基底动脉尖综合征65例临床分析

目的　探讨基底动脉尖综合征 (TOBS)的病因、临床表现和影像学特征。方法　对 6 5例TOBS患者的原始资料进行回顾性分析。结果　发现TOBS患者以老年为主 ,病因及危险因素主要为高血压、糖尿病、心脏病、高血脂等 ,临床表现多以突然眩晕或意识障碍起病 ,合并眼球运动障碍及瞳孔异常、运动障碍、视觉障碍 ,可伴有行为异常等。CT及MRI的重要特征是中脑或丘脑梗死合并其他部位梗死 ,如枕叶、小脑、颞叶。结论　TOBS的诊断主要依赖临床及影像学表现 ,早期积极全面综合治疗可以提高生存率。     

睁闭眼失用症一例报道

1 病例 患男性，51岁，右利手。以突发左侧肢体运动障碍、言语表达障碍3h，于2000年3月5日入院。该患发病当日值夜班，晨6时许准备去洗脸时突然倒地，左侧肢体运动障碍、言语表达障碍，无头痛、头晕、恶心呕吐等。2h后来诊，测血压为120／90mmHg(1mmHg=0．133kPa)，行头颅CT和     

基底动脉尖综合征的临床分析

目的研究基底动脉尖综合征（TOBS）的病因、临床表现，加深对这种疾病的认识。方法对9例TOBS患者的原始资料进行回顾性分析。结果发现TOBS患者以中老年为主，病因及高危因素有高血压、糖尿病、心脏病、高血脂等，临床表现多以突然眩晕或意识障碍起病，合并眼球运动障碍及瞳孔异常、运动障碍、偏盲，可伴有行为异常等。CT及MRI提示重要的特征是中脑或丘脑梗死合并其他部位梗死，如枕叶、小脑、颞叶。结论TOBS的诊断主要依赖临床及影像学表现，死因主要为脑疝，早期全面综合治疗可以提高生存率。     

57例老年人无肢体瘫痪脑梗塞临床与CT分析

目的：探讨老年人无肢体瘫痪脑梗塞临床与CT的关系。方法：对57例老年人无肢体瘫痪脑梗塞的发病诱因，临床表现及CT进行回顾性分析，结果：高血压，TIA，高血脂，冠心病仍为无肢体瘫痪脑梗塞的重要危险因素，结论：肢体瘫痪的发生与否是和传导通路，梗塞部位和病灶大小有头，而与梗塞数目无关，在无MRI条件时，早期头颅CT扫描是诊断的唯一依据。     

低血糖反应误诊急性脑血管病15例分析

在老年人突发意识障碍、精神症状及肢体偏瘫时，首先考虑到的是急性脑血管病，往往先去做头颅CT、脑脊液化验等检查来证实该病的存在。从1994年-2004年10年以来的临床急诊抢救中却发现，有不少的老年人实际上是低血糖反应。在我院收治的急性脑血管病人中，即有15例被误诊，后经血糖检测确诊为低血糖反应，及时治疗后，所有患者均迅速恢复正常。现将有关资料分析总结如下：     

易误诊为脑部疾病的低血糖症28例分析

在老年人出现言语及肢体功能障碍或较前加重、精神症状、癫痫发作及意识障碍时，首先考虑的是脑部病变，急诊工作中常常先查头颅CT、脑电图等，特别是既往病史中有脑部疾病的，更易误诊为脑部疾病，而从近年临床抢救中发现，有不少老年人实际上为低血糖症。近几年来我科共收治28例低血糖症，其中18例误诊为脑血管疾病，2例误诊为癫痫，后经血糖化验诊断为低血糖症，治疗     

子宫肌瘤的CT诊断价值

目的 分析子宫肌瘤的CT影像，探讨其诊断价值。方法 常规子宫平扫，发现肿块后行5mm或3mm薄层扫描，并均做增强扫描。结果 本组54例中，子宫增大38例，占73．7％，独立肿块25例，占46．3％，肿块附着于子宫体者29例，占53．7％，肿块内出现钙化影9例，占9．4％。所有肿块均能强化。结论 子宫腔增大；宫体上出现实性肿块，其边缘清楚，并可出现钙化；增强扫描时均能强化是CT诊断子宫肌瘤的重要依据。     

