56例短暂性脑缺血发作DSA分析

目的通过数字减影血管造影(DSA)研究短暂性脑缺血发作(transient ischemic attacks,TIA)与颅内-外供血动脉的关系,以探讨TIA的病因。方法对56例TIA患者行DSA全脑血管造影,观察颅内外供血动脉有无狭窄、狭窄程度及有无血管畸形等。结果 56例TIA患者中10例(17.86%)造影阴性,46例(82.14%)存在不同程度的责任血管病变,其中颅内外动脉狭窄40例(71.42%),动静脉畸形2例(3.57%),动脉瘤3例(5.36%),烟雾病1例(1.79%)。23例(41.07%)患者存在2处以上血管狭窄。结论颅内-外供血动脉狭窄是TIA的常见原因,动静脉畸形、动脉瘤、烟雾病等是TIA的少见病因,DSA对TIA患者病因检查有重要的临床价值。     

应用经颅多普勒超声对颅内动静脉畸形盗血的检测与量化评估

材料和方法：经脑血管造影数字减影(DSA)证实的颅内动静脉畸形(AVM)患者16例，男11例，女5例，年龄10～46岁，平均28．5岁。患者的经颅多普勒超声(TCD)资料完整，其中12例患并的DSA资料完整。另1例为小脑AVM患者，男，26岁，小脑出血吸收期(CT检查)，行TCD和DSA检查。     

烟雾病的临床特点分析

目的:观察烟雾病的临床特点,为临床治疗缺血性脑血管病提供依据.方法:回顾性分析20例烟雾病患者的临床资料,观察其临床特点.结果:本组患者年龄在46～60岁,平均(51.25±4.40)岁,临床表现多样,头颅影像学有改变;脑血管数字减影血管造影(DSA)可见明显烟雾病表现.结论:烟雾病是一种较少见的慢性脑血管进行性闭塞性疾病,是缺血性脑血管病发病的重要原因之一,应尽早行脑血管DSA检查,及时治疗.     

非高血压性自发性脑内血肿72例临床分析

目的　探讨非高血压性自发性脑内血肿 (SICH)的病因、临床表现、影像学特点及治疗。方法　回顾性分析 72例SICH患者的临床资料。结果　临床症状主要表现为头痛、呕吐、意识障碍、疒间 性发作、偏身无力等。头颅CT扫描 5 3例血肿呈高密度影 ,19例混杂密度影 ;数字减影血管造影 (DSA) 5 8例 ,其中动静脉畸形 2 9例 ,动脉瘤 4例 ,烟雾病 3例 ,2 2例血管造影未见异常。手术治疗 5 1例 ,术后死亡 9例。内科治疗 2 1例 ,死亡 6例。结论　SICH的常见病因是血管畸形 ,DSA对明确病因极有帮助。手术是治疗SICH的主要方法 ,手术时要注意寻找隐匿性血管畸形。     

血管性眩晕患者脑DSA结果的病因分析

目的根据脑数字减影血管造影(digital subtraction angiography,DSA)结果,探讨导致血管性眩晕的病因。方法选择神经内科住院治疗并行脑DSA检查的血管性眩晕患者211例。收集临床资料后,根据脑DSA结果分析血管性眩晕的病因以及椎动脉V1段迂曲的关系。结果脑DSA结果异常94例,包括血管狭窄(狭窄率≥30%)85例(40.3%),锁骨下动脉盗血综合征5例(2.4%),烟雾病2例(0.9%),动脉瘤9例(4.3%),蛛网膜下腔出血1例(0.5%),动静脉瘘1例(0.5%)。椎动脉V1段迂曲180例(85.3%),且与性别、年龄、高血压之间的比较,差异有统计学意义(P<0.05),与高血脂、2型糖尿病、冠心病、脑梗死、TIA及DSA异常的比较,差异无统计学意义(P>0.05)。结论头颈部血管狭窄、TIA是血管性眩晕的常见病因,动脉瘤、蛛网膜下腔出血、烟雾病、动静脉瘘是血管性眩晕的少见病因;椎动脉迂曲导致后循环血液动力发生改变,可出现血管性眩晕。椎动脉迂曲与代谢性疾病尚不相关,而女性、老龄、高血压病史是椎动脉迂曲的危险因素。     

