rt-PA静脉溶栓治疗不同时间窗椎-基底动脉系统脑梗死的临床疗效观察

目的探讨椎-基底动脉系统脑梗死患者不同时间窗重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗的临床疗效。方法回顾性分析50例椎-基底动脉系统脑梗死患者临床资料,按溶栓治疗时间窗分为4.5 h组和4.5~9 h组,每组25例。比较两组患者神经功能缺损量表(national institutes of health stroke scale,NIHSS)评分、Barthel指数(Barthel index,BI)评分、改良Rankin量表(modified Rankin scale,mRS)评分及脑出血发生率。结果与治疗前相比较,治疗后14 d、30 d、90 d时4.5 h组和4.5~9 h组NIHSS评分和BI评分均显著升高,组间比较差异显著(P0.05)。治疗前及治疗后14 d、30 d、90 d,两组患者NIHSS评分和BI评分比较均无统计学差异(P0.05)。治疗后90 d,两组患者mRS评分比较无统计学差异(P0.05)。4.5 h组和4.5~9 h组BI评分脑出血发生率分别为4.0%(1/25)、8.0%(2/25),组间比较差异无统计学意义。结论椎-基底动脉系统脑梗死患者发病9 h内应用rt-PA静脉溶栓治疗是安全有效的。     

脑卒中后中枢性面瘫闭目乏力与脑卒中预后的关系

目的探讨脑卒中后中枢性面瘫闭目乏力与脑卒中预后的关系。方法观察1年内所有起病7d内的脑卒中患者,入院当天使用拉力测量器测量双眼闭目力量,按测量结果分为中枢性面瘫伴闭目乏力和不伴闭目乏力两组,比较两组入院当天、发病第7、14、21、30天的美国国立卫生院脑卒中量表评分(National Institute of Health stroke scale,NIHSS)以及发病第30、90、180天的Barthel指数(Barthel index,BI)、修正Rankin量表评分(modified Rankin Scale,mRS)。结果入院当天2组的NIHSS无统计学差异,而伴闭目乏力者在脑卒中发病第21和30天的NIHSS较不伴闭目乏力者高(P<0.05)。在脑卒中发病第30、90、180天,伴闭目乏力者的BI≥85的比例比不伴闭目乏力者低;在脑卒中发病第90、180天,伴闭目乏力者的mRS≤2的比例比不伴闭目乏力者低。结论脑卒中后中枢性面瘫伴闭目乏力提示较差的预后。     

氢溴酸樟柳碱注射液对急性脑梗死患者NIHSS评分、改良Barthel指数和CTP参数的影响

目的 观察氢溴酸樟柳碱注射液治疗急性脑梗死的临床疗效。方法 将86例符合急性脑梗死诊断标准的患者随机分为治疗组和对照组,各43例,对照组仅采用常规治疗,治疗组在常规治疗的基础上加用樟柳碱注射液进行治疗,连用2周; 于治疗前及治疗后14 d依据美国国立卫生院脑卒中量表(NIHSS评分)对2组患者神经功能缺损程度进行评价,在治疗后14、30、90 d采用改良 Barthel 指数(MBI)对患者进行日常生活活动能力(ADL)进行评分,同时采用CT灌注成像(CTP)分析治疗前及治疗后14 d梗死区rCBF(局部脑血流量)、rCBV(局部脑血容量)、TTP(达峰时间)和MTT(平均通过时间)指标水平的变化。结果(1)在治疗后的14 d 2组患者NIHSS评分相比治疗前均下降,但治疗组显著优于对照组(P<0.05);(2)治疗后14 d治疗组较对照组rCBV、rCBF均增加,TTP、MTT均缩短(P<0.05);(3)在治疗后30 d、90 d 2组患者改良Barthel 指数(MBI)相比治疗前均呈现好转,但治疗组效果显著优于对照组(P<0.05)。结论 氢溴酸樟柳碱序贯治疗急性脑梗死能明显改善神经功能缺损症状,且安全有效。     

