左右侧大面积大脑中动脉供血区梗死继发心电图改变的预后研究

目的探讨左右侧大面积大脑中动脉(MCA)急性梗死继发心电图改变的预后。为临床早期评估及干预提供参考数据。方法选择兰州大学第二医院自2014年12月至2016年3月收治的54例急性MCA大面积脑梗死患者,按梗死部位分为左侧脑梗死组(n=20)和右侧脑梗死组(n=34),分别对两组患者入院时、1月、3月及6月时的美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)及改良Rankin(mRS)评分进行比较。结果左侧脑梗死组和右侧脑梗死组在1月内病死率比较,差异无统计学意义(χ~2=1.975,P0.05)。两组患者发病6月时BI评分比较,差异有统计学意义(t=-3.161,P0.05)。两组患者在1月、3月及6月时的NIHSS评分比较,无论是否继发心电图改变,差异均有统计学意义(P0.05)。结论不同侧大面积MCA梗死继发心电图改变的预后可能不同。     

白发性缺血预处理对大脑中动脉区脑梗死体积及预后的影响

目的评价自发性缺血预处理(IP)对大脑中动脉(MCA)脑梗死的体积和预后的影响。方法对160例MCA脑梗死病例按在一周内有无TIA史分为A组(无TIA史)及B组(有TIA史),A组按全前循环脑梗死(TACI)、部分前循环脑梗死(PACI)、腔隙性前循环脑梗死(LACI)的脑梗死亚型分为A1组,A2组,A3组；B组按TACI、PACI、LACI脑梗死亚型分为B1组,B2组、B3组,对患者入院第1天及发病后第90天后的神经功能进行NIHSS评分,对发病后第90天脑梗死CT体积按Streiner公式进行计算。分别比较A1组与B1组,A2组与B2组及A3组与B3组在发病第1天NIHSS评分,发病后第90天NIHSS评分及发病后第90天脑梗死体积三方面的差异性。结果A1与B1组的脑梗死体积及NIHSS评分无显著差异(P＞0.05),A2、A3组的脑梗死体积及NIHSS评分明显高于B2、B3组(P＜0.05)。结论自发性IP能缩小MCA区PACI型及LACI型脑梗死范围,减少致残率,减轻临床症状,改善预后,但对TACI型脑梗死的体积和预后的影响在本研究中无显著差异。     

自发性缺血预处理对大脑中动脉区脑梗死体积及预后的影响

目的评价自发性缺血预处理（IP）对大脑中动脉（MCA）脑梗死的体积和预后的影响。方法对160例MCA脑梗死病例按在一周内有无TIA史分为A组（无TIA史）及B组（有TIA史），A组按全前循环脑梗死（TACI）、部分前循环脑梗死（PACI）、腔隙性前循环脑梗死（LACI）的脑梗死亚型分为A1组，A2组，A3组；B组按TACI、PACI、LACI脑梗死亚型分为B1组，B2组、B3组，对患者入院第1天及发病后第90天后的神经功能进行NIHSS评分，对发病后第90天脑梗死CT体积按Streiner公式进行计算。分别比较A1组与B1组，A2组与B2组及A3组与B3组在发病第1天NIHSS评分，发病后第90天NIHSS评分及发病后第90天脑梗死体积三方面的差异性。结果A1与B1组的脑梗死体积及NIHSS评分无显著差异（P〉0．05），A2、A3组的脑梗死体积及NIHSS评分明显高于B2、B3组（P〈0．05）。结论自发性IP能缩小MCA区PACI型及LACI型脑梗死范围，减少致残率，减轻临床症状，改善预后，但对TACI型脑梗死的体积和预后的影响在本研究中无显著差异。     

