Dolichoectatic intracranial arteries. Association with aneurysms of the abdominal aorta

Dolichoectatic intracranial arteries (DIA) have been given several names, e.g. fusiform aneurysms, dolichomega-arteries. It is not an uncommon condition and it raises interesting points: 1) symptoms and signs result from compression (cranial nerve palsies; hydrocephalus) from ischemic or hemorrhagic episodes; 2) the diagnosis is made easier with CT since the arterial wall is often calcified; 3) the pathophysiology has long been assumed to be atherosclerotic in nature, but controversial assumptions are discussed; 4) associated arterial abnormalities are common: one of our cases and approximately half of the post mortem reported DIA were associated with aneurysm of the abdominal aorta. Two cases are reported here: 1) A 56 y/o male presented with progressive gait disorder, deafness and ischemic episodes. CT showed DIA and hydrocephalus. DIA involved the basilar artery, both intracranial carotid arteries, the abdominal aorta and probably one renal artery. A ventriculo-atrial shunt was performed unsuccessfully. Post mortem findings are reported; 2) A 52 y/o male had suffered from trigeminal neuralgia for about one year and from trigeminal permanent pain for two weeks. He had developed left hemiparesis and dysarthria. DIA involved the basilar artery and the left intracranial internal carotid artery. The right internal carotid artery and the right vertebral artery were hypoplastic. Clinical, radiographical and pathophysiological features are reviewed.     

Microvascular decompression as a treatment of essential hypertension

Microvascular decompression (MVD) proved to be the method of choice in treating trigeminal neuralgia, facial hemispasm, glossopharyngeal neuralgia, and torticollis spastica. So did MVD for the left rostral ventrolateral medulla oblongata and glossopharyngeal and vagus nerves in association with primary arterial hypertension. Five patients with primary essential hypertension were treated with MVD. During a longer follow-up, 75% of the patients had lowered blood pressure. In 2 patients, MVD was performed for trigeminal nerves due to ipsilateral trigeminal neuralgia. This paper presents and analyzes the clinical findings in these 5 patients and discusses the global state-of-the-art of MVD for arterial hypertension.     

Doppler ophthalmic blood pressure measurement in the hemodynamic evaluation of occlusive carotid artery disease

In 102 patients with angiographically proven occlusive carotid artery disease of 60-100% diameter reduction, Doppler ophthalmic artery pressure and blood flow direction were recorded by the recently developed ophthalmomanometry-Doppler technique. Among these 102 patients, 50 presented with complete carotid artery occlusions and 52 with carotid artery diameter stenoses of greater than or equal to 60%. Mean +/- SD Doppler ophthalmic artery pressure was 69 +/- 15 mm Hg ipsilateral to the occlusion and 86 +/- 18 mm Hg ipsilateral to a stenosis of the carotid artery (p less than 0.001). The mean +/- SD Doppler ophthalmic pressure index (ratio of the ophthalmic artery to systemic blood pressure) was lower ipsilateral to the occlusion (0.46 +/- 0.08) than ipsilateral to a carotid artery stenosis (0.54 +/- 0.08; p less than 0.001); in both, the index was clearly diminished compared with normal values (0.68 +/- 0.04; p less than 0.001). It is concluded that the intracranial hemodynamic consequences in the patients with occlusion are on average more profound than in the patients with stenosis. In carotid artery occlusions, the mean +/- SD ipsilateral ophthalmic pressure index was 0.46 +/- 0.06 for antegrade and 0.46 +/- 0.09 for retrograde ophthalmic artery blood flow. In carotid artery stenoses, the mean +/- SD ipsilateral ophthalmic pressure index was 0.55 +/- 0.07 for antegrade and 0.48 +/- 0.06 for retrograde ophthalmic artery blood flow (p less than 0.01). These results indicate that in carotid stenoses the collateral capacity of the ophthalmic artery is insufficient compared with intracranial collaterals, while in carotid occlusions the blood flow direction in the ophthalmic artery does not predict intracranial hemodynamic compensation.     