注射用丹参多酚酸治疗中度急性缺血性脑卒中多中心、随机、双盲、平行对照临床研究

目的观察注射用丹参多酚酸治疗中度急性缺血性脑卒中的有效性和安全性。方法采用多中心、随机、双盲、平行对照临床研究方法。以美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分为6～22分的急性缺血性卒中患者为对象,将其随机分为研究组和对照组。两组患者均给予常规基础治疗,研究组在基础治疗上加用注射用丹参多酚酸静脉滴注,每日1次,每次130 mg,对照组在基础治疗上给予等量生理盐水,两组均连续治疗14 d。在用药后第14 d、第30 d和第90 d评估NIHSS评分、Barthel指数评分,以治疗后30 d、90 d时改良Rankin量表评分(modified Rankin scale,mRS)评估预后(0～2分为预后良好),根据患者不良事件进行安全性评估。结果共纳入1529例脑卒中患者,其中研究组1021例,对照组508例。研究组和对照组在治疗后第14 d、第30 d和第90 d的NIHSS评分、Barthel指数组间差异均有统计学意义(均P0.05),治疗后30 d、90 d研究组预后良好率高于对照组,组间差异有统计学意义(P0.05)。研究组与对照组不良事件发生率差异无统计学意义(P0.05)。结论注射用丹参多酚酸用于治疗中度急性脑卒中有效且安全,在连续治疗2周后其疗效优于基础治疗。     

不同时间窗rt-PA静脉溶栓治疗椎-基底动脉系统脑梗死的疗效观察

目的探讨不同时间窗rt-PA静脉溶栓治疗椎-基底动脉系统脑梗死的临床疗效。方法选取2016年8月~2017年8月我院收治的70例椎-基底动脉系统脑梗死患者为研究对象,所有患者均经多模式MRI证实且行rt-PA静脉溶栓治疗,根据患者溶栓治疗时间窗不同,将其分为4.5 h组(35例)和4.5~9 h组(35例),比较两组神经功能缺损量表(national institutes of health stroke scale,NIHSS)评分、Barthel指数(Barthel index,BI)评分及改良Rankin量表(modified Rankin scale,mRS)评分,观察两组脑出血发生情况。结果与治疗前比较,4.5 h组和4.5~9 h组患者溶栓后24 h、14 d、30 d及90 d的NIHSS评分显著降低(P0.05),BI评分显著升高(P0.05),而两组患者在rt-PA静脉溶栓治疗后的NIHSS评分及BI评分比较,差异无统计学意义(P0.05);两组rtPA静脉溶栓后90 d的mRS评分及预后良好率比较均无明显差异(P0.05)。3 m随访期内,4.5 h组脑出血发生率为5.71%,4.5~9 h组脑出血发生率为8.57%,两组比较差异无统计学意义(P0.05)。结论 I扩大时间窗至9 h对椎-基底动脉系统脑梗死行rt-PA静脉溶栓治疗安全有效,因此,对于治疗时间窗为4.5 h~9 h的椎-基底动脉系统脑梗死也可行rt-PA静脉溶栓治疗。     

丹参多酚酸对急性脑梗死患者血清 GFAP、PGP9.5 IL-5、IL-6、IL-8、IL-10表达水平和预后的影响

目的 探讨丹参多酚酸对急性脑梗死患者血清蛋白基因产物(PGP9.5)、神经胶质纤维酸性蛋白(GFAP)、IL-5、IL-6、IL-8、IL-10表达水平和预后的影响。方法 选取我院急性脑梗死患者84例,随机分成丹参组42例和对照组42例,各组在住院当天及14 d行Barthel指数、NIHSS评分,行MRI计算梗死后体积,运用磁微粒化学发光法检测血清GFAP、PGP9.5、IL-5、IL-6、IL-8、IL-10的表达水平。采用90 d改良Rankin评分(mRS)判断预后。结果 丹参组治疗后较对照组NIHSS评分显著降低(P<0.05)、Barthel指数显著升高(P<0.05)、梗死体积显著缩小(P<0.05)。丹参组治疗后GFAP、IL-6、IL-8降低水平较对照组更显著(均P<0.05);丹参组治疗后IL-10表达水平较对照组升高更显著(P<0.05);丹参组较对照组有较好预后(P<0.05)。结论 丹参多酚酸可有效抑制急性脑梗死患者的炎性反应,减轻脑损伤,改善神经功能缺损,提高日常行为能力及改善预后。     

