皮质下动脉硬化性脑病患者精神障碍临床分析

目的 探讨皮质下动脉硬化性脑病患精神障碍的特点及其影响学基础。方法 对122例皮质下动脉硬化脑病患进行详细的病史询问和全面的神经精神检查。采用CT半定量方法分析大脑白质低密度改变的程度，检查结果使用统一表格记录。结果 患均存在脑衰弱症状和斑片状智能障碍，其中痴呆41例，多数存在症状波动。患精神障碍与大脑白质低密度改变有关，而与是否存在脑卒中病灶及皮层萎缩无显关系。结论 斑片状智能障碍是该病最显的临床特征，患精神障碍与大脑白质广泛性破坏有关。     

58例皮质下动脉硬化性脑病的CT与临床分析

本文报告皮质下动脉硬化性脑病（Ｂｉｎｓｗａｎｇｅｒ病）５８例，其中男４５例，女１３例；年龄５０～８５岁，平均６７．５岁；病程３个月～２８年，平均５．５年；有高血压者８４．５％，无高血压者１５．５％，临床特征包括慢性隐匿性起病、进行性痴呆、卒中和累积出现的以运动障碍为主的神经症状。ＣＴ扫描与ＭＲＩ对本病有决定性诊断价值。结合文献，对本病的病因、诊断及鉴别进行了讨论。     

血清同型半胱氨酸水平对皮质下动脉硬化性脑病的影响

目的 探讨血清同型半胱氨酸(Hcy)对皮质下动脉硬化性脑病(BD) 的影响及与其严重程度之间的关系.方法 测定50例符合Bennett BD诊断标准的住院病人(BD组)血Hcy等生化指标,并与42例健康患者(对照组)比较,分析血Hcy与BD及其Coto分型之间的关系.BD诊断符合Bennett诊断标准,所有患者根据头脑磁共振成像按Coto以病变部位及病变程度分为轻、中、重三型.结果 与对照组比较,BD组血Hcy平均水平为(19.46±6.52) μmol/L,明显高于对照组(8.47±4.36) μmol/L (P<0.01),轻、中、重三型间比较有统计学意义(P<0.05),Hcy随BD严重程度而增高.结论 Hcy浓度与BD的发生发展有关,可作为判断BD病情轻重、估计预后的一个参考指标.     

脑反射治疗皮质下动脉硬化性脑病的临床研究

本文将经CT证实的60例皮质下动脉硬化性脑病病人随机分成两组，对照组采用常规治疗，治疗组加用脑反射治疗。结果发现治疗后患者神经系统症状和体征均有明显改善。脑反射仪的发明，为皮质下动脉硬化性脑病的治疗增添了一种新办法。     

皮质下动脉硬化性脑病的临床、MRI与EEG研究

皮质下动脉硬化性脑病（SAE）又称Binswanger病,是高龄老年人易患疾病。近年来随着人口的老龄化,磁共振（MRI）技术的应用,该病的诊断明显增加。我院2000-11～2005-05共收治经MRI检查并结合临床诊断的SAE患者53例,占同期全部脑血管病住院病人（868例）的6．1％,现将其临床、MRI与脑电图（EEG）资料报道如下。     

单纯脑白质疏松症与皮质下动脉硬化性脑病患者记忆障碍的对比研究

目的比较单纯脑白质疏松症(LA)与皮质下动脉硬化性脑病(SAE)患者记忆障碍的特征。方法采用临床记忆量表对单纯LA、SAE患者各30例进行记忆功能检测及简易精神状态量表(MMSE)检测,并与30名健康老年人比较。结果单纯LA组患者各项记忆量表成绩及记忆商(MQ)均明显低于健康对照组(均P<0.01),其中图像自由回忆(12±5)、人像特点联系回忆(16±5)下降明显;单纯LA组各项记忆量表成绩及MQ均高于SAE组(P<0.05～0.01),其中SAE组患者指向记忆(10±7)、联想学习(14±5)明显下降;单纯LA组无痴呆发生,SAE组22例MMSE≤19分,痴呆发生率73.33%;MQ>70的患者痴呆发生率明显低于MQ≤69的患者(P<0.01)。结论(1)单纯LA组患者有明显记忆障碍,但程度明显轻于SAE患者;(2)单纯LA组患者无痴呆发生,SAE组痴呆发生率高,且与记忆损害程度成正比。     

