急性CO中毒后迟发性脑病的临床与CT,MRI表现

目的 探讨急性CO中毒后迟发性脑病的临床与CT，MRI表现。方法对18例急性CO中毒后迟发性脑病患者的临床、头颅CT，头颅MRI结果进行回顾性分析。结果本组18例均有智能障碍，8例精神症状，5例大小便失禁，2例癫痫大发作。脑电图异常15例，表现弥漫性慢波。16例头颅CT表现为脑室周围白质和半卵园中心双侧对称性的融合性病灶呈边缘模糊的低密度影。12例MRI检查，病灶均位于大脑皮质下、侧脑室旁白质或／和基底节区。结论急性CO中毒后迟发性脑病早期进行CT，MRI检查有利于病情分析和预后判断。     

颅脑外伤后迟发性硬膜外血肿的CT诊断

目的探讨反复头颅CT检查诊断迟发性硬膜外血肿的重要性及其检查指征。方法回顾性总结7例发生迟发性硬膜外血肿的颅脑外伤患者的病情发展及头颅CT检查情况。结果7例颅脑外伤患者均有明显的迟发性精神行为改变，发生时间为伤后4—52h，CT复查均发现了迟发的硬膜外血肿。有5例患者出现了颅骨骨折，5例患者有顽固的剧烈头痛，恶心,、呕吐加重患者3例，偏侧瞳孑L扩大患者2例，意识障碍及抽搐患者各1例。结论颅脑外伤患者即使首次头颅CT扫描正常或轻度异常，若有颅骨骨折和（或）精神行为改变时，应复查CT以及时发现迟发性的硬膜外血肿。     

缺氧性脑病16例报告

目的　探讨缺氧性脑病的临床特征。方法　回顾分析 16例缺氧性脑病的病因、主要临床表现、磁共振成像 (MRI)结果、治疗方法及疗效。结果　 16例均有明确的脑缺氧病史。临床主要表现意识障碍、锥体外系症状、锥体束征、精神症状、智能减退及去皮层综合征 ,部分病人呈迟发性脑病表现。头颅MRI检查主要见两侧基底节区对称性异常信号 ,呈长T1长T2 改变。本组多数病人经对症、神经营养、改善脑循环、高压氧仓等治疗 ,脑受损症状基本消失或好转。结论　认识缺氧性脑病有助于该病得到及时合理的治疗 ;头颅MRI检查对缺氧性脑病有重要诊断价值。     

迟发性外伤性硬脑膜外血肿的诊断与治疗(附78例报告)

目的 探讨迟发性外伤性硬脑膜外血肿（DEDH）的病因、诊断、治疗方法及效果。方法对78例DEDH患者按照伤后初期头颅CT检查至CT复查明确诊断为止，共划分为5个时间段（〈6h、7-12h、13～24h、25-48h、〉49h），并分别比较术前诊断、术中诊断与术后诊断DEDH的治疗结果。结果6～24h内明确诊断者共60例，占全组76．9％（60/78）；伤后12h内44例，占全组56．4％（44/78）。术中诊断出迟发性血肿病例的死亡率（37．5％，3/8）高于术前（14．3％，6/42）与术后（21．4％，6/28）诊断出迟发性血肿病例的死亡率，但没有统计学差异。结论DEDH多见于伤后24h内，特别是在伤后12h内的病例占全组病例数半数以上（56．4％，44/78）。其发病机理尚未完全明了，但与血管舒缩机制障碍、低血压、低氧血症及开颅减压术后失去“填塞效应”的作用有一定关系。术中发生的DEDH常诊断困难，且死亡率也明显增高。外伤后CT动态检查协助医生能作出及时诊断与处理，也是降低患者死亡率与伤残率的关键。     