大面积脑梗死脑血流动力学动态变化研究

目的探讨大面积脑梗死后颅内血流动力学动态的变化特点。方法对58例大面积脑梗死患者采用影像学供血模型分为完全MCA型和MCA皮质型,利用床旁经颅彩色多普勒（TCD）于入院当天和1周内隔日1次及第14天动态检测颅内血流情况,通过测定脑底动脉血流速度、搏动指数及血流速度比值（RVACA）,观察颅内血管血流动力学变化。结果大面积脑梗死病灶侧大脑中动脉（MCA）平均血流速度（Vm）、颈内动脉（ICA）平均血流速度均明显低于对照组（P〈0.05）,完全MCA型组较MCA皮质型组MCA血流速度明显减慢;完全MCA型与MCA皮质型梗死后动态观察MCA血流变化不明显,NIHSS评分及Pi在第3、5、7天较第1天明显增高（P〈0.05）,NIHSS评分变化最明显。结论大面积脑梗死患者可通过床旁TCD动态检测,及时发现侧支循环代偿及血管再通情况,评价颅内压动态变化,结合神经功能缺损评分,观察脱水降颅压治疗反应,为患者选择合适的治疗方案提供依据。     

脑梗死患者脑血管反应性与神经功能缺损及预后的相关性

目的探讨脑梗死患者脑血管反应性(cerebral vasoreactivity,CVR)与神经功能缺损及预后的相关性。方法以120例脑梗死患者作为病例组,以120例健康体检者作为对照组。入院时NIHSS≤4、5～20和 20分作为轻度组(53例)、中度组(42例)和重度组(25例)。TCD屏气试验测定CVR。结果病例组左侧MCA和右侧MCA的BHI明显低于对照组(P 0. 05)。中重度组左侧MCA和右侧MCA的BHI较轻度组明显降低,重度组上述指标较中度组明显降低(P 0. 05)。病例组BHI与NIHSS评分呈负相关,而与BI评分呈正相关(P 0. 05)。结论 CVR能反映脑梗死患者神经功能缺损程度,并可作为预后状况的评价指标,为脑梗死的临床防治提供参考意义。     

两侧大脑半球急性脑梗死的比较性研究

目的探讨左右两侧大脑半球急性脑梗死的临床特点。方法回顾性分析282例急性脑梗死患者,按照梗死部位分为左侧大脑半球脑梗死组152例和右侧大脑半球脑梗死组130例,分别对2组患者临床资料进行比较。结果左侧脑梗死组的发病率、入院时NIHSS评分和GCS评分、病死率高于右侧脑梗死组,差异有统计学意义(P0.05)。左侧大脑中动脉支配区脑梗死发病率高于右侧大脑中动脉支配区脑梗死,差异有统计学意义(P0.05)。结论左侧大脑半球急性脑梗死发病率高于右侧,且病情重、病死率高,提示不同侧大脑半球脑梗死的临床特点存在差异。     

SAS对中青年男性急性脑干梗死患者预后的影响

目的 探讨重度睡眠呼吸暂停综合征(sleep apnea syndrome,SAS)对中青年男性急性脑干梗死患者预后的影响.方法 50例急性中青年男性脑干梗死患者,其中合并重度SAS组30例,不合并SAS组20例.采用美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)及改良Rankin量(modified rankin sale,MRS)评定2组患者发病24 h内及发病1个月后神经功能缺损程度及残障程度.结果 重度SAS组和不伴SAS组患者在年龄、血糖、血脂、治疗等方面差异无统计学意义,2组在发病24 h内NIHSS及MRS评分差异无统计学意义;1个月后重度SAS组NIHSS及MRS评分与同组24 h内评分比较差异无统计学意义(P＞0.05);1个月后非SAS组NIHSS及MRS评分与同组24 h内评分比较差异有统计学意义(P＜0.05);重度SAS组和不伴SAS组患者在发病1个月后NIHSS及MRS评分差异有统计学意义(P＜0.05).结论 重度睡眠呼吸暂停综合征影响中青年脑干梗死患者的预后,导致神经功能恢复差,残障程度重.     

