精神分裂症首次发病患者的脑扩散张量成像研究

目的 利用磁共振扩散张量成像(DTI)技术研究未经药物治疗的精神分裂症首次发病(以下简称首发)患者主要脑区白质纤维束的异常.方法 选取26例首发精神分裂症患者(患者组)和20名健康志愿者(对照组)行脑DTI扫描(两组均为右利手),测量胼胝体膝部、压部、双侧额叶白质、扣带束前部及海马头的部分各向异性(FA)值.结果 (1)对照组左侧扣带束FA值(0.428±0.067)大于右侧(0.375±0.079;P＜0.05).(2)患者组两侧相对应感兴趣区FA值差异均无统计学意义(P＞0.05).(3)患者组左右侧胼胝体压部FA值(均为0.734±0.085)、左右侧扣带束前部FA值(0.300±0.068和0.306 4±0.062)均低于对照组(0.785±0.045,0.428±0.067,0.375±0.079;均P＜0.05).结论 首发精神分裂症患者存在双侧扣带束、胼胝体压部白质纤维束的受损,支持脑内连接异常假说.     

首发偏执型精神分裂症全脑磁共振质子波谱分析

目的探讨未用药首发偏执型精神分裂症患者的多个兴趣区灰质的磁共振氢质子波谱分析（MRS）的特点,以期为精神分裂症“神经发育异常假说”提供依据。方法选取20例首发偏执型精神分裂症患者,应用MRS技术对11个兴趣区的白质或灰质进行脑内神经生化代谢物检测,并与20例年龄、性别和文化程度与患者相匹配的健康对照者比较。结果与对照组比较,患者组双侧额叶皮质的NAA值、Cho值和NAA/Cr、Cho/Cr比率,左侧颞叶Cho值和NAA/Cr,胼胝体膝部和左侧小脑中脚的NAA值和Cho值,右侧丘脑和双侧尾状核Cho值（P〈0.05）。结论首发偏执型精神分裂症患者脑内胼胝体膝部和左侧小脑中脚发生了弥漫性轴突损害,支持精神分裂症神经发育异常的神经病理假说。     

轻度认知功能障碍与脑白质弥散张量成像的相关性研究

目的通过磁共振弥散张量成像研究不同区域脑白质损害与轻度认知功能(MCI)的关系。方法纳入2015年7月至2016年2月我院的住院患者56例为研究对象,其中MCI组34例,认知功能正常组22例。所有研究对象进行一般情况检查,完成神经心理学量表检测。通过头颅磁共振弥散张量成像(DTI)检查对不同脑区白质纤维进行部分各向异性(FA)值测量。结果 MCI组患者与认知功能正常组相比,右侧额叶FA值(0.335±0.068)、左侧颞叶白质FA值(0.391±0.032)及胼胝体膝部FA值(0.658±0.053)降低,差异具有统计学意义(P0.05)。将上述FA值和MMSE、Mo CA量表中各认知域进行典型相关分析,结果显示右侧额叶白质FA值与注意与计算力呈正相关,左侧颞叶白质和胼胝体膝部FA值与记忆力呈正相关(P0.05)。结论 MCI患者注意与计算力的障碍可能与右侧额叶白质损害有关,而左侧颞叶白质及胼胝体膝部白质的损害可能导致早期的记忆障碍。DTI可能成为超早期识别与诊断MCI的新方法。     

