后循环梗死患者的BAEP、BR、TCR变化的临床意义

目的探讨后循环梗死（PCI）患者脑干听觉诱发电位（BAEP）、瞬目反射（BR）、三叉神经-颈反射（TCR）三种电生理变化。方法选择50例经头颅MRI检查证实为PCI患者,分别行BAEP、BR、TCR检查。BAEP观察其波形,Ⅰ、Ⅲ、Ⅴ峰波潜伏期（PL）、峰波间期（IPL）、波幅（Amp）;BR观察R1、R2、R2’波平均潜伏期、波幅;TCR观察各成分潜伏期、波幅、A值。结果 50例中,BAEP检查异常45例,异常率90%,异常主要表现为Ⅲ、Ⅴ波PL延长,Ⅲ～ⅤIPL大于Ⅰ～ⅢIPL,Ⅰ/Ⅴ波幅大于1。BR检查异常42例,异常率84%,异常主要表现为R1、R2、R2’波PL延长,R2、R2’波幅下降。TCR检查仅5例异常,异常率10%,头颅MRI显示多为延髓梗死。结论 BAEP、BR两种电生理检查方法能较好反映PCI患者脑干功能异常;TCR电生理检查方法异常率低,但对延髓梗死检查有特异性。三者联合应用可提供重要参考价值。     

Chiari I型畸形的MRI表现及其手术治疗

目的：探讨Chiari I型畸形的MRI分型及治疗方法。方法：23例Chiari I型畸形患者，21例有颈神经根症状，16例表现为中管周围损害症状，另有8例分别存在小脑及颅神经损害症状。MR检查显示，单纯小脑扁桃体下疝（B型）7例（30．43％），小脑扁桃体下疝合并脊髓空洞症（A型）16例（69．57％）。根据MRI所显示病变部位，采用不同的手术方式，其中11例后颅窝减压术，7例行后颅窝减压并小脑扁桃体切除术，5例行后颅窝减压并脊髓空洞切开引流术。结果：手术后18例患者（78．26％）症状改善，5例（21．74％）与手术前比较无明显变化，对16例伴脊髓空洞症患者中的13例进行随访，其中3例空洞消失，7例空洞显著缩小，3例空洞较手术前缩小50％。结论：手术治疗可使延髓、颈髓充分减压，有效缓解临床症状，并对脊髓空洞症具有良好的治疗效果。     

后颅窝内减压治疗Chiari 畸形Ⅰ型并脊髓空洞中期疗效评价

目的 评价后颅窝内减压(后颅窝减压+后颅窝颅骨成形术)治疗Chiari 畸形Ⅰ型并脊髓空洞疾病的中期临床疗效.方法 采用后颅窝内减压术治疗40 例符合标准的Chiari 畸形Ⅰ型并脊髓空洞.观察手术时间、切口愈合情况,分析相关并发症.采用远期生活质量评估(KPS)和美国Lawton 和Brody1996 年制定的日常生活能力量表评分(ADL)评价疗效,并且通过影像学检查对脊髓空洞的变化、脑脊液流速情况以及颅颈交界区稳定性情况进行评价.结果 随访KPS 分值由术前的(70 ±10)分提高到到末次随访时(80 ± 10)分(P ＜0.01),ADL 分值由术前的(20.6 ±2.2)分降至末次随访时(15.8 ± 0.5)分(P ＜ 0.01),最终疗效评价优良者占86%.颅颈交界区影像学观察脊髓空洞缩小及消失率为90.5% (19 /21).脑脊液流速较术前加快.结论 后颅窝内减压术治疗Chiari 畸形Ⅰ型并脊髓空洞有一定疗效.     

脊髓中央管隔膜形成与Chiari畸形并脊髓空洞

目的探讨显微外科治疗Chiari畸形并脊髓空洞的手术方法.方法 127例Chiari畸形并脊髓空洞经MRI确诊,采用小脑扁桃体下疝切除,并脊髓中央管开口隔膜切开术. 结果术中发现脊髓中央管开口隔膜形成;术后随访89例,MRI检查示,所有患者下疝的小脑扁桃体均消失,并存脊髓空洞明显缩小和消失.结论小脑扁桃体下疝,脊髓中央管开口隔膜形成是造成Chiari畸形并脊髓空洞的原因之一;小脑扁桃体下疝切除,脊髓中央管隔膜切开术是手术治疗Chiari畸形并脊髓空洞症的有效方法.     