微创穿刺清除术治疗老年慢性硬膜下血肿54例报告

2000-2004年，我们采用微创穿刺清除术治疗老年慢性硬膜下血肿54例，效果满意。现报告如下。 临床资料：本组男42例，女12例；年龄62～82岁，平均70．5岁；病程21d～3a。有明确外伤史30例，高血压病史21例，慢性支气管炎、肺气肿、肺心病史10例，糖尿病史9例，冠心病史8例。头痛、头晕50例，各种精神症状（嗜睡、反应迟钝、智能减退、定向障碍）3例，不同程度肢体瘫痪41例，双下肢无力5例，脑疝12例。54例均经脑CT检查，其中双侧硬膜下血肿5例，血肿量80-210ml。     

尤瑞克林治疗基底动脉尖综合征疗效观察

基底动脉尖综合征(TOBS)是一种特殊类型的脑干血管病.其发病机制为基底动脉尖端血循环障碍,导致突发意识障碍、瞳孔异常及眼球运动障碍等症状.其临床表现复杂多样,致残率高、死亡率高、预后差.2005～2007年,我们应用尤瑞克林治疗22例基底动脉尖综合征患者.现报告如下.     

貌似脑梗死的低血糖反应21例临床分析

在老年人突发意识障碍及肢体瘫痪时,首先考虑到的是急性脑血管病,往往先去做一些CT等检查。忽视低血糖反应和低血糖昏迷,现将我院2001年～2007年来收治的21例貌似脑血管病的低血糖反应。现报告如下。     

老年基底动脉尖综合征患者的临床和磁共振成像特点分析

目的探讨老年基底动脉尖综合征(TOBS)患者的临床和MRI特点,为临床提供依据。方法选择TOBS老年患者28例,采用TOAST分型和美国国立卫生院卒中量表评分,分析临床和MRI特点。结果老年TOBS患者以眩晕(82%)、意识障碍(68%)多见。MRI显示,中脑梗死占64%,脑桥占36%,丘脑占43%,枕叶占39%,小脑半球占68%。结论掌握老年TOBS患者临床及MRI特点,为进一步诊断、治疗提供依据。     

Neurological diagnosis and therapeutic measures in cerebral embolism]

Stroke is caused by intracerebral or subarachnoid hemorrhage in about 15% of clinical presentations and the remaining 85% result from ischemia. About 15% of ischemic strokes are caused by emboli arising from the heart. In younger patients (18 to 50 years) with ischemic strokes or transient ischemic attacks (TIA), the incidence of cardiac embolism is increased to 23 to 36%. Diagnosis: a) Symptoms: Individual neurologic symptoms of stroke do not provide sensitive or specific indications of the underlying mechanism. In 25 to 82% of patients with possible embolic stroke, there is an acute onset with initially maximal manifestation of neurologic deficits as well an initial loss of consciousness in 20%. Antecedent TIAs occur in 11 to 30% but are more frequently associated with arteriosclerotic vascular disease. Stroke due to cardiac embolism mostly involves the cortex of both hemispheres and causes its symptoms through occlusion of isolated arterial branches. Cerebral infarctions with isolated Wernicke aphasia, global aphasia without hemiparesis and isolated syndromes of the posterior cerebral artery are frequently due to cardiac embolism. The strokes in 16 to 22% of those caused by cardiac embolism are found in subcortical regions. Amaurosis fugax is most frequently due to high-grade stenosis of the internal carotid artery. In association with cardiac embolism, secondary hemorrhage into the infarcted zone can frequently be seen on CT scans. b) Diagnostic procedures: In the case of cardiac embolism, the computer tomography (CT) usually shows infarction in or near the cortex in the region of the middle or posterior cerebral artery. About 10 to 20% of strokes due to cardiac embolism show secondary hemorrhage after the event, more frequently in association with large infarcts and in patients on anticoagulant treatment. Angiography can provide indirect evidence of embolic origin by showing occlusion of an intracerebral artery in the absence of arteriosclerotic changes. Traditional echocardiography may detect a possible source of embolism in 10% of all patients with ischemic stroke, only in 1.5%, however, in patients with no clinical signs of heart disease. Transesophageal echocardiography has a higher sensitivity for detection of sources of cardiac embolism. The use of magnetic resonance tomography and ultrafast CT will assume greater importance in the future. Holter monitoring of the ECG in patients with acute ischemic stroke or TIAs detects arrhythmias possibly responsible for emboli in about 2%. High-risk patients: The most common cause of cardiac embolism is atrial fibrillation (45%), followed by ischemic heart disease (15%) and in 10% each, aneurysm, rheumatic heart disease, prosthetic valve replacement and other cardiac diseases.(ABSTRACT TRUNCATED AT 400 WORDS)     

