丘脑结节动脉梗死的神经心理学障碍

目的探讨丘脑结节动脉梗死的神经心理学障碍及其机制。方法回顾性分析9例丘脑结节动脉梗死患者的临床资料。结果9例患者主要临床表现为:意志缺乏和行为障碍、丘脑性失语和左侧空间忽视及视空间功能障碍、记忆障碍,而均无脑神经损害及运动、感觉障碍。结论丘脑结节动脉梗死患者的临床表现主要为神经心理学障碍。     

不同部位丘脑梗死的临床特点分析

目的分析不同部位丘脑梗死的临床特点。方法分析33例丘脑梗死患者的头颅磁共振(MRI)图像与临床特征,根据解剖学与临床的关系进行分析。结果 10例丘脑结节动脉梗死患者主要表现为偏瘫、偏身感觉障碍和构音障碍;13例丘脑膝状体动脉梗死主要表现为偏瘫和偏身感觉障碍;7例丘脑旁正中动脉梗死主要表现为偏瘫、动眼神经麻痹;3例脉络膜后动脉梗死主要表现为偏瘫和意识障碍。结论不同类型的丘脑梗死表现为不同的临床特征,具体症状与梗死发生的责任动脉区域有关。     

孤立性丘脑梗死的临床及影像学分析

<正>丘脑是最常见的梗死部位之一。传统上,丘脑梗死区域可分为前部、旁正中部、下外侧部及后部,分别由丘脑结节动脉(tuberothalamic atery)、丘脑穿动脉(thalamoperforating atery)、脉络膜后动脉(posterior choroidal atery),丘脑膝状体动脉(thalamogeniculate atery)供血[1]。这些动脉起源于     

单纯性丘脑梗死的临床特点和脑血管造影分析

目的分析不同区域急性单纯性丘脑梗死的临床特点以及脑血管造影表现。方法回顾性分析48例完成全脑血管造影急性单纯性丘脑梗死患者的临床资料。结果 48例患者,24例为丘脑膝状体动脉梗死,12例为丘脑旁正中动脉梗死,8例为丘脑结节动脉梗死,4例为脉络膜后动脉梗死。48例患者中仅13例全脑血管造影结果未见异常,同侧大脑后动脉异常13例,共26条基底动脉近端的后循环血管出现明显狭窄。丘脑膝状体动脉梗死以偏身麻木表现为主,丘脑旁正中动脉梗死以意识水平下降和眼球运动异常为主,丘脑结节动脉梗死以语言功和对侧肢体运动功能异常为主,脉络膜后动脉梗死以视野改变为主,丘脑旁正中动脉梗死和丘脑结节动脉梗死患者简易智力量表评分均有不同程度下降。结论丘脑不同动脉供血区梗死可引起不同的症候群,脑血管造影是对丘脑梗死患者血管评估的重要手段。     

双侧丘脑损害的神经影像学

丘脑损害临床多见,单侧丘脑损害以血管性病损多见;导致双侧丘脑损害的病因则较为复杂,本文就双侧丘脑损害的各类病因予以综述。     

颅脑损伤患者的神经心理学研究

颅脑损伤患者的神经心理学研究在国外已有多年的历史，中到重度颅脑损伤患者在神经心理方面存在损害，而关于轻度颅脑损伤患者是否存在神经心理损害的观点不一致。颅脑损伤患者的神经心理学变化与损伤的严重程度、损伤的不同侧或部位、精神症状、赔偿等多种因素有关。近年来出现了研究颅脑损伤神经心理的新工具，这使神经心理学有了进一步的发展。     

颅脑损伤患者的神经心理学研究

颅脑损伤患者的神经心理学研究在国外已有多年的历史 ,中到重度颅脑损伤患者在神经心理方面存在损害 ,而关于轻度颅脑损伤患者是否存在神经心理损害的观点不一致。颅脑损伤患者的神经心理学变化与损伤的严重程度、损伤的不同侧或部位、精神症状、赔偿等多种因素有关。近年来出现了研究颅脑损伤神经心理的新工具 ,这使神经心理学有了进一步的发展     

