偏头痛性眩晕的临床特点初步分析

目的 初步了解偏头痛性眩晕(migrainous vertigo,MV)患者的临床特点.方法 回顾性分析上海仁济医院神经内科头痛门诊2006年1月至2007年1月159例连续偏头痛患者登记资料,共30例在偏头痛发作过程中伴有眩晕,成功电话随访17例,对其眩晕的临床特点进行分析,并与无眩晕偏头痛患者进行比较.结果 眩晕的首发年龄均晚于头痛,平均间隔为6.1年.眩晕发作可于头痛发作之前、之后或在头痛期间出现.其中12例患者在头痛间歇期也存在反复发作性眩晕.每次眩晕发作一般不超过24 h.多数患者发作不规则,频率自数天1次至数月1次不等,劳累及天气变化是最常见的诱发因素.伴或不伴眩晕的偏头痛患者,人口学及偏头痛发作特征方面无统计学差异.结论 偏头痛性眩晕有其特征性临床表现,但与不伴眩晕的偏头痛患者相比,其他临床表现方面相似.其内在机制有待进一步研究.     

前庭性偏头痛基因学研究进展

前庭性偏头痛是临床常见的良性复发性眩晕疾病，因其反复发作的临床特点、在人群中 的高发病率以及较差的药物治疗反应，严重影响了患者生活质量。作为一种遗传性疾病，前庭性偏头 痛的基因学研究对揭示其发病机制、开发诊断标记物及新型治疗手段有着重要的作用。现对前庭性偏 头痛的基因学研究进展加以综述，以期为今后前庭性偏头痛的临床诊疗提供参考。     

偏头痛性眩晕与基底型偏头痛(附9例临床分析)

目的分析9例偏头痛伴眩晕/头晕患者的临床及实验室检查结果,探讨头痛与眩晕/头晕的关系,以利正确诊治。方法作者医院收治的偏头痛伴眩晕/头晕患者9例,对所有患者均详细收集病史,并进行神经系统查体以及前庭功能、听力检查和头颅CT/MRI等实验室检查,以除外中枢性和耳源性眩晕。结果 9例偏头痛伴眩晕/头晕患者中,基底型偏头痛2例,无先兆偏头痛3例,偏头痛性眩晕(migrainous vertigo,MV)6例(其中2例为无先兆偏头痛发作数年后和50岁后转变为MV)。本组6例MV患者中,眩晕/头晕在头痛发作前数秒钟～1h内发生3例,在头痛发作后发生1例,与头痛同时发生1例,另1例偏头痛患者其头痛与眩晕从未同时发作过,为偏头痛等位征。结论 MV是不同于基底型偏头痛的头痛伴眩晕综合征,二者易与梅尼埃病、良性复发性位置性眩晕、后循环缺血(posterior circulation ischemia,PCI)等周围性和中枢性眩晕混淆或并存,临床应注意鉴别。     

儿童偏头痛102例临床分析

目的 探讨儿童偏头痛的诊断与治疗.方法 随意选择102例门诊治疗患者,并对其诊断治疗及随访情况进行分析.结果 随访68例,38例经休息、安慰剂治疗自行缓解;18例仍有头痛,多于劳累、紧张及患感冒时发作;12例服噻庚啶有效.结论 儿童偏头痛的临床特点是一种反复发作性头痛,多有家族病史,普通性双侧偏头痛及搏动性偏头痛多见,而且头痛程度、持续时间、频率差异很大,睡眠或休息后多可缓解.     

解读前庭性偏头痛诊断标准

头晕或眩晕与头痛是神经科学和耳鼻咽喉科学最常见的主诉之一.临床上有涉及头晕或眩晕与头痛交叉症状的患者,随着学科的发展进步,曾经先后被诊断为前庭性偏头痛、偏头痛相关眩晕、偏头痛相关性前庭病、偏头痛性眩晕等.这不仅是2个症状之间的交叉,还是2个学科之间的交叉.视觉、前庭觉和本体感觉共同作用以维系机体平衡,前庭外周刺激信号通过前庭感觉通路传递到中枢的过程中与头痛的相关通路有可能产生交互,病理状态下有可能引发头晕或眩晕合并头痛,临床上有可能为"一元"疾病,也可能是"二元"疾病共病,因而存在争议,引发关注.2012年中华神经科杂志组织青年医生进行了关于患者偏头痛合并眩晕时应诊断为前庭性偏头痛还是偏头痛性眩晕的辩论[1];在国际上,国际前庭学研究领域权威——Barany学会(为纪念因从事前庭学研究获1914年诺贝尔医学或生理学奖的奥地利学者Barany而命名)和国际头痛学会(IHS)共同探讨制定了前庭性偏头痛诊断标准,并于2012年在前庭研究杂志上发表[2].解读该诊断标准,同时了解与其进行鉴别诊断的相关头晕或眩晕疾病的特点及研究进展,将有助于我们在临床上对头晕或眩晕、头痛相关疾病的诊断和鉴别诊断.     

