椎-基底动脉扩张延长症的FLAIR血管高信号与后循环脑卒中的相关分析

目的探讨椎-基底动脉扩张延长症(VBD)患者的头磁共振FLAIR序列血管高信号征(FVH)与后循环血流、管径、动脉弹性的相关研究。方法收集2014年10月~2016年12月在辽宁省金秋医院住院,年龄≥65岁,经MRI和MRA检查确诊VBD患者46例,依据临床表现和磁共振弥散成像的检查结果诊断为后循环脑梗死,分为梗死组(27例),无梗死组(19例)。对两组患者的MRI图像基底动脉FVH等级与动脉直径、血管形态、经颅彩色多普勒血流速度及动脉弹性进行统计分析。结果 FVH在老年VBD患者的发生率为60.9%。VBD患者梗死组S型基底动脉较无梗死组多,两组存在统计学差异(χ~2=4.207,P=0.043)。基底动脉FVH征与血流平均速度、动脉搏动指数存在正相关(r分别为0.431、0.469,均P0.05),中重度的FVH征(FVH≥2级)与基底动脉直径(r=0.506,P0.05)弱相关。影像学上基底动脉FVH达到2级以上的梗死组较无梗死组在动脉管径更大、平均血流速度更慢,差异存在统计学意义(t=2.330,P=0.035;t=2.245,P=0.041)。结论 FVH征在VBD患者中出现率高。FVH征达到2级以上的VBD患者,预示基底动脉平均动脉血流速度(MFV≤20 m/s)减慢、动脉直径增大,提示发生后循环脑卒中的风险增大。     

后循环脑梗死的影响因素与生存状况研究

目的探讨后循环脑梗死的影响因素与生存状况。方法选取我院2013-06—2015-06收治的304例急性脑梗死患者,按梗死部位分为前循环脑梗死组158例和后循环脑梗死组146例,分析临床资料与后循环脑梗死的关系。结果后循环脑梗死组和前循环脑梗死组合并糖尿病、房颤、总胆固醇(TC)、甘油三酯(TG)和空腹血糖(FBG)水平比较有显著性差异(P0.05)。Logistic回归分析显示,合并糖尿病、房颤,TC、TG和FBG水平是后循环脑梗死的独立危险因素。146例后循环脑梗死患者入院30d时,预后良好者88例(60.27%),严重致残者51例(34.93%),死亡7例(4.79%)。结论合并糖尿病、房颤,TC、TG和FBG水平是后循环脑梗死的独立危险因素,短期预后良好。     

颅内未破裂动脉瘤介入术后微小脑梗死灶形成的危险因素分析

目的 探讨颅内未破裂动脉瘤(unruptured intracranial aneurysms,UIA)介入术后微小脑梗死形成的危险因素。方法 将238例经血管内介入弹簧圈栓塞的颅内UIA患者介入术后行核磁共振平扫检查,并根据检查表现分为无微小脑梗死灶组150例和有微小脑梗死灶组88例,对其临床资料进行回顾性分析; 采用χ²检验、t检验及logistic回归分析UIA介入术后微小脑梗死灶形成的危险因素。结果 UIA介入术后微小脑梗死灶的患者有37%,其中3%的微小脑梗死患者有相应的临床症状。Logistic回归分析显示2组患者年龄(P<0.001)、高血压病史(P=0.023)、糖尿病史(P=0.048)、脑卒中病史(P<0.001)及手术时间(P=0.007)是UIA介入术后微小脑梗死灶发生的危险因素。结论 年龄、高血压病、糖尿病、脑卒中病史及手术时间是UIA介入术后微小脑梗死灶形成的危险因素。     