急性一氧化碳中毒及迟发性脑病的临床与MRI

目的探讨急性一氧化碳中毒(ACOP)及迟发性脑病(DEACMP)患者的临床表现与头颅MRI特点。方法对ACOP 564例、DEACMP 102例患者均行头颅MRI及DWI检查,急性期患者在入院后48h内进行检查,DEACMP在临床出现异常表现后即行头颅MRI检查。结果 ACOP患者临床表现及MRI表现可分为3型:①苍白球受累型;②弥漫性脑肿胀型;③大脑皮质及白质受累型。DEACMP患者临床表现及MRI表现可分为5型:(1)脑白质受累型;(2)基底节受累型;(3)枕叶皮层受累型;(4)小脑半球受累型;(5)多灶型。结论 ACOP及DEACMP的MRI表现既有相同点又有区分点,临床应加以区分,并依据MRI的表现作出不同诊断与治疗。并报道了CO中毒并发皮质盲12例及持续低热3例。     

迟发性外伤性颅内血肿临床分析

目的：探讨迟发性外伤性颅内血肿患的临床特点,以提高疗效。方法：回顾分析1998年1月-2000年7月收治的17例迟发性外伤性颅内血肿患的临床资料,其中脑内血肿9例,硬膜外血肿5例,硬膜下血肿3例。结果：的17例迟发性外伤性颅内血肿患中,经治疗恢复良好9例,中残4例,重残2例,死亡2例。结论：迟发性外伤性颅内血肿的发生同外伤部位、脑挫伤、颅骨骨折等因素有关。降低迟发性外伤性颅内血肿的死亡率和致残率的关键的于及时诊断和及时治疗。     

有机磷农药中毒后迟发性神经病45例临床分析

目的 探讨有机磷农药中毒后迟发性神经病的发病机制及临床分型。方法 回顾45例迟发性神经病发生的时间、症状和体征，结合辅助检查，进行系统分析。结果 45例迟发性神经病中，纯运动型占35．6％，感觉运动混合型占60％，吉兰-巴雷综合征型占4．4％。结论 迟发性神经病经积极治疗，远期预后良好，其发病机制是多种因素共同作用的结果。     

脑卒中后继发性癫癎的临床分析

脑卒中后继发性癫癎临床较常见，目前临床按首次卒中后癫癎初次发作时间，将其分为早发性（2周内）和迟发性（2周后）两种。我院近年来共收治急性脑卒中患者562例，全部患者经头颅CT、MRI或腰椎穿刺检查，均符合脑血管病的分类及诊断标准，其中出现继发性癫癎42例（7．47％），现就其临床特点及治疗情况分析如下。     

外伤性迟发性面神经麻痹12例临床分析

目的探讨外伤性迟发性面神经麻痹的临床特点及治疗效果。方法回顾性分析我科近两年来收治的12例外伤性迟发性面神经麻痹患的临床资料。患一般采用理疗、高压氧、激素、神经生长因子和中药等治疗。结果经随访6个月，12例典型面神经麻痹患保守治疗，均在两周至四个月时间内逐渐恢复。结论外伤性迟发性面神经麻痹有典型的临床特点，易诊断，经保守治疗效果良好。     

脑外伤后迟发性脑梗塞患者急性期纤溶状态研究

目的初步探讨脑外伤后迟发性脑梗塞患者急性期血浆及脑脊液凝血纤溶状态变化,为临床脑外伤后迟发性脑梗塞提供诊治依据。方法脑外伤后迟发性脑梗塞患者72例,采集血浆,同时采集脑脊液,测定脑脊液及血浆部分凝血纤溶指标,并与171例脑外伤后无脑梗塞患者对照进行比较。结果脑外伤后迟发性脑梗塞组(实验组)脑脊液及血浆组织型纤溶酶原激活物(t-PA)、D-二聚体(D-D)含量明显高于非脑梗塞组(对照组)(P<0.01)而纤溶酶原(PLG)活性明显下降(P<0.01)。结论脑外伤后迟发性脑梗塞患者急性期存在明显的高凝状态和继发性纤溶活性增高。     

鼻咽癌放疗后放射性脑病的临床表现与MRI对照分析

作者对８４例鼻咽癌放疗后放射性脑病进行了研究。（１）ＲＥＰ的首发症状，多以颞叶受损的精神症状和癫痫；脑干受损的锥体束征和颅神经症状为首发症状。（２）各型ＲＥＰ的临床表现特点，按病程可分为：早期反应阶段，病情静止阶段和延迟反应阶段。（３）ＲＥＰ的ＭＲＩ表现与临床症状关系。本组ＲＥＰ有９．５％没有临床症状，ＲＥＰ的诊断，仅凭临床表现诊断是有限的。ＣＴ显示颞叶病变多无困难，但要显示脑干和小脑的病变，需行     