纳洛酮对皮质下动脉硬化性脑病认知功能改变的疗效观察

目的　观察皮质下动脉硬化性脑病应用纳洛酮治疗后对改良简易心理状况检查 (MMSE)及修订的Barthel指数评分(MBI)的变化。方法　将 67例皮质下动脉硬化性脑病患者随机分为纳洛酮治疗组和常规药物治疗组 ,治疗前和治疗 2周、5周分别进行MMSE及MBI评分对比。结果　两组治疗后MBI评分比治疗前提高 ,但无显著性差异 (P >0 0 5 )。两组治疗 2周后MMSE评分对照组无明显提高 (P >0 0 5 ) ,治疗组显著提高 (P <0 0 5 ) ,但与对照组治疗后比较 ,无显著性差异 (P >0 0 5 ) ;5周后两组与治疗前比较 ,对照组有显著性差异 (P <0 0 5 ) ,治疗组有非常显著性差异 (P <0 0 1) ,且与对照组治疗后比较 ,亦有显著性差异 (P <0 0 5 )。结论　应用纳洛酮治疗皮质下动脉硬化性脑病可显著提高MMSE评分 ,疗效可靠 ,作用快。     

Evaluation of dementia in subcortical arteriosclerotic encephalopathy (Binswanger's disease)

Summary Sixteen patients with a clinical diagnosis of subcortical arteriosclerotic encephalopathy (Binswanger's disease) were studied. Mild or moderate dementia was found in 14 cases, with characteristic disturbances of concentration, and psychic retardation with apathy. Neuropsychological studies revealed that signs of diffuse lesions in the frontal lobes dominated. Impairment of memory was significant in all cases. Although intellectual impairment in subcortical arteriosclerotic encephalopathy resembled subcortical dementia, some significant differences were found.     

The role of plasma hyperviscosity in subcortical arteriosclerotic encephalopathy (Binswanger's disease)

Summary Five haemorheological variables (haematocrit, plasma viscosity, red cell aggregation, red cell deformability and yield shear stress) and the plasma fibrinogen concentration were determined in blood samples from 21 untreated patients with subcortical arteriosclerotic encephalopathy (SAE, Binswanger's disease). The results were compared with those obtained in blood samples from 40 untreated patients with lacunar infarcts and from 275 healthy control subjects without vascular risk factors. Pathological (solid body) flow behaviour was detected in the blood of both groups of patients (SAE and lacunar infarcts). However, highly elevated plasma viscosity was a consistent feature only of SAE. The authors present the hypothesis that the high plasma viscosity in patients with SAE may account for the progressive degeneration of cerebral white matter. It is postulated that microcirculatory abnormalities due to microrheological changes may be one of the many missing links in the pathophysiology of SAE.     

皮质下动脉硬化性脑病136例临床分析

目的探讨皮质下动脉硬化性脑病的临床特点、伴发疾病、CT表现及防治措施。方法对136例皮质下动脉硬化性脑病患者的临床资料进行回顾性分析。结果皮质下动脉硬化性脑病患者中男118例（86.8％），60～70岁112例（82.4％），伴高血压116例（85．3％），脑动脉硬化134例（98．5％），高血脂症94例（69．1％），腔隙性梗死127例（93.4％）。结论防治高血压、高血脂，预防动脉硬化是减少本病发生的关键。     

P-选择素、血管内皮生长因子在皮质下动脉硬化性脑病中的表达及意义

目的探讨皮质下动脉硬化性脑病(SAE)患者血P-选择素、血管内皮生长因子(VEGF)水平及其与血糖、血脂和C反应蛋白(CRP)的相关性。方法测定54例SAE患者(SAE组)、57名健康老年人(健康对照组)血浆P-选择素、血清VEGF、血糖、血脂、CRP水平,并进行比较和相关分析。结果SAE组P-选择素[(17.61±5.63)ng/ml]、VEGF[(126.33±47.51)pg/ml]水平明显高于健康对照组[(14.72±3.89)ng/ml,(102.59±40.16)pg/ml](均P<0.01);P-选择素水平随痴呆程度加重而升高,痴呆中、重度组VEGF水平[(152.46±53.75)pg/ml、(150.52±55.94)pg/ml]明显高于轻度组[(126.79±44.83)pg/ml](P<0.01,P<0.05);中、重度组间差异无统计学意义。SAE组P-选择素与血糖、三酰甘油(TG)、CRP呈正相关(r=0.282、0.293、0.287,均P<0.05);VEGF与总胆固醇(TC)、CRP呈正相关(r=0.291、0.336,均P<0.05);P-选择素与VEGF呈正相关(r=0.295,P<0.05)。结论P-选择素、VEGF参与了SAE的血栓形成和组织修复过程;检测P-选择素、VEGF水平,指导抗血小板药物的应用,对预防SAE可能有重要意义。     

Cerebral amyloid angiopathy with attenuation of the white matter on CT scans: subcortical arteriosclerotic encephalopathy (Binswanger) in a normotensive patient

Summary Subcortical arteriosclerotic encephalopathy was diagnosed in a 56-year-old female normotensive patient with gradually progressing dementia, pseudobulbar palsy and motor deficits. CT scan showed white matter low attenuation in the frontal and parietal lobes. Neuropathological examination revealed degeneration of the white matter. Amyloid was found in walls of small cortical vessels. The walls of small vessels in the white matter showed severe thickening, fibrosis and hyalinization but not amyloid. Cerebral amyloid angiopathy may be responsible for subcortical arteriosclerotic encephalopathy.     

