脑卒中后继发癫痫的临床分析

目的 探讨脑卒中继发癫痫的临床特征、发病机制及预后。方法 回顾性分析7年来脑卒中860例继发癫痫发作68例的临床资料。结果 卒中后癫痫的发生率为7．91％，早期发作5．08％，晚期发作3．02％，前多见于蛛网膜下腔出血、脑出血、心源性脑梗死；后多见于动脉血栓性脑梗死。结论 脑卒中后癫痫的发生与病灶部位(皮质，／皮质下)有关．病损累及皮层是重要的的致痫因素，多脑叶受累使癫痫发生的危险性增加，血肿刺激和出血后脑水肿、颅内压增高、缺血及缺氧，使大脑皮层神经元大量放电是早期癫痫发作的重要机制，晚期癫痫发作是与胶质细胞增生、疤痕形成、萎缩粘连或中风囊等致痫灶有关。     

急性脑卒中后早期癫痫发作临床观察

报告急性脑卒中后早期癫痫发作患者43例,平均发病年龄58．2岁。其中,脑出血26例（60．5％）,脑梗死6例（16％）,脑蛛网膜下腔出血11例（25．6％）。癫痫发作时间以卒中后24小时内多见（76．7％）。痫性发作形式以单纯部分性发作多见,少数继发全身大发作。EEG阳性率占91％。治疗用药以苯妥英纳、卡马西平疗效较满意。     

老年人蛛网膜下腔出血诊疗方法的探讨

目的 探讨老年人自发性蛛网膜下腔出血的诊断和治疗。方法 选择本院1993年6月至1999年6月收治的60岁以上老年人自发性蛛网膜下腔出血共64例,男26例,女38例,均行头颅CT证实蛛网膜下腔出血（不合并颅内血肿）;腰穿呈血性脑脊液。40例行DSA检查,动脉瘤31例、动静脉畸形5例、Moyamoya病1例、动脉硬化3例。内科保守治疗29例,血管内治疗25例,手术夹闭及切除病灶10例。结果 内科保守治疗组死亡8例（8／29）,血管内治疗死亡2例（2／25）,手术夹闭及切除病灶组死亡1例（1／10）。结论 老年人自发性蛛网膜下腔出血以动脉瘤破裂常见,DSA是其病因诊断最有价值的手段;动脉瘤破裂至自发性蛛网膜下出血以血管内治疗及手术为有效的治疗方法。     

体感诱发电位在急性脑卒中后的变化观察和意义探讨

目的观察急性脑卒中患者体感诱发电位（SEP）改变特点，评价其对于脑功能监测的价值。方法对58例脑梗死、27例脑出血和11例蛛网膜下腔出血患者，检测发病后不同时期（1～12d）SEP和血清神经元特异性烯醇化酶（NSE）改变，结合中国卒中量表评分（CSS）、Barthel指数、Glasgow-Pittsburgh昏迷量表评分以及颅脑影像学检查结果，分析与临床神经功能缺失的关系。25例年龄和性别匹配的正常人作为对照。结果发病后4d内各型脑卒中患者的SEP—P15、N20、P25和P40峰潜伏期较正常对照显著延长（P〈0．01）。脑出血和脑梗死患者发病后4d内SEP异常率高于发病后5～12d测定结果。发病后4d内，幕下脑出血和后循环脑梗死患者SEP—N20峰潜伏期与其病灶大小呈正相关（P〈0．01）。脑出血和脑梗死患者SEP—N20峰潜伏期与其血清NSE水平和CSS评分呈正相关（P〈0．01）。各型脑卒中患者SEP—N20峰潜伏期与其Glasgow-Pittsburgh昏迷量表评分呈负相关（P〈0．01）。结论SEP—N20峰潜伏期异常反映脑出血和脑梗死患者脑损伤和神经功能缺失严重程度，并可作为评估蛛网膜下腔出血患者昏迷程度的指标。     