Trigeminal neuralgia and persistent trigeminal artery

We report a case of trigeminal neuralgia caused by persistent trigeminal artery (PTA) associated with asymptomatic left temporal cavernoma. Our patient presented unstable blood hypertension and the pain of typical trigeminal neuralgia over the second and third divisions of the nerve in the right side of the face. The attacks were often precipitated during physical exertion. MRI and Angio-MRI revealed the persistent carotid basilar anastomosis and occasionally left parietal cavernoma. After drug treatment of blood hypertension, spontaneous recovery of neuralgia was observed and we planned surgical treatment of left temporal cavernoma.     

椎动脉优势与脑血管疾病、面肌痉挛、三叉神经痛相关性的临床分析

目的探讨椎动脉优势(VAD)与面肌痉挛、三叉神经痛及脑血管疾病的相关性。方法收集在辽宁省人民医院神经科就诊并同时行头部MRI和MRA检查的后循环梗死、单纯头晕、突发性眩晕伴平衡障碍、偏头痛、面肌痉挛、三叉神经痛患者。根据有无VAD分为椎动脉优势组和非椎动脉优势组。收集患者的一般资料,记录疾病的发生率;记录后循环梗死的发生率、发生位置;分析VAD与基底动脉弯曲发生率及弯曲方向的关系;Pearson检验分析椎动脉直径差异与三叉神经痛患者的症状评分、基底动脉弯曲长度(BL)的相关性。结果本研究共纳入413例患者,VAD的发生率为52.3%;优势组中后循环梗死患者105例(105/413,25.42%),突发性眩晕伴平衡障碍患者39例(39/413,9.44%)、面肌痉挛患者12例(12/413,2.91%)、三叉神经痛患者11例(11/413,2.66%),与非优势组相比具有统计学差异(P<0.05);在199例后循环梗死患者中,优势组梗死主要发生在小脑后下动脉供血区(PICA)(27/199,13.57%)和基底动脉供血区(BA)(45/199,22.61%)。PICA区梗死发生在VAD对侧的比例(20/105,19.05%)高于同侧(7/105,6.67%),BA区梗死主要发生在椎动脉优势同侧,其差异均具有统计学意义(P<0.05);优势组中有117例存在基底动脉弯曲,明显高于非优势组(P<0.05),143例左侧VAD患者中,有92例患者椎动脉向右侧弯曲;73例右侧优势患者中有20例患者基底动脉向左侧弯曲。椎动脉直径差异与三叉神经痛患者的症状评分呈正相关(r=0.336,P=0.001),与基底动脉弯曲长度呈正相关(r=0.432,P=0.004)。结论椎动脉优势人群后循环梗死、三叉神经痛、面肌痉挛的发生率较非优势人群高;椎动脉优势合并后循环梗死中以PICA和BA支配区多见;椎动脉优势患者基底动脉弯曲发生概率高,其弯曲方向与椎动脉优势方向相反;椎动脉直径差异越大,基底动脉弯曲长度越长,三叉神经痛患者的症状评分越高。     

Transthoracic arterial bypass for the treatment of severe cerebral ischemia induced by brachiocephalic arteritis☆○ A report of 15 cases

