伴Kluver-Bucy综合征的单纯疱疹病毒性脑炎2例临床特征

目的探讨单纯疱疹病毒性脑炎的临床表现及K luver-Bucy综合征的特点。方法对2例(女1例,男1例)临床诊断的单纯疱疹病毒性脑炎患者资料进行回顾性分析。结果(1)2例患者均有发热、精神行为异常、多食、饮食习惯改变。例1还伴有口部探索(咬人)和吃一些非食物的东西。例2伴有视觉失认、温顺、性活动增强、癫痫。(2)头颅M R I均有双侧颞叶损害。(3)脑脊液细胞数轻度增高(单核细胞为主),蛋白质增高。(4)脑电图:弥漫性异常,额颞著。(5)早期经无环鸟苷治疗,病情逐渐好转。结论伴KBS的单纯疱疹性脑炎的临床特点有:高热,行为异常,视觉失认,平静温顺,贪食,饮食习惯改变,性活动增强和口部探索。诊断以临床表现,实验室和影像学检查为依据。KBS和双侧颞叶损害有关。早期无环鸟苷治疗可改善预后,镇静药或卡马西平治疗可改善KBS症状。     

迁延难愈性病毒性脑炎的治疗（附10例报告）

目的 探讨迁延难愈性病毒性脑炎的治疗策略及预后评价.方法 对10例迁延难愈性病毒性脑炎患者进行回顾性分析,其中男1例、女9例,年龄15～38岁,平均24岁.10例患者均曾接受1个月以上的常规抗病毒药物(更昔洛韦或阿昔洛韦)及糖皮质激素治疗(甲泼尼松龙或地塞米松).入组时中枢神经系统感染严重程度评分(CSSCNS)平均11.7分.患者住院治疗43～270 d.结果 患者全部好转,无一例死亡.出院时2例伴智能障碍,1例伴肢体抽搐发作,CSSCNS平均4.4分.结论 延长抗病毒治疗时间并联用激素治疗有助于改善迁延难愈性病毒性脑炎的预后.     

带状疱疹病毒性脑膜脑炎14例分析

目的 探讨带状疱疹病毒性脑膜脑炎(HZVE)的发病特点、诊断与治疗.方法 对14例HZVE病人临床资料进行分析.结果 所有病人除表现有脑膜脑炎临床表现外,均有典型的三叉神经、枕神经及肋间神经支配区皮肤疱疹,大部分患者脑炎症状出现于皮疹之后,多数以头痛为首发症状;脑脊液白细胞可轻中度增加,以淋巴细胞为主,抗病毒等治疗效果良好.结论 脑神经支配区带状疱疹感染患者,如出现发热、头痛、眩晕、精神症状、脑膜刺激征等表现,应考虑有HZVE的可能,及时予腰穿明确诊断,早期给予抗病毒等治疗.     

以精神障碍为首发症状的病毒性脑炎58例临床分析

目的 探讨以精神障碍为首发症状的病毒性脑炎患者临床特点.方法 回顾性分析本院1994-06～2007-06收治以精神障碍为首发症状的病毒性脑炎患者58例的临床资料并作电话或门诊复诊随访.结果 实验室检查中脑电图较脑脊液、CT阳性率高,58例患者经抗病毒及抗精神病药物治疗后预后良好.结论 对以精神症状为主要首发表现的患者,应重视患者前驱症状及体征,及早做脑电图、脑脊液、CT检查以免误诊.以治疗脑炎为主的同时辅以抗精神病药综合治疗,预后良好.     

以精神症状为主要首发表现的病毒性脑炎95例临床分析

目的探讨以精神症状为主要首发表现的病毒性脑炎的临床特征和治疗要点。方法回顾性分析95例以精神症状为主要首发表现的病毒性脑炎患者(研究组)的临床资料,并与同期住院的无精神症状的病毒性脑炎101例(对照组)进行对比分析。结果以精神症状为主要首发表现的病毒性脑炎其精神症状以混合型多见(60.0%),伴随的躯体症状体征出现率低(35.8%~66.3%),与对照比较有非常显著性差异(P<0.001),误诊率高于对照组(41.1%vs25.7%,P<0.05);实验室检查中脑电图较脑脊液、CT、MR阳性率高。95例患者经抗病毒等及抗精神病药治疗后,除4例死亡、3例自动出院外,大多数患者预后良好。结论对以精神症状为主要首发表现的患者,如病前有感染、腹泻、口唇疱疹等病史,应动态观察病人有无意识障碍、智能下降、癫发作、神经系统体征变化及脑脊液、脑电图是否有异常变化等特点,进行综合分析有助于诊断。以治疗脑炎为主的同时辅以少量短期的抗精神病药综合治疗,预后良好。     