丘脑卒中的神经心理研究

目的：探讨丘脑卒中后神经心理学改变,特别是记忆功能和言语的变化。方法：通过ＣＴ或ＭＲＩ确诊的丘脑卒中病人６４例。经侧性优势检查及分为优势侧丘脑卒中３６例,非优势侧２８例,并设对照组１８例,采用失语检查法、ＷＭＳ、ＳＤＳ和ＭＭＳＥ进行检查、对照相关分析。结果：优势侧丘脑卒中病人ＷＭＳ各项分测验成绩及ＭＱ与对照组比较言语视觉的记忆均有显著性。非优势侧丘脑卒中病人的ＭＱ与对照组比较有显著性,其中主要以图     

丘脑下侧动脉变异型的影像学(MRI)观察

目的 从MRI影像学角度对双侧丘脑梗死进行分析,探讨国人丘脑下侧动脉及结节动脉是否存在亚型.方法 对114例确诊为丘脑梗死患者的MRI影像学表现按照传统标准进行分型,并对单侧及双侧梗死在传统分型中所占的比例进行分析.结果 在114例丘脑梗死患者中,80例(70%)符合丘脑梗死区域传统分型,丘脑前部区域梗死、丘脑旁中央区域梗死和丘脑下侧区域梗死中,双侧与单侧梗死的比例分别为:1/4,1/4,1/3;丘脑后部区域未见双侧梗死灶.34例(30%)患者丘脑梗死分布位于传统分型区域之外.结论 支配丘脑不同区域的相关血管存在变异可能是丘脑双侧对称性梗死的重要原因.

Abstract：

Objective To analyze the bilateral thalamic infarction from the point of view of MRI imaging and to find out whether inferolateral and tuberothalamic artery had variant subtypes in the Chinese. Methods We classified the MRI imagings of 114 cases diagnosed as thalamus infarction according to the classical anatomical standards and analyzed the proportion of unilateral and bilateral infarct. Results Eighty patients ( 70% ) had the thalamus lesions in accordance with traditional classification among the 114 patients and the other 34 cases (30%) had the lesions outside the classical territories.In the groups of anteromedian, central, and posterolateral infarcts of the thalamus, the ratio of bilateral and unilateral infarct was 1/4,1/4 and 1/3, respectively. Conclusion The bilateral thalamic infarct is probably the result of a variation in the related thalamic supplying arteries.     

丘脑梗死所致单纯丘脑手的临床特点(附8例分析)

目的认识丘脑手临床表现的特征;探讨丘脑梗死所致的单纯丘脑手的发病机理、影像学特点、诊断要点及治疗原则。方法 2004年2月至2008年7月表现单纯单手不自主运动的患者8例,均进行了神经系统检查、头部MRI检查及K-F环、风湿三项、血沉、血脂、血糖、肝功能、肝脏B超等检查。结果 8例患者单手不自主运动均符合丘脑手的临床诊断;头部MRI示患肢对侧丘脑腹外侧核处4mm～10mm腔隙性梗死灶。按丘脑腔梗治疗,并针对丘脑手加用氯硝安定治疗。8例患者分别于20～30d,丘脑手临床表现消失。结论丘脑梗死所致单纯丘脑手多只累及手指运动障碍,病灶侧丘脑腹外侧核的后核或背核为责任病灶区。头部MRI敏感性高,可明确单纯丘脑手的病灶。病因治疗加氯硝安定治疗,可达到治愈标准。     

Two cases of thalamic infarction presenting with thalamic astasia]

We report two cases of so-called 'thalamic astasia', associated with thalamic infarction. A 76-year-old-man suddenly noted to fall down to the left side without severe hemiparesis. An MRI showed an infarction in the superolateral portion of the right thalamus. Over eight weeks, his astasia gradually disappeared. A 69-year-old-man suddenly noted inability to stand with loss of balance. He showed mild hemiparesis, hypesthesia and cerebellar signs on the right side. Although right hemiparesis was slight, he was unable to stand by himself. An MRI demonstrated an infarction in the ventrolateral to ventroposterior portion of the left thalamus. Three weeks later, his symptoms except for cerebellar ataxia remarkably disappeared. The overlapped MRI lesions of these two cases were localized in the ventrolateral thalamus, such as Vimi (nucleus ventrointermedii internus), Vci (nucleus ventrocaudalis internus), Cemc (nucleus centralis thalami magnocellularis). These lesions are so-called 'vestibular thalamic nuclei', in which fibers from vestibulocerebellum are terminated. Involvement of the thalamic connectivity explains that two patients noted inability to stand. Thus we concluded that these two patients had thalamic astasia, described by Masdeu and Gorelick.     

