左侧大脑半球梗死致吞咽障碍动态观察1例

卒中后出现吞咽障碍通常被认为是脑干或双侧皮质延髓束损伤所致,而单侧半球损伤后导致吞咽障碍较少.本文报道1例单侧大脑半球梗死导致吞咽障碍患者的动态观察结果并分析其发生机制.     

脑梗死后吞咽困难预后的评估

目的 探讨判断脑梗死后吞咽困难预后的评估方法。方法 对205例脑梗死后伴发吞咽困难的患者进行吞水实验,以改良的Barthel指数进行评分,根据牛津郡社区脑梗死分型（OCSP）进行分型。临床观察吞咽困难患者的预后情况。结果 脑梗死后吞咽困难晚期恢复患者和早期恢复患者在吞水试验和改良的Barthel指数方面的差异均有统计学意义（P <0.001）。延髓梗死、延髓背外侧综合征、完全性前循环脑梗死的患者发生吞咽困难较其他类型的脑梗死伴发者更难恢复。结论 判断脑梗死后吞咽困难的预后可以综合吞水实验、改良的Barthel指数和OCSP来进行。     

卒中损伤部位与吞咽困难的关系

本期《中国卒中杂志》是关于卒中后吞咽困难的专刊。关于吞咽困难的认识和管理是近15年来才逐渐认识和深入研究的,因此许多概念、相关理论及实践问题尚不为大家所认识。例如究竟什么是吞咽困难?饮水呛咳和吞咽困难有什么区别?穿透和误吸分别指什么?吞咽困难产生的机制?目前在吞咽困难领域作了哪些研究?如何规范化地管理卒中患者的吞咽困难?有哪些治疗方法?有效性如何等等。因此本期吞咽困难专刊希望能通过提供相关的内容。为大家认识吞咽、了解吞咽困难、掌握吞咽困难的诊断治疗等管理方面的内容,以及目前吞咽领域所作的各种研究等提供帮助。本期专题的主要内容包括了吞咽生理、卒中后吞咽的发生机制、临床表现和治疗。其中可能存在不同的观点、认识等,有待于进一步探讨。     

良性单侧下肢萎缩一例

<正>1病例报告患者女性,34岁,主因"左下肢小腿肌萎缩伴轻度无力麻木10年、左下肢酸胀2个月"于2015-08-27入作者医院。患者于2005-06无明显诱因感左下肢轻度的无力及麻木不适,当时患者双下肢粗细相当(与平时一样),未发现双下肢萎缩变细,于2005-08发现左侧小腿肌肉萎缩,无肌肉疼痛及肌肉跳动,无头晕、头痛、复视、口齿不清、     

表现为真性延髓性麻痹的单侧脑桥及中脑梗死1例报道

根据脑干的解剖特点及定位理论[1],脑干梗死以交叉性瘫痪或交叉性感觉障碍为特征。因锥体束在脑干腹侧,故典型的脑干腹侧损害应有锥体束损害体征。我院收治1例经MRI诊断明确的急性单侧脑桥及中脑靠腹侧梗死患者主要表现为延髓麻痹而无明显锥体束损害表现的患者。现报告如下。     

右侧基底节区出血致严重单侧空间忽略一例

单侧空间忽略是卒中后较常见的问题,其原因主要是大脑半球的病变导致空间感知能力的下降[1].……     

单侧颈内静脉结扎术后静脉窦血栓形成一例报道

1病例简介患者,女,67岁,因下唇溃疡10余年于2005年入院。患者10余年前发现下唇渍疡,无明显不适,一直未诊治。1年前溃疡质地变硬伴疼痛,右颊部红肿,遂就诊。患者无头痛,无恶心、呕吐,有高血压病史,平素血压控制可;有腔隙性脑梗死病史,经治疗后无后遗症状;无鼻窦炎病史。入院诊断:下唇癌合并右颌下淋巴结转移。患者入院后行右侧根治性颈淋巴结清扫术,术中结扎切除右侧颈内静脉。术前神经系统     

