血管循环时间延长。结论:烟雾病患者一般症状不典型,对于临床反复出现脑缺血症状或CT提示为原发性脑室出血、脑叶或颅底多发梗塞灶之青壮年患者应考虑烟雾病可能,DSA可以确诊烟雾病,同时也可以明确患者病变程度,为后续干预提供一定指导意义。     

磁共振弥散加权成像在脑病变诊断中的应用价值

目的 评价磁共振弥散加权成像（DWI）在脑部病变诊断中的应用价值。材料与方法 对110例不同脑部病变（包括脑梗塞、脑出血、脑肿瘤、脑白质病变）的DWI图像以及同一病变在不同扫描序列之间进行比较分析。结果 DWI对急性、超急性脑梗塞高度敏感（达100％）,对急性出血性脑梗塞也很敏感,对脑肿瘤的敏感性（75％）低于T2／Flair(92％）,对脑白质病的敏感性低于T2／Flair,但可显示部分多发性化的活动病灶,对急性脑出血敏感性较差。结论 DWI能诊断常规MR序列不能显示的超急性期和急性期梗塞,对急性出血性脑梗塞的诊断也很有价值。能区别急性期和慢性期脑梗塞。还有助于脑肿瘤、脑白质病变的和鉴别诊断。     

Die spontane intrazerebrale Blutung aus klinisch- neuroradiologischer Sicht

Intracerebral hemorrhage is a common cause of acute neurological deterioration and a frequent indication for emergency neuroimaging. Stroke symptoms are caused in 10 to 15% by intracerebral hemorrhage. It is often not possible to differentiate intracerebral hemorrhage from cerebral ischemia by clinical examination. The therapeutic decision between thrombolysis or conservative therapy is comprised by the etiology. To exclude intracerebral hemorrhage as the cause of clinical symptoms, a CT is usually performed. Localisation and extension of the acute intracerebral hemorrhage are easy to detect. Subacute and chronic intracerebral hemorrhage are better delineated with magnetic resonance imaging. The different signal of the hemorrhage can be used for the age of the intracerebral hemorrhage. The cause of a non-traumatic intracerebral hemorrhage is in over 60% hypertony, less frequent alcoholism, malformation, or amyloid angiopathy. Uncommon causes of hemorrhage are head trauma, blood dyscrasia, tumor or venous thrombosis. Non-traumatic intracerebral hemorrhage are most common in patients between 50 and 70 years. In younger patients a malformation should be excluded with a cerebral angiography. Intracerebral hemorrhages are usually conservatively treated, in some cases an operative decompression is performed.