青年脑卒中268例病因分析

目的 探讨青年脑卒中的病因,提高预防意识.方法 回顾性分析268例青年脑卒中患者的病因,其中67例患者接受了数字减影血管造影（DSA）检查.结果 本组268例青年脑卒中占我院同期全部住院脑卒中病例的9.92%（268/2 701）,青年脑卒中的发病率男性比例明显高于女性.268例中有明确病因者200例（74.63%）,病因不明者68例（25.37%）.在268例青年脑卒中患者中,缺血性脑卒中129例,占48.13%.其中有明确病因者101例,占77.51%,包括动脉粥样硬化65例,占50.38%;栓塞性脑血管病18例,占13.95%;非动脉硬化性血管病10例,占7.75%;凝血机制异常4例,占3.1%;疑似遗传性脑动脉病1例,占1.55%;偏头痛性脑梗死3例,占2.32%;出血性脑卒中139例,占51.86%.其中有明确病因者99例,占71.22%,包括高血压病53例,占38.12%;颅内血管发育异常（动脉瘤、动静脉畸形、烟雾病、海绵状血管瘤、脑膜动静脉瘘）37例,占26.62%;其他病因（如颅内肿瘤等）9例,占6.48%,病因不明40例,占28.78%.结论 青年缺血性脑卒中最主要的病因是动脉粥样硬化,其次是栓塞性脑血管病,其他病因如血管炎、烟雾病等较少见.青年出血性脑卒中最主要的病因是高血压病,其次是颅内血管发育异常.     

246例非高血压性自发性脑出血的病因与DSA分析

目的 探讨非高血压性自发性脑出血的病因并分析其DSA结果。方法 非高血压性自发性脑出血246例，全部做了DSA检查。结果 脑动静脉畸形l16例(47．2％)，以顶、颞叶从MVM见。颅内动脉瘤85例(34．6％)，以Willis环动脉瘤多见。Moyamoya病15例(6．1％)。硬脑膜动静脉瘘7例(2．8％)。23例DSA未发现异常。结论 非高血压性自发性脑出血常见病因是脑动静脉畸形和颅内动脉瘤，临床DSA检查是确诊病因的重要手段之一。     

烟雾病的临床特点及影像学分析(附28例报告)

目的探讨烟雾病的临床特点及影像学特征。方法对28例烟雾病患者的临床资料和影像学表现进行分析。结果本组病例中脑出血18例(64.3%),脑缺血10例(35.7%)。20例行磁共振血管成像(MRA)检查。28例均行数字减影脑血管造影(DSA)检查。结论烟雾病的临床表现多样,以脑出血多见。DSA是诊断该病的金标准,对临床疑似病例应尽早行DSA检查。     

30例烟雾病的临床及影像学特征分析

目的研究烟雾病的临床特点、影像表现及其两者之间关系。方法对30例经磁共振血管成像(MRA)和数字减影全脑血管造影(DSA)确诊的烟雾病患者,分析其临床和影像学特征。结果(1)烟雾病发病年龄在35～45岁左右,发病以脑缺血为主,临床表现以单侧肢体无力或偏瘫最为常见。(2)CT和MRI提示,脑出血11例(36.7%),脑梗死10例(33.3%),脑出血合并梗死灶5例。MRA和DSA均发现大脑前、中、后动脉狭窄或闭塞性病变,双侧病变均多于单侧病变,烟雾状异常血管网分别为5例(45.5%)和29例(100.0%);DSA发现动脉瘤3例(10.3%);后交通动脉增粗13例、前交通动脉增粗7例、眼动脉增粗6例及软脑膜吻合支增多4例。4例大面积脑梗死侧枝循环差。结论烟雾病发病高峰为35～45岁;本病临床表现多样,但以脑缺血常见;MRI和MRA为无创伤性,为本病筛选、诊断、随访的重要方法。对临床疑似病例应及早行DSA检查。     

脑血管造影诊断成人型烟雾病26例

目的对26例成人烟雾病患者的数字减影血管造影(DSA)的影像资料进行总结。方法 26例成人烟雾病患者经股动脉穿刺插管行全脑血管造影。结果 26例患者出血型18例,缺血型5例,混合型3例;大脑前动脉15例,大脑中动脉20例,同时累计大脑前动脉、中动脉者13例,大脑后动脉5例,合并动脉瘤5例。结论成人型烟雾病以出血型为主,烟雾病病变血管可以累及多支血管,可出现于单侧烟雾病,并可合并动脉瘤,DSA是确诊烟雾病的金标准。     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.