皮质下缺血性血管性痴呆患者脑梗死灶MRI诊断分析

目的进一步研究缺血性皮质下血管痴呆患者脑梗死灶MRI诊断分析,为临床治疗提供指导性意见。方法收集了2011年1月—2012年1月我院收治的皮质下缺血性血管性痴呆患者32例脑梗死灶MRI临床资料进行详细研究,设为研究组。选择同时期我院收治的无痴呆脑梗死患者32例脑梗死灶MRI临床资料进行对比研究,设为对照组。对两组梗死灶分部情况、各部位病灶梗死数、梗死体积情况进行分析。结果研究组患者基底节区梗死部位主要为豆状核20例、尾状核8例以及内囊前肢8例,皮质下白质主要为额叶20例、颞叶13例,半卵圆中线心主要为丘脑9例、后部11例,侧脑室体旁白质主要为前部13例,与对照组豆状核10例、尾状核3例以及内囊前肢2例,额叶10例、颞叶5例,丘脑3例、后部2例,侧脑室体旁白质前部6例相比,P〈0.05,差异具有统计学意义。研究组患者基底节区梗死数目在内囊前肢（0.7±0.24）、尾状核（0.4±0.23）、豆状核区域（2.3±1.7）,半卵中心的丘脑（1.5±1.15）以及后部地区（0.9±0.16）,侧脑室体旁白质的前部地区（1.4±1.07）,与对照组内囊前肢（0.1±0.03）、尾状核（0.1±0.05）、豆状核区域（0.9±0.06）,半卵中心的丘脑（0.5±0.05）以及后部地区（0.1±0.08）,侧脑室体旁白质的前部地区（0.4±0.34）相比,P〈0.05,差异具有统计学意义。研究组患者梗死体积（cm3）在皮质下白质的颞叶部位（298.6±94.5）,侧脑室体旁白质的前部（253.2±53.2）以及半卵圆中心的前部（251.3±13.5）、丘脑地区（323.2±45.3）与对照组颞叶部位（68.3±20.3）,侧脑室体旁白质的前部（105.2±23.5）、半卵圆中心的前部（88.2±25.4）、丘脑地区（181.3±52.3）相比,梗死较大,P〈0.05,差异具有统计学意义。结论缺血性皮质下血管痴呆患者的MRI检测发现,患者梗死灶分部、各部位病灶梗死数及梗死体积均有一定的规律性?     

老年缺血性脑血管病84例腔隙性脑梗死的临床分析

目的分析老年缺血性脑血管病患者腔隙性脑梗死的临床特点、发病因素及临床治疗。方法收集2011年1月—2014年12月间我院收治的84例老年缺血性脑血管病腔隙性脑梗死患者临床资料,对患者梗死部位及发病因素进行回顾性分析。结果本组84例患者中合并糖尿病29例(34.52%),高血压45例(53.57%),颅内外动脉粥样硬化19例(22.62%),长期吸烟者48例(57.14%),饮酒者22例(26.19%),血脂异常者21例(25.0%);梗死部位主要以基底节伴后循环腔隙性脑梗死(27.38%)和深部白质及基底节区腔隙性脑梗死(35.71%)为主;84例患者给予治疗后,75例(89.29%)患者症状得以改善。结论老年腔隙性脑梗死干预重点为大动脉粥样,临床中应积极控制高血压、糖尿病,以预防再次脑梗。     

腔隙性脑梗死的TCD改变与CT诊断对比分析

目的：应用经颅多普勒超声（TCD）探讨以小动脉病变为主要发病机制的腔隙性脑梗死患者的血流动力学改变,与CT比较并进行相关分析。方法：利用TCD技术检测120例经CT或MRI确诊的腔隙性脑梗死患者,经颞窗探测双侧大脑中动脉、前动脉及后动脉;经枕窗探测双侧椎动脉、基底动脉;记录血流速度,观察频谱形态及监听音频变化、脉动指数及阻力指数等。结果：120例确诊为腔隙性脑梗死患者,TCD检测结果血流动力学异常109例（90.8%）,脑动脉硬化112例（93.3%）,血流速度正常11例（9.2%）,差异有统计学意义（P〈0.01）。 CT/MRI显示96例（80%）梗死部位发生在基底节区和基底节合并放射冠、侧脑室旁等多发梗死灶。结论：患者同时行TCD和CT检测,对腔隙性脑梗死的临床诊断、病因和危险因素及治疗方案提供参考依据。     