Clinical profiles of cerebrovascular disorders in a population-based patient sample

Clinical features of different types of stroke were investigated in a sample of 409 patients representative of all cases admitted for acute stroke, except subarachnoidal hemorrhages, within a well defined population. A specific cerebrovascular diagnosis was obtained by detailed clinical investigation, including CT scan. In people greater than 50 years old, men/women risk for stroke was estimated to be 1.40:1. The risk was higher in men up to the age of 80; above this age similar risk for the two genders was observed. Eleven per cent had intracerebral hemorrhage, 13% TIA, 51% non-embolic and 25% embolic brain infarction. In all diagnostic categories there were similar proportions of patients who had a history of hypertension and previous stroke, neither did hemoglobin and hematocrit levels differ between the different stroke disorders. TIA preceded intracerebral hemorrhage in 11% and brain infarction in 15-20%. As opposed to patients with ischemic lesions, subjects with intracerebral hemorrhage had higher systolic blood pressure levels and more severe symptoms on admission to hospital. Ischemic stroke was associated with male predominance, different ischemic manifestations of heart diseases and diabetes.     

高血压脑出血患者流行病学及临床特征分析

目的探讨高血压脑出血患者流行病学特征及临床表现特点。 方法应用宁夏回族自治区人民医院病案管理系统检索2012年1月至2017年12月收治的高血压脑出血病例,对病例资料按照流行病学特点及临床特征进行回顾性分析。 结果共收集病例693例,男性422例,女性271例;其中青年患者68例、中年患者242例、老年患者383例,汉族、回族病例中均为老年患者居多;6~22点发病率较高;基底节区为最常见出血部位;肢体无力为基底节区出血最常见症状。 结论做好高血压脑出血的预防,特别是老年男性患者,如出现头痛头晕、肢体无力、言语障碍、意识障碍等症状要警惕脑出血。     

老年急性右心室心肌梗死误漏诊18例临床分析

目的分析老年急性右心室心肌梗死的误诊、漏诊原因,降低临床误诊率。方法回顾性分析选择总参保健处在2011年1月~2014年2月收治的18例老年急性右室心肌梗死的误诊、漏诊病例资料进行回顾性分析。结果 18例误诊、漏诊患者中误诊为急性前壁心肌梗死2例,心功能不全2例,急性上腹痛2例,脑血管病2例,肺源性心脏病2例,感染性休克1例,急性咽痛1例,急性肠炎1例;仅诊断其他部位心肌梗死而漏诊急性右室心肌梗死者5例。结论老年急性右心室心肌梗死临床表现不典型,易发生误诊、漏诊,临床工作中应提高警惕,仔细辨认尽力减少误漏诊事件的发生。     

Acute myocardial infarction in elderly Chinese. A clinical analysis of 631 cases and comparison with 389 younger cases

The purpose of this study was to define the clinical features of acute myocardial infarction in a group of elderly Chinese. The presenting symptoms, complications and mortality of acute myocardial infarction were compared in 631 patients (430 men and 201 women) aged 60 and over and 389 patients (333 men and 56 women) whose ages were under 60 years. The incidence of painless myocardial infarction was 17.6% in the elderly versus 5.9% in the younger group. Typical chest pain was present in 63.1% of the elderly and 84.3% of the younger Chinese. However, the incidence of other nonspecific presenting symptoms was higher in the elderly group. Likewise, the major complications in the elderly group were more severe than those in the younger group. For example, the incidences of cardiogenic shock, heart failure, arrhythmia, pulmonary infection and cardiac rupture in the older group were 19.8, 24.2, 77.2, 22.0 and 4.4%, versus 15.1, 19.5, 48.1, 9.5 and 1.1% in the younger group, respectively. The immediate (4 week) mortality rate of the older group was 21.9% (over 80 years 51.5%), but was only 11.0% in the younger group. Although the incidences of hypertension and pulmonary disease were significantly greater in the elderly group, these diseases alone did not account for the higher mortality rate in the elderly.     