蛛网膜下腔出血诊断和病因的若干问题

蛛网膜下腔出血（subarachnoid hemorrhage，SAH）系指脑表面血管破裂后血液流人蛛网膜下腔而言，可由各种病因引起，故它不是一独立的原发性疾病，而是由多种病因引起的一组临床综合病症。蛛网膜下腔出血的患病率为31／10万，年发病率为5-20／10万，其发生率占急性脑血管病的10％左右，仅次于脑梗死和脑出血，占第三位，而总病死率高达25％，病残率33％，严重地影响和威胁着人类的生命和生活质量。笔重点对蛛网膜下腔出血诊断和病因中的几个问题予以再认识。     

脑血管疾病分类(1995年)

脑血管疾病分类（１９９５年）一、短暂性脑缺血发作（４３５）（一）颈动脉系统（二）椎－基底动脉系统二、脑卒中（一）蛛网膜下腔出血（４３０）１．动脉瘤破裂引起２．血管畸形３．颅内异常血管网症４．其它５．原因未明（二）脑出血（４３１）１．高血压脑出血２．脑...     

西洛他唑用于动脉瘤性蛛网膜下腔出血患者疗效的meta分析

目的本研究旨在评价西洛他唑用于动脉瘤性蛛网膜下腔出血患者的临床疗效,为其应用提供依据。方法计算机检索西洛他唑用于动脉瘤性蛛网膜下腔出血的对照研究,时间截止2013年1月。由2位研究者独立评价纳人研究的质量、提取数据,统计分析采用RevMan5．2．3软件进行。结果纳入3个研究,共259例患者。Meta分析结果显示：西洛他唑降低症状性脑血管痉挛（RR=0．46;95％CI=0．30～0．71;P=0．0005）、血管造影脑血管痉挛（RR=0．60;95％CI=0．44～0．81;P=0．0008）、血管痉挛性脑梗死（RR=0．38;95％CI：0．22～0．67;P=0．0008）发生率,但不改善短期临床预后（RR=1．28;95％CI=0．98～1．66;P=0．07）。结论西洛他唑可预防动脉瘤性蛛网膜下腔出血后脑血管痉挛、血管痉挛性脑梗死,对患者预后影响还需大样本多中心临床研究进一步证实。     

脑脊液置换与尼莫地平防治动脉瘤性蛛网膜下腔出血后脑血管痉挛的疗效

迟发型脑血管痉挛（delayed cerebral vasospasm ，DCVS）是动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hem‐orrhage ，aSAH）患者最常见的并发症之一，易引起迟发型缺血性不可逆性脑损伤，可导致继发性脑梗死等并发症的发生［1］。我院2012‐01—2013‐12收治的79例动脉瘤性蛛网膜下腔出血患者，观察脑脊液置换联合尼莫地平对动脉瘤性蛛网膜下腔出血后脑血管痉挛的防治效果，现报告如下。     

支架辅助栓塞在颅内动脉瘤治疗中的应用

蛛网膜下腔出血是仅次于脑梗死和高血压性脑出血的第三大脑血管疾病,目前人群的发病率在2％～7％[1],致死致残率高,颅内动脉瘤破裂是导致其发生的最主要的原因.2002年国际蛛网膜下腔动脉瘤试验(International Subarachnoid Aneurysm Trial,ISAT)[2]及颅内破裂动脉瘤治疗的临床和...     

