缺血性脑血管病定量脑电图与影像及功能影像检测的相关研究概况

缺血性脑血管病定量脑电图与影像及功能影像检测的相关研究概况潘映辐定量脑电图（ｑＥＥＧ）对脑血管病（ＣＶＤ）中的一过性脑缺血发作（ＴＩＡ）和可逆性神经系损伤（ＲＩＮＤ）以及部分非进行性卒中（ＰＮＳ）的早期检出有较高的敏感性和特异性（区分病人和健康人）已...     

急性脑血管病所致言语障碍与病变部位的关系研究

观察了６１例急性脑血管病所致失语症患者，男２９例，女３２例，年龄５３～６９岁，平均５８．５岁。头颅ＣＴ或ＭＲＩ检查，病灶位于语言中枢３１例（占５０．８％）；位于非语言中枢３０例（占４９．２％），包括左额叶内侧、左颞顶枕结合区，峡部岛叶等“非语言皮质区”和左基底节、内囊、外囊等皮质下深部结构。分析了失语症类型与病变部位和性质的关系。提示“非语言中枢”病变，也可导致各类型失语     

急性脑血管病与血浆同型半胱氨酸水平关系研究

血浆同型胱氨酸(Hcy)又称高半胱氨酸,是一种机体内不能合成的含硫氨基酸,只能从食物中的甲硫氨酸转变而来.近年来许多研究表明,Hcy水平可能是脑血管病(CVD)发生、发展的重要独立危险因素.此研究对急性CVD患者血浆Hcy水平与CVD的发病、类型及病情轻重之间的关系进行了探讨.     

癫癎患者脑电图癎样放电起源区域与头颅MRI病变部位的相关性研究

目的：探讨脑电图（EEG）样放电起源区域与头颅MRI病变部位的关系.方法：回顾性总结221例因癫癎症状就诊患者的病史和EEG特点,分析其影像学改变,利用描述性分析及Logistic回归分析等统计学方法进行分析.结果：221例癫患者EEG出现样放电波127例（57.47%）,局灶懒波51例（23.07%）,背景节律改变39例（17.65%）,前额部高波幅δ节律44例（19.91%）,局部高波幅慢活动13例（5.88%）.头颅EEG癎样放电波出现区域与头颅MRI发现病变部位相吻合者101/127例（79.53%）,与头颅MRI发现病变部位异侧的为8/127例（6.30%）.Logistic回归分析结果显示大部分EEG癎样放电波起源区域与头颅MRI病变部位有着较好的对应关系.结论：癎样放电波形起源区域与头颅MRI病变部位有着较好的吻合程度.     

老年人脑血管病的临床及脑电图分析

目的探讨脑电图与老年人脑血管病的临床关系。方法对确诊的95例老年人脑血管病的临床及脑电图总结。结果脑电图正常24例（25．3％）,异常71例（74．7％）,其中轻度异常28例,占异常的39．4％;中度异常以上7例（9．9％）,局限性异常者36例,占异常脑电图的50．7％。结论脑血管病的脑电图虽无特异性改变,但脑电图的动态观察对于诊断、鉴别诊断及预后有一定的指导价值,脑电图复查好转或正常,一般预后较好。而脑电图异常,临床症状好转或正常,说明受损脑部不具有重要性,但要定期复查。     

溶血磷脂酸与脑血管病相关性的研究

溶血磷脂酸(LPA)是脂类中小分子物质,是磷脂生物合成早期阶段关键性前体,在体内信号传递过程中起着十分重要的作用,被称为多功能“磷脂信使”。它可以通过G蛋白偶联受体影响靶细胞功能[1],因而对血小板聚集、平滑肌收缩、细胞增殖、肿瘤细胞侵入等具有广泛的生物学效应。正常人血浆LPA水平很低,一旦发生凝血过程,血小板被凝血酶活化产生大量LPA释放到血液中,可导致LPA水平大幅度增高。该文检测了短暂性脑缺血发作(transicent ischemic attacks,TIA)、脑梗死(cerebralinfarction,CI)、脑出血发生时血浆LPA水平,以探讨LPA与脑血管病…     

大鼠全脑缺血模型的脑电图验证

目的：用脑电图验证四管关闭全脑缺血模型。方法：选取30只Wistar大鼠,按pulsinelli方法制成全脑缺血模型,以脑电图出现直线波作为全脑完全缺血指标,分别与正常鼠、椎动脉关闭鼠、颈动脉关闭鼠脑电图比较,并与正常鼠比较全脑缺血后脑组织病理学改变。结果：单纯 颈动脉或椎动脉关闭鼠脑电图均不出现直线波,全脑缺血5－10s后,25只鼠中的23只出现直线波,模型成功率92％,全脑缺血鼠与正常鼠比较,脑组织病理学无差异。结论：脑短暂缺血不会造成脑组织的明显损害,以脑电图出现直线波作为全脑完全缺血的指标来验证全脑缺血模型的方法简单、可靠、易行,有实际应用价值。     