ChiarⅠ型畸形的MRI表现及其手术治疗

目的探讨ChiariⅠ型畸形的MRI分型及治疗方法.方法 23例Chiari Ⅰ型畸形患者,21例有颈神经根症状,16例表现为中央管周围损害症状,另有8例分别存在小脑及颅神经损害症状.MR检查显示,单纯小脑扁桃体下疝(B型)7例(30.43%),小脑扁桃体下疝合并脊髓空洞症(A型)16例(69.57%).根据MRI所显示病变部位,采用不同的手术方式,其中11例行后颅窝减压术,7例行后颅窝减压并小脑扁桃体切除术,5例行后颅窝减压并脊髓空洞切开引流术.结果手术后18例患者(78.26%)症状改善,5例(21.74%)与手术前比较无明显变化.对16例伴脊髓空洞症患者中的13例进行随访,其中3例空洞消失,7例空洞显著缩小,3例空洞较手术前缩小50%.结论手术治疗可使延髓、颈髓充分减压,有效缓解临床症状,并对脊髓空洞症具有良好的治疗效果.     

枕颈减压、脊髓空洞穿刺抽液治疗Chiari畸形合并脊髓空洞症

目的：探讨一种治疗Chiari畸形合并脊髓空洞症的新手术方法。方法：61例经MRI诊断为Chiari畸形合并脊髓空洞症患,均采用枕颈减压加脊髓空洞空刺抽液术治疗。结果：全部病例术后临床症状,体征均有不同程度改善;随访48例（术后1－5年）,明显转好45例,好转3例,其中8例术后2－4年经MRI复查,脊髓空洞消失2例,空洞明显缩小5例,轻微缩小1例,手术无并发症,无死亡,结论：枕颈减压加脊髓空洞空刺抽液术治疗Chiari畸形合并脊髓空洞症是一种有效的方法。     

三叉神经-颈反射检测方法的建立及其对脑干梗死的诊断价值

目的 建立三叉神经-颈反射的肌电检测方法，探讨其在脑干梗死中的诊断价值。方法 受检测者取仰卧位，头部轻度抬高，刺激一侧眶下神经，于双侧胸锁乳突肌记录，结果 刺激对照者一侧的眶下神经，可于双侧胸锁乳突肌引出正/负波，脑干梗死组患者波形正常者7例（31.8%)，波形消失者5例（22.7%)，波幅降低者2例（9.1%)，潜伏期延长者2例（9.1%)，双侧反射的超常不对称者6例（27.3%)。结论 TCR可作为低位脑干病变的一种辅助检查手段。     

神经外科麻醉对体感诱发电位的影响

目的探讨神经外科手术麻醉对体感诱发电位（SEP）的影响,以期为麻醉和手术处理提供依据。方法随机抽取我科17例全麻手术病人,分成颅内疾病手术组（A组）与脊柱、脊髓疾病手术组（B组）,于术前、麻醉（诱导完成）、术始、术中、术毕和术后6个时程连续监测SEP的潜伏期、波幅及波形并记录。结果麻醉后SEP潜伏期延长5.96%,波幅下降24.00%,未出现波形消失的情况。结论麻醉抑制SEP,表现为潜伏期延长和波幅下降,但未出现波形消失的情况。     

神经电生理检查在Arnold-Chiari畸形诊断和治疗中的应用

目的探讨神经电生理检查在Arhold-Chiari畸形中的诊断价值及术后效果判定。方法对确诊Ar hold-Chiari畸形的30例患者行电生理检查:脑干听觉诱发电位(BAEP)、上下肢躯体感觉诱发电位(SEP)、三叉神经-颈反射(TCR)、上下肢运动诱发电位(MEP)的术前评估,并在术后20-25 d进行电生理复查。结果术前30例患者27例(90％)电生理检查有异常改变,后颅窝减压术后各项电生理指标有不同程度的改善,MRI示空洞减小, 小脑扁桃体回缩。结论电生理的各项检查指标对Arnold-Chiari畸形具有较高的诊断价值,并且是术后疗效评估的客观依据之一。     

青少年Chiari畸形脑脊液流动状态的临床研究

目的 检测Chiari畸形枕颈交界区蛛网膜下腔脑脊液流动状态。方法对7例Chiair畸形病人（年龄10～20岁）,行常规脑脊髓磁共振（MRI）检查,同时采用MRI相位对比电影法检测C2椎体下缘水平椎管内蛛网膜下腔脑脊液向下最大流速（MSV）、向上最大流速（MDV）、向下流动所占据整个流动周期比例（SFR）、向上流动所占据整个流动周期比例（DFR）和静止期比例。以7例年龄匹配正常人作为对照组,检测方法相同。结果与正常对照组比较,Chiari畸形脑脊液流动状态发生改变,脑脊液流速减慢,SFR明显缩短,静止期比例延长（P〈0．05）。结论Chiari畸形病人C2处椎管内脑脊液流速减慢,相对静止期延长,提示脑脊液流动状态与Chiari畸形的病理生理改变有关。     

