Unilateral cerebral polymicrogyria with ipsilateral cerebral hemiatrophy

We evaluated six children in whom MR imaging showed unilateral cerebral polymicrogyria associated with ipsilateral cerebral atrophy and ipsilateral brain stem atrophy. The aim of this study was to clarify whether this disorder based on neuroimaging constitutes a new homogeneous clinical entity. The subjects were six children whose ages at the time of MR imaging ranged from 8 months to 11 years. Their clinical and MR features were analyzed. All of the children were born between 38 and 42 weeks gestation, without any significant perinatal events. Spastic hemiplegia and epilepsy were observed in all of the patients, and mental retardation was observed in four. The MR findings included unilateral cerebral polymicrogyria associated with ipsilateral cerebral hemiatrophy and ipsilateral brain stem atrophy in all patients. The ipsilateral sylvian fissure was hypoplastic in four patients. These patients showed relatively homogeneous clinical and neuroimaging features. Although the additional clinical features varied according to the site and the extent affected by the polymicrogyria, this disorder could constitute a new relatively homogeneous clinical entity.     

Reversible cytotoxic cerebral edema in cerebral fat embolism

We present a case of cerebral fat embolism (CFE) that demonstrated evidence of diffuse white matter cytotoxic edema on diffusion-weighted magnetic resonance imaging, in addition to punctate hyperintensities on T2-weighted and diffusion-weighted imaging. The case suggests that CFE represents a combination of occlusive arteriolar disease and secondary neurotoxicity.     

Association of cerebral arteriovenous malformation with cerebral arterial fenestration

Cerebral arteriovenous malformations (AVMs) are rarely associated with other vascular lesions. Our goal was to examine the incidence of the coexistence of cerebral AVMs and cerebral arterial fenestrations. During the past 18 years, 51 patients with a cerebral AVM were examined with selective cerebral angiography in our institution. We retrospectively reviewed these cerebral angiographies and noted associated cerebral arterial fenestrations. We found five fenestrations distributed among 3 patients. In each patient one fenestration was located in the vertebral artery (VA). In 1 patient there were additional basilar and left middle cerebral artery fenestrations. Vertebral artery angiography was performed in 43 of the 51 patients; thus, the frequency of coexistence of AVM and VA fenestration was 7 % (3 of 43). Although the clinical significance may not be great, we found a noteworthy incidence of associated VA fenestrations in AVM cases. Received: 3 February 2000 Revised: 24 July 2000 Accepted: 25 July 2000     

Sequential changes of regional cerebral circulation in cerebral infarction

Summary Sequential changes of regional cerebral circulation and effects of spontaneous recanalization of occluded artery on cerebral circulation were observed in 50 patients with cerebral infarction. 1) Luxury perfusion was predominatly recognized in the recanalized patients within 16 days after onset. 2) Impairment of vasomotor responses was almost the same in the recanalized patients and the occluded patients. 3) CO₂ response tended to recover about 3–4 weeks after onset, but disautoregulation to induced hypertension persisted up to 2 months after onset. Some clinical problems are discussed.     

MR imaging of middle cerebral artery occlusion without cerebral infarction

Magnetic resonance (MR) images of 12 patients with angiographically proven middle cerebral artery (MCA) occlusion were analyzed, retrospectively. In three of the 12 patients, cerebral infarctions related to the MCA occlusions were not evident. Two of the three patients were cases of atherosclerotic occlusion and the remaining patient had an acute thromboembolism. In all of the occluded M1 portions of the MCA the flow void was absent and there were isointense linear structures, with or without a hyperintense component in the Sylvian vallecula, on T1-weighted images. For nine of the 12 patients, the absence of flow void in the ipsilateral Sylvian fissure was evident on the T2-weighted images. Therefore, even in cases with no evidence of a cerebral infarction, the presence of flow void in the Sylvian vallecula and Sylvian fissure must be searched for in routine reviews of MR images. If MR imaging can be obtained on an emergency basis, appropriate interventional therapy may be immediately initiated.     

Calcified cerebral emboli

Intracranial calcifications may represent calcified cerebral emboli. Calcified emboli may be overlooked even though cerebral CT is widely used as a stroke assessment. We report 4 cases of calcified cerebral emboli and demonstrate the value of CT in the diagnosis and temporal evaluation of such emboli.     

