TCD、MRA对儿童脑血管烟雾病诊断的对比研究

目的探讨经颅多普勒超声(TCD)在儿童烟雾病的特征表现并与核磁共振(MRA)对照比较其诊断价值.方法对6例由MRA确诊为烟雾病患儿的TCD检查资料比较分析.结果 6例患者TCD获得的检测结果具有一定的特征性,TCD所测出的病变血管与MRA证实的病变部位基本符合. TCD与MRA对照分析结果:①MRA显示血管狭窄,TCD均见相应动脉血流速度增快;②MRA显示血管严重狭窄,TCD显示该血管血流速度减慢、血流频谱降低或无血流信号;③椎动脉系统因其与颈内动脉系统由后交通动脉相连,当颈内动脉系统出现狭窄闭塞,椎动脉系统血流代偿性增快,也为TCD所证实.结论 TCD作为一种无创的检查手段,可以对烟雾病患者的脑血流进行追踪观察.对于烟雾病的早期诊断,具有重要的临床意义,并且具有明显优势.     

磁共振血管成像和数字减影血管造影在烟雾病诊断中的应用

目的分析磁共振血管成像（MRA）和数字减影血管造影（DSA）影像表现与临床特点之间的关系,探讨对烟雾病（MMD）的诊断价值。方法回顾性分析30例烟雾病MRA和DSA表现,分析其临床和影像学特征。结果 MRA与DSA均发现颈内动脉、大脑前、中、后动脉狭窄或闭塞性病变;DSA对双侧病变检出率较MRA高,还可检测出基底动脉狭窄、椎动脉闭塞及动脉瘤,临床表现与MRA及DSA检测结果有不一致性。结论 MRA是烟雾病筛选诊断、随访的重要方法;临床表现与MRA不一致及疑似病例应及早进行DSA检查。     

磁共振FLAIR序列柔脑膜高信号对烟雾病的诊断价值

目的:探讨MR的FLAIR序列上柔脑膜的高信号(IVY征)对烟雾病的诊断价值及其形成原因.资料与方法:分析10例确诊为烟雾病患者的临床及MR(包括MR平扫及MRA)资料.结果:MR平扫上分别表现为横断面鞍上池层面没有看到完整的双侧大脑前动脉、中动脉,在相应区域看到不同程度的纤细的断续的线样、点样流空信号(T2WI明显)(10/10);双侧基底节区的细小的血管流空信号影(5/10);双额顶叶的FLAIR序列柔脑膜线样高信号(5/10);脑实质内缺血梗塞灶(1/10).MRA上表现为双侧颈内动脉末端(虹吸部)的狭窄或闭塞及双侧大脑前、大脑中动脉的程度不一的狭窄或闭塞;大脑后动脉增粗延长;MRA上细小的点条状烟雾血管(10/10).结论:烟雾病中FLAIR序列柔脑膜高信号(即IvY征)代表着柔脑膜的新生血管,是烟雾病较晚期阶段所形成的侧枝血管,它的存在对烟雾病的诊断有重要意义.     

彩色多普勒超声在椎动脉粥样硬化诊断中的研究进展

后循环缺血（PCI）是一种临床常见病和多发病,系指椎基底动脉系统短暂性脑缺血发作和脑梗死。椎动脉粥样硬化是PCI常见的病因之一。 PCI的影像学检查包括经颅多普勒超声（TCD）、数字减影血管造影术（DSA）、计算机控制体层摄影造影术（CTA）、磁共振血管造影术（MRA）及彩色多普勒超声（CDU）等。TCD可作为PCI的初步筛查工具,DSA是目前椎动脉疾病诊断的“金标准”;CTA和DSA同属有创检查,且都需要造影剂,不易被患者接受;MRA属于无创检查,但其可能夸大血管狭窄程度;CDU可较准确测量椎动脉内径及评价血流动力学参数,可作为PCI无创伤性的检查手段,具有直接、准确、方便及可重复性等优点,为PCI的明确诊断和疗效评价提供客观依据。就CDU在椎动脉粥样硬化患者诊断中的研究进展作一综述。     

经颅多普勒超声诊断颅内段后循环动脉狭窄或闭塞的应用价值

目的 探讨经颅多普勒超声（TCD）诊断颅内段后循环动脉狭窄或闭塞的敏感性和特异性.方法 选取颅内段后循环动脉狭窄或闭塞的患者72例,进行TCD和CT血管造影术（CTA）检查,并进行对比分析.结果 与CTA相比,TCD对颅内段后循环动脉检查的敏感性为82.50％,特异性为94.64％,阳性预测值为91.67％,阴性预测值为88.33％,准确性为89.58％.结论 TCD对颅内段后循环动脉病变的诊断特异性高,敏感性一般,其中对颅内段椎动脉的诊断准确性最高.TCD可作为颅内动脉病变的早期筛查手段.     