年龄及其他临床因素对急性脑梗死患者支架取栓术预后的影响

目的 探讨年龄及其他临床因素对急性缺血性脑梗死患者支架取栓术预后的影响。方法 回顾性分析蚌埠医学院第二附属医院神经外科2015年6月—2019年5月收治的62例急性缺血性脑梗死行支架取栓术患者的临床资料。其中≥70岁的患者30例,70岁的患者32例。分析比较两组患者的血管再通率,术后24 h美国国家卫生研究院卒中量表(NIHSS)评分改善率,术后90 d改良Rankin量表(mRS)评分改善率。结果 ≥70岁组患者中,支架取栓术后成功血运重建者28例,其中血管完全再通者18例,24 h NIHSS评分改善者12例,90 d mRS评分改善者15例。70岁组患者中,支架取栓术后成功血运重建者30例,其中血管完全再通者17例,24 h NIHSS评分改善者13例,90 d mRS评分改善者21例。≥70岁组与70岁组患者的成功血运重建率、血管完全再通率和90 d mRS评分改善率比较,差异均无统计学意义(均P 0. 05)。回归分析显示,基线NIHSS评分和完全血运重建是对术后90 d预后的影响因素。结论 影响急性脑梗死患者支架取栓术后预后的主要因素是基线NIHSS评分和完全血运重建,而不是年龄。     

丁苯酞对急性脑梗死患者血清NSE S-100β及氧化标记物的影响

目的观察丁苯酞注射液对急性脑梗死患者神经功能、预后及血清神经元特异性烯醇化酶(NSE)、S-100β蛋白、丙二醛(MDA)和超氧化物歧化酶(SOD)的影响。方法将60例急性脑梗死患者随机分为丁苯酞组和对照组各30例。2组均给予常规治疗,丁苯酞组在此基础上给予丁苯酞注射液静滴,2次/d。于治疗前、治疗后7d和14d检测2组患者血清NSE、S-100β、MDA和SOD的水平变化,并比较2组治疗前后美国国立卫生研究院卒中量表评分(NIHSS)和2组3个月后改良Rankin量表(modified Rankin Scale,mRS)评分变化。结果丁苯酞组在治疗后7d和14d,血清NSE、S-100β和MDA水平均较对照组明显降低(P0.05),血清SOD水平较对照组明显升高。丁苯酞组在治疗后7d和14d,NIHSS评分较对照组明显降低,差异有统计学意义(P0.05);3个月后,丁苯酞组mRS评分较对照组明显降低,差异有统计学意义(P0.05)。结论丁苯酞注射液可降低急性脑梗死患者血清NSE、S-100β和MDA水平,提高血清SOD水平,有助于神经功能恢复,改善患者预后。     

急性缺血性脑卒中发病6 h内MR-DWI阴性与阳性患者静脉溶栓的临床结局对比研究

目的 对比分析急性缺血性脑卒中(AIS)发病6 h内头颅磁共振(MR)弥散加权成像(DWI)显示为阴性及阳性的患者使用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的临床结局和安全性。方法 回顾性分析50例AIS患者住院治疗行rt-PA静脉溶栓，根据静脉溶栓前MR-DWI检查结果将AIS患者分为DWI阴性组18例和DWI阳性组32例，分析两组患者的人口学特征以及临床资料，包括入院至静脉溶栓时间(DNT)、发病至静脉溶栓时间(OTT)，溶栓结束24 h内复查DWI，以发病后90 d的NIHSS评分和改良Rankin量表(mRS)评分作为预后的评估指标。结果 两组患者年龄、性别、脑梗死病史、高血压病病史、糖尿病病史、房颤病史、吸烟史、饮酒史、DNT、OTT、颅内出血发生率和病死率比较差异均无统计学意义(均P>0.05)；两组患者静脉溶栓前mRS评分及NIHSS评分均高于溶栓后90 d mRS评分及NIHSS评分(均P<0.05),DWI阴性组90 d mRS评分及NIHSS评分低于DWI阳性组(P<0.001,P=0.001)。结论 发病6 h内DWI阴性及阳性的AIS患...     