精神分裂症患者及其健康同胞的弥散张量成像研究

目的 探索精神分裂症患者及其健康同胞是否存在类似的脑白质完整性异常.方法 采用弥散张量成像技术扫描精神分裂症患者(患者组)、患者的健康同胞(同胞组)和健康对照(对照组)的全脑,用基于体素的分析方法比较3组的白质纤维分数各向异性(fractional anisotropy,FA)值.结果 在左侧前额叶和海马区,患者组(左侧前额叶:0.303±0.006,海马:0.310±0.O05)和同胞组(左侧前额叶:0.320±0.006,海马:0.318±0.006)的白质FA值显著小于对照组(左侧前额叶:0.338±0.007,海马:0.338±0.005),差异均有统计学意义(P＜0.05),患者组与同胞组的差异无统计学意义(P＞0.05);在左侧前扣带区,患者组白质FA值(0.391±0.006)显著小于同胞组(0.423±0.006)和对照组(0.412±0.007),差异有统计学意义(P＜0.05),同胞组的FA值大于对照组,但差异无统计学意义(P＞0.05).结论 精神分裂症患者及其健康同胞存在相似的脑白质完整性异常,左侧前额叶和海马白质FA值降低可能意味着精神分裂症的患病风险,左侧前扣带的白质FA值降低则可能是向该病转换的决定因素.     

首发精神分裂症阳性症状为主型患者脑弥散张量成像研究

目的 探讨首发精神分裂症阳性症状为主型患者主要脑区白质纤维束有无异常.方法 对未系统使用过精神药物治疗的20例首发精神分裂症阳性症状为主型患者和20名正常对照进行磁共振弥散张量成像(DTI)扫描,测量胼胝体膝部、压部、双侧额叶白质、双侧扣带束前部和双侧海马头部分各向异性(FA)值.结果 ①患者组及对照组组内比较,左右侧FA值差异均无统计学意义(P>0.05).②患者组左侧海马头和胼胝体压部FA值[(0.17±0.03),(0.73±0.09)]显著低于对照组[(0.20±0.02),(0.79±0.05)],差异均有统计学意义(P<0.05);③患者组左右侧扣带束前部FA值[(0.28±0.06),(0.29±0.05)]低于对照组[(0.43±0.07),(0.38±0.08)],差异均有统计学意义(P<0.01).结论 首发精神分裂症阳性症状为主型患者双侧扣带束前部、胼胝体压部及左侧海马头的白质纤维束完整性受损,提示其可能存在脑神经发育连接异常.     

癫(癎)患者磁共振弥散张量成像及其与智能损害的关系

目的 采用磁共振弥散张量成像技术研究癫(癎)患者智能损害的相关脑区及病理改变,探讨其可能的发生机制.方法 对44例癫(癎)患者和20名健康人进行韦氏成人量表和磁共振弥散张量成像检查.结果 癫(癎)组患者的全量表智商(FIQ,98.19±17.76)、语言智商(VIQ,100.52±17.63)、操作智商(PIQ,95.10±16.72)均显著低于对照组(VIQ:109.77±13.54、PIQ:108.11±12.17、FIQ:109.81±10.57).癫(癎)智能缺损患者胼胝体膝部平均扩散率(MD值)高于癫(癎)智能正常组,双侧内囊前肢、左侧内囊膝部、左侧外囊、双侧枕叶白质和双侧壳核的各向异性(FA)值低于癫(癎)智能正常组,差异有统计学意义(P＜0.05).相关分析发现,右枕叶FA值与FIQ呈正相关;右侧额叶MD值与VIQ呈负相关;右侧枕叶FA值与VIQ呈正相关;两侧枕叶FA值均与PIQ正相关.结论 本组癫(癎)患者在FIQ、VIQ、PIQ均存在损害.癫(癎)患者伴有智能缺损的胼胝体膝部平均扩散率增加,双侧内囊前肢、左侧内囊膝部、左侧外囊、双侧枕叶白质和双侧壳核各向异性减低;枕叶的各向异性减低与FIQ减低有关,额叶平均扩散率增加与VIQ减低有关,皮质下白质在认知中可能起较重要的作用.     