急性单发腔隙性脑梗死患者BG/CSO-VRS扩大严重程度的危险因素分析

目的 探讨急性单发腔隙性脑梗死患者基底节(basal ganglia,BG)/半卵圆中心(central semioval,CSO)-血管周围间隙(Virchow-Robin Spaces,VRS)扩大严重程度的危险因素。方法 回顾性分析本院2018年1月-2019年3月收治急性单发腔隙性脑梗死患者共476例的临床资料,其中基底节(BG)梗死262例,半卵圆中心(CSO)梗死214例,根据影像学手段评估BG/CSO-VRS扩大严重程度; 采用χ²检验和Logistic回归模型分析确定BG/CSO-VRS扩大严重程度的相关危险因素。结果 基底节和半卵圆中心梗死VRS评分比较无显著差异(P>0.05); BG-VRS轻度扩大和重度扩大患者性别、高血压病比例、收缩压及BMI水平比较有明显差异(P<0.05); CSO-VRS轻度和重度扩大患者高血压病、糖尿病比例及BMI水平比较有明显差异(P<0.05); 采用多因素Logistic回归模型分析显示,高血压病和BMI均是BG-VRS扩大严重程度的独立影响因素(P<0.05),而BMI也是CSO-VRS扩大严重程度的独立影响因素(P<0.05)。结论 高血压病和BMI与急性单发腔隙性脑梗死患者VRS扩大密切相关,其中合并高血压病和BMI降低是导致BG-VRS扩大的独立危险因素,而BMI降低也是CSO-VRS扩大的独立危险因素     

急性脑梗死尿激酶静脉溶栓后24h内缺血加重的影响因素分析

目的探讨急性脑梗死经尿激酶静脉溶栓后24 h内缺血加重的影响因素。方法纳入119例经尿激酶静脉溶栓的急性脑梗死患者进行回顾性队列研究,根据24 h内是否出现缺血加重,分为加重组(NIHSS评分增加≥2分)26例及非加重组93例,比较2组临床资料,采用Logistic回归分析24 h内缺血加重的影响因素。结果单因素Logistic回归分析发现,责任血管中重度狭窄/闭塞、溶栓前高NIHSS评分是影响缺血加重的危险因素(均P0.05)。多因素Logistic回归分析显示,男性(OR=6.224,95%CI=1.303～29.921,P=0.022)、责任血管中重度狭窄/闭塞(OR=6.326,95%CI=1.910～20.947,P=0.003)是尿激酶静脉溶栓后24 h内缺血加重的危险因素。结论尿激酶静脉溶栓后24 h内早期缺血加重多见于男性及大动脉粥样硬化型的脑梗死患者。     

腔隙性脑梗死并发卒中相关性头痛的危险因素分析

目的 分析卒中相关性头痛(stroke-associated headache,SH)在腔隙性脑梗死患者中发生的危险因素和探讨可能的发病机制.方法 从南京卒中注册系统中提取首次发病的腔隙性脑梗死患者371例,分析录入信息中的人口学因素、卒中危险因素、临床表现和影像学检查,并通过多因素Logistic回归分析sH危险因素.结果 51例患者合并SH,发生率为13.7%;性别、年龄、糖尿病、偏头痛病史、前后循环分布以及中脑位置的梗死在SH组与无SH组对比中有统计学差异(P＜0.05),然后通过多因素Logistic逐步回归分析后发现女性、偏头痛病史、后循环以及中脑位置的梗死是腔隙性脑梗死患者并发SH的独立危险因素.结论 对腔隙性脑梗死的危险因素分析不但对临床诊疗提供帮助,而且对探讨SH的发生机制有重要意义.     