临床-ASPECTS评分不匹配在急性颈内动脉或大脑中动脉主干闭塞8～14 h再通治疗中的探讨

目的 探讨对急性颈内动脉或大脑中动脉主干闭塞8～14 h的患者采用临床-Alberta卒中项目早期CT评分(Alberta stroke programme early CT score,ASPECTS)不匹配指导血管内介入再通治疗的可行性。方法 将2012年1月～2017年12月确诊的41例急性颈内动脉或大脑中动脉主干闭塞的住院患者分为治疗组(24例)和对照组(17例),行ASPECTS评分、改良的脑梗死溶栓(modified Thrombolysis in Cerebral Infarction,mTICI)分级、侧枝代偿评估及症状性颅内出血(symptomatic intracranial hemorrhage,SICH)风险评估; 于入院时和入院治疗后24 h、7d分别进行美国国立卫生研究院卒中量表评分(National Institutes of Health stroke Scale,NIHSS),治疗后90 d用改良Rankin量表(Modified Rankin Scale,mRS)评定临床预后,采用Logistic回归预测良好临床预后的相关因素。结果 与基础NIHSS评分比较,治疗组患者血管再通治疗后24 h和7 d NIHSS评分呈显著性下降(P<0.05),治疗后24 h、7 d NIHSS评分治疗组较对照组显著下降(P<0.05); 治疗后90 d治疗组良好预后较对照组明显改善(P<0.05),治疗组出血转化率较对照组显著下降(P<0.05)。治疗组良好临床预后与临床-ASPECTS不匹配、良好的侧枝代偿等相关。结论 对急性颈内动脉或大脑中动脉主干闭塞8～14 h的患者采用临床-Alberta卒中项目早期CT评分不匹配结合侧枝代偿、mTICI分级可能有利于筛选时间窗外血管再通受益患者。     

Presurgical functional mapping with functional MRI

PURPOSE OF REVIEW: The present article describes current indications for functional MRI in the preoperative planning of neurosurgical patients. Functional MRI continues to have an expanding role. RECENT FINDINGS: There are three main categories of patients who commonly undergo preoperative functional MRI. Patients with lesions close to eloquent cortex can benefit from preoperative functional MRI to assess resectability and reduce the possibility of functional deficit. The second group are those patients who have functional MRI as part of their preoperative planning to localize language dominance and for functional localization of memory. The final group are those patients in whom attempts are made to image and localize abnormal brain function. This has a specific application in the field of epilepsy surgery (electroencephalographic-correlated functional MRI). These three roles require different spatial resolutions. Advances in multimodality imaging are enabling more accurate localization of function intraoperatively. SUMMARY: It is hoped that the increasing use of functional MRI in combination with both preoperative and intraoperative imaging modalities may reduce the risk of neurological deficit while improving completeness of resection. Electroencephalographic-correlated functional MRI may provide an additional method for localization of epileptogenic foci.     

Anatomical and functional distribution of functional MRI language mapping

ObjectiveThe aim of the present study was to compare localization of the language cortex using electrical cortical stimulation (ECS) and functional magnetic resonance imaging (fMRI) to establish the relevance of fMRI language mapping.MethodsLanguage mapping with fMRI and functional ECS mapping were retrospectively compared in ten patients with refractory epilepsy who underwent fMRI language mapping and functional ECS mapping between June 2012 and April 2019. A shiritori task, a popular Japanese word chain game, was used for fMRI language mapping.ResultsBOLD signal activation was observed in the left inferior frontal gyrus (including the pars opecularis and the pars triangularis), and superior temporal gyrus, which is a language-related area, as well as in the left superior and middle frontal gyri, the intraparietal sulcus, and fusiform gyrus. These results were compared with ECS to elucidate the functional role of the activated areas during fMRI language tasks. These activated areas included language areas, negative motor areas, supplementary motor areas (SMAs), and non-functional areas.ConclusionThe activated areas of fMRI language mapping include language-related areas, the negative motor area, and SMAs. These findings suggest the involvement of language and higher order motor networks in verbal expression.     

Predictors of change in functional competence and functional behavior after functional adaptation skills training for schizophrenia

ABSTRACT: Functional recovery is an important treatment target in schizophrenia. Although medication is effective at reducing positive symptoms of the disorder, these improvements do not translate to improved functioning. In this study, schizophrenia outpatients (N = 54) received the psychosocial treatment Functional Adaptation Skills Training. Hierarchical regression analyses determined whether baseline neurocognitive, symptom, course of illness, and demographic variables predicted improvement in performance-based measures of functional competence and case manager-rated real-world behavior after the intervention. Consistent with previous research, neurocognition emerged as a predictor of improved competence and behavior. Symptoms played a minor role in predicting change; however, institutionalization history seemed to be an important rate limiter for functional recovery. Correlations among change scores were modest, with evidence for concomitant changes in competence and performance. The predictors of change after psychosocial treatment vary by the domain (e.g., adaptive and interpersonal) of functioning and the level of assessment (e.g., competence and performance).     