以脑内囊灶表现的血管周围间隙增宽、腔隙性脑梗死、脉络膜裂囊肿的影像诊断浅析

目的总结以脑内囊灶表现的血管周围间隙增宽、腔隙性脑梗死、脉络膜裂囊肿的CT、MRI表现及其鉴别要点,提高对此三种疾病的认识及鉴别诊断水平。方法回顾性分析我院2008年7月至2012年6月间的10例血管周围间隙增宽、30例腔隙性脑梗死、10例脉络膜裂囊肿患者的影像学资料,综合分析所有病例CT、MRI的影像学特点。结果依据三种脑内囊灶的发病部位及CT、MRI的表现可以作出正确的鉴别诊断,其中尤以MRI的表现较具有特征性。结论CT、MRI对以脑内囊灶表现的血管周围间隙增宽、腔隙性脑梗死、脉络膜裂囊肿的诊断与鉴别诊断尤其是MRI有较高的价值。     

脑梗死与梗死性痴呆

目的探讨脑梗死与梗死性痴呆的关系。方法对内蒙古医学院附属人民医院收治住院392例脑梗死患者和其中60例多梗死性痴呆患者进行回顾性分析。结果男性患者发病率明显高于女性,61-70岁年龄段为高发年龄,多在静态下发病（66.8%）,高血压是主要的危险因素（66.3%）。CT特征分析：梗死部位多在双侧基底节区,多梗死性痴呆以多发腔隙性梗死发病率最高（83.3%）。痴呆患者大多伴有不同程度脑萎缩（93.3%）。痴呆的原因与梗死的部位、大小、多少、萎缩的程度呈不同程度正相关。结论反复卒中容易导致梗死性痴呆,预防控制高血压、及时治疗脑梗死对于降低梗死性痴呆的发病率至关重要。     

脑梗死合并脑出血患者的护理

脑梗死是指因脑部血液循环障碍,缺血缺氧所致的局限性脑组织的缺血性坏死或软化。梗死后出血根据血供情况可分为2类,即相同血供区和非相同血供区出血。1临床资料 2008年2月至今,我科共收入脑梗死后继发出血患者6例,其中男4例,女2例,基底节区脑梗死5例,腔隙性脑梗死1例,基底节区出血4例,脑室出血1例,颞叶出血1例。     

中等直径基底节区单灶脑梗死早期运动障碍加重的危险因素及与大脑中动脉病变关系分析

目的 探讨中等直径基底节区急性单灶脑梗死患者早期运动障碍加重的危险因素及与大脑中动脉主干病变的关系.方法 选择发病24 h内的局限于基底节区的急性单灶脑梗死患者150例,根据弥散加权成像(DWI)上梗死灶最大直径分为中等大小梗死组(梗死灶直径1.5～3.0 cm)和腔隙梗死组(梗死灶直径＜1.5cm),每组75例.通过发病7d内动态的美国国立卫生研究院卒中量表评分、多元Logistic回归分析,研究早期运动障碍加重的危险因素.结果 中等大小梗死组早期运动障碍加重的发生率为32.0％(24/75),高于腔隙梗死组的8.0％ (6/75),差异有统计学意义(P＜0.05);多元Logistic回归分析显示入院时升高的收缩压是早期运动障碍加重发生的独立危险因素(P=0.016).中等大小梗死组中同侧大脑中动脉主干病变的发生率为41.3％(31/75),高于腔隙梗死组的9.3％(7/75),差异有统计学意义(P＜0.01).结论 直径1.5～3.0cm的基底节区急性单灶脑梗死患者较直径＜1.5cm相同部位腔隙性脑梗死患者更易发生早期运动障碍加重,且可能与入院时升高的收缩压有关.这种中等直径的梗死灶可能与同侧大脑中动脉主干病变有关.     

