动脉瘤性蛛网膜下腔出血后慢性脑积水形成的相关因素分析

目的分析动脉瘤性蛛网膜下腔出血后慢性脑积水形成的相关因素。方法选择2011年1月—2014年2月巴中市中心医院神经外科收治的动脉瘤性蛛网膜下腔出血患者143例,根据患者是否有慢性脑积水形成分为慢性脑积水组23例和非慢性脑积水组120例。回顾性分析两组患者的临床资料,包括性别、年龄、吸烟史、饮酒史、高血压病史、出血是否破入脑室、动脉瘤位置、出血次数、Hunt-Hess分级及Fisher分级等。结果两组患者性别、吸烟史和饮酒史阳性率及动脉瘤位置比较,差异无统计学意义(P0.05);慢性脑积水组患者年龄、Hunt-Hess分级和Fisher分级大于非慢性脑积水组,高血压病史阳性率和出血破入脑室发生率高于非慢性脑积水组,出血次数多于非慢性脑积水组(P0.05)。多因素Logistic回归分析结果显示,高龄〔OR=1.83,95%CI(1.21,2.59)〕、高血压病史〔OR=2.09,95%CI(1.46,3.14)〕、出血破入脑室〔OR=2.01,95%CI(1.27,3.09)〕、多次出血〔OR=1.95,95%CI(1.42,3.61)〕、Hunt-Hess分级较高〔OR=2.82,95%CI(1.79,4.28)〕及Fisher分级较高〔OR=2.12,95%CI(1.58,3.90)〕是动脉瘤性蛛网膜下腔出血后慢性脑积水形成的危险因素(P0.05)。结论高龄、有高血压病史、出血破入脑室、多次出血、Hunt-Hess分级较高及Fisher分级较高的动脉瘤性蛛网膜下腔出血患者易并发慢性脑积水。     

脑积水的手术疗法应用进展

迄今为止，手术仍是脑积水的主要治疗方法。治疗脑积水的术式较多，其适应证各不相同。急性脑积水的手术疗法主要是脑室体外引流术，慢性脑积水的手术疗法主要是侧脑室-腹腔分流术、“套管式”侧脑室-肝膈间隙分流术和脑室镜手术三种。现将脑积水的各种术式的临床应用进展情况综述如下。     

外伤性脑积水28例诊治体会

目的进一步提高外伤性脑积水的诊治水平。方法对28例外伤性脑积水患者的诊治情况进行分析。结果急性外伤性脑积水临床表现无特异性,慢性外伤性脑积水则表现为伤后持续浅昏迷或神志恍惚,病情停滞不前或倒退,不同程度的瘫痪,智力或语言障碍。影像学检查示脑室系统扩大,以侧脑室前角最为显著。结论外伤性脑积水是脑损伤急性期后继发性损害主要表现形式之一,常见于重型闭合性颅脑损伤后,一旦发生较明显脑积水,应积极采取侧脑室—腹腔分流术,妥善、持续控制颅高压。     

动脉瘤性蛛网膜下腔出血后急性脑积水的研究进展

<正>动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后脑积水是颅内动脉瘤破裂后常见并发症之一[1]。根据发病时间将a SAH脑积水分为急性(0~3 d)、亚急性(4~13 d)和慢性(≥14 d)[2]。aSAH后急性脑积水指动脉瘤破裂后3 d内发生的脑积水,发生率为15%~87%[3],其中约     

