脑损害病人运用障碍的成套测验研究

参照国内外学者使用过的检查项目编制了一套运用功能测验，对３０名对照及５２例脑损害病人施测后发现，左右侧额叶、顶叶、丘脑、基底节及左枕叶、左内囊、左外囊、右外囊和胼胝体等部位受损都可引起失用症，观念运动性失用症和结构性失用症发生率较高且左右半球受损无显著差异；观念性失用症发生率较低并都是左半球受损。结果提示失用症是脑损害病人的常见症状但却没有局部定位意义。     

PET脑显像及其他显像技术在放射性脑损伤诊断的对比性研究

目的 探讨^18F－脱氧葡萄糖（FDG）正电子发射型计算机断层显影（PET）脑显像和其他医学影像方法对早期诊断放射性脑损伤的价值，以达到预防、减少脑放射损伤的目的。方法 静脉注射^18F-FDG后行脑显像，获得横断面、冠状面、矢状面断层显像。所有病人均进行CT检查。结果 20例正常人脑PET显像图像可见大脑皮质各叶、基底神经节、丘脑及小脑放射性分布均匀对称。12例完成头颈部恶性肿瘤放疗后有临床症状者均检出不同程度局灶性脑组织葡萄糖代谢下降，显像阳性率100％；其中10例鼻咽癌放疗后PET结果提示放射脑损伤病灶共23处，最常见于颞叶病灶13处、脑干4处、小脑4处以及顶叶2处。2例脑胶质细胞瘤放疗病人，PET结果提示病灶：顶叶2处、颞叶1处、枕叶1处。12例放疗后病人CT检查仅10例提示放射性脑损伤。结论 PET脑显像能准确、早期诊断脑放射损伤，是头颈部恶性肿瘤肿瘤放疗后的非常重要的监测手段。     

病毒性脑炎患儿脑脊液NO含量与临床意义

目的：探讨病毒性脑炎患儿脑脊液一氧化氮含量(NO)变化与脑损伤程度的相关性．方法：用比色法检测37例病毒脑及20例正常对照儿脑脊液NO含量．结果：病毒脑患儿脑脊液NO含量明显高于对照组，脑损伤重者NO含量更高，急性期的脑脊液NO含量明显高于恢复期．结论：病毒脑患儿脑脊液NO含量升高，增高幅度与脑损伤程度有关，NO含量测定有助于脑脊液常规及生化正常的病毒脑的诊断．     

重度抑郁症患者任务态和静息态脑功能磁共振成像研究（英文）

目的:本研究通过结合任务态与静息态的fMRI数据探讨导致抑郁症患者脑功能障碍的神经病理学因素。方法:采集25例抑郁症患者、24例健康对照N-back任务和静息态fMRI数据,采用双样本t检验进行任务态数据组间比较,低频振幅(ALFF)测量静息态。结果:重度抑郁症患者在静息态下,左丘脑、壳核、脑岛、额中回及额下回活跃程度显著增高,在任务态下,双边颞下回、右丘脑、契前叶、后扣带回、顶下回及左枕上回和梭状回活跃程度减弱。结论:皮质-丘脑-纹状体回路受损可能是抑郁症患者认知功能障碍和抑郁症状严重程度的潜在神经病理学因素。     

脑结构性病变患儿视频脑电图改变探讨

目的：探讨不同类型脑结构性病变与视频脑电图（V—EEG）表现的关系。方法：对73例影像学检查确认为脑结构性病变患儿进行V—EEG检查,分析其结果。结果：皮层损害患儿组EEG异常率高于颅内囊肿及血管畸形组,其间的差异有显著意义。有抽搐病史的结构性脑损伤患儿EEG异常率高于无抽搐病史的患儿,其间的差异有非常显著意义。结论：大脑皮层的结构性损害及有抽搐病史患儿的EEG异常率及痫波检出率均高。     