强化瑞舒伐他汀联合阿司匹林对早期进展型脑梗死的效果评价

目的探讨强化瑞舒伐他汀联和阿司匹林对早期进展型脑梗死患者的临床疗效及对血清高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、D-二聚体(D-dimer)的影响。方法选取宿迁市第一人民医院住院治疗的早发进展型脑梗死患者73例,随机分为对照组35例和试验组38例。对照组给予瑞舒伐他汀10 mg及阿司匹林300 mg(1周后减为100 mg);试验组给予瑞舒伐他汀20 mg及阿司匹林300 mg(1周后减为100 mg),分别在入院后第1天、3天及第14天监测患者血清hs-CRP、D-二聚体含量,第3天、第14天及第8周时评估NIHSS评分,第14天及第8周时评估改良Batherl评分。结果进展型脑梗死患者血hs-CRP在梗死后第3天达到高峰,D-二聚体在梗死后第14天达到高峰,强化瑞舒伐他汀在梗死后14 d时可显著减少血清hs-CRP及D-二聚体水平,且在8周时能显著改善神经功能缺损症状。结论强化瑞舒伐他汀可降低早期进展型脑梗死患者hs-CRP及D-二聚体水平,能有效改善急性脑梗死患者预后。     

影响大面积脑梗死患者死亡率的有关因素分析

目的 探讨影响大面积脑梗死患者死亡率的有关因素.方法 对25例大面积脑梗死死亡和43例非死亡患者的临床资料,包括年龄、性别、脑卒中危险因素(心房纤颤、高血压、糖尿病)以及临床特征[梗死面积、美国国立卫生研究院卒中量表(NIHSS)及格拉斯哥昏迷量表(GCS)评分]和并发症进行比较、分析.结果 死亡组的年龄、NIHSS评分显著高于、GCS评分显著低于生存组；有心房纤颤及肺部感染、肾功能不全、病灶面积＞ MCA分布区的比率亦显著高于生存组(均P＜0.05).结论 年龄、心房纤颤、梗死灶面积、病情以及并发肺部感染、肾功能不全是影响大面积脑梗死患者死亡率的主要因素.     

急性缺血性脑卒中患者远期预后的预测因子分析

目的探讨患者的血压参数、硝酸氧化代谢产物(NOx)及肾上腺髓质素(AM)对脑卒中远期预后的预测作用。方法纳入急性缺血性脑卒中患者82例,脑卒中后第1、2、7天抽取外周血分析血浆中NOx及AM;根据NIHSS卒中量表及Rankin量表评估患者的脑梗死体积及神经损害程度。结果高血压患者的临床症状严重程度更加明显(NIHSS3,P0.01),血压的变异性能够评估神经系统损害的严重程度及梗死体积的进展;脑卒中患者血浆内的NOx含量显著低于健康对照组;第7天及3个月时的NIHSS评分及3个月时的Rankin评分显示脑卒中后2d以内的NOx水平增加对患者是相对有益的[优势比(OR),0.91];脑卒中患者第1天及第2天的AM水平显著高于对照组,第7天时则恢复正常;AUC曲线显示第2天AM水平528.3pg/mL提示第7天神经损害严重程度增加(曲线下面积0.716);发病之前服用抗凝剂与抗高血压药物可一定程度上抑制梗死病灶的进一步进展。结论急性脑卒中患者的血压特征及血浆内的NOx与AM水平能够预测患者的远期预后。     

Venous Infarction of Brainstem and Cerebellum

The authors describe 2 cases of posterior fosa venous infarction. A 56-year-old woman with essential thrombocytemia presented with fluctuating complaints of headache, nausea, vomiting, left-sided numbness-weakness, and dizziness and became progressively stuporous. Cranial magnetic resonance imaging (MRI) showed bilateral parasagittal fronto-parietal and left cerebellar contrast-enhancing hemorrhagic lesions. On magnetic resonance venography, the left transverse and sigmoid sinuses were occluded. The second patient, a 39-year-old woman, presented with acute onset of diplopia, numbness of the tongue, vertigo, and right-sided weakness following a gestational age stillbirth. MRI revealed lesions in the right half of midbrain and pons and in the superior part of the right cerebellar hemisphere. Digital subtraction angiography showed right transverse and sigmoid sinus occlusion. The authors suggest that one should investigate the possibility of venous infarction in the presence of posterior fossa lesions that are often hemorrhagic and are not within any arterial territory distribution but respect a known venous drainage pattern. Recognition of the observed clinical and neuroimaging features can lead to earlier diagnosis and, potentially, more effective management.     