BACKGROUND: Carotid arterial reconstruction is hard to cure the extensive lesions of carotid arteries and subclavian arteries in patients with brachiocephalic arteritis; however, transthoracic arterial bypass surgery provides an opportunity for the treatment of brachiocephalic arteritis. OBJECTIVE: To report the improving effects of transthoracic arterial bypass surgery on the clinical symptoms of severe cerebral ischemia induced by brachiocephalic arteritis and observe the occurrence of complications after the intervention. DESIGN: Case observation. SETTING: Department of Vascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. PARTICIPANTS: Fifteen patients with Takayasu arteritis, including 1 male and 14 females, were selected from Department of Vascular Surgery, Wuhan Union Hospital from June 2003 to June 2007. Their ages ranged from 16 to 37 years. All patients were finally diagnosed by clinical histories, health examinations and color Doppler detection. All patients provided the confirmed consent. METHODS: All patients had received transthoracic artificial vascular bypass surgery. Among them, 6 patients had the bridge from ascending aorta to bilateral axillary arteries to lateral internal carotid artery; 3 from ascending aorta to bilateral axillary arteries; 5 from ascending aorta to lateral axillary artery to lateral internal carotid artery; In particular, one patient combining with abdominal aorta occlusion had received two step surgical interventions. In the first step, bridging surgery was performed from ascending aorta to bilateral axillary arteries to lateral internal carotid artery; in the second step, patients received left axillofemoral bypass. MAIN OUTCOME MEASURES: ① Detecting blood velocity in variously intracranial-arterial systoles by using transcranial Doppler postoperatively; ② following-up the improve of clinical symptoms at 40 months after surgery; ③ observing postoperative complications. RESULTS: All 15 patients were involved in the final analysis. ① Intracranial-arterial blood velocity: Average intracranial-arterial blood velocity was significantly increased postoperatively (P < 0.01). ② Following-up results of clinical symptoms: All patients did not have death and blindness; while, transient cerebral ischemia, dizzy, photophobia, giddiness, hemoptysis and other symptoms disappeared gradually; therefore, patients were able to live by themselves. ③ Postoperative complications: Among them, 3 patients had injury of hypoglossal nerve and 3 patients had injury of recurrent laryngeal nerve. All recovered after 1–3 months conservative treatment. One patient with injury of brachial plexus nerve on one side relieved gradually after a half-year treatment. One patient had occlusion in subclavian arterial bridge on the third day after surgery and once more embolism after arterial embolectomy on the next day; however, the limb did not have obvious ischemic symptoms but low skin temperature as compared with the contralateral side. CONCLUSION: Transthoracic arterial bypass surgery can relieve clinical symptoms of brachiocephalic arteritis postoperatively, complications are mild, and the effects are confirmed.     

Migraine in pregnancy and lactation

Whether arterial or venous compression or arachnoid adhesions are primarily responsible for compression of the trigeminal nerve in patients with trigeminal neuralgia is unclear. The aim of this study was to determine the causes of trigeminal nerve compression in patients with trigeminal neuralgia. The surgical findings in patients with trigeminal neuralgia who were treated by micro vascular decompression were compared to those in patients with hemifacial spasm without any signs or symptoms of trigeminal neuralgia who were treated with microvascular decompression. The study included 99 patients with trigeminal neuralgia (median age, 57 years) and 101 patients with hemifacial spasm (median age, 47 years). There were significant differences between the groups in the relationship of artery to nerve (p < 0.001) and the presence of arachnoid adhesions (p < 0.001) but no significant difference in relationship of vein to nerve. After adjustment for age, gender, and other factors, patients with vein compression of nerve or with artery compression of nerve were more likely to have trigeminal neuralgia (OR = 5.21 and 42.54, p = 0.026 and p < 0.001, respectively). Patients with arachnoid adhesions were less likely to have trigeminal neuralgia (OR = 0.15, p = 0.038). Arterial compression of the trigeminal nerve is the primary cause of trigeminal neuralgia and therefore, decompression of veins need not be a priority when performing microvascular dissection in patients with trigeminal neuralgia.     

Noninvasive assessment of cerebral collateral blood supply through the ophthalmic artery