大脑中动脉分布区脑梗死模式的分析研究

目的：探索影像学梗死模式在判定动脉粥样硬化性大脑中动脉分布区梗死的责任血管及发生机制中的临床价值。 方法：选取2015年1月—2016年12月在我院神经内科住院的缺血性脑卒中患者105例,分为颈内动脉（ICA）梗死组68例,大脑中动脉（MCA）梗死组37例,比较两组患者的临床资料及病变血管的狭窄程度,并对不同狭窄程度下的脑梗死模式进行统计分析。 结果：ICA梗死组的低密度脂蛋白水平高于MCA梗死组,差异具有统计学意义[（2.34±0.70）mmol/L vs.（2.08±0.49）mmol/L,t=2.00,P<0.05];两组间的临床病史、侧支循环情况、单双侧梗死、单发及多发梗死、三酰甘油、高密度脂蛋白、同型半胱氨酸、血压的差异均无统计学意义。105例脑梗死患者共累及108支血管。其中37支为MCA病变所致,71支为ICA病变所致。ICA组中轻度狭窄血管的比例高于MCA组,差异有统计学意义（42.3% vs. 8.1%,P<0.05）;两组中、重度狭窄和闭塞血管的比例差异无统计学意义。ICA梗死组和MCA梗死组发生大面积梗死分别为1/0例,散在皮层梗死2/2例,单独内分水岭梗死3/13例,单独外分水岭梗死7/9例,单独穿动脉梗死7/13例,散在皮层及内分水混合梗死4/16例,穿动脉及内分水岭混合梗死4/8例,穿动脉、散在皮层及内分水岭混合梗死9/10例;轻度、中度及重度狭窄程度的ICA与MCA两组间梗死模式差异无统计学意义;闭塞的MCA组中发生穿动脉梗死的比例高于闭塞的ICA组（4/13 vs. 0/16,P=0.03）,差异有统计学意义。 结论：影像学梗死模式在临床判定责任血管的价值依赖于后期更严谨的研究设计,此类依靠管腔狭窄程度作为分组指标的方法可能是影响研究结果的重要因素。     

Multiple cerebral aneurysms

BACKGROUND: To define risk factors for the multiplicity of cerebral aneurysms, as well as clinical and therapeutical characteristics of patients with single aneurysms (SA) and multiple aneurysms (MA). METHODS: Retrospective study on 95 patients with SA and 22 patients with MA. For patients with SA and MA the following parameters were compared: gender, age, clinical state, aneurysmal localization and size, incidence of rebleeding and vasospasm, manner and outcome of treatment, preoperative interval, intraoperative rupture and postoperative complications. RESULTS: Aneurysms on anterior communicating artery existed in 37.4% of SA and in 17.8% of all MA (p < 0.05). As much as 44.2% of all aneurysms on middle cerebral artery and only 19% of all aneurysms on anterior communicating artery were associated with some other aneurysm (p < 0.02). The average size of SA was 15.4 +/- 11.8 mm, and 9.8 +/- 9 mm for MA (p < 0.05). Surgery was performed in 77.3% of patients with MA and 78.9% of patients with SA (p > 0.05), but complete surgical clipping was performed in 89.3% of patients with SA and in 47.1% of patients with MA (p < 0.01). Among operated patients with MA and SA, intraoperative rupture occurred in 36% and 17.6% of cases, respectively (p < 0.05) and ischemic postoperative complications were found in 29.4% and 17.3% of the cases (p > 0.05). Among 72.7% of all patients with MA and in 69.5% of all patients with SA the outcome was good, while among surgically treated patients it was good in 76.5% and 70.7% of cases, respectively. CONCLUSION: The treatment outcome was similar for patients with MA and SA, but complete operative treatment is significantly more frequent for SA. Multiple aneurysms were considerably smaller and with different anatomical distribution in relation to solitary aneurysms.     

Rotational cerebral roentgenography

A rotational cerebral roentgenographic technique with a 70 mm camera is elaborated in model studies of the plain and cerebrovascular system. The tube-camera-unit rotates in a semicircle in 5 to 6 seconds around a skull placed in the isocentrum. All special projections of the skull are obtained routinely during one rotational manoeuvre, and intracranial calcifications, foreign bodies and abnormalities of the calvarium are demonstrated sequentially in oblique or tangential views. Studies of the basal cerebral arteries have shown that the localization, size and configuration of arterial aneurysms and stenoses can be demonstrated reliably without changing the position of the skull. An exposure frequency of 6/sec results invariably in excellent stereoscopic views. The diagnostic value and applicability of this technique is discussed.     

Calcified cerebral metastasis

A hyperdense intraparenchymal lesion on a cerebral computed tomography (CT) usually corresponds to an acute hematoma; however, it is sometimes necessary to rule out a metastatic cause. Focal calcifications in the brain are common and are most often due to granulomas (tuberculosis, cysticercosis...), hamartomas, and primary brain tumors. Cerebral metastases are the most common intracranial neoplasm; however, their rate of calcification in classic series is only approximately 1%. We report the case of a completely calcified cerebral metastasis studied by CT and magnetic resonance imaging (MRI) that was interpreted as acute hemorrhage on the first CT examination.     