Holoprosencephaly and diabetes insipidus in a 3-month-old infant

Holoprosencephaly is a developmental defect caused by incomplete cleavage of the embryonic forebrain structures during early embryogenesis. We describe a 3-month-old boy with median cleft palate, surgically reconstructed cleft lip, hypotelorism with a flat nose, cryptorchidism, clubfoot, and microcephaly. During the laboratory investigation, his blood sodium level was 154 mmol/L and urine specific gravity was 1.007. Serum osmolarity was 317 mOsm/kg and urine osmolarity was 268 mOsm/kg. Given these findings and the clinical response to vasopressin, diagnosis of central diabetes insipidus was made. Magnetic resonance imaging revealed semilobar holoprosencephaly. The patient responded very well to vasopressin treatment with restoration of serum electrolytes, which remained within normal limits on follow-up. In case of midline facial defects accompanied by hypotelorism with or without developmental delay, the brain should be imaged to confirm its morphology and investigations should be directed by a high index of suspicion of associated endocrinologic dysfunctions.     

Primary hypothalamic lymphoma in a patient with systemic lupus erythematosus: case report and review of the literature

A 67-year-old female was admitted to our department with difficulty in speech, disorientation, memory loss and seizures. Blood laboratory tests revealed diabetes insipidus. This patient had been treated with steroids for systemic lupus erythematosus (SLE) for 30 years. Due to this treatment neurological symptoms had been understated causing a long delay in performing ulterior researches. A brain MRI revealed a mass lesion in the hypothalamic area. A biopsy was performed and histopathological diagnosis was malignant large B cell lymphoma. Subsequently, she received methotrexate therapy but died of pneumonia during the second cycle. Primary central nervous system lymphoma in association with SLE is a rare occurrence but it should be considered in the diagnostic process when neurological symptoms occur. A brain MRI must be performed and corticosteroids should be interrupted. A biopsy of the cerebral mass lesion permits diagnosis and appropriate therapy may be administered.     

50例肝豆状核变性临床分析

目的探索肝豆状核变性的临床特点,为早期诊断提供依据。方法我院1988～2008年收治的50例肝豆状核变性患者,对其临床表现,实验室检查及CT和MRI检查进行分析。结果铜代谢异常损害以肝脑为主。结论青少年患者以肝硬化、贫血、骨骼畸形、锥体外系损伤临床表现为首发症状,无常见病因可寻,应考虑到本病的可能,尽早进行检查,以便能早期确诊及时治疗。     

Central diabetes insipidus in children with acute brain insult

Central diabetes insipidus occurs in patients with overwhelming central nervous system injuries, and may be associated with brain death. The clinical picture of children with acquired central diabetes insipidus after acute brain insult is seldom reported. We retrospectively reviewed cases dating from January 2000-February 2008 at a tertiary pediatric intensive care unit. Fifty-four patients (28 girls, 26 boys), aged 3 months to 18 years, were enrolled. Etiologies included severe central nervous system infection (35.2%), hypoxic-ischemic events (31.5%), head injury (18.5%), and vascular lesions (14.8%). In 39 (72.2%) patients, diabetes insipidus was diagnosed during the first 2 days after acute central nervous system injury, and 40 (74.0%) developed maximum serum sodium concentrations of >160 mEq/L. In 16, sequential cerebral salt wasting syndrome developed after their initial diabetes insipidus presentation. Overall mortality at 2 months after admission was 77.8%. Our results demonstrate that patients who develop central diabetes insipidus after acute central nervous system injury manifest high mortality. Development of central diabetes insipidus within the first 2 days and a maximum plasma sodium >160 mEq/L were significant predictors of outcomes.     