Epileptic seizures in subcortical vascular encephalopathy

Cerebrovascular disease is one of the most common causes of epilepsy in the elderly. Most of the studies published relate to cortical infarction, subarachnoid, and intracranial hemorrhage, whereas the incidence of epilepsy from subcortical ischemia, i.e. deep lacunar infarctions and diffuse white matter lesions, is obscure. Therefore, we prospectively examined 18 patients with the precisely defined diagnosis of subcortical vascular encephalopathy (SVE), who were admitted to our hospital due to epileptic seizures (group A), and compared them to a similarly selected group matched for age, sex, risk factors, and neurological deficits with an equivalent severity of SVE but without seizures (group B). Subcortical lacunar infarctions were significantly more frequent in group A than group B (15/18 versus 4/18, p < 0.001), whereas neither the extension, degree, distribution of periventricular white matter changes, nor the presence of internal hydrocephalus, focal or diffuse cortical atrophy showed any statistical significance. However, a temporal constant theta or delta EEG focus was present in 10/18 patients in group A but only in 1/18 patients from group B (p 0.005). 10/18 patients developed epilepsy with further seizures during follow-up. The association of SVE, multiple subcortical lacunas, and temporal EEG abnormalities are suggestive for an increased risk for epileptic seizures, which is particularly important for the treatment of patients with SVE if uncertain paroxysmal episodes occur, e.g. transient ischemic attacks, seizures, or cardiac syncope.     

Assessment of gait in subcortical vascular encephalopathy by computerized analysis: a cross-sectional and longitudinal study

In subcortical vascular encephalopathy (SVE) gait disturbance is a common and early clinical sign which might be used to monitor disease progression. In the absence of reliable scales and with regard to the equivocal results of highly complex gait imaging devices we assessed the natural course of SVE in a prospective study, using a new straight forward technique to quantify and compare sequential gait studies. We report the results of 300 computerized gait analyses in 119 patients with SVE and 63 age-matched controls. Thirty-nine SVE patients were re-evaluated to monitor the natural course of the disease and to study the correlation of gait disturbances with MRI changes and neuropsychological findings. The system consists of a set of shoes containing 16 load sensors and a measuring-unit reading each sensor at 20-ms intervals. By off-line analysis we graded each recording on a Gait Disorder Score (GDS) with six variables indicating gait steadiness: step frequency, length of gait lines (which represent the movement of the centre of gravity during heel to toe movement), length of single support lines, variability of single and of double support lines, and double support time. In cross-sectional analysis, patients with SVE showed cadence (steps/min) to be reduced at 87.3±19.5 (96.4±7.8 in controls, P < 0.05). Length of gait lines was significantly less: 0.70±0.13 vs. 0.80±0.05 in controls, with length of single support gait lines reduced at 0.42±0.14 in SVE (0.58±0.06 in controls, P < 0.05). Variability of both single support lines (5.69±1.90%; 4.24±1.07% in controls, P < 0.05) and double support lines was elevated (3.59±1.62% vs. 2.54±0.59%), while duration of double support phases was increased (0.19±0.10 s vs. 0.13±0.02 s in controls, P < 0.05). The progressive character of the disease was demonstrated by increasing GDS values in 39 SVE patients with a frontal gait disorder who were re-investigated after a mean interval of 26 months (5.4±4.5 vs. 8.4±5.5, P < 0.05). This study shows the value of a new and practicable gait analysis system for the evaluation of gait disorders and it quantifies the deterioration of gait in SVE patients. Received: 6 September 1999 / Received in revised form: 25 April 2000 / Accepted: 28 May 2000     

新生儿缺氧缺血性脑病的CT诊断

目的 总结新生儿缺氧缺血性脑病(HIE)的CT表现特点.方法 137例HIE病例进行CT检查,对病变的部位、大小、形态、密度等方面进行总结分析.结果 137例HIE病例中,轻度79例,中度43例,重度15例.CT主要表现为脑内大小和数目不等的低密度影、皮髓质分界模糊或消失等.结论 HIE有比较特征性的CT表现,不同时期的病变位置、形态和密度都有不同的表现和变化,对指导临床治疗和判断预后有积极意义.