开颅减压治疗单纯疱疹病毒性脑炎1例报告并文献复习

目的分析单纯疱疹病毒性脑炎的临床表现、影像学特点,开颅治疗和预后。方法对1例初诊为脑梗塞的单纯疱疹病毒性脑炎的临床资料进行回顾性分析,并复习文献。结果本例以精神异常起病,渐意识障碍,误诊为脑梗塞、重症肺炎并予相应治疗;因脑疝,行颅内压监测术及开颅减压术,术后病理结果确诊为单纯疱疹病毒性脑炎,术后发生恶性颅高压,经治疗无效死亡。结论临床接诊类似患者,需详细询问病史、仔细查体,并发散诊断思维,以防止误诊误治。对重症单纯疱疹病毒性脑炎应早期给予足量抗病毒药物、糖皮质激素,出现脑疝,行开颅减压,以改善预后。     

单纯疱疹病毒性脑炎18例临床分析

目的探讨单纯疱疹病毒性脑炎（HSE）的临床表现、早期诊断及治疗。方法回顾18例HSE患者的临床资料并结合文献进行分析。结果HSE患者的临床表现以精神症状为主,大多数患者脑电图有异常表现,少数脑脊液病毒学检查阴性。结论HSE的诊断应以临床症状为主,同时结合脑电图（EEG）、脑脊液病毒学及影像学检查综合判断。EEG有利于早期诊断及疗效观察。治疗应以抗病毒治疗为主,同时结合免疫治疗。     

小儿病毒性脑干脑炎的诊治体会

目的探讨小儿病毒性脑干脑炎疾病特点、诊断和治疗。方法对我科收治的11例病毒性脑干脑炎患儿的临床资料作一回顾性分析。通过一般检查、生物电学检查和神经影像学检查进行确诊,给予退热、镇静、降低颅内压等对症治疗,抗病毒、抗生素治疗以及神经细胞活化剂治疗等。结果患儿行脑电图和MRI检查多可发现相应病变,经治疗11例患儿中痊愈4例,明显好转1例,留有症状性癫1例,肢体轻瘫1例,死亡1例。结论小儿病毒性脑干脑炎属于危重病,临床表现无特异性,强调综合诊断与治疗,早期、足量使用大剂量丙种球蛋白冲击疗法治疗效果确切。     

磁共振成像及扩散加权成像对以精神障碍为首发症状的病毒性脑炎的诊断价值

病毒性脑炎是中枢神经系统常见的感染性疾病,常导致精神障碍,临床表现除有神经症状,还常有严重的精神紊乱。研究表明病毒性脑炎精神症状的出现率高达81％,部分以精神障碍为首发症状的病毒性脑炎常误诊为功能性精神病［1-2］。通过分析我院34例以精神障碍为首发症状的病毒性脑炎患者的磁共振成像及扩散加权成像表现,以期对精神障碍为首发症状的病毒性脑炎临床早期诊断和治疗提供依据。     

单纯疱疹病毒性脑炎的临床与脑电图,头颅CT及MRI

对１２例单纯疱疹病毒性脑炎患者进行分析，其临床表现以颞叶症状及意识障碍为主。脑脊液单纯病毒抗体９／１０例阳性。脑电图８／９例异常，以广泛异常加局限异常为多见，蝶骨电极可提高其阳性率，动态观察见ＥＥＧ随病情好转而改善，头颅ＣＴ（或）和ＭＲＩ９／１１例异常，以额颞叶为主，早期用无环鸟苷治疗预后较好。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -     

Summary of legislation of 1941 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -     

Asymmetry of on- and off-pathways of blue-sensitive cones of the retina of macaques

Macaque retinal ganglion cells whose receptive-field center recieves input from blue-sensitive cones show an overt asymmetry of the frequency of ON-center and OFF-center varieties, an asymmetry not present in ganglion cells whose center receives input from the other two cone types. A similar asymmetry of ON/OFF responses is found in the local electrotetinogram (d-wave) mediated by signals from blue-sensitive cones. ‘Blue-ON-center’ ganglion cells have larger receptive-field centers and shorter conduction latencies than other opponent-color varieties, suggesting an appreciable degree of receptor convergence and presumably large cell bodies. Intracellular stainings of these neurons with Procion Yellow show that they correspond to diffuse stratified (Parasol) ganglion cells whose flat-topped dendritic arborization stratifies in the sclerad half of the inner plexiform layer. In view of the known characteristics of macaque bipolar cells and of the ON/OFF asymmetry, it is proposed that these ganglion cells are postsynaptic to cone-specific flat bipolars possibly mediating sign-inverting synaptic contacts. The results also indicate a reversal, for the blue-cone pathway, of the ON/OFF lamination of the inner plexiform layer that has recently been described in other species.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.