中枢性低钠血症的诊断和治疗(附128例报告)

目的探讨中枢性低钠血症的诊断和治疗。方法对我科收治的128例中枢性低钠血症患者的临床资料进行回顾性分析,根据临床症状、实验室检查、中心静脉压确定低钠的程度及类型并进行相应处理。结果128例中枢性低钠血症患者中,脑性盐耗综合征(CSWS)患者92例,占71%(92/128),其中伴随尿崩症(DI)占22%(20/92),抗利尿激素分泌异常综合征(SIADH)患者36例,占29%(36/128),其中伴尿崩症4例,占11%(4/36)。除5例患者因原发性脑干损伤,在伤后6天内死亡,4例自动出院,其余患者的低钠血症得到纠正。结论中枢性低钠血症包括脑性盐耗综合征(CSWS)和抗利尿激素分泌异常综合征(SIADH)两种类型,CSWS患者发病率较SIADH患者高,同时CSWS患者常伴有DI。CSWS和SIADH临床表现相似,而处理原则相反,CSWS的治疗原则是以补盐、补水达到恢复血容量及维持钠的平衡为目的;SIADH的治疗原则是以限制水入量,降低血容量,使血钠恢复正常为目的。     

Delayed diagnosis of pediatric Langerhans' cell histiocytosis: case report and retrospective review of pediatric cases seen at Mayo Clinic.

Langerhans' cell histiocytosis is a disease of the dendritic histiocytes with a wide variety of clinical manifestations. This report describes a boy with Langerhans' cell histiocytosis who presented with primarily neurologic and endocrinologic findings, without pain. The diagnosis of Langerhans' cell histiocytosis was not made until 10 years after symptom onset. The pathology database at Mayo Clinic was searched for cases of Langerhans' cell histiocytosis between 1985 and 1999 under 19 years of age (65 children), and information regarding clinical presentation was abstracted. Database review found a range of 1 day to 156 weeks (mean 13.8 weeks) from symptom onset to diagnosis. No other patients with primarily neurologic symptoms were found. The diagnosis of Langerhans' cell histiocytosis was made significantly sooner after onset if pain was present (chi-square = 19.1, P < .001, two-tailed, phi coefficient 0.54). Our findings indicate that neurologic manifestations of Langerhans' cell histiocytosis are rare, and the combination of diabetes insipidus, ataxia, skin rash, or osseous pain should alert the clinician to the possibility of Langerhans' cell histiocytosis and avoid delayed diagnosis.     

创伤后迟发性脑肿胀的临床特点与治疗

目的 探讨创伤后迟发性脑肿胀的临床特点、发病机制与治疗。方法 回顾性分析1998年1月～2005年6月年收治的17例迟发性脑肿胀患者的临床特点和救治情况。结果 所有颅脑损伤患者采用保守治疗后均有好转，但于伤后5-10d出现恶化，CT复查有脑肿胀，经加强综合脱水等治疗后16例治愈，1例死亡。结论 迟发性脑肿胀好发于对冲性额、颞叶挫裂伤伴明显蛛网膜下腔出血、硬膜下薄层血肿及早期CT有脑肿胀者。其发病机制可能与创伤后的迟发性脑血管痉挛、微循环障碍、静脉回流障碍及甘露醇作用下降等因素有关。此类患者病情隐蔽性强，应加强观察、积极行CT复查，如能早期明确诊断，保守治疗多数效果良好。     

Germinoma in a boy with precocious puberty: evidence of hCG secretion by the tumoral cells

The present report concerns a 10-year-old boy in whom diabetes insipidus and short stature were the first manifestations of a suprasellar germinoma. Neuroradiological investigations performed when these symptoms appeared were negative. 2 years later, a rapid and early pubertal development was observed and related to secretion by the germinoma of human chorionic gonadotropin (hCG) identified immunohistochemically. This clinical evolution is unusual and indicates that plasma hCG measurements in patients with so-called idiopathic diabetes insipidus can be of clinical value in predicting the presence of an hCG-secreting tumor.     

孤立性眩晕起病的后循环缺血性脑卒中患者临床分析

目的 探讨后循环缺血性脑卒中的患者中最初仅表现为孤立性眩晕的患者的临床特点.方法 回顾性分析阜新市中心医院2018-08—2019-08以孤立性眩晕起病的后循环缺血性脑卒中患者13例,对13例以孤立性眩晕起病的后循环缺血性脑卒中患者的危险因素、临床表现、磁共振特点及预后进行回顾性分析.结果 13例患者的发病危险因素主要...