左颞叶和颅底占位性病变在韦氏智力量表中的损害模式

目的 :探讨左颞叶和颅底占位性病变在韦氏智力量表分测验中的损害模式。方法 :对 96例脑部占位性病变患者采用韦氏智力量表 (WAIS -RC)中的常识、词汇和相似性分测验进行测试。同时采用一个常识、词汇与相似性相对照的参数来对不同部位的患者进行比较。结果 :左颞叶和颅底占位性病变患者在常识和词汇分测验上比相似性分测验成绩差 ,5 8.8%的左颞叶患者和 72 .7%的颅底部患者参数〔(常识 +词汇 ) /2 -相似性〕为负数 ,而左额叶组、左顶叶 /左枕叶组及右半球组患者参数值则正数比率高 ,比率分别为 6 3.6 %、5 7.9%及 5 9.3%。与左额叶组、左顶叶 /左枕叶组和右半球组相比 ,左颞叶组和颅底组参数值更多为负数 ,差异有显著性 ,P <0 .0 5。结论 :本研究显示左颞叶及颅底部损害与常识和词汇分测验比相似性测验受损更明显相联系 ,支持左颞叶和颅底部损害可能更易损害记忆功能 ,尤其是语义记忆功能。     

皮层下失语的语言特点及与病灶部位关系的研究

目的:研究皮层下失语的语言特点及与病灶部位的关系。方法:选择经颅脑CT扫描证实为单侧皮层下病变患者105例,在发病2周、1月及2月分别进行失语症检查。同时,进行脑电地形图(BEAM)及CT图象标准化处理。结果:皮层下失语患者病灶多在基底节区外侧部、前部、上部及丘脑。基底节区外侧部及丘脑性失语者BEAM皮层慢波功率增高,且此类患者多有较重的听理解障碍,而尾状核受损者失语中有明显的构音障碍及音韵障碍。结论:皮层下失语有其语言特点,导致失语的原因多与皮层下病变直接或间接影响皮层语言区有关,但丘脑可作为皮层下语言中枢,在少数患者的失语中起作用。     

脑血管疾病与智力测验

本文为脑血管疾病患者神经系统受损程度进行分组，１５例伴有不同程度的肢体活动受限，另１４例经积极治疗无肢体残疾，作了ＷＡＩＳ－ＲＣ的对比分析。结果为伴有神经系统体征者智力水平普遍降低，后者则无明显智力障碍，说明脑损害与智力障碍成正比关系。     

脑卒中与心律失常的关系

目的 探讨脑卒中与心律失常的关系。方法 对157例脑卒中患者的心电图及临床资料分析。结果 脑卒中的心律失常检出率为56．6％，出血性卒中心律失常发生率高于缺血性卒中（P〈0．05）。结论 脑卒中病灶位于丘脑者及有高血压伴昏迷症状者心律失常发生率高，心律失常与预后有关。     

狗脑积水时某些脑代谢变化

目的：观察实验性狗脑积水某些脑代谢变化，评价脑受损状况。方法：20条成年健康杂种狗随机分为诱导后3 d、8 d、4月和对照组4组。经穿刺枕大池，注入白陶土(kaolin)悬浊液诱导、建立经CT证实的狗脑积水模型。经高效液相色谱(HPLC)检测右侧顶叶1 cm×1 cm×1 cm离体脑组织腺苷酸、磷酸肌酸(PCR)及肌酸(CR)含量。结果：脑积水脑组织AMP、ADP、ATP、PCR及CR的含量均低于对照组，但各时点有不同特点。脑积水诱导后3 d脑PCR的变化有明显差异(P＜0.05)，变化先于ATP。诱导8 d PCR几乎耗竭，ATP、ADP和CR低下也最严重(均P＜0.01)。4月组均高于诱导后3、8 d组，但均低于对照组。结论：脑积水脑ATP、ADP、AMP、PCR及CR的含量低下，反应脑积水时脑的能量状况受损；ATP、ADP、AMP的变化影响脑细胞的能量代谢及化学信号传递，从而导致脑的生理功能不同程度的损害。     

Lateralized brain damage and performance on trail making A and B, Digit Span Forward and Backward, and TPT Memory and Location.