16层螺旋CT血管成像对Moyamoya病诊断价值（附30例报告）

目的探讨Moyamoya病的多层螺旋CT血管成像（CTA）临床应用价值。方法30例Moyamoya病病人,其中男性18例，女性12例，年龄14～62岁，平均年龄42．60岁。发病高峰中30～40年龄段为12例，40～50年龄段10例。做16层螺旋CTA，扫描参数为：250kV，250mA，螺距15，扫描层厚1mm。同时6例又行DSA检查，将其CTA结果与DSA图像进行比较。结果30例中病变累及颈内动脉者共27例，占总例数的90．0％，受累段均为颈内动脉末段。病变累及双侧者26例（占总例数86．7％）。30例CTA均清晰显示发生狭窄、闭塞的颈内动脉远端、大脑前中动脉近端及迂曲扩张的大脑后动脉、后交通动脉等代偿动脉，狭窄血管显示率100％；清晰显示脑底异常血管网者28例，异常血管网显示率93.3％。30例中有6例同时行DSA检查，两者检查结果完全一致。结论CTA可以清楚显示Moyamoya病脑血管改变特点，包括颅内血管狭窄及脑底异常血管网，可以考虑作为Moyamoya病诊断的重要影像学筛查方法之一。     

经颅多普勒超声诊断（续）

偏头痛TCD表现： （1）偏头痛发作期和间歇期脑动脉血流速度增快者多见，减慢者少见，血流速度异常改变多见于单侧或双侧MCA和（或）ACA。Thie 1990年提出偏头痛患者血流速度异常标准为MCAV。大于100cm／s。ACAVm大于90cm／s，PCAVm大于80cm／s。血流速度增快为血管紧张度增高（血管功能性狭窄）所致，血流速度减慢可能是血管张力减低，血管扩张的表现。     

90例短暂性脑缺血发作数字减影全脑血管造影分析

目的：通过数字减影全脑血管造影（DSA）检查,观察短暂性脑缺血发作（TIA）患者脑血管狭窄或闭塞的部位及程度。方法：采用DSA对90例TIA患者进行全脑血管造影检查,观察颈总动脉、颈内动脉和椎基底动脉颅内、颅外段血管有无狭窄以及狭窄部位,并判断血管狭窄程度。结果：本组90例,血管造影正常18例、烟雾病2例、血管狭窄或闭塞70例。血管狭窄或闭塞70例中,颈动脉系统受累36例（51．4％）,椎基底动脉系统受累12例（17．1％）,锁骨下动脉受累2例（2．9％）,颈动脉系统和椎基底动脉系统同时受累有20例（28．6％）。颈动脉系统中以颈内动脉起始段和大脑中动脉M1段受累最为常见,椎基底动脉系统中以椎动脉开口处受累最为常见。结论：脑血管狭窄是TIA的主要病因,DSA可以明确TIA患者血管狭窄的部位及程度,对了解TIA的病因、指导有效治疗起重要作用。     

33例烟雾病的临床与MRA表现分析

目的 探讨烟雾患者的临床与MRA表现特征。方法 对33例烟雾病患者的临床及MRA资料进行全面的分析总结。结果 未成年患者以缺血性脑卒中为主要表现，成年患者以出血性脑卒中为主要表现，全部患者颈内动脉或分支均有狭窄或闭塞及异常血管形成，最常见的临床表现为脑卒中和头痛。结论 对于年轻患者反复头痛、有卒中史者，成年患者有脑出血史，MRI有异常血管信号者，可采用MRA技术除外烟雾病。     

血管狭窄与中老年椎基底动脉供血不足的关系探讨

目的探讨血管狭窄与中老年椎基底动脉供血不足(VBI)的关系。方法临床拟诊的125例VBI患者,采用Innova 2000全数字平板血管减影机(美国产)进行双侧椎动脉、颈内动脉颅内及颅外段正侧处投照,测量血管狭窄程度分布,比例。结果69例存在颈及颅内动脉狭窄或闭塞,51例患者中有两处或两处以上血管狭窄。单纯前循环病变分布中颈内动脉狭窄共7例,狭窄病变有11处。后循环病变分布中左侧椎动脉狭窄30例;右侧椎动脉狭窄26例,双侧椎动脉同时受累19例。结论脑血管狭窄是中老年患者VBI的重要原因。     

小儿颅脑疾病与头颅计算机断层成像术

目的 探讨头颅ＣＴ检查在小儿颅脑疾病诊断中的重要意义。方法 以３７０例头颅ＣＴ异常的非外伤性病变的患儿为研究对象,按疾病增将其归类、比较、分析,从中揭示其关系。结果 各类癫痫的主要ＣＴ改变是脑萎缩,脑软化次之;小儿颅脑肿瘤以幕下、中线部位多见,颅高压征出现象,定位体征少见,易于误诊;新生儿颅脑损伤发病率高,头颅ＣＴ检查得于新生儿缺氧缺血性脑病和新生儿颅内出血的诊断。结论 头颅ＣＴ是小儿颅脑疾病的首选检查方法,安的应用使颅脑疾病的诊断水平明显提高。     