We assessed the potential of 2-MHz pulsed-wave transorbital Doppler ultrasonography to delineate the role of the ophthalmic artery as a source of collateral cerebral blood supply by comparing oculopneumoplethysmography, transorbital Doppler ultrasonography, periorbital continuous-wave Doppler ultrasonography, and transcranial Doppler ultrasonography in 25 patients with unilateral internal carotid artery occlusion and five controls with 10 normal internal carotid arteries. Systolic ophthalmic artery blood velocity was reduced ipsilateral to an internal carotid artery occlusion (38.2 +/- 10.2 cm/sec) compared with the contralateral and control velocities (46.0 +/- 10.3 and 47.5 +/- 6.8 cm/sec, respectively; p less than 0.05). Ophthalmic systolic pressure measured by oculopneumoplethysmography was 94.7 +/- 13.2 mm Hg ipsilateral to an internal carotid artery occlusion compared with 108.4 +/- 15.3 mm Hg on the contralateral side (p less than 0.01). Transorbital and periorbital Doppler ultrasonography detected reversed ophthalmic artery blood flow ipsilateral to an internal carotid artery occlusion in 44.0% and 40.0% of the patients, respectively. Systolic middle cerebral artery blood velocity was 55.2 +/- 22.3 cm/sec ipsilateral to an internal carotid artery occlusion compared with 79.4 +/- 23.5 cm/sec on the contralateral side (p less than 0.05) and 101.2 +/- 18.9 cm/sec in the controls (p less than 0.05). Reversed ophthalmic artery blood flow was associated with a low middle cerebral artery blood velocity and lack of major intracerebral collaterals. Transorbital Doppler ultrasonography permits noninvasive evaluation of the ophthalmic artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

微血管减压术治疗三叉神经痛的临床分析

目的探讨微血管减压术治疗三叉神经痛的疗效及桥脑旁区血管与三叉神经“敏感区”的关系。方法回顾性分析微血管减压术治疗的96例三叉神经痛病人的临床资料。术中探查发现“敏感区”责任血管92例（95．83％），其中小脑上动脉20例（21．74％），小脑前下动脉13例（14．13％），椎动脉及基底动脉11例（11．96％），其他多根血管压迫7例（7．61％），起源不清楚的动脉19例（20．65％），岩静脉21例（22．83％），脑血管畸形1例（1．09％），未见责任血管为动脉瘤者。按文献报道的标准将这些血管与三叉神经的关系进行分型：无接触型4例，接触型32例，压迫型27例，粘连包绕型32例，贯穿型1例。根据不同分型，采取不同方法对血管进行处理。结果手术总有效率98．96％（95例）。主要并发症包括听力下降及消失4例，轻-中度面肌障碍8例，轻度后组颅神经症状1例，小脑症状3例，脑脊夜漏1例，术后切口枕大神经痛1例，伤口延迟愈合2例，无死亡与致残病例。术后随访3个月。4年，平均2．7年，未见疼痛复发患者。结论微血管减压术是目前外科治疗三叉神经痛的有效方法，术中正确识别桥脑旁区三叉神经“敏感区”的责任血管并充分减压，是确保微血管减压术成功的关键。     

微血管减压术治疗典型及非典型三叉神经痛的疗效对比研究

目的探讨微血管减压术治疗典型及非典型三叉神经痛的不同疗效及其可能机制。方法寸比分析2003～2004年间经微血管减压术治疗的45例典型三又神经痛患者及17例非典型三叉神经痛患者的临床特征、术中所见年口手术疗效。结果45例典型三叉神经痛患者中，平均痛程3．1年，平均发病年龄60．3岁。其中20例（44．4％）患者中疼痛累及三又神经的单一分支，其余25例（55．6％）疼痛均累及2或3个分支。术中见39例（86．7％）为动脉压迫，6例（13．3％）为动脉和静脉混合压迫。术后疼痛完全缓解44例（97．8％），明显减轻1例（2．2）。而在17例非典型三叉神经痛患者中，平均病程8．7年，平均发病年龄55.5岁，疼痛均累及三叉神经的2或3个分支。术中见10例（58．8％）为动脉压迫，7例（41．2％）为动脉年口静脉混合压迫。术后疼痛完全缓解5倒（29.4％），明显减轻10例（58．8％），无效2例（11．8％）。结论微血管减压术治疗典型三叉神经痛的疗效明显优于非典型患者，这可能与典型三叉神经痛患者的病程较短、发病年龄较晚、疼痛多呈单支分布、且以动脉压迫为主以及术中能够实现充分减压有关。     