精神分裂症首次发病患者的磁共振弥散张量显像研究

目的探讨从未用过药的精神分裂症首次发病(以下简称首发)患者的重要白质及部分灰质区的磁共振弥散张量显像(DTI)的特点。方法选取9例首发精神分裂症患者(患者组)及9名年龄、性别、受教育程度与患者组相配对的健康者,应用DTI成像技术检测脑额颞交界处、内囊等白质区和颞中回灰质、中央前回、中央后回等灰质区的各向异性(FA)、表观扩散系数(ADC)及双侧海马体积。结果患者组及对照组组内左右两侧兴趣区FA值及ADC值的差异无统计学意义(P>0.05);患者组与对照组各感兴趣区FA值差异无统计学意义(P>0.05),但患者组颞中回灰质(8.655×10-9)、中央前回(7.816×10-9)、中央后回(7.855×10-9)ADC值高于对照组(分别为7.428×10-9,6.921×10-9,7.013×10-9;P=0.049,0.009,0.005);两组内及组间双侧海马体积比较,差异均无统计学意义(P>0.05)。结论首发精神分裂症患者与健康者DTI参数之间没有明显区别。     

磁共振扩散张量成像对轻型颅脑损伤的临床诊断价值

目的探讨磁共振(MR)扩散张量成像(DTI)在轻型颅脑损伤患者诊断中的价值。方法选择轻型颅脑损伤患者(病例组)和健康志愿者(对照组)各40例,病例组再分为有/无认知功能障碍亚组(分别为22例和18例),分别行MR DTI扫描,对病例组进行里蒙德脑震荡后综合征问卷(RPQ)评分,比较两组额叶白质、颞叶白质、内囊、胼胝体的部分异向性(FA)和表观扩散系数(ADC),并比较病例组有和无认知功能障碍患者的上述各项指标。结果病例组和对照组MRI常规扫描和DTI扫描均未见异常信号;病例组和对照组两侧额叶白质、颞叶白质、内囊、胼胝体膝部、压部的ADC值差异均无统计学意义(P0.05);病例组两侧额叶白质、颞叶白质、内囊及胼胝体压部的FA值均低于对照组(P0.05),RPQ评分高于对照组;病例组有认知功能障碍亚组两侧额叶、颞叶FA值低于无认知功能障碍亚组(P0.05)。结论轻型颅脑损伤患者存在脑组织损伤,FA值是判断脑组织损伤的敏感指标,DTI检查为轻型颅脑损伤的临床诊断提供了有力的依据。     

腔隙性脑梗死形似正常区的白质损害与超敏C反应蛋白的关系

目的 应用磁共振弥散张量成像(DTI)研究腔隙性脑梗死(LI)患者脑"形似正常区"白质损害(WML)的特点及其与血清超敏C反应蛋白(hs-CRP)的相关性.方法 选取南方医科大学南方医院神经内科自2008年3月至10月收治人院的32例LI患者和10名年龄及文化程度相当的健康志愿者分别做为研究组和对照组;行脑部T1WI、T2WI、DWI、水抑制反转恢复序列(FLAIR)和DTI扫描,选择双侧额叶白质、前部扣带回、前部扣带、半卵圆中心、视放射、前角周围白质、后角周围白质、尾状核头部、丘脑、海马旁回、外囊以及胼胝体膝部、胼胝体干、肼胝体压部等25个T1WI、T2WI"形似正常区"作为兴趣区(ROI),分别测量部分各向异性值(FA)、平均弥散系数(ADC)值;应用免疫透射比浊法检测血清hs-CRP水平.结果 与对照组比较,研究组左、右侧额叶白质,肼胝体膝部,左、右侧前部扣带,左、右侧半卵圆中心.左、右侧视放射,左侧前角、后角周围白质.左、右侧海马旁回.右侧外囊的FA值降低;胼胝体干、胼胝体压部、左侧半卵圆中心、左侧后角周围白质、左侧海马旁回的ADC值升高,差异均有统计学意义(P＜0,05).其中左、右侧额叶白质,胼胝体膝部的FA值与hs-CRP水平呈负相关关系(r=-0.642,P=0,021;r=0.388,P=0.016;r=-0.402,P=0.028).结论 LJ患者常规MRI上显示"形似正常区"的白质早期已存在广泛损害;部分受损白质区域FA值与hs-CRP水平呈负相关关系,提示动脉硬化可能在LI患者WML发病机制中超重要作用;DTI可作为早期发现WML、评估预后及治疗效果的一种重要工具.     