The present retrospective study was undertaken to determine whether Trail Making Test A and B, Digit Span Forward and Backward, and TPT Memory and Location scores are differentially sensitive to right or left hemisphere brain damage. Groups of patients with right, left, and generalized cerebral lesions and matched normal controls were compared. Results showed a relative failure for any individual measure, difference, or ratio score to reliably distinguish between right and left hemisphere lesions. Patients with diffuse lesions performed significantly worse than non-neurologic medical controls and right and left lesion groups on Trails A and TPT Memory and Location. Results are discussed in terms of specific methodological variables including chronicity of lesion, the nature of the task demands, and priming effects.     

脑血管病人的心理健康状况调查

脑血管病人常常会出现明显的心理改变 ,除认知功能受损外 ,抑郁、焦虑、恐怖、强迫、躯体化、精神病性等症状亦十分突出 ,这些改变严重影响病人的康复和预后 ,影响病人的生活质量 ,给家庭和社会带来沉重的负担。本文旨在探讨脑血管病人的这些心理改变特点 ,以便提供必要的临床干预和治疗。1　资料和方法1.1　病例组病例组选自哈尔滨医科大学附属二院神经科2 0 0 1年 10月至 2 0 0 2年 2月住院治疗的脑血管病病人 ,共计 6 0例。符合中华医学会第四届全国脑血管病学术会议各类脑血管病诊断要点 ,全部病例均否认曾经患过脑卒中 ,经CT或MRI确…     

无症状性脑梗死患者智能障碍及相关因素研究

目的：探讨无症状性脑梗死（ACI）患者的智能障碍及相关因素。方法：用韦氏智力量表对经CT或MRI证实的56例ACI患者进行神经心理学检查,并与症状性脑梗死（SCI）组及正常对照组比较。对ACI病例中智能障碍组与非智能障碍组的梗死灶数量和部位、既往史及受教育程度进行对比分析。结果：36例ACI患者智力低于正常,其中13例出现智能障碍;ACI组分测验值与SCI比较无差异,但明显低于正常对照组;右侧梗死组中PIQ明显低于VIQ（P＜0．05）;智能障碍组受教育程度低、糖尿病史、多发性梗死、双侧梗死、颞叶梗死、侧脑室旁及丘脑梗死者与非智能障碍组相比有显著差异（P＜0．01－0．05）;智能障碍与文化程度呈负相关,与高血压病程呈正相关。结论：多发性梗死、双侧梗死、皮质及皮质下梗死与智能障碍发生密切相关,尤其是颞叶、侧脑室旁及丘脑梗死更易出现智能障碍;文化水平低、高血压、糖尿病是ACI智能障碍的危险因素。     

MMPI correlates of relatively localized brain damage

Examined the MMPI correlates of relatively localized brain damage classified along dimensions of laterality and caudality. Forty patients with lateralized lesions that involved anterior or posterior cerebral areas were studied. Based on a multivariate analysis of variance, results revealed significant differences in MMPI profiles between left hemisphere and right hemisphere lesion groups. The MMPI profile for the left hemisphere lesion group is well within the normal range; the right hemisphere lesion group is beyond normal limits, primarily on scales 8 and 2. Several issues are dis cussed in an effort to integrate these findings with previous studies.     

