脑梗塞并发视网膜中央动脉阻塞2例报告

脑梗塞并发视网膜中央动脉阻塞２例报告胡兴东李雅范孟庆民例１，男，５３岁。于１９９４年１２月１４日入院。该患于入院前３天休息时觉左侧肢体运动失灵约２小时后右眼突然失明，无头痛及呕吐。查体：血压２２／１４ｋＰａ。左眼视力及眼底正常。右眼无光感，瞳孔极度散...     

颅脑术后并发精神障碍(附42例报告)

目的：探讨颅内术后并发精神障碍的发病因素、机制和临床表现特点。方法：通过对我院1991年1月－2002年1月间，42例颅脑术后并发精神障碍的临床有关资料进行分析研究。结果：本组42例，占同期颅脑手术的0．87％，出院随访2－6个月，精神障碍无一例复发或加重，痊愈36例，显著进步4例，进步2例，治愈85．7％。结论：颅脑术后并发精神障碍主要是因手术和脑部原发病变对脑组织的损害，导致司管情感部位的脑细胞功能下降，与手术创伤程度、手术时间、脑部原发病变的部位及病人术前的心因基础有着密切的关系，精神障碍一般持续时间短暂，多以兴奋和偏执症状为主，并随着颅脑术后恢复而逐渐好转，预后令人满意。     

巨细胞动脉炎并发脑卒中一例报告

我们自 1997年 7月至 2 0 0 1年 6月共诊治巨细胞动脉炎2 1例 ,其中有 3例并发脑卒中 ,现报道 1例如下。患者女 ,5 1岁。因头痛、间歇性发热、全身肌肉痛 2周来我院门诊。发病以来即按“感冒”和“感染性疾病”治疗无效。体格检查 :Ｔ 38 3℃ ,血压 12 0 / 80ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ) ,右颞浅动脉前支搏动消失 ,双肺呼吸音粗。血常规 :白细胞 13 3× 10 9/Ｌ ;肌酶正常 ;血沉为 6 7ｍｍ/ｈ ;Ｃ 反应蛋白为2 0 7ｍｇ/Ｌ ;胸部Ｘ线检查正常。头部ＣＴ报告 :右顶叶皮质下小片状低密度灶 ,考虑为脑梗死。右颞浅动脉活检 :ＨＥ染色显示…     

淋巴细胞脉络丛脑膜炎并发SAH1例报告

淋巴细胞脉络丛脑膜炎(Iynphocytic-choriomeningitis,Lcm)临床上很难确诊,并且腰穿时并发蛛网膜下腔出血(SAH)死亡者罕见.现将我们遇到的经病理证实的1例报道如下.     

重型脑挫裂伤并发迟发性颅内血肿36例报告

目的 总结重型脑挫裂伤并发送发性颅内血肿的诊治经验。方法 回顾性分析我院近年来收治的重型脑挫裂伤并发送发性颅内血肿的总者36例。结果 经治疗1月后按GCS评定，保守治疗6例，恢复良好2例，中残2例，重残1例，死亡1例；手术治疗30例，恢复良好18例，中残6例，重残3例，植物状态1例，死亡2例。结论 严密动态观察，尽早开颅手术清除血肿，解除颅高压，防治术后并发症是救治的关键；对单纯局灶性脑挫裂伤并发迟发颅内血肿者术后效果良好，对广泛性脑挫裂伤、脑肿胀或脑干伤并发迟发性颅内血肿者预后不良。     

神经外科领域的静脉血栓栓塞症

肺栓塞症(PTE)和深部静脉血栓症(DVT)近年来有增高的倾向,其原因尚不明确。在美国发病率为270～400人/100万人。一般认为东方人本病发病率较低,被认为是一种比较少见的疾病,但近10年其发病增加了约3倍。所以,对PTE及DVT作为重症合并症不断增加的倾向要给予足够的认识。我们报道10例临床病例,对神经外科领域的PTE及DVT的特征进行探讨。     

白血病性脊髓病1例报告

白血病性脊髓病１例报告马兰张纪恩朱庆国夏乐三以脊髓损害作为首发或唯一表现的急性白血病少见，易于误诊，现报告一例如下。：男，３４岁，因上背部疼痛３月，继以双下肢麻木无力、大便秘结５天，尿潴留并发热１天于１９９５年１２月１日收入神经内科。体检：体温３９°...     

小脑毛霉菌病1例报告

小脑毛霉菌病１例报告郭密刘群包雪英苏丹颖脑型毛霉菌病近年来在我国逐有报道，但多数报导病变部位主要在大脑，其次为脑膜及基底节部，而发生在小脑尚报道极少，现将我们经手术证实小脑毛霉菌病１例报告如下。男，２４岁，农民。因右侧肢体无力６个月，逐渐右手运动不协...     

Pulmonary embolism in the ECT patient: a case report and discussion

OBJECTIVES: Our objective was to discuss the risk for pulmonary embolism (PE) in the patient population with comorbid psychiatric and medical issues and risk management. It was also our objective to discuss the potential use of electroconvulsive therapy (ECT) following a PE with a case presentation format. METHODS: We present a case report, a review of the literature and a discussion. RESULTS: We report on the case of a 68-year-old man with bipolar disorder who had a PE after two ECTs. He required stabilization and treatment in the intensive care unit before returning to the psychiatry unit for completion of a course of ECT, which was well tolerated and highly effective. CONCLUSIONS: Patients with comorbid medical and psychiatric illness are at high risk of developing deep venous thrombus/PE and need to be monitored for this. They often require ECT, which can be administered safely even after a PE.     

颅内蛛网膜囊肿的手术治疗（附19例报告）

本文报告１９例颅内蛛网膜囊肿，对其手术适应证、手术方法选择和手术注意事项进行了讨论。作者认为：凡有颅内高压的囊肿，充分建立囊腔与周围脑池或腹腔之间的交通是手术成功的关键。     

Frequent association with neurosurgical conditions in adult Proteus mirabilis meningitis: report of five cases

Adult Proteus (P.) mirabilis meningitis is relatively rare and has not been examined individually in the English-language literature. During a period of 15 years (January 1986-December 2000), four adult patients with P. mirabilis meningitis and one adult patient with mixed bacterial meningitis involving P. mirabilis were identified at Chang Gung Memorial Hospital, Kaohsiung. These five patients included one man and four women, aged from 19 to 74 years (mean age=55.4). P. mirabilis infection accounted for 1.7% (4/229) of cases of our culture-proven monomicrobial adult bacterial meningitis and was involved in 7.1% (1/14) of cases of our adult mixed bacterial meningitis during this period. Underlying debilitating conditions including diabetes mellitus and neurosurgical disorders were common in these five cases. Adult P. mirabilis meningitis had an acute clinical course, with fever and consciousness-disturbance occurring as most prominent clinical manifestations in all patients. Other common manifestations included hydrocephalus, seizure, septic shock and wound infection. Hematogenous spread would appear to be the most likely mechanism. Multi-antibiotic resistant strains of P. mirabilis were not found in our patients. All strains were susceptible to third-generation cephalosporins, imipenem, aztreonam and ciprofloxacin. The results of treatment for adult P. mirabilis meningitis were not satisfactory, most of the patients surviving with severe neurological deficit.     

Diastematomyelia: report of 21 cases surgically treated by a neurosurgical and orthopedic team

We studied 21 cases of diastematomyelia associated with myelo-meningocele (3 cases) or congenital spine deformities (18 cases). Analysis of bone and neuraxis abnormalities with special reference to the spinal canal, related to operative findings demonstrate in all cases an embarrassed cord by localized compression or global narrowing of the malformed spinal canal (11 cases), bone spur fixation (13 cases) and tethered cord associated lesions (5 cases). Mechanisms of neural damage and prophylactic value of laminectomy before the orthopedic treatment of the curve during the same operation is discussed.     

小剂量奥氮平治疗新型冠状病毒肺炎患者冲动攻击行为2例

本文目的是报道2例新型冠状病毒肺炎患者在被隔离治疗期间出现冲动攻击行为时,小剂量奥氮平疗效确切。该2例患者系来自同一个家庭的一对母女,均有疫区接触史。在被隔离治疗后对医护人员表现出各种不配合、言语攻击,予一般心理疏导收效甚微,但联合奥氮平1. 25~2. 50 mg/晚治疗后效果好,情绪稳定、配合治疗,冲动攻击行为消失,未见副作用。     

Nocardial cerebral abscess: report of three cases and review of the current neurosurgical management

Nocardia asteroides cerebral abscesses are rare but challenging intracranial lesions. Early diagnosis, institution of appropriate antimicrobial therapy, lack of underlying systemic disease and limited intracranial disease are recognized factors leading to good outcome. However, the optimal treatment approach has not been established and nocardial brain abscesses have been managed either conservatively, with steroetactic aspirations or with open craniotomy and enucleation. We present three cases of Nocardia asteroides cerebral abscesses cured only after neurosurgical enucleation, and discuss the current management alternatives and conclude that a more aggressive approach than that currently preferred for this entity may be more effective.     

脑干血管畸形的显微手术治疗(附19例报告)

目的 探讨脑干血管畸形的显微外科手术治疗方法和预后.方法 显微手术切除脑干血管畸形19例.6例经枕下正中第四脑室底入路切除;9例经枕下乙状窦后入路切除;3例经小脑延髓裂入路切除;1例经枕下正中入路上抬蚓垂后切除.结果 19例病灶均镜下全切,其中海绵状血管瘤15例,动静脉畸形4例.13例症状改善,5例出现并发症,1例因下呼吸道感染死亡.随访中GOS 5分15例,GOS 4分2例,GOS 3分1例.MRI复查无病灶残留.结论 在恰当选择手术适应证、手术时机和手术入路的基础上,运用娴熟的显微外科技术,脑干血管畸形的手术治疗结果是令人满意的.