Etiologic exploration of magnetic resonance tomographic angiography negative trigeminal neuralgia

Our objective was to explore the etiologic factors involved in trigeminal neuralgia with negative magnetic resonance tomographic angiography (MRTA) results. Clinical data from 341 patients with idiopathic trigeminal neuralgia who were treated with neurovascular decompression between March 2003 and December 2011 were retrospectively analyzed. The etiologic causes of preoperative MRTA-negative trigeminal neuralgia were categorized based on comparisons between preoperative MRTA and intraoperative endoscopic images. MRTA was highly sensitive (92.4%, 291/315) to neurovascular compression, whereas its specificity was 65.4% (17/26). Among the 24 false-negative cases, there were nine patients with petrosal vein compression, 12 with superior cerebellar artery compression, two with superior cerebellar arterial branch compression, and one patient with anterior inferior cerebellar artery compression. Among the 17 true-negative cases, three patients had arachnoid adhesions, one had a protruding temporal eminence, five had micro-cholesteatomas, and eight patients exhibited no compression. The factors responsible for the MRTA-negative results included small-diameter arterial vessels, veins with slow blood flow, arachnoid adhesions, protruding temporal eminences, micro-cholesteatomas, and other pathologies such as multiple sclerosis. Preoperative diagnoses of MRTA-negative patients need to integrate the MRI results from multiple sequences to discriminate between arteriolar compression, venous compression, and small compressive lesions. When narrow cerebellopontine angles are shown in MRTA, arachnoid adhesion and temporal eminence compression should be considered.     

Atherosclerotic aortic arch plaques in cryptogenic stroke: a microembolic signal monitoring study

BACKGROUND AND PURPOSE: To find out the prevalence of relevant atherosclerotic plaques in the aortic arch and their potential role as a source of embolism in cryptogenic stroke. METHODS: We performed a transoesophageal echocardiography (TEE) on 49 patients with cryptogenic stroke from a total series of 212 non-selected patients with acute ischaemic stroke studied prospectively by cranial computed tomography (CT), colour-duplex and transcranial Doppler (TCD) sonography with micro-embolic signal (MES) monitoring. Cryptogenic stroke was diagnosed in those patients without carotid or intracranial stenosis > 50%, nor lacunar or cardio-embolic strokes. We defined relevant plaques as those > or = 4 mm thick located in the ascending aorta or proximal arch. RESULTS: Twenty-three patients (46.9%) had atherosclerotic aortic plaques (AAP): 3 in the ascending aorta (in 1 > or = 4 mm), 11 in the proximal aortic arch (in 4 > or = 4 mm) and 9 in the descending aorta (in 5 > or = 4 mm). Hence, 5 patients (10.2%) had relevant plaques. Aortic plaques were significantly related to older age (p < 0.001) and male gender (p = 0.042). A carotid artery stenosis < 50% was found in 39% of patients with AAP and in 8% of those without AAP (p = 0.009). MES were detected in 3 patients with plaques > or = 4 mm thick, but not in those without AAP or with AAP < 4 mm thick (p = 0.006). CONCLUSION: Although few patients with cryptogenic stroke had relevant plaques in our non-selected population, our results support the hypothesis that relevant aortic plaques have embolic potential.     

Distribution, severity and risk factors for aortic atherosclerosis in cerebral ischemia

Significant thoracic aortic plaques (>4 mm) are an independent risk factor for ischemic stroke. Within 1 week of stroke/transient ischemic attack (TIA) onset, 105 consecutive patients underwent transesophageal echocardiography assessment of aortic plaque thickness using the criteria of Amarenco et al. (N Engl J Med 1994;331:1474-1479). A proximo-distal gradient was found in the distribution of aortic atheroma >4 mm (p = 0.04). Symptomatic coronary artery disease was associated with plaque in the proximal aorta (p = 0.03); extracranial carotid stenosis >70% was associated with plaque in the arch and descending aorta (p < 0.01). The severity of aortic plaque was associated with age on multivariable analysis (p = 0.0003 to p < 0.01). Only smoking showed predictive regional specificity (p = 0.03);no other risk factors were associated with aortic atheroma in any segment. In stroke/TIA patients, carotid stenosis >70% predicts aortic arch atheroma plaques >4 mm which may predispose to reinfarction after endarterectomy. Atheroma of the ascending aorta is associated with ischemic heart disease, and cardiac screening should be considered in asymptomatic patients.     