颅内动脉瘤血管内介入术后慢性脑积水患者血清CCCK-18、Netrin-1、HPA水平变化及意义

目的 探讨颅内动脉瘤血管内介入术后慢性脑积水患者血清半胱氨酸蛋白酶裂解细胞角蛋白-18(CCCK-18)、神经轴突向导因子-1(Netrin-1)、乙酰肝素酶（HPA）水平变化及意义。方法 选取200例颅内动脉瘤破裂后蛛网膜下腔出血患者，根据患者血管内介入术后是否发生慢性脑积水分为发生组52例与未发生组148例。比较两组临床资料及血清CCCK-18、Netrin-1、HPA水平，Logistic回归分析颅内动脉瘤患者血管内介入术后慢性脑积水的影响因素，绘制受试者工作特征（ROC）曲线评价CCCK-18、Netrin-1、HPA对颅内动脉瘤患者血管内介入术后慢性脑积水的预测价值，比较不同血清CCCK-18、Netrin-1、HPA水平患者生存预后情况。结果 发生组年龄、Hunthess分级及Fisher分级与未发生组比较差异有统计学意义（P均<0.05）；发生组术后第1、3、7天血清CCCK-18、Netrin-1、HPA水平均高于对照组（P均<0.05）;Logistic回归分析结果显示，CCCK-18、Netrin-1、HPA均为颅内动脉瘤患者血管内介入术后慢性脑积水发生...     

早期腰大池持续引流对动脉瘤性蛛网膜下腔出血术后并发症的疗效观察

目的探讨早期采用颅内压监测下腰大池持续引流对动脉瘤性蛛网膜下腔出血术后脑血管痉挛、脑积水等严重并发症的治疗效果。方法本组患者114例,随机分为两组,治疗组69例,早期(发病48 h以内)行颅内压监测下腰大池持续引流。对照组45例,于发病3天以上行颅内压监测下腰大池持续引流,通过比较两组脑血管痉挛及脑积水的发生率评定疗效。结果脑血管痉挛发生率及慢性脑积水发生率治疗组分别为27.5%和10.1%,均明显低于对照组的68.8%和26.6%,两组急性脑积水分别为7.2%和11.1%,无明显差异。结论早期颅内压监测下腰大池持续引流能够有效地减少动脉瘤性蛛网膜下腔出血术后脑血管痉挛、慢性脑积水等严重并发症的发生率。     

蛛网膜下腔出血继发脑积水

SAH继发脑血管痉挛及再出血是神经内科常见并发症 ,一直被临床所重视 ,而 SAH继发脑积水则常被忽略。脑积水是造成 SAH病情加重、致残和死亡的重要因素之一 ,现结合文献对其发病机制及防治介绍如下。1　病因与发病机制据报道 ,SAH继发脑积水的发生率为 2 0 %～ 70 % ,其发病率的差异可能与发病后 CT或 MR检查的时间、次数和病例选择有关。脑积水于 SAH后 2周内发生者为急性脑积水 ,2周后发生者为慢性脑积水。SAH继发脑积水的发病机理与脑室积血有关。 SAH后脑室内或脑池内积血 ,血块常堵塞中脑导水管、第四脑室及基底池 ,影响脑脊…     

老年正压性脑积水与非肿瘤性导水管狭窄的关系

正常颅内压性脑积水(正压性脑积水)是以步态不稳,轻、中度智力衰退和慢性脑积水性偶发尿火禁三联症为临床表现的一种综合征,腰穿检查颅内压正常。此综合征可发生于交通性或非交通性脑积水,但以交通性脑积水更多见,其病因还不完全清楚,据文献报道常与非肿瘤性导水管狭窄有关,而且多见于儿童,老年人罕见。作者总结1981.1～85.1收治的18例正压性脑积水病人,其中9人为老年非肿瘤性导水管狭窄所致的正压性脑积水,年龄均在60岁以上。方法全组病人均做常规头颅拍片,脑电图、头颅CT(对照与非对照),反复腰穿测定颅内压,压力超过200mmH_2O为升高,用放射性碘标记的人血清白蛋白(RIHSA)和甲泛影酰胺对5个病人做     

非感染慢性颅内压增高患儿的临床分析

目的探讨无影像学及脑脊液常规生化改变的非感染慢性颅内压增高症患儿的临床表现及病因。方法对31例颅脑CT及脑脊液常规生化正常的慢性颅内压增高症患儿的临床资料进行回顾性分析。结果慢性颅内压增高症主要表现为头痛、呕吐、视力减退及眼底改变;病因复杂,31例患儿中良性颅内压增高症22例,脑部血管病变3例,钩体病2例,交通性脑积水3例,红斑狼疮性脑病1例。结论影像学正常的非感染性慢性颅内压增高症病因复杂,需要详细检查加以明确。其中良性颅内压增高症最常见,其次为血管病变、交通性脑积水、免疫性疾病等。     