脑电地形图对脑血管病早期诊断价值的研究

目的：探讨脑电地形图（BEAM）在急性脑血病中的临床应用价值。方法：采用日本光电公司4418型18导脑电图检查仪和广州三端医疗器械有限公司LQWY－N2型BEAM处理仪对128例急性脑血管病患者进行了检测,并做了部分病例的动态分析。结果：急性期脑血管病患者的BEAM改变主要为病变侧局限性慢波功率（短阵节律的δ波,θ波）明显增高,与头颅CT扫描发现的病灶区相吻合,与常规脑电图比较,其阳性率明显增高（分别为92．9％,64．1％）,经卡方检验显示BEAM阳性率明显高于脑电图（P＜0．01）,结论：BEAM可早期准确反映脑卒中发生后异常脑电活动的来源,因此,对脑卒中早期药物主疗效判断来源,BEAM是可供参考的检测手段。     

抗心磷脂抗体与脑血管病相关性研究

目的研究抗心磷脂抗体(ACA)与脑血管病的关系,为脑卒中的预测提供临床依据。方法采用前瞻性研究方法,对91例脑梗死(CI)、42例脑出血(CH)患者及30例健康者血清中的抗心磷脂抗体(ACA)进行检测。结果CI及CH组ACA总阳性率、IgG型ACA阳性率均显著高于对照组。ACA阳性卒中容易复发,病灶常为多个。ACA在脑卒中发病一周内阳性率最高,且抗体分型以IgG型为主。结论ACA是CI及CH的危险因素,对脑卒中的预测有一定意义。     

脑微出血与卒中

脑微出血作为一种具有出血倾向的脑小血管病变,随着影像学技术的发展,其检出率越来越高.目前,大量研究表明,脑微出血与缺血性卒中、脑出血和溶栓或抗栓治疗后症状性脑出血关系密切.本文旨在探讨脑微出血与上述疾病的相关性,将有利于脑微出血患者卒中防治策略的制定.     

Association between cerebral microbleeds and prior primary intracerebral hemorrhage in ischemic stroke patients

OBJECTIVE: To investigate association between cerebral microbleeds (CMB) and prior intracerebral hemorrhage (ICH) on MRI and topographic correlation of the two types of lesions. PATIENTS AND METHODS: Two hundred and sixty consecutive patients (67.0+/-11.1 years) with ischemic stroke were included. CMB and prior ICH were assessed on T2-gradient-echo MRI. The presence and number of CMB as predictors for prior ICH were examined. Topographic correlations between CMB and ICH lesions in patients with prior ICH in the infratentorial, basal ganglionic/thalamic and cortico-subcortical regions were tested. RESULTS: CMB were observed in 113 (43.5%) patients and a total of 50 prior primary ICH lesions were observed in 39 (15.0%) patients. Among the ICH lesions, 39 (78%) were asymptomatic. Presence of CMB (odds ratio 2.53, p=0.015) and number of CMB (odds ratio 1.11, p<0.001) were independent determinants for prior ICH. Topographic correlation between CMB and ICH was significant in the basal ganglionic/thalamic region (p=0.017), but not in the infratentorial (p=0.548) or cortico-subcortical regions (p=0.389). CONCLUSION: CMB were associated with prior ICH on MRI of patients with ischemic stroke. CMB in the basal ganglion or thalamus was associated with prior ICH in the same region.     

脑出血患者血清瘦素浓度及意义

目的 分析脑出血患者血清瘦素浓度的变化,探讨瘦素与脑出血的关联。方法 对86例脑出血患者和58例对照者进行瘦素、空腹胰岛素等的检测,并进行比较。结果 （1）脑出血组与对照组相比胰岛素敏感指数（ISI）降低（P〈0．01）,男性患者瘦素水平高于对照组（P〈0．01）。（2）脑出血组与对照组相比收缩压和舒张压水平均升高（P〈0．01）。（3）脑出血患者血清瘦素水平与ISI呈负相关（P〈0．05）。（4）男性患者中高瘦素-高血压水平（收缩压或舒张压）的联合作用与增加脑出血的危险强烈相关。结论 脑出血患者存在胰岛素抵抗;男性脑出血患者的瘦素水平升高,高瘦素-高血压水平的联合作用增加发生脑出血的危险。     

Anoxic-ischemic encephalopathy and strokes causing impaired consciousness

Coma due to global or focal ischemia or hemorrhage is reviewed. Impaired consciousness due to anoxic-ischemic encephalopathy after cardiac arrest is common but prognostically problematic. Recent guidelines need to be refined for those patients who have received therapeutic hypothermia. Strokes, both ischemic and hemorrhagic, can affect the level of consciousness by damaging specific brain structures involved in alertness because of widespread cerebral injury or secondary cerebral or systemic complications.     