脑肿瘤患者认知功能障碍的初步研究

目的 :探索脑肿瘤患者认知功能障碍的特点。方法 :采用CLB测验对 31例左侧大脑肿瘤患者、34例右侧大脑肿瘤患者及正常对照组进行测验。结果 :(1)左侧大脑脑肿瘤组四项语言—序贯能力测验成绩明显低于对照组 (P <0 .0 5 ) ,四项空间认知能力成绩无明显差别 (P >0 .0 5 ) ,病例组CLQ为正值 ,表明右半球信息加工能力无明显损害 ;(2 )右侧大脑脑肿瘤组四项空间认知能力测验成绩明显低于对照组 (P <0 .0 5 ) ,四项语言—序贯能力测验成绩中系列数字、偏旁组字、类别组词与对照组间无明显差异 (P >0 .0 5 ) ,系列声音测验成绩有明显差异 (P <0 .0 5 ) ,病例组CLQ为负值 ,表明左半球信息加工能力基本正常。结论 :CLB可以对脑肿瘤患者认知功能障碍进行量化 ,是一种评估左右侧大脑肿瘤患者认知功能障碍的有效方法。     

Hemispheric specialization in the co-ordination of arm and trunk movements during pointing in patients with unilateral brain damage

During pointing movements involving trunk displacement, healthy subjects perform stereotypically, selecting a strategy in which the movement is initiated with either the hand or trunk, and where the trunk continues after the end of the hand movement. In a previous study, such temporal co-ordination was not found in patients with left-hemispheric brain lesions reaching with either their dominant paretic or with their non-dominant non-paretic arm. This co-ordination deficit may be associated in part with the presence of a lesion in the dominant left hemisphere. If so, then no deficit should be observed in patients with stroke-related damage in their non-dominant right hemisphere moving with their ipsilesional arm. To verify this, 21 right-hand dominant adults (7 who had had a stroke in the right hemisphere, 7 who had had a stroke in the left hemisphere and 7 healthy subjects) pointed to two targets located on a table in front of them in the ipsilateral and contralateral workspace. Pointing was done under three movement conditions: while not moving the trunk, while bending the trunk forward and while bending the trunk backwards. The experiment was repeated with the non-paretic arm of patients with stroke and for the right and left arms of healthy subjects. Kinematic data were recorded (Optotrak). Results showed that, compared to healthy subjects, arm-trunk timing was disrupted in patients with stroke for some conditions. As in patients with lesions in the dominant hemisphere, arm-trunk timing in those with lesions in the non-dominant hemisphere was equally more variable than movements in healthy subjects. However, patients with dominant hemisphere lesions used significantly less trunk displacement than those with non-dominant hemisphere lesions to accomplish the task. The deficit in trunk displacement was not due to problems of trunk control or sitting balance since, in control experiments, all subjects were able to move the trunk the required distance, with and without the added weight of the limb. Results support the hypothesis that the temporal co-ordination of trunk and arm recruitment during pointing movements is mediated bilaterally by each hemisphere. However, the difference in the range of trunk displacement between patients with left and right brain lesions suggests that the left (dominant) hemisphere plays a greater role than the right in the control of movements involving complex co-ordination between the arm and trunk. Electronic Publication     

Social and emotional functions in three patients with medial frontal lobe damage including the anterior cingulate cortex

Introduction. The aim of this study was to explore social and emotional functions in patients with medial frontal damage including the anterior cingulate cortex (ACC).

Methods. Three patients with medial frontal lobe lesions primarily involving the ACC performed tasks on motivational decision making, emotional facial expression recognition, and social cognition, including theory of mind (ToM). Their performance on these tasks was compared with age and education matched healthy controls.

Results. Patient performance on the motivational decision making and social situations tasks did not differ from controls. Selective emotional facial expression recognition impairment for fear was evident in one patient with a unilateral right ACC lesion (patient 3). ToM impairment was present in only one patient with a bilateral ACC lesion (patient 2). In contrast, the two patients with unilateral right ACC lesions had intact ToM (patients 1 and 3).

Conclusions. These findings suggest that medial frontal lobe lesions primarily involving the ACC do not appear to critically disrupt motivational decision making or social situation processing. The ACC plays a role in processing particular types of emotion (fear). Bilateral ACC damage impairs ToM processing, but unilateral damage to the right ACC is not sufficient to disrupt ToM.     

