痉挛型脑瘫病儿眼位分析

目的探讨痉挛型脑瘫病儿并发斜视的临床分型差异及其相关因素。方法随机搜集63例痉挛型脑瘫病儿,采集其年龄、围生期高危因素、病史、影像学资料,评定其脑瘫解剖学分型。同时进行眼科常规、屈光、眼位、眼球运动和眼底等检查,评价其眼位。比较不同解剖学分型脑瘫病儿的眼位及斜视类型的分布。结果 63例痉挛型脑瘫病儿中,双瘫31例,偏瘫11例,四肢瘫21例。斜视共29例（46.0%）,双瘫组斜视20例（31.6%）,偏瘫组斜视3例（4.8%）,四肢瘫组6例（10.0%）,各组间差异有统计学意义（χ2=71.06,P〈0.05）。内斜视18例（62.1%）,外斜视4例（13.8%）,垂直型斜视-DVD 1例（3.4%）,麻痹型斜视6例（20.7%）,不同解剖学分型脑瘫病儿斜视类型分布差异有显著性（χ2=10.36,P〈0.05）。结论痉挛型脑瘫病儿斜视发生率较高并且临床分型也存在差异,应早期进行眼科检查并给予相应的干预治疗,促进全面康复。     

脑性瘫痪伴发视觉障碍的研究进展

视觉障碍是脑性瘫痪患儿常见的并发症,临床可见视敏度降低、屈光参差、斜视、视野缺陷、立体视觉障碍、眼底结构异常、眼球震颤等。其中约3／4的脑瘫患者视敏度降低,斜视的发生率为39％～50％,眼球震颤为9．5％。脑室周围白质软化、脑室内出血、低出生体重等为脑瘫患者视觉障碍的高危因素。     

小儿脑性瘫痪高危因素与神经功能障碍特征:265例分析

目的:分析了解小儿脑性瘫痪(脑瘫)的高危因素致病率,脑瘫分型及其并发的神经系统功能障碍与神经功能检查的特征。方法:回顾性分析2003年度复旦大学附属儿科医院康复中心门诊的265例脑性瘫痪患儿。结果:其中高危因素中早产、窒息、异常分娩所占比例最高,分别为43.0%,36.6%,30.2%。具有2个以上高危因素的患儿占60.4%,有12.1%的脑性瘫痪患儿没有发现明显的高危因素。临床分型:以痉挛型双瘫和四肢瘫最多,分别占33.2%和37.0%,偏瘫占17.4%。合并症:232例(87.5%)有不同程度的智力低下;12例(4.5%)有听力障碍;20例(7.5%)有癫痫;15例(5.7%)有视觉障碍。脑电图异常率为57.6%(34/59)、头颅CT的异常率为89.1%(164/184),脑干听觉诱发电位的异常率为40%(12/30)。结论:早产、窒息、异常分娩、颅内出血和双胎等在脑性瘫痪患儿中比较多见。脑性瘫痪患儿的智力功能障碍发生率较高,并可有CT、脑电图的异常病理变化。     

不同类型及不同程度弱视儿童的立体视觉损害现状分析

目的分析不同类型及不同程度弱视儿童的立体视觉损害情况。方法回顾性分析2012年1月至2014年1月初诊的不同类型弱视儿童共142例,按照弱视类型将患儿分为屈光不正性弱视78例、屈光参差性弱视39例和斜视性弱视25例三组。每组类型弱视根据不同程度分为轻度、中度和重度。采用颜少明立体视觉检查图测定三种不同类型、不同程度弱视儿童的近零视差、交叉视差和非交叉视差的发生情况。结果屈光不正性弱视组、屈光参差性弱视组与斜视性弱视组比,患儿的近零视差、交叉视差和非交叉视差存在率的差异有统计学意义(P0.05),斜视性弱视组的立体视觉存在率最低,屈光不正性弱视组最高。随着弱视程度的加重,立体视也随之损害加重,非交叉视差在三种类型弱视组及不同程度弱视组的存在率最低。结论儿童弱视可影响其立体视觉发育,影响程度随着屈光不正性弱视、屈光参差性弱视和斜视性弱视的顺序而加重,随着弱视程度的加重,立体视也随之损害加重。     

Berg平衡量表对痉挛型脑瘫儿童平衡功能评定的信度研究

目的:检验Berg平衡量表对痉挛型脑性瘫痪儿童平衡功能评定的信度,为Berg平衡量表在脑瘫儿童的临床应用提供客观依据。方法:选取20例脑瘫儿童,每例在1周内分别同时接受2位治疗师2次Berg平衡量表测试评分;并使用等级间相关系数(ICC)检验Berg平衡量表的组间及组内信度。结果:Berg平衡量表的组间信度ICC=0.941-0.977,组内信度ICC=0.963-0.988,且95%可信区间集中(P0.001)。结论:Berg平衡量表用于评定痉挛型脑性瘫痪儿童的平衡功能时具有较好的信度。     

石家庄地区学龄前儿童屈光状态调查分析

目的了解学龄前儿童屈光状态,探讨学龄前儿童所在地域、父母屈光不正史及年龄与其屈光不正的关系。方法使用美国Suresight手持自动验光仪,对石家庄市区及石家庄市山区部分幼儿园儿童进行屈光筛查、外眼及眼底检查,并按年龄组进行统计。结果学龄前受检儿童1550例,资料完整的共1139例,屈光不正发生率为12．29％（140／1139）。2～5岁各组间屈光不正发生率差异无统计学意义（χ^2=5．931,P=0．115）。屈光不正类型主要为复合远视散光、单纯远视、混合性散光,不同性别、地域及家族史儿童屈光异常发生率差异无统计学意义（χ^2=0．381,P=0．537;χ^2=3．115,P=0．078;χ^2=2．440,P=0．118）。排除屈光状态异常者后,各年龄组双眼球镜、柱镜屈光度差异无统计学意义（F=0．861,P=0．674;F=1．132,P=0．297;F=0．999,P=0．468;F=0．945,P=0．537）。结论学龄前儿童屈光不正与年龄、性别、地域及家族史无关,屈光不正类型以复合远视散光、单纯远视、混合性散光为主,学龄前儿童进行屈光筛查对早期发现屈光不正具有重要意义。     

针灸配合上田法在小儿痉挛型脑性瘫痪治疗中的应用

目的探索针灸配合上田法在小儿痉挛型脑性瘫痪治疗中的作用。方法67例痉挛型脑瘫患儿随机分为两组,观察组41例,运用针灸及上田法治疗;对照组26例,采用上田法进行治疗,效果应用马若飞标准评定。结果经90d治疗,两组总有效率分别为95.12%和73.08%,观察组明显高于对照组(χ2=4.89,P<0.05),且两组治疗后综合评估分值对比差异有显著性(t=2.15,P<0.05)。结论针灸与上田法结合治疗小儿痉挛型脑瘫,能有效提高治疗效果。     

小儿脑性瘫痪高危因素与神经功能障碍特征：265例分析

目的：分析了解小儿脑性瘫痪(脑瘫)的高危因素致病率，脑瘫分型及其并发的神经系统功能障碍与神经功能检查的特征。方法：回顾性分析2003年度复旦大学附属儿科医院康复中心门诊的265例脑性瘫痪患儿。结果：其中高危因素中早产、窒息、异常分娩所占比例最高，分别为43．0％，36．6％，30．2％。具有2个以上高危因素的患儿占60．4％，有12．1％的脑性瘫痪患儿没有发现明显的高危因素。临床分型：以痉挛型双瘫和四肢瘫最多，分别占33．2％和37．0％，偏瘫占17．4％。合并症：232例(87．5％)有不同程度的智力低下；12例(4．5％)有听力障碍；20例(7．5％)有癫痫；15例(5．7％)有视觉障碍。脑电图异常率为57．6％(34／59)、头颅CT的异常率为89．1％(164／184)，脑干听觉诱发电位的异常率为40％(12／30)。结论：早产、窒息、异常分娩、颅内出血和双胎等在脑性瘫痪患儿中比较多见。脑性瘫痪患儿的智力功能障碍发生率较高，并可有CT、脑电图的异常病理变化。     

早产儿和足月儿脑性瘫痪类型及共患病比较

目的探讨早产和足月脑瘫患儿在脑瘫类型及共患病的差异。方法将233例脑瘫患儿分为早产儿组(n=98)和足月儿组(n=125),对两组脑瘫临床类型及共患病情况进行分析。结果高危因素主要顺序在早产儿组依次为低出生体重、黄疸、窒息、颅内出血、脐带绕颈;在足月儿组依次为窒息、黄疸、宫内窘迫、颅内出血、宫内感染。早产儿组痉挛型双瘫发生率显著高于足月儿组(P<0.001),足月儿组痉挛型偏瘫发生率(P<0.01)明显高于早产儿组。除听觉障碍外(P<0.05),早产儿和足月儿在智力障碍、癫痫、视觉障碍的共患病方面无显著性差异(P>0.05)。结论早产儿脑瘫临床类型以痉挛型双瘫为主,足月儿脑瘫以痉挛型偏瘫为主,早产儿脑瘫共患病中听觉障碍发生率高于足月儿。     

脑性瘫痪的围产期高危因素:139例回顾性分析

目的:脑性瘫痪(cerebralpalsy,CP)是儿科常见的致残性疾病,明确脑性瘫痪发生的高危因素、临床表现特点以及并发症等情况对降低脑性瘫痪发生率,改善患儿预后以及提高生活质量有重要意义。分析139例脑性瘫痪患儿的临床资料特点,探讨脑性瘫痪的围生期高危因素并。方法:对139例脑性瘫痪患儿的围生期高危因素进行回顾性调查,并对脑性瘫痪的诊断年龄、头颅计算机体层摄影(CT)或磁共振成像(MRI)、脑电图改变以及并发癫痫的情况进行分析。结果:139例脑性瘫痪患儿以痉挛型(66.2%)最多见,其次为手足徐动型(18.0%)和共济失调型(5.8%)。111例脑性瘫痪患儿存在围生期高危因素,常见的高危因素依次为新生儿窒息、早产和低出生体质量;77.5%的脑性瘫痪患儿具有2种或2种以上的围生期高危因素。64.8%的脑性瘫痪在6月龄前确诊,22.3%的在3月龄前确诊。84.7%的脑性瘫痪患儿头颅CT和/或MRI异常,常见改变包括脑发育不良(30.5%)、脑积水(21.0%)、脑萎缩(15.2%)等。35.7%的脑性瘫痪患儿脑电图异常,合并癫痫的脑性瘫痪患儿脑电图异常率高达84.4%,并且以典型痫样波出现的比例较高(54.2%);未合并者以背景慢活动为主(61.1%),两组差异有显著性意义(χ2=7.11,P<0.05)。结论:脑性瘫痪的发生与围生期高危因素密切相关,多个高危因素提高脑性     

Corona phenomenon as visual aura symptom in migraine

The visual illusion of a typical corona phenomenon was represented as a visual migraine aura symptom in six of 562 Migraine Art pictures, whereas another five pictures illustrated atypical variants of the said illusion. The extra edges of the corona phenomenon are commonly seen around the perceptual images of objects, but in atypical cases they can similarly surround illusory images and both elementary and complex hallucinatory images. The corona phenomenon is strongly associated with visual loss and the presence of elementary geometric hallucinations.     

Illusory splitting as visual aura symptom in migraine

Illusory splitting was illustrated as a visual migraine aura symptom in six of 562 Migraine Art pictures. In this type of illusion, objects or persons appear to be split, along fracture lines of varying form and orientation, into two or more parts that may be displaced and separated from each other. The illusion is strongly associated with the presence of elementary geometric hallucinations. Phenomenological similarities and differences of illusory splitting to the visual perceptual disturbances of fragmentation and mosaic illusion are discussed.     

Charles Bonnet Syndrome: Three Cases in the Emergency Department

Background: Charles Bonnet Syndrome (CBS) is a cause of visual hallucinations in elderly patients that is often unrecognized by emergency physicians and has a relatively benign course. As the population ages, it is likely that the number of cases of CBS will increase (and thus, the numbers of those who present to an Emergency Department [ED] will be increasing). Objectives: The case reports presented in this article will facilitate the recognition of CBS by the emergency physician. Case Report: We describe 3 patients who presented to one ED for visual disturbances and were diagnosed with CBS in a 4-month time period. Conclusion: Recognition of this unusual but stereotypical cause of visual disturbances facilitates an accurate diagnosis, and spares patients the time and expense of blood testing, imaging, and consultations. If emergency physicians begin to recognize this benign entity, we can provide improved (and safer) patient care with appropriate ED interventions.     

Migrainous visual auras: a life history

We document, as an autobiographical case report, a 72-year history of migraine and its changing nature. Minor neurological events have waxed and waned, causing repeated searches for pathology, but instead reconfirming an intact central nervous system. In this case it appears that visual migraine auras do not reflect severity of pathology. Visual auras of migraine are cyclical in frequency and intensity and may have remissions as long as 15 years.     

VEP及ERG联合检查1456例患者的临床分析

目的：分析视觉电生理检查病例，探讨该检查技术在视觉功能评定中的作用。方法：对2004年10月-2006年10月接受VEP及ERG检查的病例资料进行回顾性分析，以临床第一诊断为依据进行统计。结果：共1456例患者接受检查，年龄分布在4岁-87岁之间。疾病分类表明本组病例主要集中于白内障、眼外伤、视力下降原因待查、青光眼、视网膜脱离、视神经疾病及其他视网膜疾病等方面，占总数的91．28％。电生理检查结果主要表现为幅值降低或（和）潜伏期延迟。结论：视觉电生理学检查能够客观反映视觉功能，适用于临床诊断、术前预测、疗效评价、疾病预后、医学鉴定。但也有一定的局限性，须联合检查多项电生理指标并结合临床情况才能够作出正确结论。     

Interictal pattern-induced visual discomfort and ictal photophobia in episodic migraineurs: an association of interictal and ictal photophobia

Background.— Pattern‐induced visual discomfort and photophobia are frequently observed symptoms in migraineurs. The presumed pathophysiologic mechanisms of pattern glare and photophobia seem to overlap anatomically within the central nervous system. Objective.— To assess the relationship between interictal pattern‐induced visual discomfort and ictal photophobia in episodic migraineurs. Methods.— We compared pattern‐induced visual discomfort among 3 groups: controls, migraineurs without ictal photophobia (MwoP), and migraineurs with ictal photophobia (MwP). Photophobia was assessed with a validated photophobia questionnaire. Visual discomfort tests were performed using 3 striped patterns with different spatial frequencies. After viewing the patterns for 10 seconds, subjects were asked to report the severity of visual discomfort using 4 scales (none, mild, moderate, and severe) and using a 0‐10 visual analog scale (VAS). We compared the proportion of subjects choosing moderate‐to‐severe discomfort and the median values of VAS scores for each pattern among the 3 groups. Results.— We enrolled 35 controls, 18 MwoP, and 44 MwP, and there were no significant differences in clinical features among the 3 groups. MwP reported a significantly higher proportion of moderate‐to‐severe discomfort and higher median VAS scores than the controls and MwoP did. The intensity of discomfort increased with higher frequency of visual stimuli. Conclusions.— We conclude that MwP experienced more severe pattern‐induced visual discomfort as compared with the controls and MwoP.     

不同视觉刺激模式对视觉诱发电位的影响

目的：通过视觉诱发电位探索适合的脑机接口视觉刺激模式。方法：采用ActiveOne生理信号测量系统和双计算机构建实验系统。利用VC＋＋语言编程，设计多种视觉刺激模式：模块闪烁方式、模块背景图案变化方式、模块字符变化方式。采用累加平均和小波滤波方法提取视觉诱发电位。结果：可以检测到多种视觉刺激模式引发的视觉诱发电位信号．不同刺激模式引发的诱发电位波形及诱出率存在差别。结论：模块闪烁、刺激模块棋盘格翻转、条纹变化、字符跳动等视觉刺激模式能引发波形幅度较大，易识别的视觉诱发电位信号，适用于脑机接口。在脑机接口应用中应提供多种视觉刺激模式供使用者选择。     

Visual distortion provoked by a stimulus in migraine associated with hyperneuronal activity

BACKGROUND: Migraineurs with visual aura are highly susceptible to illusions and visual distortion and are particularly sensitive to a pattern of regularly spaced parallel lines or stripes. PURPOSE: To determine whether the high degree of susceptibility to illusions and visual distortion in migraineurs with aura is associated with hyperneurological activity of the occipital cortex. METHODS: In order to investigate any relationships among neuronal activity, spatial frequency of square-wave gratings, and self-described visual distortion, we investigated the neuronal and psychophysical responses to square-wave gratings in migraineurs with visual aura and in nonheadache controls. RESULTS: Square-wave gratings provoked various types of visual distortion and illusions and induced a hyperneuronal response in the visual cortex of migraineurs with visual aura, a response that strongly depended upon the stimulus spatial frequency. CONCLUSION: The hyperneuronal activity of the occipital cortex is consistent with general cortical hyperexcitability in migraine.     

Simultaneous recording of pattern reversal electroretinograms and visual evoked potentials in migraine

We recorded full-field pattern seversal electroretinograms (PERGs) and visual evoked potentials (PVEPs) simultaneously in 15 migraine with aura, 14 migraine without aura patients during the interictal period, and in 23 sex- and age-matched normal subjects. All subjects had normal visual fields. The visual aura in all patients was hemianopsia or fortification spectra. Neither migraine group showed significant differences from normal in latency and amplitude of PERGs. In migraine with aura, the amplitudes of PVEPs in classic migraine at the mid-occipital electrode were significantly ( p <0.01) higher than normal. PVEP amplitudes were significantly ( p <0.01) high or on the contralateral side of the aura than the ipsilateral side in both visual aura and normal subjects, but there was no significant difference in latency. This high amplitude and asymmetry of PVEPs may contribute to defective inhibition between interhemispheric visual occipital areas or striate and peristriate areas.     

帕金森病患者视学整体与局部认知工能研究

Visualfigureoftenreferstostructuralstratifyingimagecon－tainingalotoflittlestructurewhichformentirefigure．Inrecentyears，anumberofstudieswerecarriedouttostudyprocessingmechanismofstratifyingfiguresbybrain．Itwasreportedthatrightsuperiortemporalgyruswasinvolvedinvisualglobalcognition，andleftsuperiortemporalgyrusinvolvedinvisuallocalcognition犤１～３犦．ReportsaboutvisualglobalandlocalcognitiondisorderinPDareunavailablenow．Inthisstudy，weinvestigateifPDpatientssuf－feredfromvisualglobalandl…