脑积水

1引言1.1背景脑积水可宽泛地定义为脑脊液(cerebrospinal fluid,CSF)的形成、流动或吸收紊乱导致其在中枢神经系统(central nervous system,CNS)内所占的体积增加。这种情况也可称为CSF的流体动力学紊乱。急性脑积水在数天内发生,亚急性脑积水在数周内、慢性脑积水在数月或数年内发生。诸如脑萎缩和局部破坏性损害之类的病变也可导致CNS内CSF异常增多。在这些情形下,脑组织缺失会留下一个可由CSF被动充盈的未用空间。此类情况不是流体动力学紊乱的结果,因此不能归为脑积水。过去用来描述这些情况的错误名称是脑外积水(hydrocephalus ex vacuo)。     

Acute hydrocephalus and chronic hydrocephalus with the need of postoperative shunting after aneurysmal subarachnoid hemorrhage

During a 6-year period, 168 consecutive patients who presented with subarachnoid hemorrhage (SAH) and underwent surgical clipping of aneurysms were reviewed at a follow-up examination from 6 to 77 months (mean 38 months) after the ictus. Acute hydrocephalus was defined when the bicaudate index was greater than the 95th percentile for age on a computed tomographic scan within 72 hours of the hemorrhage. Forty (24%) patients developed acute hydrocephalus. The Hunt and Hess grades and Fisher's SAH grades at the time of admission, the presence of intraventricular hemorrhage and symptomatic cerebral vasospasm, and cerebrospinal fluid (CSF) diversion were found to be significantly associated with acute hydrocephalus. The overall mortality in this study was 16%. Of the 141 surviving patients, 20 (14%) patients underwent ventriculoperitoneal (VP) shunt replacement secondary to chronic hydrocephalus. In the present study, we found that the following factors were significantly related to the need of VP shunting: increasing age, the presence of acute hydrocephalus, preoperative CSF diversion, low admission Hunt and Hess grades, and poor Fisher's SAH grades. No patient was readmitted for shunt replacement at our hospital later than 117 days after hemorrhage. Acute hydrocephalus was combined with high mortality (28%) at our follow-up review. Ten of 29 (34%) patients with acute hydrocephalus required definite shunt replacement. However, less than 10% of patients without acute hydrocephalus needed shunting postoperatively. We recommend that patients with aneurysmal SAH should be followed up at least 6 months after the hemorrhage, especially in those patients with high risks of developing chronic hydrocephalus.     

脑积水脑室-腹腔分流术后常见并发症及防治对策

目的：探讨脑积水脑室-腹腔分流术后常见并发症的原因及防治措施。方法回顾性分析2008-04～2013-01收治的脑积水脑室-腹腔分流术后并发症患者19例临床资料。结果19例中分流管阻塞7例,感染4例,硬膜下血肿或积液4例,分流管异位2例,分流管自肛门脱出1例,经治疗后患者临床症状不同程度缓解,13例患者再次行脑室-腹腔分流术,16例进行性脑积水患者复查头颅CT或MRI提示脑积水明显好转。19例患者中治愈18例,1例死于严重颅内感染,近期有效率为94.7％。结论临床应严格脑积水脑室-腹腔分流术适应证选择及无菌操作,提高手术技巧,个体化选择分流系统,对年幼患者应用可调压分流管,可减少术后并发症的发生。     

Normal pressure hydrocephalus in a patient with systemic lupus erythematosus

We describe a patient who had concomitant systemic lupus erythematosus (SLE) and a normal pressure hydrocephalus. She improved only after appropriate therapy for each. Although 6 patients with arthritis and normal pressure hydrocephalus have been described, this is the first report of it occurring in a patient with SLE. It has been emphasized that normal pressure hydrocephalus can easily be overlooked in elderly patients with arthritic conditions. Since neuropsychiatric symptoms are likelier to occur in patients with SLE than in other rheumatologic conditions, the diagnosis of normal pressure hydrocephalus may be delayed or overlooked. Because normal pressure hydrocephalus is a potentially reversible cause of neurologic dysfunction, it should be considered in appropriate populations.     