Side effects after disulfiram. Comparison of disulfiram and placebo in a double-blind multicentre study

A double-blind, randomized study was carried out on the side effects of disulfiram in 241 men and women with alcohol abuse. Of the 158 patients completing the study, 83 received disulfiram and 75 placebo. Each patient was questioned on side effects after a 2-week wash-out period and thereafter once a week during the 6-week treatment period.. There was no statistically significant difference between the two groups, apart from over-representation of complaints of sexual problems in the placebo group. The patients who dropped out of the study were equally distributed between the two groups with regard to the number, diagnosis, and reasons for dropping out.     

Antiepileptic drug toxicity: Definition and mechanism of action

A detailed review of the adverse reactions of anticonvulsants is given, focusing on the definitions of drug toxicity, sources of information, patterns of durg utilization, pharmacokinetic variables and different mechanisms of action. The information available in the literature provides a wide spectrum of drug toxicity with no attempt at a practical definition of the reported events. This favors uncertainty among practising physicians, who are led to use the individual items with different attitudes. Suggestions are given for the evaluation, prevention and treatment of anticonvulsant drug toxicity.

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Sommario La presente è una revisione critica dei diversi aspetti della tossicità dei farmaci antiepilettici. L'analisi della letteratura è condotta con particolare riferimento alle diverse fonti di informazione, ai pattern di utilizzo dei singoli principi attivi, ai dati farmacocinetici ed ai meccanismi di azione farmacologica sottostanti. L'ampio panorama che ne deriva non consente una definizione pratica degli effetti indesiderati degli anticonvulsivanti. Ciò determina incertezza e confusione nella pratica medica, con conseguente diversità di comportamenti. La rassegna si conclude con la presentazione di alcuni suggerimenti pratici per la valutazione, la prevenzione ed il trattamento della tossicità da anticonvulsivanti.

     

伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病的临床和影像学特征分析

目的 报道1例影像学上表现为双侧小脑和胼胝体膝部梗死的伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(Cerebral autonomic dominant arteriopathy with subcortical infarcts and leucoencephalopathy CADASIL),探讨CADASIL的临床及影像学表现。方法 对1例疑诊为CADASIL的78岁女性患者进行临床表现、影像学检查及实验室检查,神经心理测评的收集,取得患者知情同意后对其进行NOTCH3基因检测和皮肤活检,并对家系成员进行验证分析。结果 患者首发症状为记忆力减退,起病年龄较大,伴有情感淡漠、步态不稳、小便功能障碍,无偏头痛,头颅磁共振见广泛的脑白质脱髓鞘,丘脑、胼胝体膝部、双侧基底节、双侧小脑半球多发陈旧性腔隙性脑梗死,NOTCH3基因检测发现11号外显子存在c.1630C>T错义突变,即p.R544C。结论 本例CADASIL患者的起病年龄75岁,首发症状为记忆力减退,腔隙性脑梗死不仅累及丘脑、基底节,同样也可以累及小脑。胼胝体全层梗死为CADASIL的特征性影像表现之一。     

Effects of Bromocriptine on Neuroleptic-Induced Amenorrhea, Galactorrhea and Impotence

Abstract: The effects of bromocriptine on neuroleptic-induced endocrinological disturbances (amenorrhea, galactorrhea and impotence) were investigated. Bromocriptine (5.0-7.5 mg/day) was administered to psychiatric patients receiving neuroleptics and developing hyperprolactinemia. The following results were obtained.
1. Menses recurred in 7 of 10 patients with amenorrhea.
2. A decrease in lactation appeared in 5 of 6 patients with galactorrhea.
3. A significant increase in the serum levels of testosterone was observed after 8 weeks of the treatment in male patients. (N = 6)
4. There was no remarkable deterioration in regard to the psychotic symptoms in schizophrenic patients. (N = 7)
5. In non-schizophrenic patients (N = 9), a significant improvement was observed in regard to "somatic concern" (in Brief Psychiatric Rating Scale).     

