270例动脉瘤性蛛网膜下腔出血积血部位与动脉瘤部位相关性分析

目的研究动脉瘤性蛛网膜下腔出血的积血部位与动脉瘤部位之间的相关性。方法回顾性分析270例动脉瘤性蛛网膜下腔出血患者的影像学资料,以了解积血部位与动脉瘤部位之间的相关性。结果 270例患者中前交通动脉瘤86例,大脑前动脉瘤19例,头颅CT均显示前纵裂积血;脉络膜前动脉瘤40例,后交通动脉瘤82例,多数在CT上显示广泛鞍上池积血,病变同侧积血多于对侧;大脑中动脉瘤32例,CT多显示病变同侧外侧裂积血;后循环动脉瘤11例,头颅CT多见鞍上池及脑室系统积血;出血量较大时,除具备上述特征外,积血部位更广泛,特异性相对较小。结论动脉瘤性蛛网膜下腔出血的积血部位与动脉瘤部位存在一定的对应关系,根据头颅CT所示积血部位可初步判断动脉瘤的部位,对数字减影血管造影时血管检查顺序的选择及治疗方法的预估有重要价值。     

脑动脉瘤破裂伴灶性积血的临床意义

报告９８例经ＣＴ确诊的灶性积血，均为数字减影脑血管造影和手术证实为动脉瘤破裂。其中后交通动脉瘤４６例，前交通动脉瘤３１例，大脑中动脉瘤１２例，其他部位动脉瘤９例。积血主要在基底池、纵裂前上方和侧裂内。认为，ＣＴ示灶性积血是动脉瘤破裂的重要依据，并可判断动脉瘤破裂的位置，同时根据积血部位、积血量、临床和其他ＣＴ表面预测是否有血管痉挛。     

无蛛网膜下腔出血的破裂脑动脉瘤

目的 总结无蛛网膜下腔出血(SAH)的破裂脑动脉瘤的诊治经验.方法 对15例在起病后2 d内首次CT或MRI上表现为脑内出血(ICH),和(或)脑室内出血(IVH)、硬脑膜下血肿(SDH)和壁间出血(IMH)而无SAH的破裂脑动脉瘤患者的临床表现、影像学检查结果 、治疗方法 和预后进行回顾性分析.结果 本组首次CT或MRI检查表现为ICH者3例、IVH合并ICH者6例、SDH者1例、IVH者1例、IMH者3例和等高混合密度者1例.其中动脉瘤位于大脑中动脉6例、前交通动脉4例、后交通动脉3例、大脑前动脉1例和小脑后下动脉1例.开颅手术夹闭动脉瘤13例,血管内栓塞2例.出院时GOS评分:恢复良好8例、中残3例、重残3例和植物生存1例.本组15例占同期破裂脑动脉瘤的3.8%.结论 破裂脑动脉瘤首次CT扫描可表现为单纯ICH,和(或)IVH、SDH、IMH而无SAH,与CT扫描时间、动脉瘤的部位和指向以及出血量有关.早期控制颅内高压、及时诊断和有效处理破裂动脉瘤,是改善预后的关键.     

前循环动脉瘤破裂伴颅内血肿和脑疝患者的CT特点和直接手术疗效

目的 探讨前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现和直接手术疗效. 方法 回顾性分析四川省人民医院神经外科自2007年12月至2010年12月收治的11例前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现及治疗,分析前循环动脉瘤破裂形成血肿与动脉瘤位置关系及手术处理要点. 结果 本组患者颅内出血原因术中均证实为动脉瘤破裂出血,其中前交通动脉瘤2例,后交通动脉瘤3例,大脑中动脉瘤6例;多发动脉瘤2例,1例为大脑中动脉瘤(责任动脉瘤)合并同侧后交通动脉瘤,1例为后交通动脉瘤(责任动脉瘤)合并对侧大脑中动脉瘤:术后GOS分级显示V级6例,Ⅳ级2例,Ⅲ级1例,Ⅱ级0例,Ⅰ级2例. 结论 依据前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现,早期手术治疗效果满意.     