小儿颅脑疾病与头颅计算机断层成像术

目的探讨头颅CT检查在小儿颅脑疾病诊断中的重要意义.[ BF] 方法以370例头颅CT异常的非外伤性病变的患儿为研究对象,按疾病增将其归类、比较、分析,从中揭示其关系.结果各类癫痫的主要CT改变是脑萎缩,脑软化次之;小儿颅脑肿瘤以幕下、中线部位多见,颅高压征出现晚,定位体征少见,易于误诊;新生儿颅脑损伤发病率高,头颅CT检查利于新生儿缺氧缺血性脑病和新生儿颅内出血的诊断.结论头颅CT是小儿颅脑疾病的首选检查方法,它的应用使颅脑疾病的诊断水平明显提高.     

Cerebral ganglioglioma

Summary The morphological characteristics of neurons revealed by Golgi's method are reported in a case of cerebral ganglioglioma.Spindle-shaped (leptodendritic) neurons and radiated type I neurons form the bulk of this tumour. According to Ramon-Moliner (1968) isodendritic neurons (both leptodendritic and radiate type I) are philogenetically primitive cells and differ greatly from those observed in most of the deep cerebral nuclei of the mammalian's brain.     

Cerebral neuroblastoma

Summary A cerebral neuroblastoma removed surgically from a female child is presented. Electron microscopy showed numerous neuronal processes with growth cones which are a feature of the developing neurone. In addition there were some rosettes with distinct lumina. The luminal surfaces were covered with a smooth plasma membrane lacking any surface differentiation and the lateral surface of these cells had many cell junctions (terminal bars), reminiscent of a primitive neural tube. These features in a nerve cell tumor help to substantiate it as a neuroblastoma arising from immature rather than differentiated cells.The nature of this rare tumor is discussed.     

Cerebral malaria

Cerebral malaria is a rapidly progressive potentially fatal complication of Plasmodium falciparum infection. It is characterized by unarousable and persistent coma along with symmetrical motor signs. Children, pregnant women and non-immune adults are more susceptible to have cerebral malaria. Several clinical, histopathological and laboratory studies have suggested that cytoadherence of parasitized erythrocytes (mechanical hypothesis), and neuronal injury by malarial toxin and excessive cytokine (e.g. tissue necrosis factor-alpha) production (cytotoxic hypothesis) are possible pathogenic mechanisms. Several associated systemic complications like hypoglycemia, hypovolemia, hyperpyrexia, renal failure, bleeding disorders, anemia, lactic acidosis and pulmonary oedema may contribute in the pathogenesis of coma, and are responsible for high mortality. The meticulous supportive care along with intravenous administration of antimalarial drugs are corner-stone of the treatment. Quinine is currently, drug of choice. Artimisinin derivatives are equally effective and can be used by intramuscular route. In severe cases exchange blood transfusion may be an effective alternative. Corticosteroids has no place in the management of cerebral malaria. The occurrence of convulsions are common in children, these can be prevented with the use of single intramuscular administration of phenobarbitone. Despite advances in the management mortality and morbidity have not changed much. A large number of surviving patients are left with permanent neurological sequelae. There is a need to search for effective malaria prevention and interventional strategies to avert high mortality and morbidity associated with cerebral malaria.     

Cerebral vasospasm

Cerebral vasospasm (specifically, intracranial arterial spasm) is variously defined as: (1) an arteriographically evident narrowing of the lumen of one or more of the major intracranial arteries at the base of the brain due to contraction of the smooth muscle within the arterial wall, or due to the morphological changes in the arterial wall and along its endothelial surface that occur in response to vessel injury; (2) the delayed onset of a neurological deficit following subarachnoid hemorrhage, thought to be due to ischemia or infarction of a portion of the brain; or (3) the combination of these two features (symptomatic vasospasm). The arterial contraction of intracranial arterial spasm typically develops a few days after the rupture of an intracranial aneurysm and lasts 2 to 3 weeks. Such arterial spasm can also occur in other conditions such as head trauma. If it is severe enough it can lead to cerebral infarction. The pathogenesis of this condition is still unclear. Many ingenious attempts have been made to prevent or treat cerebral vasospasm, but most have failed. The best current approach is to ensure adequate blood volume, and to elevate the patient's blood pressure (especially if the aneurysm has been secured by an early operation). The continuing investigation of drugs such as calcium channel blocking agents to improve the cerebral circulation has begun to provide additional help.