微血管减压术治疗典型及非典型三叉神经痛的疗效比较

目的比较微血管减压术治疗典型及非典型三叉神经痛的疗效,探讨其机制.方法对比分析62例经微血管减压术治疗的三叉神经痛病人的临床特征、术中所见和手术疗效.其中45例为典型者,17例为不典型者.结果典型病人平均病程3.1年,平均年龄60.3岁;20例（44.4%）疼痛累及三叉神经的单一分支,25例为2～3支痛;术中见39例（86.7%）为动脉压迫,6例为动静脉混合压迫;术后44例（97.8%）疼痛缓解,1例无效.非典型病人平均病程8.7年,平均年龄55.5岁;均为多支疼痛病人;术中见10例（58.8%）为动脉压迫,7例为动静脉混合压迫;术后疼痛缓解5例（29.4%）,减轻10例（58.8%）,无效2例.结论微血管减压术治疗典型三叉神经痛的疗效明显优于非典型者,可能与其病程较短,发病年龄较晚,疼痛多呈单支分布,以动脉压迫为主,且术中能够实现充分减压有关.     

Aortic Pulsatility Propagates Intracranially and Correlates with Dilated Perivascular Spaces and Small Vessel Compliance

Introduction: To test the hypotheses that changes in the aortic pulse-wave produced by arterial stiffening are (1) propagated into cerebral small vessels, (2) associated with reduced compliance of small cerebral arterial vessels, and (3) associated with the presence of dilated perivascular spaces (PVS). Methods: Fifteen volunteers and 19 patients with late-onset depression (LOD) were prospectively recruited, of which 6 fulfilled the criteria for treatment-resistant depression (TRD). Aortic pulse-wave velocity (PWV) was determined using Carotid-Femoral Doppler. Pulse-wave analysis (PWA) was performed using a SphygmoCor system. White-matter lesion load and PVS were scored on established MRI scales. Cerebral arterial and aqueductal cerebrospinal fluid (CSF) flow patterns were studied using quantitative phase-contrast angiography. Results: Depressed patients had more PVS (P < .05) and prolongation of the width of the arterial systolic pulse-wave in the carotid arteries (P < .01). There was no significant group difference for any PWV or PWA measurement. TRD patients showed more PVS than other LOD patients (P < .05). The fractional width of the arterial systolic peak correlated significantly with augmentation index (AIx) and heart rate-corrected augmentation index (AIx75; R²?=?0.302, P < .01and R²?=?0.363, P < .01 respectively). Arterial–aqueductal delay showed a negative correlation with estimated aortic systolic pressure (PWVsys; R²?=? 0.293; P < .01), AIx (R² = ?0.491; P < .01) and AIx75 (R² = ?0.310; P < .01). PVS scores correlated with AIx (R²?=?0.485; P < .01) and AIx75 (R²?=??0.292; P < .01). Conclusion: Our findings support the hypothesis that increased arterial pulsatility resulting from central arterial stiffness propagates directly into cerebral vessels and is associated with the development of microvascular angiopathy, characterized by dilated PVS and decreased compliance of small arterial vessels.     

Prevalence of and risk factors associated with carotid artery stenosis: the Troms? Study.