Macrosquare-wave Jerks Subsiding after Hydrocephalus Treatment in a Thalamic Hemorrhage Patient

A 54-year-old man suddenly developed impaired consciousness and left hemiplegia due to a right thalamic hematoma. Emergent ventricular drainage for acute hydrocephalus improved the level of consciousness, but macrosquare-wave jerks (MSWJ) consisting of a right-ward intrusive saccade and corrective saccade appeared. The MSWJ disappeared on day 2 when follow-up CT revealed improvement of hydrocephalus. However, on day 36, after ventricular drainage was clamped, the MSWJ reappeared. After ventriculoperitoneal shunt, MSWJ again subsided. In this patient, hydrocephalus may have stretched the superior colliculus, thereby decreasing activity of the fixation neurons and then omnipause neurons, and eventually resulting in the reversible MSWJ.     

Hydrocephalus. Abesia--dementia--incontinence. Drain or not?

The syndrome of abasia (gait disorder) and incontinence in old age is aetiologically ambiguous. If it is combined with an internal communicating hydrocephalus, it is necessary to think of the syndrome of malabsorption hydrocephalus and consequently of a drainage of the cerebro-spinal fluid. The indication for a shunt is defined with a diagnostic lumbar puncture, a cerebrospinal fluid scan, and if it is still uncertain, by continuous cerebro-spinal fluid pressure records. In a well-defined indication with the shunt, more than half of the patients would improve and about one third of them would have a very good recovery. However, a shunt operation on a patient with hydrocephalus ex vacuo (from cerebral atrophy) should be avoided since it could worsen the patient's condition. Therefore it is essential to discriminate clearly between these two very different types of hydrocephalus.     

Circulating parasite antigen in patients with hydrocephalus secondary to neurocysticercosis

End stages of neurocysticercosis include residual intraparenchymal brain calcifications and hydrocephalus. Although brain calcifications alone have a benign prognosis, hydrocephalus is frequently associated with chronic inflammation and intracranial hypertension, together with a protracted clinical evolution, and may lead to patient deaths. By using a monoclonal-based antigen detection enzyme-linked immunosorbent assay, we measured the levels of circulating parasite antigen in the sera of 56 patients with neurocysticercosis: 27 with calcifications only and 29 with hydrocephalus. The assay gave positive results in 14 of 29 patients with hydrocephalus but was consistently negative in patients with calcifications. Circulating parasite antigen in hydrocephalus secondary to neurocysticercosis indicates the presence of live parasites in these patients and thus a potential benefit from antiparasitic therapy.     

Hydrocephalus in herpes simplex type 2 meningitis

A 34-year-old woman presented to hospital with symptoms of meningitis, later confirmed to be due to herpes simplex virus type 2. She developed hydrocephalus on day 2 of her admission. We describe the first case of hydrocephalus associated with herpes simplex type 2 meningitis in an adult.     

Communicating hydrocephalus in systemic lupus erythematosus with antiphospholipid antibody syndrome.

We report a case of communicating hydrocephalus in a 24-year-old woman with previously undiagnosed systemic lupus erythematosus (SLE) presenting with malignant hypertension, nephritis, serositis, and a seizure disorder of 16 months' duration. The patient demonstrated features of the antiphospholipid antibody syndrome (APS). In proposing cerebral venous thrombosis as a possible, yet unproven, pathophysiologic mechanism for the hydrocephalus in this case we have reviewed and summarized literature relating to SLE, APS, hydrocephalus and pseudotumor cerebri. In cases of unexplained pseudotumor cerebri or hydrocephalus, a search for SLE and APS should be considered.     

老年结核性脑膜炎脑积水35例临床分析

目的探讨老年结核性脑膜炎(结脑)并发中?重度脑积水的临床特征与影像学变化?方法回顾性分析经影像学证实的老年结脑并发中?重度脑积水35例?结果大脑导水管梗阻占82.9%,基底池粘连占20.0%?脑脊液(CSF)蛋白定量?白蛋白?IgG升高与脑积水有关?结论脑膜纤维蛋白渗出?粘连与老年性脑室变窄是造成脑积水的主要因素?CT与CSF中蛋白指标监测对脑积水的早期诊断?预后评估具有重要价值?