腰大池置管外引流术在动脉瘤术后早期应用分析

目的探讨术后早期行腰大池置管外引流术对缓解动脉瘤性蛛网膜下腔出血患者头痛症状和缩短病人住院时间的影响。方法将我科2010年6月至2012年5月收治的72例动脉瘤性蛛网膜下腔出血患者分层随机分为两组：动脉瘤夹闭术后早期（24。48h）行腰大池置管外引流组（A组,39例）术后未行腰大池置管外引流分组（B组,33例）。结果A、B组患者的术后住院时间分别为（16．89±2．51）d和（21．42±2．54）d,两者相差显著（P〈0．05）。A、B组术后1周内头痛症状缓解率分别为74．36％（29／39）和15．15％（5／33）,两者相差显著（P〈0．05）。结论破裂动脉瘤夹闭术后早期（24～48h内）行腰大池置管外引流术,能够有效的减轻因蛛网膜下腔出血造成的头痛症状,缩短患者的住院时间。     

Stroke complicating pregnancy and the puerperium

Stroke complicating pregnancy and the puerperium in Taiwan and the comparison between Western and Eastern countries have not been well studied. We identified retrospectively 32 cases of stroke from 66 781 deliveries, including 21 intracranial hemorrhages and 11 cerebral infarctions from 1992 to 2004. The most common causes of intracranial hemorrhage were vascular anomaly (29%), pre-eclampsia/eclampsia (24%), undetermined (24%) and coagulopathy (19%). The most common causes of cerebral infarction were cardioembolism (36%), cerebral venous thrombosis (27%) and pre-eclampsia/eclampsia (18%). Perinatal adverse outcome included two stillbirths, nine premature deliveries and four abortions. The compiled results of previous studies and ours revealed that intracranial hemorrhage appeared to be slightly more common in Taiwan (43–69%) than in the Western countries (33–52%). The average maternal mortality rate was 17.8% (range 9–38) with 77.8% due to intracranial hemorrhage. The average incidence of stroke associated with pregnancy and the puerperium was 21.3 per 100 000 deliveries (range 8.9–67.1). Our study, different from the Western countries, showed that intracranial hemorrhage is slightly more common than cerebral infarction. Pre-eclampsia/eclampsia is an important cause of stroke, however, the possibility of cardioembolism in cerebral infarction and vascular anomaly in intracranial hemorrhage should be studied.     

动脉瘤性蛛网膜下腔出血并发脑血管痉挛患者血清血管内皮生长因子表达的变化

目的:探讨动脉瘤性蛛网膜下腔出血(SAH)并发脑血管痉挛(CVS)与血清血管内皮生长因子(VEGF)表达的关系.方法:27例动脉瘤性SAH患者为试验组(SAH组),再依据是否并发不同程度CVS分为:无CVS亚组(11例),轻度CVS亚组(9例)、中度CVS亚组(4例)和重度CVS亚组(3例);另设10名健康体检者为对照组.采用ELISA法检测血清VEGF水平.结果:SAH各时间点各组血清VEGF水平为①SAH组发病第1天起即明显高于对照组;②无CVS组不增高.SAH后第1、3、5、7天时血清VEGF水平为①轻度CVS组与中度CVS组相同时间点比较,差异无统计学意义;②重度CVS组明显高于轻度和中度CVS组.SAH后出现脑梗死患者血清VEGF水平明显高于未出现脑梗死患者.结论:SAH后出现CVS患者和出现脑梗死的患者血清VEGF水平明显增高,血清VEGF水平能反映脑血管痉挛的程度.     

颅内动脉瘤性蛛网膜下腔出血血管痉挛治疗的临床探讨

目的探讨颅内动脉瘤性蛛网膜下腔出血脑血管痉挛的治疗方法。方法回顾性分析颅内动脉瘤性蛛网膜下腔出血合并脑血管痉挛患者临床资料67例。结果 23例并发脑血管痉挛,6例发生一侧肢体功能障碍,3例发生脑血栓形成。经治疗后61例C-反应蛋白恢复正常,6例明显下降,4例肢体功能恢复正常,1例恢复到4级,1例死亡。结论炎症因子在脑血管痉挛中明显升高;钙离子拮抗剂尼莫地平加抗氧化剂依达拉奉中药川芎嗪联合治疗动脉瘤性蛛网膜下腔出血所致的脑血管痉挛有较好疗效。     

