垂体瘤合并胶质瘤1例

患者，男，７０岁。自述２个月来双眼视力急剧下降，并出现发作性头痛，伴幻嗅，似童年闻到的一种花香味；左半身无力、跛行，有时大小便失禁。检查：皮肤苍白，腋毛及阴毛稀疏，双眼视力２０ｃｍ指数，双视乳头水肿，双颞侧偏盲。左下肢肌力３级，肌张力亦低于右侧。头颅ＭＲＩ示蝶鞍明显扩大，鞍内有一３ｃｍ×３－５ｃｍ×２－８ｃｍ大小病灶，Ｔ１ＷＩ为中等信号，Ｔ２ＷＩ呈中等偏高信号，质地均匀。右侧颞叶见一囊性占位病变，Ｔ１ＷＩ呈低信号，Ｔ２ＷＩ呈高信号，造影后见明显环状强化。周围脑组织水肿，已涉及基底节及额顶叶，中线…     

急性蛛网膜下腔出血的低场强MRI诊断

探讨低场ＭＲＩ诊断急性蛛网膜下腔出血的价值。对８０例临床疑诊急性蛛网膜下腔出血的病人行ＭＲＩ检查,扫描机为ＡＳＭ－０１５Ｐ,采用ＳＥ序列,参数Ｔ２,ＷＩ≤Ｔ的２０００／ＴＥ１００ｍｓ,所有病例分别经腰穿、手术或治疗后复查证,并与化脓性脑膜炎、结核性膜炎等脑脊液蛋白量增高的疾病进行了鉴别,与脑出血破入脑室或溢入蛛网膜下腔者进行对照。结果显示本组病例在低场ＭＲＩ条件下于病变区脑沟（裂池）等蛛网膜下腔Ｔ     

老年人脑白质疏松症的MRI表现与临床意义

本文分析了１００例６０岁以上老年人脑血管病患者的ＭＲＩ脑白质异常表现，即Ｔ２ＷＩ呈高信号，Ｔ１ＷＩ呈等、低信号。将其分为Ⅰ—Ⅲ级，用以分析ＭＲＩ表现与临床表现的关系，并探讨了脑白质疏松的临床意义和发病机制。     

视神经炎与多发性硬化的关系研究

目的为了探讨视神经炎与多发性硬化的关系。方法分析２８例视神经炎患者的头颅磁共振（ＭＲＩ）及体感诱发电位（ＳＥＰ）检查情况。结果（１）头颅ＭＲＩ扫描异常率为３２．１％，病灶呈多发性，主要分布在侧脑室旁、半卵圆中心，长Ｔ２信号，少数合并长Ｔ１信号。（２）ＳＥＰ中枢传导异常率为４２．９％，下肢异常多于上肢，单侧异常多于双侧。（３）发病两次及两次以上，脊髓受累机会增加。结论伴有较多的亚临床损害的视神经炎可能是多发性硬化的一个临床类型     

儿童MELAS综合症

报告三例儿童ＭＥＬＡＳ综合症，其中男２例，女１例，年龄９～１４岁，临床症状以抽搐为主的癫痫样发作和卒中样发作，肢体瘫痪，轻偏瘫，缓解和反复发作，逐渐智力减退，头颅ＭＲＩ示额，顶，枕，颞叶和双侧基底节区多发性长Ｔ１和长Ｔ２异常信号，呈灶状，囊状和层性改变，２例肌活检可见ＲＲＦ和异常线粒体，诊断符和ＭＥＬＡＳ型。本文对临床症状，实验室检查，脑电图，影像学所及治疗等进行讨论。     

多发性硬化的MRI增强的临床意义研究

目的探讨在ＭＲＩ增强中多发性硬化（ＭＳ）病灶强化的机制与临床的关系。方法对２３例ＭＳ患者均作ＭＲＩ平扫与增强扫描,其中９例作ＭＲＩ平扫与增强复查,使用德国西门子公司Ｐ８０．２Ｔ永磁型ＭＲ成像仪,采用ＳＥ序列。造影剂使用ＧＤ－ＤＴＰＡ,剂量为０．１ｍｌ／ｋｇ。结果ＭＲＩ平扫,ＭＳ病灶呈长Ｔ１长Ｔ２的斑片状异常信号,静脉注入ＧＤ－ＤＴＰＡ后产生的强化。用以分析ＭＳ的ＭＲＩ强化特征与临床分型的关系。结论不同临床类型的ＭＳ患者,在ＭＲＩ平扫及增强上均有不同的表现,这可能与ＭＳ斑的形成有不同的病理机制有关     