Aberrant functional brain network dynamics in patients with functional constipation

The aberrant static functional connectivity of brain network has been widely investigated in patients with functional constipation (FCon). However, the dynamics of brain functional connectivity in FCon patients remained unknown. This study aimed to detect the brain dynamics of functional connectivity states and network topological organizations of FCon patients and investigate the correlations of the aberrant brain dynamics with symptom severity. Eighty‐three FCon patients and 80 healthy subjects (HS) were included in data analysis. The spatial group independent component analysis, sliding‐window approach, k‐means clustering, and graph‐theoretic analysis were applied to investigate the dynamic temporal properties and coupling patterns of functional connectivity states, as well as the time‐variation of network topological organizations in FCon patients. Four reoccurring functional connectivity states were identified in k‐means clustering analysis. Compared to HS, FCon patients manifested the lower occurrence rate and mean dwell time in the state with a complex connection between default mode network and cognitive control network, as well as the aberrant anterior insula–cortical coupling patterns in this state, which were significantly correlated with the symptom severity. The graph‐theoretic analysis demonstrated that FCon patients had higher sample entropy at the nodal efficiency of anterior insula than HS. The current findings provided dynamic perspectives for understanding the brain connectome of FCon and laid the foundation for the potential treatment of FCon based on brain connectomics.     

Transsylvian functional hemispherectomy

Objective To describe the technique of transsylvian–transventricular functional hemispherectomy developed at our institution.Methods We review appropriate patient selection and evaluation, timing of surgery, selection of surgical approach, preoperative preparation, details of operative procedure, and postoperative management.Conclusions The transsylvian “keyhole” functional hemispherectomy technique involves a smaller craniotomy than other functional hemispherectomy techniques and consists of transsylvian exposure, resection of mesial temporal structures, transventricular frontobasal disconnection, callosotomy, and occipitoparietal disconnection. The key advantages of this approach compared to the Rasmussen’s “classic” functional hemispherectomy are smaller exposure, shorter operative time, and lower blood loss. The efficacy of functional hemispherectomy procedures in achieving seizure freedom appears to be at least as good compared to resective procedures. The long-term complication rate will require longer follow-up times.     

论"功能神经外科学"

神经外科学从治疗的疾病谱上主要划分为脑肿瘤、脑血管病、脑外伤和功能脑病。采用手术的方法修正神经系统功能异常的医学分支是为功能神经外科学(Functional Neurosurgery),早期亦称生理神经外科学(Physiologic Neurosurgery),或应用神经生理学     

Nonlinear functional network connectivity in resting functional magnetic resonance imaging data

In this work, we focus on explicitly nonlinear relationships in functional networks. We introduce a technique using normalized mutual information (NMI) that calculates the nonlinear relationship between different brain regions. We demonstrate our proposed approach using simulated data and then apply it to a dataset previously studied by Damaraju et al. This resting‐state fMRI data included 151 schizophrenia patients and 163 age‐ and gender‐matched healthy controls. We first decomposed these data using group independent component analysis (ICA) and yielded 47 functionally relevant intrinsic connectivity networks. Our analysis showed a modularized nonlinear relationship among brain functional networks that was particularly noticeable in the sensory and visual cortex. Interestingly, the modularity appears both meaningful and distinct from that revealed by the linear approach. Group analysis identified significant differences in explicitly nonlinear functional network connectivity (FNC) between schizophrenia patients and healthy controls, particularly in the visual cortex, with controls showing more nonlinearity (i.e., higher normalized mutual information between time courses with linear relationships removed) in most cases. Certain domains, including subcortical and auditory, showed relatively less nonlinear FNC (i.e., lower normalized mutual information), whereas links between the visual and other domains showed evidence of substantial nonlinear and modular properties. Overall, these results suggest that quantifying nonlinear dependencies of functional connectivity may provide a complementary and potentially important tool for studying brain function by exposing relevant variation that is typically ignored. Beyond this, we propose a method that captures both linear and nonlinear effects in a “boosted” approach. This method increases the sensitivity to group differences compared to the standard linear approach, at the cost of being unable to separate linear and nonlinear effects.