脑梗死患者颅内大动脉狭窄相关危险因素分析及介入治疗效果观察

目的分析脑梗死患者颅内大动脉狭窄相关危险因素及介入治疗效果。方法以我院2012-01—2014-12收治的120例脑梗死患者为研究对象,其中颅内大动脉狭窄(观察组)80例,无狭窄(对照组)40例,收集2组患者临床资料(年龄、性别、高血压病史、糖尿病史、高Hcy血症),单因素及Logistic回归分析颅内大动脉狭窄危险因素,评价介入治疗效果。结果单因素及Logistic多因素回归分析发现,糖尿病、高Hcy血症是脑梗死颅内大动脉狭窄的独立危险因素。观察组血管内支架介入治疗均1次置入成功,血管狭窄减少80%以上者占91.3%,并发症发生率2.0%,为上消化道出血;随访5个月,无复发,且无新的脑梗死病灶出现。结论脑梗死颅内大动脉狭窄独立危险因素为糖尿病、高Hcy血症,且血管内支架介入治疗颅内大动脉狭窄疗效明确,并发症少。     

脑梗死患者伴脑白质疏松症的相关危险因素及与脂蛋白相关磷脂酶A2相关性的研究

目的 探讨脑梗死患者伴脑白质疏松症(LA)的相关危险因素及与脂蛋白相关磷脂酶A2( LP - PLA2)的相关性.方法 选取178例脑梗死患者,依其影像学表现将其分为脑梗死合并LA组(83例)和脑梗死不合并LA组(95例),对比分析两组的Lp-PLA2含量以及临床、辅助检查指标.结果 (1)脑梗死患者共178例,LA的发病率46.63％.(2)单因素分析结果显示:在LA例组和无LA组年龄、Lp-PLA2、高血压病史及腔隙性脑梗死之间的差异具有统计学意义;多因素Logistic回归分析结果筛选出3个具有统计学意义的指标:Lp-PLA2、年龄和腔隙性脑梗死.(3)性别、糖尿病史、高脂血症、吸烟史、饮酒史、冠心病史及脑血管狭窄发生率在LA组和无LA组的差异无统计学意义.(4)两组高脂血症患者的LDL、甘油三脂、胆固醇水平及两组糖尿病患者的空腹血糖值差异无统计学意义,脑血管狭窄分为单纯前循环病变、单纯后循环病变及前后循环均有病变后,两组间构成比差异无统计学意义.结论 年龄、Lp-PLA2、腔隙性脑梗死是LA独立的危险因素.颅内外大血管狭窄与LA无确切的相关性.高血压是LA重要的危险因素.糖尿病、高血脂、吸烟史、饮酒史、冠心病史是LA和缺血性脑卒中的共同危险因素.     

静脉溶栓桥接机械取栓对急性脑梗死的临床疗效及预后因素分析

目的 探讨静脉溶栓桥接机械取栓对急性脑梗死(ACI)的临床疗效及预后影响因素。方法选取2018年1月至2022年1月安徽省临泉县人民医院收治的120例ACI患者,根据术后90d改良Rankin评分(mRS)分为预后良好组(53例)和预后不良组(67例)。对比两组患者基础资料及实验室指标,采用Logistic回归分析影响ACI治疗预后的相关因素。结果 与预后良好组相比,预后不良组患者入院NIHSS评分高、侧支循环分级低、取栓次数增加、血管再通情况差且症状性出血发生率高(均P<0.05)。Logistic回归显示,入院NIHSS评分、侧支循环、血管再通情况、取栓次数及症状性出血是影响ACI患者桥接取栓预后的独立危险因素(P<0.05)。ROC曲线显示,NIHSS评分评估预后不良的曲线下面积(AUC)为0.837,灵敏度为61.2%,特异度为90.6%。结论 入院NIHSS评分高、侧支循环差、血管再通不良、多次取栓及症状性出血是ACI患者桥接取栓治疗预后不佳的危险因素。     

液体衰减反转恢复序列血管高信号征与急性缺血性卒中的临床及影像学相关研究

目的 探讨FLAIR序列血管高信号(FLAIR vascular hyperintensity,FVH)征对急性缺血性卒中(acute ischemic stroke,AIS)患者动脉狭窄程度、卒中病情严重程度及梗死灶分布部位的评估价值.方法 回顾性分析2017年1月-2019年6月在河北医科大学第三医院连续就诊的大脑...     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.