BACKGROUND AND PURPOSE: To assess prevalence, distribution, ultrasound characteristics and determinants of carotid artery stenosis in a large, population-based study of both women and men. METHODS: A total of 6,727 persons aged 25-84 years were screened for extracranial stenosis with Duplex ultrasound of the right carotid artery. Risk factors were compared in 225 persons with stenosis and 5,514 persons without. RESULTS: The prevalence of carotid stenosis was higher in men than in women, where 3.8% (95% CI, 3.2-4.6%) had carotid stenosis, compared to 2.7% (95% CI, 2.2-3.3%) in women (p = 0.001). The prevalence gradually increased by age in both genders. Cholesterol, HDL cholesterol, fibrinogen, systolic blood pressure levels and current smoking were independently associated with carotid artery stenosis in both women and men. The presence of carotid stenosis was significantly associated with a history of cerebrovascular disease, coronary heart disease and peripheral artery disease. For each 10% increase in the degree of carotid stenosis, the risk of having had a cerebrovascular event increased by 26%. CONCLUSIONS: The prevalence of carotid stenosis in the general population, as measured by ultrasound, is low. Age, male gender, smoking, total cholesterol, HDL cholesterol (inverse), fibrinogen and systolic blood pressure are all independent predictors of carotid artery stenosis.     

181例原发性三叉神经痛微血管减压术疗效分析

目的 探讨微血管减压术在原发性三叉神经痛疗中的效果,为指导诊疗提供临床依据.方法 对广东省人民医院神经外科自2000年1月至2007年12月收治的181例原发性三叉神经痛患者的一般资料、责任血管和外科手术效果等临床资料进行总结分析.结果 181例三叉神经痛患者中,O型血患者79例(占43.65%),较国人正常O型血分布(33.80%)有增高趋势;发病率右侧:左侧=1.8:1;2条以上责任血管者45例(24.86%);责任血管包括小脑上动脉96例,小脑后下动脉7例,小脑前下动脉以及动静脉混合接触或压迫者各25例.内听动脉13例,基底动脉15例,椎动脉9例,单纯静脉15例(主要为岩静脉和桥静脉),无名血管9例(主要为以上动静脉血管的分支).181例患者术后1月内171例症状完全消失(94.48%);症状改善,但需结合药物控制者9例(4.97%);植物生存1例(0.55%).结论 本组资料提示O型血可能更易患三叉神经痛;微血管减压术是原发性三叉神经痛的理想治疗手段,防止遗漏多发性责任血管是减少术后复发的重要因素.     

2型糖尿病患者合并卒中的相关危险因素分析

目的 探讨2型糖尿病患者合并卒中的相关危险因素。方法 采用回顾性分析的研究方法对连续选取自2003年1月至2010年6月于卫生部北京大学第五临床医学院内分泌科住院治疗的2099例2型糖尿病患者进行分析,依据患者是否合并卒中分为2型糖尿病合并卒中组和2型糖尿病不合并卒中组,比较两组患者一般资料及血糖、血脂、血尿酸等代谢指标,分析2型糖尿病患者合并卒中的危险因素。性别不同相应的危险因素略有差异,进一步按照性别进行分层,分别比较不同性别2型糖尿病患者合并卒中的危险因素。结果 2099例2型糖尿病患者中,212例（10.1%）合并卒中,年龄、腰臀比、糖尿病病程、空腹胰岛素、餐后2小时胰岛素、收缩压、尿酸以及颈动脉内中膜厚度和股动脉内中膜厚度在糖尿病合并卒中组均高于糖尿病不合并卒中组,差异具有显著性（P<0.05）。糖尿病合并高血压及合并冠状动脉粥样硬化性心脏病均较无相应并发症者卒中发病率明显增高（P均<0.01）。在男性患者中,合并卒中者130例（10.9%）。年龄、糖尿病病程、空腹胰岛素、2小时胰岛素、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、尿酸、收缩压、颈动脉内中膜厚度和股动脉内中膜厚度在合并卒中组均高于不合并卒中组,差异具有显著性（P<0.05）。糖尿病合并高血压及合并冠状动脉粥样硬化性心脏病均较无相应并发症者卒中发病率明显增高（P均<0.01）。在女性患者中,合并卒中者82例（9.04%）。年龄、腰臀比、糖尿病病程、收缩压、尿酸、高密度脂蛋白胆固醇、颈动脉内中膜厚度和股动脉内中膜厚度在合并卒中组均高于不合并卒中组,差异具有显著性（P<0.05）。在男性及女性患者中,糖尿病合并高血压或合并冠状动脉粥样硬化性心脏病病史的均较无相应并发症者卒中发病率明显增高（P均<0.01）。多因素Logistic回归分析表明,年龄［优势比（odds ratio,OR）为1.067,95%可信区间（confidence interval,CI）1.021～1.115,P=0.004］、股动脉内中膜厚度（OR 1.590,95%CI 1.041～2.431,P=0.032）、收缩压（OR 1.026,95%CI 1.008～1.044,P=0.004）、冠状动脉粥样硬化性心脏病病史（OR 2.342,95％CI 1.081～5.070,P=0.031）与2型糖尿病患者合并卒中具有相关性。结论 2型糖尿病患者合并卒中的相关危险因素为年龄、腰臀比、糖尿病病程、空腹胰岛素、餐后2小时胰岛素、收缩压和尿酸及颈动脉内中膜厚度和股动脉内中膜厚度。不同性别2型糖尿病患者合并卒中的危险因素略有差异。合并高血压及冠状动脉粥样硬化性心脏病可增加卒中的发生。     