出血性脑梗死的MRI特征性表现及临床分析

目的探讨出血性脑梗死(HI)的MRI特征性表现及与临床关系。方法分析30例HI患者的MRI表现和临床资料。结果HI以发病2周内常见,约占76.7%。不同部位脑梗死HI的出血形态、位置不同:脑叶HI15例(50.0%),脑回状、斑片状出血位于皮层和/或皮层下白质;脑深部HI(基底节及丘脑)10例(33.3%);小脑HI4例(13.3%),斑片状、线状出血位于梗塞区内、边缘;混合型2例(6.7%)。T2*WI呈低信号。结论HI的MRI表现与脑梗死部位、面积有密切关系。T2*WI有助于HI的检出。脑梗死患者病情加重或考虑大面积脑梗死应在2周内进行影像学复查,以利于HI的早期诊断和治疗。     

Improvement in verbal memory after withdrawal of carbamazepine and valproate in patients with well-controlled epilepsy: a randomized, double-blind study

Hessen E, Lossius MI, Gjerstad L. Improvement in verbal memory after withdrawal of carbamazepine and valproate in patients with well‐controlled epilepsy: A randomized, double‐blind study.
Acta Neurol Scand: 2011: 123: 385–389.
© 2010 John Wiley & Sons A/S. Background – For most major antiepileptic drugs, neuropsychological side effects have been reported. Healthy volunteer studies have found that both carbamazepine and valproate impair aspects of verbal memory. Objective – The aim of this study was to assess the effects of carbamazepine and valproate on verbal memory, in a well‐controlled epilepsy population. Methods – This was carried out with a randomized, double‐blind and placebo‐controlled study of anticonvulsant withdrawal in patients receiving monotherapy. Results – In the carbamazepine group (n = 92), withdrawal significantly improved recall after 30 min (P = 0.03). In the valproate group (n = 32), withdrawal significantly improved performance of immediate word span (P = 0.04). Conclusions – Withdrawal was randomized to placebo, but the choice of medication was not randomized to placebo. This means that the shown differences in neuropsychological outcome cannot with full certainty be attributed to either antiepileptic drug. The improvement of memory, after both carbamazepine and valproate withdrawal, was slight, and the impact on daily life function is uncertain.     

托吡酯快速加量治疗癫痫安全性研究

目的:评价托吡酯快速加量法治疗癫癎发作对病人的安全性影响。方法:将130例癫癎病人分成两组。一组为常规加量组,另一组为快速加量组。常规加量组为每周加25 mg,4～8周达到治疗量,快速加量组为每3天加25 mg,在10～20 d达到治疗量。分别观察其不良反应出现的时间、频度、分级和严重程度。结果:快速加量组和常规加量组的不良反应发生率分别为41.54％和38.46％,而且其持续时间均相近。结论:托吡酯的快速加量法是安全的。     

氟西汀致锥体外系副反应的临床观察

目的 了解氟西汀与锥体外系副反应的关系。方法 选用单用或合用氟西汀的患者,共观察住院病人101例,用RSESE和TDRS量表对患者服用氟西汀前后进行锥体外系副反应评定,对有锥体外系症状的病人给予停药观察,以证实氟西汀与锥体外系症状的关系。结果 101例患者中发现锥体外系症状者5例,其中静坐不能4例,肌张力增高1例。结论 氟西汀可产生锥体外系副反应,在临床应用时应予以注意。