动脉瘤性蛛网膜下腔出血形态分析

目的 探讨动脉瘤性蛛网膜下腔出血计算机断层扫描（computed tomography,CT）形态特征,根据CT出血形态预判颅内动脉瘤的部位。方法 回顾性分析82例动脉瘤性蛛网膜下腔出血患者CT出血形态及全脑血管造影结果,总结不同部位动脉瘤破裂出血CT形态特征。结果 大脑前动脉、前交通动脉、大脑中动脉动脉瘤出血CT形态特异,为单纯前纵裂、外侧裂出血,蛛网膜下腔出血伴前纵裂、额叶、外侧裂血肿;颈内动脉、后交通动脉瘤出血CT形态多样,特异性较差,但常见形态为一侧鞍上池、外侧裂出血,波及其他脑池,前纵裂出血少或无出血;大脑后动脉、椎动脉、基底动脉、小脑后下动脉等后循环动脉瘤出血CT形态较典型,为脚间池、桥前池、环池、四叠体池、小脑延髓外侧池、小脑幕上下出血,但与脑干周围非动脉瘤性蛛网膜下腔出血鉴别困难。结论 根据特异性CT出血形态能够预判部分大脑前动脉、前交通动脉、大脑中动脉动脉瘤,预判颅内后循环动脉瘤时与脑干周围非动脉瘤性蛛网膜下腔出血鉴别困难,预判颈内动脉、后交通动脉瘤特异性差。     

急诊脑动脉瘤破裂显微手术治疗

１临床资料３８例中，男２５例，女１３例。年龄２８～７０岁。术前病情按Hunt分级：Ⅰ级５例，Ⅱ级８例，Ⅲ级１３例，Ⅳ级９例，Ⅴ级３例。全脑血管造影：动脉瘤位于颈眼动脉５例，后交通动脉１０例，分叉部２例；前交通动脉１３例；大脑前动脉１例；大脑中动脉２例；大脑后动脉１例；小脑上动脉１例；椎动脉１例，双侧颈内动脉－后交通动脉瘤和前交通动脉瘤加颈内动脉－眼动脉瘤各１例。螺旋CT扫描均有不同程度脑池积血，其中位于侧裂池２３例，鞍上池１９例，环池１２例，四叠体池９例，纵裂池８例，伴有脑内血肿者１２例；伴有脑室血…     

颅内幕上动脉瘤的显微手术治疗

本文报导近三年来显微手术治疗颅内幕上动脉瘤60例的经验。资料(1)性别,年龄:女32例,男28例。年龄17～70岁,其中43例小于50岁。(2)动脉瘤的部位:按发生率多寡顺序为:前交通动脉28例,床突上颈动脉14例,大脑中动脉13例,颈内动脉分叉处7例,后交通动脉3例,大脑前动脉1例,胼周枝1例,双侧病变(前交通动脉+大脑中动脉)1例。(3)手术     

源于大脑前动脉A1段的动脉瘤

大脑前动脉(ACA)动脉瘤通常发生于A_2段或前交通动脉(ACOA),而少见于A_1段.本文报道38例A_1段动脉瘤患者的临床、血管造影及CT表现并简要复习了有关文献.     

大脑前动脉水平段动脉瘤血管造影分型

本文分析10例大脑前动脉水平段(A_1)动脉瘤。根据动脉瘤颈起源于A_1的部位将此10例分为三型:Ⅰ型起源于A_1和豆纹动脉的连接处(7例),Ⅱ型起源于A_1开口的近端(2例),Ⅲ型起源于A_1环(A_1延伸或卷曲处)的顶部(1例)。并就上述10例动脉瘤瘤体大小、发于A_1之何侧、多发或单发、是否合并高血压及病情级别、CT扫描所见之蛛网膜下腔出血(SAH)、手术效果进行讨论。作者从1971～1983年为437例大脑动脉瘤患者施行了脑血管造影,其中392例作了直接手术。在9例位于A_1的动脉瘤中8例表现为SAH,1例动脉瘤未破裂。A_1的动脉瘤发病率为2.1%。9例中有1例在同一部位上有2个动脉瘤。患者年龄为30～62岁(平均48岁)。从临床病     

大脑中动脉闭塞合并颅内动脉瘤

本文报告8例大脑中动脉闭塞合并颅内动脉瘤,男6例,女2例,平均年龄58岁。7例动脉瘤破裂出血之前无脑缺血症状,仅1例动脉瘤破裂前有大脑中动脉血栓形成病史。8例动脉瘤均发生于大脑中动脉闭塞同侧。动脉瘤分布部位:前交通支动脉2例,后交通动脉3例,大脑前动脉1例,大脑后动脉,颈内动脉 C_2段各1例。脑血管造影可见大脑中动脉闭塞均在中动脉起始部,大脑中动脉分布区有充分代偿供血且动脉瘤的载瘤动脉为代偿供血的主要动脉.我们认为,大脑中动脉闭塞以后可以导致其它脑血管的血流动力学改变,后者又可以加剧动脉血管壁的变性损伤,最终形成动脉瘤。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.