Abstract：

Objective To investigate the microsurgical treatment of brainstem vascular malformation and evaluate the surgical outcome. Method Brain stem vascular malformations in 19 cases were resected by microsurgical techniques. Six cases of cavernous malformations ( CM ) in the dorsal of pons and medulla underwent operations via through the base of the forth ventrical approach. Another nine cases of CM in lateral and ventral lateral pons were treated via suboccipito - retrosigmoid approach. Three cases of arteriovenous malformation(AVM) in cerebellomedullary fissure were treated via telovelar approach. One case of AVM in the dosal medulla were resected via transvermian approach. Results All the lesions were totally resected. Pathologic diagnosis were CM( 15 cases) and AVM(4 cases). The diameter of all the CM were less than 1 centimeter. One AVM was 1.5 centimeter in diameter, the other two lesions was 2. 0 centimeter, the last one was 2. 5 centimeter. The functional disorders were improved after operation in 13 cases. Complications appeared in five patients, which improved between one week and three months. One patient died of sever pneumonia. During two months to six years after operation, the brainstem vascular malformation didn't recrudesce and re - bleed. No one patient appeared new syndromes. Conclusions The microsurgical management of brainstem vascular malformation can effectively prevent re - bleeding. Selecting different surgical approach basing on the locations can reduce the neurofunction damage. In order to accelerate the recovery of damaged brainstem, early surgery should be choosen for the patients with surgical indications. Basing on the correct choice of surgical indications, using the extensive knowledge of microanatomy,new concept of minimal invasive surgery and skillful microsurgical techniques, the surgical results of brainstem vascular malformation are satisfactory.     

AIDS伴颅内占位性病变的立体定向活检术分析

目的 探讨立体定向活检术在获得性免疫缺陷综合征（AIDS）伴颅内占位性病变病人中的应用价值。方法 回顾性分析2017年8月至2021年12月收治的19例AIDS病人伴颅内占位性病变的临床资料,均行立体定向活检术取闹组织进行病理检查。结果 19例中,18例获得确诊,诊断阳性率为94.74%;其中真菌感染7例,肿瘤3例,进行性多病灶脑白质病、HIV脑病2例、结核肉芽肿各2例,弓形虫病、病毒性脑炎各1例。1例（5.26%）术后病理检查诊断不明确。术后出现穿刺道少量出血1例（5.26%）,无神经功能障碍,无手术死亡病例。根据活检术后病理结果给予相应治疗,随访4个月～1年,平均6个月,复查颅脑增强MRI显示15例病灶变小、数量减少和（或）周围水肿减少,好转率为78.95%;4例无明显变化。结论 AIDS病人伴发的颅内占位性病理性质多样,立体定向活检术能提供精准的诊断,并具有微创、安全的优点,可为治疗方案的制定提供有效的依据,提高临床治疗效果。     

Meningiomas in pediatric patients: report of 2 cases

Meningiomas correspond to 1% - 4% of primary intracranial tumors in pediatric group, with their incidence raising according to age. There is not gender prevalence, in spite of some authors describe a male tendency opposed to female one in adulthood. At present study we describe two cases of pediatric meningiomas reviewing clinical, radiological and histological aspects of these lesions. The authors review also treatment options and prognosis of childhood meningiomas. A two-year-old boy was admitted with seizures. Computerized tomography showed a right parietal lesion, which was totally resected. Histological features were compatible with meningioma. After 17 months the child is doing well, with no deficits or seizures. The second case is a 12-year-old girl, with a headache complain. During investigation, a CT revealed a right frontal lesion. She was operated under a right frontal craniotomy with total tumor resection. Nowadays she is asymptomatic, 20 months after surgery. Despite meningiomas in pediatric group are uncommon; they should be included in differential diagnosis list of expansive intracranial lesions of childhood.     

Transient epileptic amnesia: a neurosurgical case report

One memory disorder that is potentially treatable with antiepileptic drugs is transient epileptic amnesia (TEA). Working diagnostic consensus criteria for TEA include: (1) a history of recurrent witnessed episodes of transient amnesia; (2) confirmation by a reliable witness that cognitive functions other than memory are intact during typical episodes; and (3) evidence for a diagnosis of epilepsy. We describe a case with both complex partial seizures and episodes of TEA. This is the first reported case of a neurosurgical intervention for symptoms resembling those described in refractory TEA. Video/EEG, 3-T MRI, neuropathology, and neurological as well as neuropsychological findings are presented with postsurgical clinical outcome. The patient underwent right anterior amygdalohippocampectomy for symptoms resembling refractory TEA with additional complex partial seizures at our epilepsy surgical center. She remained seizure free at the 15-month follow-up, and memory complaints remitted. This case report illustrates one memory disorder, transient epileptic amnesia, that is potentially treatable with antiepileptic drugs or surgery.