Disparities in diagnosis of cerebral amyloid angiopathy based on hospital characteristics

Cerebral amyloid angiopathy (CAA) categorized as a cerebral small vessel disease can cause lobar intracerebral hemorrhage (ICH), convexity subarachnoid hemorrhage (SAH) and ischemic stroke (IS). The purpose of this study was to evaluate the differences in the diagnosis of CAA based on hospital characteristics and to assess the discharge outcomes of patients with CAA admitted for IS, ICH and SAH. Adult patients admitted with secondary diagnosis of CAA were identified in National Inpatient Sample in 2016 and 2017. Multivariable logistic regression analysis was performed to evaluate outcomes. A total of 16,040 patients had a secondary diagnosis of CAA. Among CAA patients, 1810 (11.3%) patients were admitted for IS, 4765 (29.7%) for ICH and 490 (3.1%) for SAH. Diagnosis of CAA was five-fold higher among patients admitted to urban teaching hospitals (aOR = 5.4;95% CI = 4.1–7.2) compared to rural hospitals and two-fold higher in large bed size hospitals (aOR = 2.3;95% CI = 2.0–2.7) compared to small bed size hospitals. Compared to non-CAA group, patients with history of CAA had lower odds of in-hospital mortality among patients admitted for ICH (10% vs 23%, aOR = 0.35; 95%CI = 0.27–0.44) and SAH (6% vs 19%, aOR = 0.24; 95%CI = 0.10–0.55); and higher odds of discharge to home among patients admitted for ICH (17% vs 18%, aOR = 1.27; 95%CI = 1.05–1.53). CAA diagnosis is less common in rural and small bed size hospitals compared to urban and large bedside hospitals, respectively. Patients with CAA admitted for ICH have better discharge outcomes compared to non-CAA patients admitted for ICH.     

Sex matters in stroke: A review of recent evidence on the differences between women and men

For the most part, stroke is a disease of old age. With the predicted increase in the aged population and longer life expectancies, the number and proportion of people living with stroke is expected to increase, especially among women and the elderly. For those who suffer stroke, there is a high likelihood of experiencing death and severe disability. Therefore, the issue of stroke amongst women (and men) is a key priority in global public health. In this review, we consider sex and gender differences in ischemic and hemorrhagic stroke, and we summarize data that outlines the epidemiology, risk factor, treatment recovery and prevention of stroke. We discuss possible mechanisms for the sex differences, specifically in areas of biology, medical management and social and behavioral context. With evidence showing that women and men experience stroke differently, sex must be taken into account when treating patients and when designing clinical trials.     

Arterial sympathetic innervation and cerebrovascular diseases in original rat models

The role of the arterial sympathetic innervation in cerebrovascular pathology was investigated in new experimental models using Brown Norway (BN) and Long-Evans (LE) rats. The BN rat is susceptible to intracerebral hemorrhage (ICH) within the cerebral cortex when rendered hypertensive whereas the LE rat is prone to cerebral aneurysms (CAs) in arteries of the circle of Willis with hypertension and carotid ligation. Noradrenaline (NA) content, determined by high performance liquid chromatography (HPLC), was lower both in the caudal and cerebral arteries in the BN than in the LE rat. Denervation of cerebral arteries by superior cervical ganglionectomy did not increase ICH lesion incidence in BN hypertensive rats. A possible link between the level of caudal artery NA content and the occurrence of ICH lesions and CAs was studied in rats from two distinct BNXLE crosses: back-cross (BC) rats (F1XBN) and F2 rats (F1XF1) which respectively display, with hypertension and carotid ligation, a high incidence of either ICH lesions or CAs. In BC rats, the level of caudal artery NA content was not related to ICH lesion occurrence. However, in F2 rats a low caudal artery NA content was associated with a high incidence of ruptured CAs. Thus, a low arterial sympathetic innervation may participate in mechanisms leading to rupture of CAs.     

The Impact of a Neuro-Intensivist on Patients with Stroke Admitted to a Neurosciences Intensive Care Unit

Introduction  Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences Intensive Care Unit (NICU). Methods  Data regarding 433 stroke patients admitted to a 10-bed university hospital NICU were prospectively collected in two 19-month periods, before and after the appointment of a NI. Outcomes and disposition of patients with ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were compared between the two periods, using univariate and multivariate analyses. Results  One hundred and seventy-four patients with strokes were admitted in the period before and 259 in the period after the NI. Observed mortality did not differ between the two periods. More patients were discharged home in the after period (75% vs. 54% in the before period (P = 0.003). After adjusting for covariates, the NICU and hospital LOS were shorter for each type of stroke in the after period (Cox proportional hazard ratios, 95% CI were 2.37, 1.4–4.1 and 1.8, 1.04–3 for IS, 1.98, 1.3–3 and 1.2, 0.8–1.9 for ICH, and 1.6, 1.1–2.3 and 1.4, 1.01–2 for SAH, respectively) or for all strokes (1.92, 1.52–2.43 and 1.7, 1.28–2.25 for the first 12 days of hospital admission). Conclusion  The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and improved the disposition of patients with strokes admitted to a NICU.