首发偏执型精神分裂症患者胼胝体微结构异常研究

目的 探讨未用药首发偏执型精神分裂症患者胼胝体纤维束的细微结构改变及其可能的神经生化代谢原因,以期为精神分裂症"神经发育假说"提供依据.方法 选取20例首发偏执型精神分裂症患者,应用DTI和MRS技术对脑内胼胝体膝部、压部和体部进行成像检测,并与20名年龄、性别和文化程度与患者相匹配的健康对照者比较.结果 (1)患者组胼胝体膝部FA值小于健康对照组(0.731±0.102:0.815±0.043.t=3.358,P=0.002),胼胝体膝部和体部的ADC值高于健康对照组(8.043±0.462:7.564±0.470,t=2.645,P=0.012;8.543±0.462:7.743±0.470,t=3.898,P=0.000).(2)患者组胼胝体膝部NAA值和体部NNA值、Cho值均低于健康对照组(1.449±0.406:1.748±0.392,t=2.365.P=0.023;0.911±0.130:1.164±0.153,t=5.618.P=0.000;1.006±0.869:1.275±0.367,t=3.190,P=0.003).结论 首发偏执型精神分裂症患者胼胝体膝部纤维束在疾病早期阶段即存在各向异性降低,其可能原因是神经发育不良.     

Spatial patterns of visual cortical fast EEG during conditioned reflex in a rhesus monkey

A preliminary assay was made of the existence of time-space coherence patterns of fast EEG activity in the visual cortex of a Rhesus monkey. The primary intent of the present study was to evaluate the similarities and differences in relation to the olfactory bulb, where such coherences ave been described and have been demonstrated to be associated with behavior. Segments 1.5 s in duration were recorded simultaneously without averaging from 16 of 35 subdural electrodes fixed over the left occipital lobe in an array3.6cm× 2.8cm. Each segment was taken during the delivery of a visual conditioned stimulus (CS) and the performance of a conditioned response (CR) by a well-trained Rhesus monkey. The EEGs appeared chaotic with irregular bursts lasting 75–200 ms, resembling those in the olfactory EEG but with lower peak frequencies. Fourier spectra showed broad distributions of power resembling ‘ 1/fnoise’ with multiple peaks in the range of 20–40 Hz. Time intervals were selected where coherent activity seemed to be present at a number of electrodes. A dominant component waveform that was common to all channels was extracted by principal components analysis (PCA) of each segment. The distribution of the power of this component across the electrodes (the factor loadings) was used to describe the spatial pattern of the coherent cortical activity. Statistical analyses suggested that different patterns could be associated to the CS and the CR, as has been found in the olfactory system. These patterns remained stable over a 6 week recording interval. The patterns can be better discriminated, when the factor loadings of each channel are normalized to zero mean and unit variance, to discard a basic pattern of power distribution, which may reflect anatomical and electrode positioning factors that are related to behavioral information processing by the cortex. The wide spatial distribution of the common patterns found suggests that EEG patterns that manifest differing states of the visual cortex may also be accessible with scalp electrodes.     