三叉神经-颈反射在无先兆偏头痛和慢性紧张型头痛中的意义

目的 研究三叉神经-颈反射(trigemino-cervical reflex,TCR)在无先兆偏头痛(migraine without aura,MWOA)和慢性紧张型头痛(chronic tension-type headache,CTTH)中的意义.方法 选取2009年1月至2010年2月福建省级机关医院门诊25例单侧MWOA患者、25例CTTH患者及36名健康成年对照进行TCR检测.刺激一侧眶下神经(infraorbital nerve,ION),可在同侧胸锁乳突肌(sternocleidomastoid muscle,SCM)上记录到一个短潜伏期正-负波,即TCR.比较各组TCR参数[峰潜伏期(PL)、刺激前后波幅比率的平方根(A值)]的差异.结果 MWOA组和CTTH组双侧PLP19[MWOA右侧(19.81±1.79)ms,左侧(19.49±1.95)ms;CTTH右侧(19.16±1.67)ms,左侧(19.56±2.02)ms]、PLN31[MWOA右侧(30.75±2.35)ms,左侧(30.44±3.75)ms;CTTH右侧(30.32±3.47)ms,左侧(30.11±3.34)ms]较对照组缩短(t=2.027～3.654,P＜0.05);CTTH组和MWOA组双侧PLP19、PLN31及A值差异无统计学意义.结论 MWOA组和CTTH组的双侧PLP19、PLN31潜伏期较对照组缩短,提示三叉神经、脑干系统参与MWOA、CTTH的发病机制;但两组病例无明显差异,MWOA和CTTH在内源性疼痛调节系统的某个部位如三叉神经或脑干系统,存在共同的功能障碍.     

Diagnostic utility of F waves in cervical radiculopathy: electrophysiological and magnetic resonance imaging correlation

OBJECTIVE: F wave study is a simple, non-invasive method commonly utilized for evaluation of cervical root lesions. Its diagnostic sensitivity is low. There are no large series comparing F wave studies with MRI as a reference standard. PATIENTS AND METHODS: We performed F wave studies in 30 controls (15 men; mean age: 50 years; standard deviation: 17.9 years; range: 21-80 years) and, prospectively, 31 patients (19 men; mean age: 48 years; standard deviation: 16.2 years; range: 26-79 years) referred for evaluation of cervical spondylotic radiculopathy (CSR). All patients' MRIs were compared with F wave parameters. RESULTS: Combined utilization of minimal F latency, F chronodispersion, F persistence and side to side differences resulted in 55% sensitivity and 100% side concordance for detecting CSR, with MRI as a comparison standard. F wave parameters also provided complementary information to needle electromyography in the diagnostic evaluation of CSR. Although F waves were not indicative of radiculopathy levels, 4/31 (13%) of cases had at least one abnormal F wave parameter, despite normal electromyography findings. CONCLUSIONS: Combined utilization of multiple F wave parameters is a useful, diagnostic adjunct in the electrophysiological evaluation of CSR.     

瞬目反射及脑干听觉诱发电位对脑干梗死疗效的评价

目的探讨瞬目反射和脑干听觉诱发电位对脑干梗死患者疗效的评价作用。方法40例经临床症状、体征定位于脑干髓内并经头部MRI检查明确诊断的脑干梗死患者(脑桥梗死31例、中脑梗死4例和延髓梗死5例),分别计算治疗前后瞬目反射各成分的平均潜伏期;观察脑干听觉诱发电位波形及各波潜伏期、峰间期的变化。结果经治疗后40例患者临床症状及体征均有不同程度改善,治疗前后瞬目反射各成分平均潜伏期之间差异无统计学意义(P>0.05);3例脑桥梗死患者R1波恢复正常,临床基本痊愈。治疗前后脑干听觉诱发电位各波潜伏期及峰间期比较,差异亦无统计学意义(P>0.05);治疗后中脑梗死及脑桥梗死患者各有2例恢复正常,临床症状明显好转。结论瞬目反射与脑干听觉诱发电位均能敏感地反映脑干功能的变化,与临床表现具有一致性,但在发病15d内大部分病例的电生理活动不能恢复正常。     