急性脑梗死患者脑微出血的发生及相关危险因素研究

目的探讨急性脑梗死后发生脑微出血（CMB）的危险因素。方法回顾性分析2008年9月-2011年10月于我院神经内科就诊的脑梗死患者的一般资料、临床、实验室及影像学检查资料,对比脑微出血阳性组与阴性组患者的各项记录指标,并采用多元回归方法对脑微出血阳性组患者进行危险因素分析。结果两组患者年龄、高血压、服用抗血小板药物、腔隙性脑梗死、脑白质稀疏等方面具有显著差异（P〈0．05）,腔隙性脑梗死、脑自质稀疏、高血压、高血脂是急性脑梗死患者微出血发生的危险因素。结论脑微出血在急性脑梗死患者中有较高的发生率,其与腔隙性脑梗死、脑白质稀疏、高血压、高血脂密切相关。     

Post-traumatic cerebral infarction caused by thrombus in the middle cerebral artery

A woman in her 80s was found unconscious after being hit by a car while crossing a road. After admission to hospitals, computed tomography (CT) scans revealed traumatic brain injury (TBI), and the patient was treated symptomatically. However, despite improvement of TBI in CT images, she died unexpectedly. Postmortem CT demonstrated cerebral infarction in the territory of the right middle cerebral artery (MCA). Histopathological examination revealed lumen-obstructing thrombosis and intimal injury upstream of the thrombosis in the right MCA. These findings suggested that the intimal injury in the MCA had led to thrombus formation, and thromboembolism in the region distal to the injury leading to post-traumatic cerebral infarction (PTCI). Both postmortem CT and autopsy were able to reveal the final condition of the deceased, which had not been fully anticipated by the clinicians who had treated her after the accident. The longitudinal antemortem to postmortem course revealed by multiple CT images and the histopathological examination provided crucial clues to the pathogenesis of PTCI in this case.     

The diagnosis of cerebral atrophy on the basis of cerebral angiogram

Summary An increased distance between brain surface, represented by the terminal arterial branches, and skull causes the appearance of a broad avascular band in the carotid angiogram, which — apart from other criteria —has been valued as a sign of cerebral atrophy. We investigated 54 patients (ages 60–79 years) suffering from cerebrovascular disease. Carotid angiographies of the afflicted hemispheres were carried out within 4 to 90 days after the stroke. The distance between vessels and skull was measured in frontal and lateral projection. We evaluated statistically the impact on this distance of alterations in extracranial vessel walls, number of attacks, severity of stroke, and patient's age. The results are compared to those of CAT. Only limited correlations have been found between the above-mentioned parameters and the distance between vessels and skull. Thus the distance is only of limited diagnostic value for the verification of senile cerebral atrophy on a vascular basis.     

干预基质金属蛋白酶-9对高血压脑出血后期脑水肿治疗的影响

 目的 探究基质金属蛋白酶-9(MMP-9)对高血压脑出血(hypertensive cerebral hemorrhage,HCH)患者后期脑水肿形成及治疗方案的影响。方法 纳入2014-06至2016-05医院神经外科住院HCH患者112例,随机分为两组,常规治疗联合MMP-9抑制药(实验组),常规治疗(对照组),每组56例。对比治疗2周后两组脑部水肿体积的变化、MMP-9值、神经功能缺损的评分(简称为NIHSS评分)以及治疗有效率。结果 实验组脑部水肿的体积(5.8±3.1)cm³、MMP-9值(61.3±21.9)μg/L及NIHSS评分(7.1±3.7)分,对照组脑部水肿的体积(12.5±3.4)cm³、MMP-9值(98.2±25.4)μg/L及NIHSS评分(13.2±4.3)分,两者之间的差异是存在着统计学意义的(P＜0.01),同时实验组有效率明显高于对照组(85.71% vs 64.29%,P＜0.01)。结论 对于HCH后期脑水肿给予常规化的治疗联合MMP-9抑制药可以提高临床治疗效果,提示MMP-9可能促进脑出血后期脑水肿的形成。     

慢性脑供血不足（CCCI）的脑血流灌注成像研究进展

脑血流灌注不足是CCCI的主要病理生理机制。目前用于评价脑血流量的方法有CT灌注成像（CTPI）、磁共振灌注加权成像（PWI）、正电子发射性体层显像（PET）、单光子发射性体层扫描（SPECT）、氙气CT-灌注成像（Xe-CT）等。利用CT、MRI等影像学技术可显示CCCI低灌注损伤的范围和程度,早期发现脑缺血,有效避免脑梗死、血管性痴呆的发生。