Concentration of antiepileptic drugs in persons with epilepsy: a comparative study in serum and saliva

Aim of the study: The monitoring of antiepileptic drugs (AEDs) in clinical setting is important for measuring the efficacy of drugs and their safety and in personalizing drug therapy. We investigated the levels of AED, carbamazepine (CBZ), phenytoin (PHT) and phenobarbital (PHB), to understand their association in saliva compared with those in serum during the therapy. Materials and methods: In this study, we performed a prospective study of 116 persons with epilepsy (PWE; mean age 26.90 ± 11.83 years). Serum and saliva samples were collected at trough levels from the patients, who were under the treatment of CBZ, PHT and PHB either alone or in combination of these drugs for at least three months. The drug levels were assessed by high-performance liquid chromatography. Results and conclusions: The number of males (n = 88; 75.86%) was higher than females (n = 28; 24.14%) among the recruited patients. The intake of CBZ, PHT and PHB was observed in 49.14%, 68.10% and 38.79% of PWE, respectively. The levels of these AEDs showed a significant correlation (p < 0.05) between serum and saliva. Interestingly, the levels of mono-therapy or bi-therapy showed a significant association (p < 0.05) between serum and saliva, however, there was no significant association in case of poly-therapy. This is the first report in the Indian population on simultaneous estimation of the three commonly used AEDs, such as CBZ, PHT and PHB in serum and saliva implicating their associations, either in mono-therapy or bi-therapy in PWE.     

Toward noninvasive monitoring of ongoing electrical activity of human uterus and fetal heart and brain

Objective

To evaluate whether a full-coverage fetal-maternal scanner can noninvasively monitor ongoing electrophysiological activity of maternal and fetal organs.

Health consequences of acute and chronic marihuana use

Chemical content, assay procedures, and pharmacokinetics of cannabis sativa are discussed briefly. Cannabinoid cellular effects relating to chromosomes and immunity including cellular metabolism and allergic reactions are presented. Gross and microscopic brain pathology due to cannabis use is reviewed involving EEG alterations, psychopathology including aggressive behaviour as well as properties of psychomotor impairment, tolerance and dependence. Cardiopulmonary effects of marihuana are recorded under pulmonary pharmacological effects including the macrophage defense system and effects of smoke constituents; under cardiovascular effects cardiac toxicity and possible mechanism of action are discussed. Alterations of reproductive hormonal production and maturation of reproductive cells by marihuana in males and females with attendant impairment of reproductive function or fertility including reproductive outcome are reported. Field studies with healthy chronic cannabis users in Jamaica, Greece and Costa Rica are related as to observed medical alterations. Potential clinical effects are summarized in point form.     

Do scalp-recorded slow potentials during neuro-feedback training reflect the cortical activity?

Objective

Neuro-feedback (NFB) training by the self-regulation of slow potentials (SPs) <0.5?Hz recorded from the vertex scalp has been applied for seizure suppression in patients with epilepsy. However, SP is highly susceptible to artifact contamination, such as the galvanic skin response (GSR). This study aimed to evaluate the correlation between SPs recorded from the scalp and intracranial electroencephalography (EEG) by event-related coherence analysis.

Update of the original HDLS kindred: divergent clinical courses

Sundal C, Ekholm S, Nordborg C, Jönsson L, Börjesson‐Hanson A, Lindén T, Zetterberg H, Viitanen M, Andersen O. Update of the original HDLS kindred: divergent clinical courses.
Acta Neurol Scand: 2012: 126: 67–75.
© 2011 John Wiley & Sons A/S. Background – Hereditary diffuse leukoencephalopathy with spheroids (HDLS) was first identified among a Swedish kindred with 17 cases. The average age of onset was 36 years. Autopsy in four cases revealed the presence of axonal spheroids. The causative gene is unknown. Methods – We performed genealogical and longitudinal observations of the original kindred. Forty members were examined, five telephone‐interviewed, and one of the original HDLS cases from 1984 was neuropathologically examined. The clinical course was documented. The cerebrospinal fluid (CSF) findings of two recently affected cases were examined, and one of those autopsied. Results – Of those examined, two developed HDLS during our survey and 38 were healthy. Those interviewed by telephone were healthy. One had symptoms suggestive of HDLS in 1984, but autopsy during our survey showed no spheroids. This patient, two relatives healthy at our examination and one without symptoms at telephone interview had HDLS diagnoses in the 1984 report. Thus, four HDLS diagnoses were unconfirmed. The number of identified patients amounts to 15 among 75 individuals in four generations, including two recent cases who demonstrated a subacute multisystem encephalopathy in Case 1 and an insidious course in Case 2. CSF showed signs of neurodegeneration without inflammation, and autopsy verified HDLS in Case 1. Conclusions – Some HDLS cases were misdiagnosed with unspecified psychiatric diagnoses in affected relatives from the original 1984 publication. However, HDLS is an encephalopathy dominated by a frontal lobe syndrome with an inexorably progressive and fatal course, where the different symptomatology in two recent cases confirmed the existence of acute and chronic variants.     