早期低脑血流量和高乳酸血症预测蛛网膜下腔出血后迟发性脑缺血的临床研究

目的 探讨早期低脑血流量和高乳酸血症对蛛网膜下腔出血(SAH)后迟发性脑缺血(DCI)的预测作用。方法 选择2010年1月-2014年12月来本院接受治疗的SAH患者90例; 根据患者有无DCI发生分为DCI发生组(n=35)和DCI未发生组(n=55); 根据病历信息及临床检查详细记录SAH患者的年龄、性别、体质量指数(BMI)、烟酒嗜好,高血压病、糖尿病史和现状、治疗方式,责任动脉瘤位置、血肿形成、脑积水、有无高乳酸血症、Hunt-Hess分级、Fisher分级等; 应用单因素、多因素非条件Cox回归分析预测SAH后DCI发生的危险因素。结果 90例SAH患者中35例(38.89%)发生DCI,55例(61.11%)未发生DCI。2组患者在性别、Fisher分级、Hunt-Hess分级、血肿形成、脑积水、有高乳酸血症、脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)方面差异显著(P<0.05)。其中,DCI发生组在高乳酸血症患者比例方面显著高于DCI未发生组(P<0.05),在CBF方面显著低于DCI未发生组(P<0.05)。CBF、CBV、MTT、TTP的ROC曲线下面积分别为0.88、0.70、0.89、0.73,预测DCI最佳诊断界值分别为15.95 mL·100 g^-1·min^-1、1.77 mL·100 g^-1、9.62 s、11.48 s。 单因素、多因素Cox回归分析显示,有高乳酸血症、Hunt-Hess分级≥Ⅲ级、Fisher分级≥Ⅲ级、CBF<15.95 ml/100 g/min会增加SAH后DCI发生的风险(P<0.05)。结论 早期低脑血流量和高乳酸血症可预测SAH后DCI发生。     

Atypical case of perimesencephalic subarachnoid hemorrhage

Perimesencephalic subarachnoid hemorrhage (PM‐SAH) refers to intracranial hemorrhage located in the perimesencephalic cistern. The etiology remains mainly unclear, although venous leakage or rupture has been postulated. We report an interesting case of a 57‐year‐old healthy man who presented initially with PM‐SAH with worsening of subcortical lesions on follow‐up neuroimaging. Histopathological examination demonstrated cerebral amyloid angiopathy with perivascular inflammation.     

Stroke in Saudi Arabian young adults: a study of 120 cases

One hundred and twenty cases of stroke occurring in Saudi Arabian subjects aged 15 to 45 years are reviewed. These constituted 12.7% of a group of 946 stroke patients. Males outnumbered females (76/44). The frequency of intracranial hemorrhage, including subarachnoid hemorrhage, was slightly lower than cerebral infarction (41.5 vs 58.5%). The causes of large cerebral infarction were as follows: atherosclerosis 17 (28%), cardiac embolism 12 (19.5%), uncommon and uncertain causes 21 (34.5%). Some unusual causes were encountered such as dissecting arterial aneurysm due to popular healing manoeuvres or to traditional dance, retrograde embolism from a thoracic outlet syndrome or embolism from a fibroelastoma of the mitral valve chorda. Lacunar cerebral infarction was diagnosed in nine cases. Hypertension (25.5%) and arteriovenous malformations (20.5%) were the main causes of cerebral hemorrhage; all subarachnoid hemorrhages except one were due to berry aneurysms. The cause was undetermined in 16% of cerebral infarction and 26% of intracranial hemorrhage. The high frequency of stroke in young Saudi Arabian adults is probably a reflection of the demographic structure of the predominantly young Saudi society. The observed causes were relatively similar to those in industrial societies. Contrary to other developing countries infectious disease no longer seems to be an important cause of stroke. Drug abuse, which is becoming an important cause in Western societies, was encountered in only two of our cases.     