Effect of neck flexion on F wave, somatosensory evoked potentials, and magnetic resonance imaging in Hirayama disease

BACKGROUND: Flexion myelopathy is one of the suggested mechanism for Hirayama disease (HD) but simultaneous radiological and neurophysiological evaluation is lacking. This study therefore evaluates the effect of neck flexion in HD using somatosensory evoked potentials (SEPs), F waves, and magnetic resonance imaging (MRI). METHOD: Eight HD patients and seven matched controls were subjected to median and ulnar F wave (minimal latency, FM ratio, persistence, and chronodispersion), and SEPs evaluating N9, N13, and N20 potentials in neutral and neck flexion. Spinal MRI was carried out in neutral and neck flexion and evaluated for cord atrophy, signal changes, cord compression, posterior epidural tissue, and loss of dural attachment. RESULTS: The patients were aged 19 to 30 years. Minimal F latency, FM ratio, persistence, and chronodispersion in neutral and neck flexion did not show any change nor was there any change in N13 latency and amplitude on median and ulnar SEPs. The difference in these parameters in neutral and neck flexion were also not significant in HD compared with controls. The change in N13 was also not related to loss of dural attachment and posterior epidural tissue. CONCLUSION: Neck flexion does not produce significant changes in N13 and F wave parameters and is not related to dynamic MRI changes. The other mechanisms for HD should therefore be explored.     

支架置入术对椎基底动脉系统短暂性脑缺血发作患者诱发电位的影响

目的 观察支架置入术能否改善椎基底动脉系统短暂性脑缺血发作（TIA）患者的亚临床症状。方法 11例症状性椎基底动脉狭窄的椎基底动脉系统TIA患者,支架置入术前后分别检测体感诱发电位（SEP）、脑干听觉诱发电位（BAEP）、视觉诱发电位（VEP）,记录各诱发电位的潜伏期及波幅。结果 （1）术前诱发电位均异常,主要表现为SEP N20及P40潜伏期异常,BAEPⅠ、Ⅲ、Ⅴ波潜伏期延长,VEP P100潜伏期延长。（2）与术前相比,术后1周BAEP表现为Ⅰ～Ⅲ波潜伏期缩短（P =0.046）、Ⅲ波幅升高（P =0.05）;SEP表现为N20潜伏期缩短（P =0.012）,N13～N20间期缩短（P =0.013）,P14～N20间期缩短（P =0.005）;VEP表现为 P100潜伏期缩短（P =0.022）。结论 支架置入术后,椎基底动脉系统TIA患者的SEP、BAEP、VEP好转,提示患者的亚临床症状恢复。     

肯尼迪病患者的三叉神经-颈反射异常

目的 探讨肯尼迪病(Kennedy's disease,KD)患者三叉神经一颈反射(TCR)有无改变及改变特点.方法 比较30例KD患者、30例肌萎缩侧索硬化(ALS)患者及30名健康对照者的TCR各参数.结果 KD组TCR同侧P19、N31、A值及对侧P19、N31、A值分别为(23.91±4.84)、(35.45±4.76)ms、1.24±0.33以及(24.34±4.82)、(36.20±4.91)ms、1.19±0.25,与健康对照组[分别为(18.37±2.16)、(28.50±1.56)ms、1.90±0.43以及(18.72±2.18)、(29.19±1.43)ms、1.84±0.40]比较,差异均有统计学意义(同侧t=5.77、8.19、-6.64;对侧t=5.05、7.62、-7.77,均P<0.01).结论 KD患者的TCR存在异常,其原因可能与延髓部和三叉神经受累有关.     

急性HICH患者行FVEP ICP监测的临床应用价值

目的 探讨对急性高血压性脑出血(HICH)患者用闪光视觉诱发电位(FVEP)进行无创颅内压(ICP)监测的临床价值。方法 选取本院神经内科收治的110例急性HICH患者作为研究对象,根据患者治疗28 d的结局分为存活组87例和死亡组23例,分别对比2组患者入院后第12、24、48、72 h的ICP值,同时分析ICP值与患者的格拉斯哥昏迷评分(GCS)、急性生理与慢性健康评分(APACHEⅡ)、FVEP各波潜伏期的关系。结果 存活组患者的出血量、血弹值、WBC、中线移位发生率均显著低于死亡组(P<0.05); 在入院第12、24、48及72 h存活组患者的ICP值均显著低于死亡组患者(P<0.05); 在入院第12 h存活组患者的GCS评分显著高于死亡组患者(P<0.05),APACHEⅡ评分、FVEP各波潜伏期(P2、N2、P3、N3)均显著低于死亡组患者(P<0.05); 在入院第12 h HICH患者的ICP值与GCS评分呈显著负相关(r=-0.572,P<0.05),与APACHEⅡ评分、FVEP各波潜伏期(P2、N2、P3、N3)呈显著正相关(r=0.496,P<0.05)。结论 通过监测HICH患者的ICP值能够密切反映患者的病情程度、预后情况,对于指导临床治疗具有一定的价值。     