脊髓型多发性硬化的临床特点探讨

多发性硬化 (ＭＳ)是中枢神经系统脱髓鞘疾病 ,脊髓型ＭＳ是发生在脊髓的脱髓鞘病 ,随着ＭＲＩ和脑脊液寡克隆带在临床上的应用 ,使脊髓型ＭＳ的临床确诊率得到提高。关于脊髓型ＭＳ的特点国内未见综合性报道。本文对我院1998年 1月到 2 0 0 0年 4月收治 11例脊髓型ＭＳ患者的临床特点、ＭＲＩ及脑脊液寡克隆带进行分析 ,以进一步提高对脊髓型ＭＳ临床特点的认识。1　资料与方法急性起病 3例 ,亚急性起病 4例 ,慢性起病 4例 ,起病前有上呼吸道感染 3例。病程特点　进展型 8例 ,复发与缓解型 3例。症状和体征　肢体麻木 11例 ,肢体乏力 10例 …     

葡萄膜炎合并多发性硬化1例报告

葡萄膜炎合并多发性硬化（ＭＳ）国内报道不多，现将我院收治的１例报告如下。1 资料患者，男性，３８岁，农民，因反复发作双眼视力下降、眼痛５年，头昏、头痛，双下肢、左上肢无力４天入院。患者５年来曾３次发生双眼视力下降、眼痛，伴眼前光团。最严重时１ｍ处视物不清，曾３次住眼科治疗，诊断为葡萄膜炎。用过皮质类固醇等治疗，视力有所恢复。最好时双眼视力达０．５。本次入院前４ ｄ视物不清，合并出现双下肢及左上肢无力、麻木，头昏、头痛。既往无糖尿病、心脏病、高血压病病史。体检及辅助检查：意识清楚，血压 １７．１／１０…     

垂体后叶胶质瘤1例

患者，男，７０岁。因头痛伴双眼视力减退２年于２０００年２月２４日入院。检查：神志清楚，双眼视力稍降低，无视野缺损，双瞳孔等大，光反射灵敏。其它各组颅神经正常，四肢肌力，肌张力正常，无病理征。头颅ＭＲＩ见鞍内及鞍上Ｔ１加权呈低信号，Ｔ２加权里高信号的实性肿物，鞍上肿物突向右额及前颅凹底并囊变，右侧侧脑室前角受压。激素水平检测无异常。４天后以颅咽管瘤经右侧额下人路行肿瘤切除术，切除右额底囊变肿物，囊液呈淡黄色，约３０ｍＬ，见实质肿瘤呈灰白色，质软，包绕双侧视神经及视交叉与鞍内实质性肿物相延续。大部分…     

磁共振成像在三叉神经痛和面肌痉挛诊断中的应用

目的　对应用磁共振成像（ＭＲＩ）特殊序列诊断三叉神经痛（ＴＮ） 和面肌痉挛（ＦＳ）血管神经压迫的价值进行评价。方法　临床诊断ＴＮ１８ 例,ＦＳ１１ 例。先行ＳＥＴ１ＷＩ、Ｔ２ＷＩ扫描,然后行三维时间飞越破坏性稳态梯度回波序列（３ＤＴＯＦＳＰＧＲ） 分析。利用原始图像对两侧三叉神经进行斜矢状位和冠状位重建。结果　ＴＮ中,２ 例为肿瘤所致,１５ 例为血管压迫引起,１ 例未发现病因。１１ 例ＦＳ中发现血管神经接触１０ 例,未发现病因１ 例。８ 例手术证实病例中,７ 例与ＭＲＩ诊断完全符合。结论ＭＲＩ对发现ＴＮ和ＦＳ病因具有重要价值,特别是３ＤＴＯＦＳＰＧＲ原始图像是显示神经血管接触的敏感方法,对选择手术方法具有重要的指导意义。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.