The perception of emotional chimeric faces in patients with depression,mania and unilateral brain damage

BACKGROUND: Judgements made on chimeric faces elicit reliably a perceptual bias to the left hemispace, presumed to be due to right hemisphere dominance for emotional processes. Major depressive illness has been shown to attenuate this bias. The aim of this work was to examine lateral perceptual bias in bipolar I and II patients in a hypomanic state and unipolar depressed patients and those with unilateral hemisphere damage following stroke. METHOD: Sixty patients with DSM-IV affective disorder (30 bipolar I or II, currently hypomanic, 30 unipolar depressives), 30 right brain-damaged patients, 30 left brain-damaged patients and 30 healthy controls were given the Happy-Sad Chimeric Faces Test. RESULTS: Right hemisphere damaged and unipolar depressed patients both showed a significantly reduced left hemispatial bias (LHB) compared to controls, bipolars and left brain-damaged patients. No significant difference in mean LHB between controls and both hypomanics and left brain-damaged patients was found. There was no significant association between LHB and clinical variables. CONCLUSIONS: The results suggest a physiological distinction between bipolar and unipolar depression. The significantly diminished left hemifacial bias in depressed patients suggests right hemisphere dysfunction.     

Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume

Sixty surviving patients from a community-based stroke register who had CT scan evidence of a single brain lesion and neurological signs appropriate to it were interviewed three to five years following their first-ever stroke. Mood disorder (anxiety and depression), physical disability, and intellectual impairment were assessed using standardized measures. The position and volume of the brain lesion was determined from CT scans performed soon after the stroke. The prevalence of depressive disorder was lower in this sample than that reported in previous studies (DSM-IIIR major depression 8.3%; all DSM-IIIR depressive disorders 18.3%). Reports by other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere, were not supported. Neither was there evidence of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions. Anxiety disorders, especially agoraphobia, were relatively common (20% if diagnosed in the presence of depressive disorder), but were not related to lesion location or volume.     

The effects of competition and motor reprogramming on visuomotor selection in unilateral neglect

Patients with unilateral neglect following right hemisphere damage may have difficulty in moving towards contralesional targets. To test the hypothesis that this impairment arises from competing motor programs triggered by irrelevant ipsilesional stimuli, we examined 16 right hemisphere patients, eight with left visual neglect and eight without, in addition to eight healthy control subjects. In experiment 1 subjects performed sequences of movements using their right hand to targets on the contralesional or ipsilesional side of the responding limb. The locations of successive targets in each sequence were either predictable or unpredictable. In separate blocks of trials, targets appeared either alone or with a simultaneous distractor located at the immediately preceding target location. Neglect patients were significantly slower to execute movements to contralesional targets, but only for unpredictable movements and in the presence of a concurrent ipsilesional distractor. In contrast, healthy controls and right hemisphere patients without neglect showed no directional asymmetries of movement execution. In experiment 2 subjects were required to interrupt a predictable, reciprocating sequence of leftward and rightward movements in order to move to an occasional, unpredictable target that occurred either in the direction opposite to that expected, or in the same direction but twice the extent. Neglect patients were significantly slower in reprogramming the direction and extent of movements towards contralesional versus ipsilesional targets, and they also made significantly more errors when executing such movements. Right hemisphere patients without neglect showed a similar bias in reprogramming direction (but not extent) for contralesional targets, whereas healthy controls showed no directional asymmetry in either condition. On the basis of these findings we propose that neglect involves a competitive bias in favour of motor programs for actions directed towards ipsilesional versus contralesional events. We suggest that programming errors and increased latencies for contralesional movements arise because the damaged right hemisphere can no longer effectively inhibit the release of inappropriate motor programs towards ipsilesional events. Received: 1 October 1996 / Accepted: 21 October 1997