The auditory oddball paradigm in patients with vascular cognitive impairment: a prolonged latency of the N2 complex

OBJECTIVE: The event-related potential (ERP) evoked by the auditory oddball paradigm has been investigated mainly in patients with Alzheimer's disease and in patients with different causes of subcortical dementia. Subcortical ischemic vascular disease (SIVD) seems to be an important cause of vascular cognitive impairment (VCI) frequently not fulfilling the criteria for dementia. Recognition of VCI is needed in order to provide adequate care and therapy. The aim of this study was to investigate the diagnostic value of the different elements of this response (N(1), N(2) complex and P(3) latencies) in a group of elderly patients with VCI caused by SIVD. METHODS: The study population consisted of patients with a clinical and neuropsychological diagnosis of VCI caused by SIVD (n = 38) and healthy control subjects (n = 53) aged 60 years or older. The mean Mini Mental State Examination score of both groups was 27.6, and the mean HIV Dementia Scale score was 6.1 in the patient group and 12.3 in the control group. In all subjects, the ERP was recorded under standardized conditions, and the latencies and amplitudes of N(1), N(2) and P(3) were analyzed by two clinical neurophysiologists in consensus. Both were blinded to the diagnosis. RESULTS: The N(2) latency was significantly longer in patients with VCI than in age-matched controls, whereas the latencies of the P(3) and N(1) were not significantly different. The peak-to-peak amplitude of the N(2) complex to the P(3) wave was significantly lower in the patient group. White matter abnormalities on MRI were not significantly correlated with the N(2) latency. CONCLUSION: Our findings suggest that the latency of the N(2) complex is prolonged and the peak-to-peak amplitude of the N(2) complex to the P(3) wave is lowered in patients with VCI caused by SIVD.     

The N2 component of the event-related potential in schizophrenic patients

Event-related potentials (ERPs) to easy and difficult infrequent visual target stimuli were recorded in unmedicated schizophrenic patients and age-matched controls. N2 difference wave forms were computed by subtracting the ERP to a frequent non-target stimulus from the ERP to each target. The N2 component was identified in these difference wave forms. All subjects showed longer latency N2 and P3 peaks to the difficult target than to the easy target. Schizophrenic patients had longer latency N2 peaks than controls to both targets. Schizophrenic patients also showed reduced P3 amplitudes to both targets compared to controls. The prolonged N2 latency in schizophrenics accounts for a substantial portion of the delayed reaction time commonly observed in this group. N2 latency prolongation appears to be yet another evoked potential abnormality in schizophrenic patients.     

Prospective study of anterior cervical microforaminotomy for cervical radiculopathy.

Cervical radiculopathy caused by a posterolateral disc herniation or spondylosis is a common pathology. Decompression of a stressed cervical nerve root is a routine neurosurgical procedure. To determine the safety and effectiveness of anterior cervical microforaminotomy (ACM), we prospectively studied patients undergoing this treatment at our institution to determine the efficacy of the approach for the treatment of unilateral cervical spondylotic or discogenic radiculopathy. Twenty-five patients were treated with ACM and were followed up for 15-40 months. Clinical signs, neurological results, and complications were recorded. Radiological imaging studies for measurement of post-operative changes were performed to evaluate spinal stability and effectiveness of the ACM procedure. We used MRI, axial cervical CT and reconstructive sagittal cervical CT to assess foraminal decompression. Eight men and 17 women (mean age 51.8 years) were included in this study. Nineteen patients had a single ACM, and six underwent procedures at adjacent 19 levels. The ACM procedure involves microsurgical removal of the lateral portion of the uncinate process to identify the nerve root. Post-operatively, none of the patients' conditions had worsened symptomatically or neurologically. A positive outcome at last follow-up examination was achieved in all patients. The visual analoge scale pain rating was 6.36 pretreatment and 0.64 after 1 year (p<0.0001). ACM appears to be a good alternative procedure, and a good non-fusion disc-preserving technique. Disc and bone resections are minimal in carefully selected patients with unilateral cervical radiculopathy. This method avoids osteoarthrodesis or arthroplasty with disc prostheses.