脑红蛋白在脑梗死大鼠表达及丁苯酞干预效应

目的探讨脑红蛋白在脑梗死大鼠中的表达和丁苯酞干预在氧化应激损伤中作用。方法将90只雄性SD大鼠随机分为假手术组、模型组、治疗组。每组再分为3个亚组:1 d组、3 d组和7 d组,每亚组10只。模型组和治疗组采用线栓法制作大鼠大脑中动脉闭塞模型(MCAO),假手术组只分离不结扎。治疗组在动物苏醒后以丁苯酞植物油灌胃,假手术组和模型组同法给予等量植物油灌胃。每只大鼠在术后3h和处死前行神经功能评分,应用RT-PCR和免疫组化检测脑组织脑红蛋白(NGB)表达,化学比色法检测超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量。结果 (1)神经功能评分,模型组和治疗组术后3 h评分差异无统计学意义(P>0.05),各时间点处死前评分差异均有统计学意义(P<0.05)。(2)NGB mRNA和免疫组化表达随时间延长逐渐降低,各时间点模型组较假手术组、治疗组较模型组高,差异均有统计学意义(P<0.05)。(3)SOD活性和MDA含量随时间延长逐渐减少。SOD活性假手术组较治疗组、治疗组较模型组高,差异均有统计学意义(P<0.05);MDA含量假手术组较治疗组、治疗组较模型组低,差异均有统计学意义(P<0.05)。结论丁苯酞促进脑缺血大鼠脑红蛋白表达,减少氧化应激损伤。     

Factors affecting the survival following surgical treatment of chronic subdural haematoma: Single institutional experience

BackgroundChronic subdural haematoma (CSDH) is one of the most commonly treated condition in neurosurgery. It affects elderly populations who often have significant medical co-morbidities resulting in poor prognosis. The study aimed at identifying clinical factors influencing the survival following surgical management of CSDH.MethodsRetrospective study included 267 cases that underwent surgery for CSDH and followed over 5-year period (2010–2015); data retrieved with reference to operation details, radiology reports and discharge. Using logistic and Cox regression analysis, the patient survival data was analysed with respect to patient demographics, type of surgery, co-morbidities, anticoagulation treatment, and discharge destination.ResultsThe overall survival in the cohort was 37.0 months (IQR: 20.0–60.0). The median age of the patients was 76 years (IQR: 66–82) and the median length of hospital stay was 10 days (range 1–126 days; IQR: 6–17 days). The recurrence rate was 6.37% (n = 17). Fifty-three (19.85%) patients recorded deceased on the IPM database as of October 2016 and of those 11 died in hospital. Univariate Cox-regression analysis revealed increased age (HR: 1.80; 95%CI: 1.04–3.11), length of hospital stay (HR: 2.50; 95%CI: 1.41–4.41) and number of co-morbidities (HR: 2.19; 95%CI: 1.26–3.79) were associated with poor prognosis. Glasgow coma scale (GCS) at discharge was found to be significantly associated with survival whilst anticoagulation treatment did not. Multivariate analysis confirmed similar findings significant statistically.ConclusionAge at admission, median length of hospital stay, number of co-morbidities, GCS at discharge and discharge destination have been found to influence survival significant statistically.