Crohns disease with central nervous system vasculitis causing subarachnoid hemorrhage due to aneurysm and cerebral ischemic stroke

Cerebral vasculitis secondary to Crohn''s disease (CD) seems to be a very rare phenomenon. We report a 39-year-old male who presented with headache, vomiting, and left-sided weakness in the known case of CD. Cross-sectional imaging (computed tomography and magnetic resonance imaging,) showed right gangliocapsular acute infarct with supraclinoid cistern subarachnoid hemorrhage (SAH). Cerebral digital substraction angiography (DSA) showed dilatation and narrowing of right distal internal carotid artery (ICA). Left ICA was chronically occluded. His inflammatory markers were significantly raised. Imaging features are suggestive of cerebral vasculitis. Arterial and venous infarcts due to thrombosis are known in CD. Our case presented with acute subarachnoid hemorrhage in supraclinoid cistern due to rupture of tiny aneurysm of perforator arteries causing SAH and infarction in right basal ganglia. Patient was treated conservatively with immunosuppression along with medical management of SAH.     

蛛网膜下腔出血后迟发性脑血管痉挛的临床研究

为了探讨蛛网膜下腔出血（ＳＡＨ）后迟发性脑血管痉挛（ＤＣＶＳ）的临床规律，本文对６１例ＳＡＨ住院病人的脑动脉造影（ＣＡＧ）、ＣＴ及临床资料进行了回顾研究，结果如下：１、ＳＡＨ并ＤＣＶＳ的主要病因为颅内动脉瘤破裂，ＤＣＶＳ发生与颅内动脉瘤所在的部位及大小无明显关系．ＤＣＶＳ时轻度痉挛略多于重度痉挛．２、ＣＴ见基底池存在明显的高密度影时，能预示ＤＣＶＳ的发生。３、ＤＣＶＳ常与脑内血肿、脑室出血、脑积水或脑梗塞同时存在。４、ＳＡＨ再发出血，尤其是近期再发出血，可能产生或加重ＤＣＶＳ．５、ＤＣＶＳ的发生及程度与临床病情严重程度有关，ＤＣＶＳ的程度越重，临床病情也越重。６、ＤＣＶＳ的主要体征为意识障碍，近半数的病人有神经示位体征。     

Oculomotor Nerve Palsy Associated with Rupture of Middle Cerebral Artery Aneurysm

Oculomotor nerve palsy (ONP) with subarachnoid hemorrhage (SAH) occurs usually when oculomotor nerve is compressed by growing or budding of posterior communicating artery (PcoA) aneurysm. Midbrain injury, increased intracranial pressure (ICP), or uncal herniation may also cause it. We report herein a rare case of ONP associated with SAH which was caused by middle cerebral artery (MCA) bifurcation aneurysm rupture. A 58-year-old woman with clear consciousness suffered from headache and sudden onset of unilateral ONP. Computed tomography showed SAH caused by the rupture of MCA aneurysm. The unilateral ONP was not associated with midbrain injury, increased ICP, or uncal herniation. The patient was treated with coil embolization, and the signs of oculomotor nerve palsy completely resolved after a few days. We suggest that bloody jet flow from the rupture of distant aneurysm other than PcoA aneurysm may also be considered as a cause of sudden unilateral ONP in patients with SAH.     

中风后癫痫的临床研究

本文报告３６例中风后癫痫发作的临床和ＣＴ资料。通过回顾性病历复习和随访发现，中风后癫痫的发生率占同期住院中风患者的５．２６％，以蛛网膜下腔出血和脑栓塞发生癫痫比率最高，分别为１５％和１２．５％。癫痫发作与ＣＴ所见病灶分布密切相关，皮质病灶较皮质下病灶更易发生病病。癫痫发作可发生于中风后任何时期，但早期癫痫以出血性中风多见，而迟发性癫痫则更多见于脑梗塞患者。