Amnesia in thalamic infarction

Restricted thalamic infarctions are in man a useful model for investigating the consequences of limited diencephalic lesions on memory and verbal or visual learning. Two new cases of amnesia with thalamo-sub-thalamic infarctions are presented, with a general review of the problem. The gathering of the different cases according to the vascular thalamic territories and, as a consequence, to nuclear or associative structures concerned, allows a better approach of the relations between amnesia and infarctions. Uni or bilateral anterior lesions are the cause of more important and pure memory deficits, posterior infarctions are more often associated to language involvement or spatial cognitive problems which interfere with memorizing.     

Occurrence of thalamic high frequency oscillations in patients with different tremor syndromes

Objective

To assess whether high frequency oscillations (HFOs, >150?Hz), known to occur in basal ganglia nuclei, can be observed in the thalamus.

Cheiro-oral-pedal syndrome in thalamic infarction

Sensory disturbance around the corner of the mouth, in the palm of the hand and in the foot on the same side (cheiro-oral-pedal syndrome) has been reported only in 2 patients with brainstem lesion. We report 2 cases of cheiro-oral-pedal syndrome; the causative lesion was revealed by magnetic resonance imaging to be in the ventral posterolateral and ventral posteromedial nuclei of the thalamus.     

Peduncular hallucinosis associated with posterior thalamic infarction

Summary Peduncular hallucinations are generally associated with lesions of the midbrain. We describe a 68-year-old man who developed left hemiparesis, paraesthesias on the left side and vivid visual hallucinations, suggesting peduncular hallucinosis. MRI demonstrated a right posterior thalamic infarct as the sole lesion.     

Bilateral paramedian thalamic infarction with hypothalamic dysfunction

Unilateral thalamic lesions cause transient or permanent behavioral, sensory and oculomotor disturbances; bilateral lesions of thalamus result in more severe and longer lasting symptoms. We present an atypical case of bilateral paramedian thalamic infarct with concomitant hypothalamic dysfunction. The only risk factor of ischaemic stroke found in the patient was a short lasting episode of atrial fibrillation. Bilateral paramedian thalamic infarcts may result from occlusion of one paramedian thalamic artery, which arises from the posterior cerebral artery, either with separated or with a common trunk, thus supplying the thalamus bilaterally. Independently of anatomical variants of thalamus blood supply, the most probable cause of infarct in our patient was unilateral or bilateral occlusion of the posterior cerebral artery by cardioembolism, probably in the course of basilar artery occlusion. Hypothalamic dysfunction may accompany thalamic infarcts; thus hypothalamo-pituitary function should be routinely assessed in bithalamic infarcts.     

不同部位重型脑梗死患者肠黏膜屏障功能变化研究

目的探讨不同部位重型脑梗死(脑干梗死、半球大面积梗死)患者肠黏膜屏障变化。方法选取重型脑梗死患者共56例,(脑干梗死22例,半球大面积梗死34例),分别于患病后24h、72h、1w及2w采集空腹静脉血,同时选取同期门诊健康体检者30例作为对照,抽取空腹静脉血,采用双抗体夹心ELISA法测定血清二胺氧化酶(DAO)、D-乳酸(D-LAC)检测含量。结果无论半球大面积梗死还是脑干梗死,患者在患病后很快出现肠黏膜屏障功能的改变,在患病24h达较高水平,随后的72h、1w及2w血清D-LAC及DAO持续高水平,2组患者于2w后呈降低趋势,但仍高于对照组。结论无论半球大面积脑梗死还是脑干梗死,患者患病后24h内即可出现黏膜屏障功能损伤,2组患者肠黏膜屏障功能损伤可持续2w或更长时间。