汉族急性脑血管病患者血浆血栓调节蛋白的变化和血栓调节蛋白基因Ala455Val(C1418T)多态性研究

目的 探讨急性脑血管病患者血浆可溶性血栓调节蛋白(soluble thrombomodulin,sTM)含量的变化和血栓调节蛋白基因Ala455Val(C1418T)多态性的分布.方法 在79例汉族急性脑血管病患者(脑出血患者30例,脑梗死患者49例)和30名年龄和性别相匹配的健康对照者中,采用聚合酶链反应限制性酶切片段长度多态性分析技术检测TM Ala455Val(C1418T)多态性,酶联免疫吸附试验检测血浆sTM含量.结果 脑梗死组和脑出血组sIM含量分别为(32.08±6.98)ng/ml和(38.93±6.77)ng/ml,显著高于正常对照组的(9.90±3.09)ng/ml(P均<0.01),而且与高血压、糖尿病、心脏病等高危因素无关;脑出血组和脑梗死组TM 1418C/C基因型频率分别为53.3%和57.1%,高于对照组的40%,但无统计学差异.结论 无论足脑出血还是腑梗死患者,血浆sTM含量均显著高于正常人群;汉族人群中脑出血和脑梗死患者TM 1418C/C基因型频率虽然高于正常人群,但并非脑血管病的易感基因.     

Serum creatinine: an independent predictor of survival after stroke

We prospectively studied the relationship between serum creatinine and survival among 492 elderly subjects admitted for stroke and monitored for a mean period of 18 months post-stroke. In multivariate proportional hazards models, serum creatinine remained an independent predictor of mortality (P = 0.0001) after accounting for other important predictors such as level of consciousness. Mini-Mental State Score, age, leucocyte count, presence of heart disease, diabetes, heart failure, atrial fibrillation and use of cardiovascular medication. This association between elevated serum creatinine and mortality was also found in patient subgroups with CT-proven infarction and intracerebral haematoma. It is concluded that serum creatinine is an independent predictor of survival after stroke. Further studies are required to confirm this relationship and to elucidate the underlying mechanism.     

老年急性脑梗死合并肺部感染患者的危险因素和预后相关性研究

目的探讨老年急性脑梗死合并肺部感染患者的危险因素及对预后的影响。方法选择老年急性脑梗死患者131例,根据是否合并肺部感染分为肺部感染组34例和对照组97例。分析肺部感染的危险因素和预后相关性。结果与对照组比较,肺部感染组患者年龄偏高,入院时美国国立卫生研究院脑卒中量表(NIHSS)评分、存在球麻痹症状和意识障碍比例明显增高,合并肺部疾病、心脏病明显增多(P<0.05,P<0.01)。脑梗死合并肺部感染的危险因素有年龄、肺部疾病、心脏病、球麻痹、意识障碍。肺部感染组患者住院时间较对照组明显延长,病情明显加重,病死率明显增高(P<0.01)。结论对于高龄、入院时NIHSS评分高、意识障碍、球麻痹、肺部疾病和心脏病的老年急性脑梗死患者应及早预防,已发生肺部感染的患者应当给予积极有效的治疗。     

A case of recurrent cerebral hemorrhage considered to be cerebral amyloid angiopathy by cerebrospinal fluid examination]

A 73-year-old man was admitted with gait disturbance and dysarthria. He showed right-side cerebellar ataxia. Computed tomography of brain showed left thalamic bleeding. Nine months later, he was admitted again because of seizure and consciousness disturbance. He had a history of diabetes mellitus and gout for five years, but no hypertension. On physical examination the lungs and heart were normal. On neurological examination, he showed stupor,pupils and eye position were normal. He showed right hemiparesis and urinary incontinence. The deep tendon reflexes were (+) at the upper limbs and (2+) at the right knee and ankle. Blood pressure was 162/88 mmHg and glucose was 275 mg/dl. Other laboratory data were normal. Brain CT showed hemorrhage of the left frontal lobe. The cystatin C level in cerebrospinal fluid was 68 ng/ml. Therefore we suspected cystatin C deposit amyloid angiopathy. In this case, thalamic hemorrhage was initially thought to be amyloid angiopathy. In cases of cerebral hemorrhage in the elderly without hypertension, we must be considered amyloid angiopathy.