缺血性卒中患者吞咽困难的一种异常吞咽方式

目的 明确卒中后吞咽困难患者一种异常吞咽方式的性质。方法 用电视透视检查观察21例卒中后吞咽困难患者吞咽5ml稀钡（60%w/v）过程中喉结构的运动轨迹。从入院至电视透视检查的时间为0～9d（中位数5d）。测量喉结构在每帧即0.03s（单位时间）内垂直方向上提升的距离x（mm）,以及同时在水平方向上前移的距离y（mm）,计算每0.03s内喉结构上提单位距离（1mm）时前置的距离（y/x mm）,以时间（帧）为横坐标,y/x为纵坐标,做出喉结构运动的曲线图。结果 21例吞咽困难患者的电视透视检查影像中有6例存在一种不同于其他患者的吞咽方式,表现为喉结构上提单位距离（1mm）内显著前移。有异常方式组和无异常方式组y/x最大值之间存在统计学差异（P =0.002）。曲线图上,异常方式组y/x最大值均大于1.5mm,无异常方式者均小于1.5mm。结论 在卒中后吞咽困难患者可能出现喉结构过度前置的异常方式,与舌骨上肌群在水平方向上代偿性收缩增强有关。     

黄芪注射液治疗大脑半球脑梗死58例疗效观察

目的探讨黄芪注射液对大脑半球脑梗死的治疗效果。方法对照组常规治疗(脱水、扩管、抗凝、营养脑细胞等)。黄芪治疗组为常规治疗加黄芪注射液。结果对照组显效10例,有效14例,无效4例,总有效率86%。黄芪治疗组显效19例,有效9例,无效2例,总有效率93%。结论黄芪注射液治疗大脑半球脑梗死疗效确切,而且简单易行,易于推广。     

卒中和口咽吞咽困难

正常口咽吞咽过程通常包括四个阶段:(1)口准备阶段,食物通过咀嚼形成食团为吞咽做准备;(2)口阶段,舌通过顺序地向上向后的推挤动作将食物从口腔前部送至后部;(3)咽阶段,该阶段由脑干诱发,表现为软腭     

脑淀粉样血管病导致痴呆一例

1病例简介患者,男性,78岁,干部,主因“进行性智能减退5年”入院。患者于入院5年前出现记忆力减退,以近记忆力障碍为主,常忘记重要的出行,不能自行购物。此后逐渐出现情感淡漠,不参加老干部活动,不关心家人,有时外出迷路,时常夜间起床无目的行走。仍可看电视、读报纸,但不能复述内容,亦不能正确理解,语言减少。近1年终日不语。     

肥厚性硬脑膜炎致脑静脉窦血栓形成一例

1病例简介患者男性,54岁,主因"发作性意识不清24年,行走不稳3年,加重半年"于2005年入院。患者于1981年无明显诱因出现一次猝倒,伴     

Bihemisphere Ischemia Due to a Unilateral Lesion: A Case Report

Bihemispheric ischemic strokes secondary to unilateral vessel disease are uncommon. We present the case of a 70-year-old man with multiple acute/subacute bilateral infarcts. The patient was found to have stenosis of the left internal carotid artery secondary to herpes zoster ophthalmicus vasculopathy, with involvement of the left proximal middle and anterior cerebral arteries. Angiographic studies also revealed A1 segment aplasia of the right anterior cerebral artery (ACA), thus indicating dependence on the left-sided circulation for perfusion of the bilateral ACA vascular territory. This case illustrates how A1 segment aplasia, an anatomic variant of the circle of Willis detected by angiographic studies, can contribute to bilateral infarction in the ACA vascular territory.     

Reversible Splenial Lesion in Postpartum Cerebral Angiopathy: A Case Report

Reversible lesions on magnetic resonance imaging that transiently restrict diffusion in the splenium of the corpus callosum (SCC) without any other accompanying lesions have been reported in various clinical conditions. We offer the first report of postpartum cerebral angiopathy with reversible SCC lesions.     

贫血并颈动脉纤维肌发育不良导致癫(癎)发作1例

1 病例简介 患者,女性,15岁,主因"反复发作右侧肢体抽搐2年"收住我科.患者于入院1年前开始,在活动以后出现右侧肢体抽搐,症状持续4～10 min,未给予特殊治疗.以后症状常常在活动中、劳累后反复发作,症状严重时可以导致全身强直-阵挛发作,伴有意识障碍.曾于院外行颅脑MRI检查未见异常,脑电图检查发现左侧额颞叶有短程发放的中至极高波幅的3.5～7 Hz波.诊断为局灶性癫(癎),给予抗癫(癎)药物(卡马西平,0.1 g,3次/d)治疗,症状发作明显缓解.为进一步明确病因来我院诊治.     