脑梗死后癫痫发作20例临床观察

目的：探讨脑梗死后继发癫痫的临床特点。方法：分析经头CT证实的脑梗死患者436例继发癫痫发作20例的临床资料。结果：脑叶病变15例：基底节区4例;腔隙性脑梗死1例;梗死2周内继发癫痫发作16例;2周后继发癫痫4例．需长期服药。     

腔隙性脑梗死

腔隙性脑梗死（ＬＩ）也称脑腔隙梗死、穿通支系梗死、皮质下梗死、腔隙梗死等，约占缺血性卒中的１／４。ＬＩ是指脑深部小的梗死，由脑深穿支动脉闭塞后脑组织缺血坏死、液化引起的小的圆形软化灶，最常见的部位是豆状核、丘脑、放射冠和桥脑等。过去ＬＩ只能在尸检中发...     

精神障碍为主要症状的脑梗死临床研究

目的：了解以精神障碍为主要症状的脑梗死临床特点。方法：将符合CCMD－2－R有关缺血性脑血管病所致精神障碍诊断标准的病例进行临床分析。结果：梗死部位依次为内囊、顶叶等。精神障碍分为精神病性症状、神经症样症状、抑郁状态、意识障碍、血管性痴呆，各型多发部位分别为颞叶、左内囊、左基底节、左额叶。左基底节、颞叶等部位的腔隙性或多发性梗死易发脑萎缩。此型梗死危险因素与躯体症状的脑梗死相似。治疗有效率97．92％。结论：本型脑梗死较多见，可见五型精神障碍表现，误诊率高，应引起注意。     

大脑中动脉供血区不同梗死部位对预后的影响

目的：探讨大脑中动脉供血区不同部位梗死对预后的影响。方法：收集大脑中动脉供血区急性梗死病例,根据梗死部位的不同分为脉络膜前动脉组、分水岭组、中央支组和主干组。梗死后4~16个月电话随访进行改良Rankin量表（MRS）和日常生活能力评分（ADL）,比较各组间MRS和ADL评分及高血压、糖尿病和胆固醇等脑血管疾病危险因素的差异。根据MRS评分,将病例分成预后好组与预后差组,逐步判别分析筛查影响预后的因素。结果：入组88例,其中大脑中动脉中央支组22例,大脑中动脉主干组15例,脉络膜前动脉组40例,分水岭组11例。四组之间的MRS和ADL评分比较,分水岭组ADL评分最高,MRS评分最低,脉络膜前动脉组ADL评分最低,MRS评分最高（P〈0.05）。48例预后好,40例预后差。年龄和梗死部位两项指标进入判别方程。结论：不同梗死部位对大脑中动脉供血区梗死预后有影响,分水岭区梗死预后较好,脉络膜前动脉供血区梗死的预后最差。     

Neuroanatomic and functional correlates of depressed mood: the Cardiovascular Health Study.

Although a number of studies suggest an association between stroke and depression, few have examined the relation between magnetic resonance imaging (MRI)-identified lesions and depression among community-dwelling older adults. This cross-sectional study sought to assess the association between MRI infarcts in the basal ganglia and non-basal-ganglia areas, potential functional consequences of these lesions, and depressive symptomatology in 3,371 US men and women aged 65 years or older who participated in the Cardiovascular Health Study between 1992 and 1994. By using multiple linear regression models, the authors found that after adjustment for age, gender, and stroke history, Center for Epidemiologic Studies Depression Scale scores were independently associated with non-basal-ganglia lesions (p = 0.04) but were not independently associated with basal ganglia lesions (p = 0.11). When measures of physical disability and cognitive impairment were added to the models, these measures displaced MRI-identified infarcts in their association with depressive symptoms. In additional models, hemispheric location and size of the basal ganglia lesion were found to have no relation to depression levels. These results suggest that the functional consequences of cerebrovascular disease may be the causal pathway by which basal ganglia and non-basal-ganglia lesions are associated with depressive symptomatology.     

结核性脑膜炎51例临床分析

目的：分析结核性脑膜炎的临床表现、诊断和治疗特点,以提高对该病的诊治水平。方法：对2007年2月-2012年2月笔者所在防治所收治的51例结核性脑膜炎住院患者的临床资料、实验室检查结果、诊断及预后情况进行总结分析。结果：本组51例结核性脑膜炎患者临床表现以发热、头痛、呕吐为主要症状,脑脊液改变以压力、白细胞、蛋白升高,葡萄糖、氯化物降低为主。96.08%合并颅外结核。头颅CT或MRI检查异常51例。经正规抗结核治疗,恢复良好33例,恢复不理想18例,死亡2例。结论：患者的临床表现、脑脊液、头颅CT或MRI检查、是否合并颅外结核感染及正规抗结核治疗是否有效,是诊断结核性脑膜炎的重要依据;早期诊断及合理治疗可提高结核性脑膜炎的治愈率。     

Cerebral microbleeds: a review

Cerebral microbleeds (CMBs) are frequent findings in MRI scans of elderly subjects. Depending on the MRI protocols applied 4.7% to 24.4% of community-based subjects show incidental CMBs. The rates reported for various types of ischemic strokes and intracerebral hemorrhages vary between 19.4% and 68.5%. Most studies also demonstrated CMBs in approximately one third of Alzheimer cases. A lobar distribution of CMBs is considered to relate to cerebral amyloid angiopathy, while CMBs located in the basal ganglia or in infratentorial brain regions are thought to relate to hypertensive vasculopathy. Besides age, hypertension, diabetes mellitus, and low serum cholesterol have so far been identified as risk factors for CMBs. Presence of an APOE ε4 allele is the only genetic factor that was consistently shown to increase the risk for CMB development. There are only few longitudinal studies on the predictive value of CMBs. For incident ischemic strokes and intracerebral hemorrhages hazard ratios of 4.48 and 50.2 have been reported. CMBs also doubled the risk for conversion to dementia in MCI patients, and there are indications for CMBs being possible predictors of increased mortality. Given the small number of longitudinal investigations with often small sample sizes the role of CMBs as predictors of disease needs to be further elucidated. CMBs were significantly more common in warfarin-treated stroke patients who developed intracerebral hemorrhages (ICH). These data are cross-sectional. They do not provide enough evidence to consider CMBs as a contraindication for antithrombotic agents in primary and secondary stroke prevention. CMBs are likely to unfavourably affect cognitive functioning. It remains to be determined if direct lesion-related effects are responsible for this finding or if CMBs are sole markers of more extensive tissue damage in the wake of cerebral small vessel disease leading to widespread visible but also non-visible tissue destruction with a high likelihood for cognitive consequences.     

亚临床肝性脑病的磁共振灌注成像表现与临床研究

目的 应用磁共振灌注成像技术探索亚临床肝性脑病(SHE)患者的脑灌注模式,探讨肝性脑病的发病机制.方法 对24例SHE患者和24例健康志愿者进行磁共振(MR)平扫和灌注成像.分别测量双侧尾状核头、苍白球、壳核、丘脑和额叶白质的脑血容量(CBV)、脑血流量(CBF)和平均通过时间(MTT),以同侧额叶白质作为参照,计算上述感兴趣区对比额叶的比率,并与对照组相比较.结果 所有SHE患者T1WI像都出现了基底节区对称的高信号.与正常对照组相比,各感兴趣区的CBF都明显升高,左侧苍白球(1.61±0.65)的升高差异具有统计学意义(P<0.05);SHE组各感兴趣区的NIT明显降低,右侧尾状核头(0.81±0.16)、双侧丘脑区(右侧0.78±0.14,左侧0.78±0.17)的降低差异具有统计学意义(P<0.05).各感兴趣区的CBV值差异无统计学意义(P>0.05).结论 SHE患者T1WI像可见基底节对称性高信号,基底节区CBF明显增加,NIT明显缩短,表示基底节区血流灌注增加.     

Cerebrovascular dementia; correlation of computed and histopathologic findings

Computed tomography is often insensitive to such lesions as atrophic demyelination, enlarged perivascular spaces and infarction in the periventricular white matter. In attempt to better understand the discrepancy between the pathologic and X-CT findings, the author correlated areas that had focal, patchy on X-CT and brains with gross and microscopic findings. Patients with cerebral strokes had larger volume infarcts characterized centrally by necrosis, axonal loss, and demyelination. The progressive subcortical vascular encephalopathy (Binswanger's disease) is characterized by ischemic demyelinization of white matter provoked by hypertensive vascular changes in small vessels and is usually accompanied by multiple lacunar infarcts in a periventricular area and the basal ganglia. Small, deep hemispheric infarcts may be of no clinical significance unless a sufficient aggregate of these occurs. It should be pointed out that many small infarcts are clinically silent, and chronic multifocal ischemia may be responsible for observed senescent changes in cerebral tissue. The extension of the infarcted area might be most important in the development of cerebrovascular dementia. Mixed forms of degenerative dementia and any type of cerebral vascular disease are common and account for 10-20% of all dementias.     

神经内镜下三脑室底造瘘术联合脑室腹腔分流术治疗结核性脑膜炎并发脑积水的疗效分析

目的：探讨神经内镜下三脑室底造瘘术联合脑室腹腔分流术对结核性脑膜炎并发脑积水的治疗效果。方法：回顾性分析12例结核性脑积水患者经神经内镜下三脑室底造瘘术联合脑室腹腔分流术的治疗效果。结果：所有患者均随访6个月,12例患者中11例术后脑积水症状均明显改善,1例患者术后2个月死亡。结论：三脑室底造瘘术联合脑室腹腔分流术是治疗结核性脑膜炎并发脑积水的有效方法。     

急性脑卒中并发抑郁症临床分析

目的调查研究急性脑卒中并发抑郁症的临床特征。方法对我院收治的100例急性脑卒中患者资料进行回顾性分析,并将其分为55例的合并抑郁症组(观察组)与45例的非抑郁症组(对照组),研究分析观察组患者抑郁程度与脑卒中病变位置关系,通过药物治疗后对比分析两组之间神经缺损综合性功能。结果左额叶及基底节区的抑郁指数显著高于右额叶及基底节区(P<0.05),治疗后观察组患者神经缺损综合功能评分为(13±4.5),与对照组的(26.3±2.3)相比具有较大差异性(P<0.05)。结论脑卒中患者极易在急性期产生抑郁症,左额叶及基底节区的抑郁程度显著高于右额叶及基底节区,通过药物治疗后患者的神经缺损功能将得到显著性改善。     

急慢性出血性脑卒中患者受损皮质脊髓束磁共振弥散张量成像特点分析

目的:探究急慢性出血性脑卒中患者受损皮质脊髓束磁共振成像(MRI)的弥散张量成像(DTI)特点分析.方法:选取60例出血性脑卒中患者,依据诊断结果将其分为急性出血性脑卒中组(急性组,21例)和慢性出血性脑卒中组(慢性组,39例).对两组患者进行DTI扫描,测量病变侧皮质脊髓束、病变对侧分数各向异性(FA)值及平均弥散率...     

Risk factors in various groups of stroke patients (Analysis of 500 cases of the Budapest Stroke Database)]

Risk factor profile of 500 consecutive acute++ stroke cases in the protocol of the Budapest Stroke Data Bank has been analysed. High frequency of risk factors and additive occurrence have been documented when compared with other stroke registries; hypertension 75%, hypercholesterolemia 68%, ischemic heart disease 61%, hypertriglycerolemia 39%, smoking 38%, serious hypercholesterolemia 36%, diabetes mellitus 30%, peripheral artery disease 10%, elevated hematocrit 7% and elevated number of platelets 7%. More than one risk factors have been registered in 85% of the patients. Three risk factors at the same patient have been found in 28%. The highest number of risk factors is seven at the same patient. The stroke subtypes have been characterized with "cluster-like" association of risk factors. In the hemorrhagic group (9.4% of all cases) hypertension and alcoholism are the main factors; in the atherosclerotic group (49.4%) more male, smoking peripheral artery disease and hypercholesterolemia have been registered; in the lacunar stroke group (27%) high frequency of hypertension, smoking, diabetes mellitus, hypercholesterolemia and hypertriglycerolemia have been found and in the cardiogenic embolia group (10.6%) more female, higher age, ischemic heart disease and atrial fibrillation are the recurrent risk factors. There is no difference between the risk factor profile++ registered in the left versus right hemispheral strokes, in the anterior versus posterior strokes and in the first ever or recurrent strokes.