Association between intracranial, arterial pulse pressure amplitudes and cerebral autoregulation in head injury patients

OBJECTIVE: To explore whether intracranial pulse pressure amplitudes relate to arterial pulse pressure amplitudes and whether correlations between time-related changes in intracranial and arterial pulse pressure amplitudes associate with indices of cerebral autoregulation. METHODS: A total of 257 continuous and simultaneous intracranial pressure (ICP), arterial blood pressure (ABP) and middle cerebral artery (MCA) blood velocity recordings were obtained 1-14 days after ictus in 76 traumatic head injury patients and analysed retrospectively. Clinical outcome was assessed using the Glasgow outcome scale (GOS). Pulse pressure amplitudes of corresponding single ICP and ABP waves were correlated in consecutive 200 wave pairs. Mean ICP, mean ABP and mean ICP wave amplitudes, and mean and systolic MCA blood flow velocities, were computed in consecutive 6 second time windows. The indices of cerebral autoregulation PRx (moving correlation between mean ICP and mean ABP), and Mx and Sx (moving correlation between mean and systolic MCA blood velocity and cerebral perfusion pressure) were calculated over 4 minute periods and averaged over each recording. RESULTS: Intracranial pulse pressure amplitudes were not related to arterial pulse pressure amplitudes (mean of Pearson's correlations coefficients: 0.04). Outcome was related to mean ICP, PRx and Sx (p 相似文献   

Trigeminal neuralgia in an elderly patient associated with a variant of persistent primitive trigeminal artery

An 86-year-old woman presented with a 10-year history of right paroxysmal facial pain. The trigger zone was the right maxilla. Magnetic resonance (MR) angiography and MR cisternography sourse images showed an aberrant artery originating from the right internal carotid artery anastomosed to the anterior inferior cerebellar artery territory (AICA) of the cerebellum, and it was closed at the root entry zone of trigeminal nerve. The patient underwent microvascular decompression (MVD), and her pain resolved after the operation. Most of the offending vessels that cause trigeminal neuralgia are the superior cerebellar artery (75-80%) and AICA. Although persistent primitive trigeminal artery (PTA) is the most common type of persistent carotid-basilar anastomosis, trigeminal neuralgia associated with PTA or a PTA variant is very rare, and particularly, a PTA variant is an uncommon, anomalous, intracranial vessel. It is necessary to inspect MR imaging scans carefully prior to MVD surgery because they are frequently associated with intracranial aneurysms. During surgery, we must be careful not to injure the perforating arteries from the PTA variant. MVD for trigeminal neuralgia in elderly patients is effective if the patients can have a tolerate general anesthesia. However, when we plan surgery for elderly patients, we must take care that it does not to lead to unexpected complications.