Amnesia After Unilateral Temporal Lobectomy: A Case Report

Summary: We report a mixed handed (L>R) patient with exclusive right cerebral language representation who de–veloped a permanent anterograde amnestic syndrome after right anterotemporal lobectomy. Preoperative neuropsychological performance consisted of impaired verbal memory and normal nonverbal memory. Wada memory performance was asymmetrical for objects presented soon after amobarbital injection in conjunction with no memory asymmetry for items presented later in the Wada evaluation. Preand postoperative magnetic resonance imaging (MRI) scans showed no structural lesions; however, postoperative MRI hippocampal volume measurements suggested decreased hippocampal volume for the nonresected temporal lobe. These results confirm the risk of anterograde amnesia after unilateral temporal lobectomy and demonstrate that baseline neuropsychological testing may falsely literalize material-specific memory functions in patients with atypical cerebral language dominance.     

Unilateral Lesion of Dorsal Hippocampus Enhances Reinforcing Lateral Hypothalamic Stimulation in the Contralateral Hemisphere

Whereas convincing evidence exists for an important role of the hippocampus in mechanisms underlying memory and encoding of location in space, the contribution of the hippocampus to the system underlying central processes of reinforcement is less well established. Scattered data suggesting that hippocampal ablation increases the effectiveness of positive reinforcers have alternatively been interpretated in terms of general and unspecific behavioral disinhibition, which results in higher levels of activity and rates of responding. In the present experiment, 22 Wistar rats were either given a neurotoxic or a sham lesion in the CA₁ region of the hippocampus, and the effect on lateral hypothalamic self-stimulation behavior was assessed. To control for nonspecific performance effects rates of lever pressing were assessed ipsi- and contralateral to the lesioned hemisphere as well as under condition of extinction (current set to zero). Following the neurotoxic lesion the animals displayed significant higher rates of self-stimulation at the electrode sites in the hypothalamus situated contralateral but not ipsilateral to the hemisphere with the lesion compared with controls. The increase in self-stimulation commenced on the third day postlesion and was maintained over the 8 days of testing. The lesion did not change the animals’ behavior under extinction. Thus, the hippocampal lesion led to an amplification of rewarding lateral hypothalamic self-stimulation behavior, indicative of a lesion induced disinhibition of the brain’s reinforcement system.     

单侧Moyamoya病合并动静脉畸形一例

1病例资料患者,女性,16岁,主因"突发头晕头痛7d"入院。7d前于活动中突发头晕头痛,伴恶心,呕吐,无视物模糊,无肢体麻木及运动障碍,于当地医院行颅脑CT示:左小脑半球及蚓部出血,四脑室无明显受压(图1),为进一步诊治来我院。     

Fatal Case of Cerebral Aspergillosis : A Case Report and Literature Review

Cerebral aspergillosis is rare and usually misdiagnosed because its presentation is similar to that of a tumor. The correct diagnosis is usually made intra-operatively. Cerebral abscess with fungal infection is extremely rare and few cases have been reported, but it carries a poor prognosis.A 73 year-old man presented with decreased visual acuity and paresis of the right cranial nerve III. Magnetic resonance imaging (MRI) revealed a mass in the right cavernous sinus, extened to the anterior crainial fossa and the superior orbital fissure. During surgery, a well encapsulated pus pocket was found, and histopathological examination of the mass resulted in the diagnosis of aspergillosis. Despite appropriate anti-fungal treatment, the patient eventually died from fatal cerebral ischemic change and severe brain swelling.The correct diagnosis of cerebral aspergillosis can only be achieved by histopathological examination because clinical and radiological findings including MRI are not specific. Surgical intervention and antifungal therapy should be considered the optimal treatment. Early diagnosis and aggressive antifungal treatment provide good results.     

脑梗死致口面失用一例

患者,男性,52岁,右利。于2006年3月31日无明显诱因突发右手活动不灵,10余分钟后出现言语不能,双上肢屈曲,下肢伸直,头转向左侧,家属未注意眼位,无二便失禁,约10min好转,留有轻度言语不清,无饮水呛咳,事后对肢体强直发作无记忆。外院行头颅CT显示右侧基底节区陈旧