前庭性偏头痛发病机制及诊疗的研究进展

前庭性偏头痛为眩晕和偏头痛共存的良性复发性眩晕,发病率较高,反复发作严重影响患者的生活质量,近年来受到研究眩晕学者们的极大关注。与偏头痛一样,前庭性偏头痛的病理生理机制尚不明确,药物治疗方面缺少大样本多中心的随机对照试验验证药物的有效性。临床研究、动物实验等发现前庭性偏头痛与偏头痛存在许多共性。电生理技术、神经影像技术及检验技术为前庭性偏头痛发病机制的研究提供了有效手段。文中对前庭性偏头痛的发病机制、诊断、鉴别诊断以及治疗的研究现状进行综述,以期为临床诊疗提供参考。     

中西医结合治疗血管性头痛22例临床分析

普通型偏头痛为偏头痛的一种类型.其特点是:发作前无先兆症状,主要表现为反复发作性的头痛,伴有恶心呕吐.头痛时间较长,可达数日,是一种周期性发作的神经-血管功能性障碍引起的头痛[1].目前采用的治疗方法为:预防发作,预防性治疗和发作期治疗.药物有:轻症的有阿司匹林、颅痛定等.重症者用麦角制剂、可待因、氯灭酸等.存在着许多不良反应.     

偏头痛性眩晕

眩晕的终身患病率约7.4%,是神经内科最常见的就诊原因之一.临床发现有部分反复发作性眩晕的患者不能用良性发作性位置性眩晕(BPPV)、Menière病、后循环缺血等常见疾病来解释,根据病史却提示与偏头痛存在联系,并对偏头痛性治疗有一定反应.     

中国原发性头痛诊疗的证据、指南与规范

偏头痛、紧张型头痛和丛集性头痛是临床常见的原发性头痛。正确的诊断和规范地治疗是减少原发性头痛发病率及药物过度使用的重要措施。随着国内、外对原发性头痛诊疗临床研究的不断深入, 陆续增添了许多新的循证医学证据。特别是在原发性头痛的预防性治疗和非药物治疗领域都有了新的研究进展。在国内、外临床研究的基础上, 结合我国国情, 中华医学会神经病学分会头痛协作组组织相关专家撰写了中国偏头痛、紧张型头痛及丛集性头痛的诊断与治疗指南, 旨在提高以神经内科为主体的临床医师对原发性头痛的认识、管理与规范化诊疗。     

偏头痛慢性化的潜在危险因素

目的 探讨与偏头痛慢性化相关的潜在危险因素.方法 依据ICHD-Ⅱ(2004)及其关于慢性偏头痛最新修订版(2006)的诊断标准,2006年3月至2008年3月上海仁济医院神经内科头痛门诊连续就诊登记偏头痛患者250例,其中慢性偏头痛43例、发作性偏头痛207例,回顾分析两组患者的人口学资料及头痛病史.结果 慢性偏头痛占总偏头痛就诊人数的17.2%.单因素分析结果显示两组中性别构成、教育程度、体力劳动者比例以及存在一级亲属家族史、系统疾病史者的比例相似(P>0.05);头痛严重程度、持续时间、既往发作频率以及存在先兆的比例也无显著差异(P>0.05).慢性偏头痛组中急性期止痛药物的使用率较对照组明显增高(P=0.0005).两组患者偏头痛起病年龄相当,但慢性偏头痛组患者病程明显长于对照组,并于多因素分析中仍显示明显差异.结论 偏头痛慢性化的风险可能随病程延长而增大,但须行进一步的前瞻性队列研究以证实.在临床工作中,对病程长、可能存在止痛药物滥用的患者应加强治疗及随访.     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -