中年女性头晕、行走不稳进行性加重2年余——Gerstmann-Sträussler-Scheinker综合征

1 资料 患者,女,45 岁,家庭主妇,因"头晕伴行走不稳进行性加重2 年余"于2016 年08 月03 日入中山大学附属第一医院神经科诊治. 患者于2013 年12 月开始无明显诱因出现头晕、行走不稳.头晕多为昏沉感,不伴视物旋转,无耳鸣或听力下降.头晕与体位改变有关,曾有跌倒(具体不详).2014年2 月症状加重,...     

脑干小脑占位1例临床病例讨论

<正>病例资料病史患者住院号436×××,女性,47岁。因"头晕伴视物模糊行走不稳2个月余"收入院。现病史患者于入院前2个月(2012年6月初)无明显诱因下出现持续性头晕,伴恶心呕吐,同时向右侧视物模糊,未引起重视。2012年6月15日出现行走不稳,向两侧摇晃,无肢体麻木疼痛。2012年6月26日至市     

误诊为多发性硬化的原发性中枢神经系统淋巴瘤1例报告

正本文通过1例误诊为多发性硬化的原发性中枢神经系统淋巴瘤(PCNSL)病例,分析多发性硬化(MS)和PCNSL在临床症状,影像学表现和治疗反应等方面的异同。1病例男,46岁,因"头晕5个月,加重伴视物成双半月余"于2013年5月2日入院。患者于入院前5个月,无明显诱因出现头晕,伴间断恶心呕吐,以颈椎关节病治疗,头晕无明显缓解。患者于入院前3个月,自觉头晕伴恶心呕吐症状     

行走不稳两年 言语不清一年 眼睑痉挛四个月

病历摘要 患者男性,62岁。因行走不稳2年、言语不清1年、右眼睑痉挛4个月,于2014年2月入我院神经科。患者2012年4月无明显诱因突然出现行走不稳、步基宽,走路易向右侧偏斜,伴视物成双、视物模糊,站立时有明确的头晕症状,卧位时减轻,无恶心、呕吐,无视物旋转,无饮水呛咳、吞咽困难、言语不清,无肢体麻木、无力等症状与体征。     

替罗非班联合阿替普酶治疗后循环梗死1例报告及文献复习

<正>1病例介绍患者,男,52岁,主因"突发头晕3 h,加重伴右肢乏力1 h"于2017年9月8日14∶30入住永州市中心医院神经内科。患者于入院前3 h行走过程中突然出现头晕,头重脚轻,活动时较为明显,伴有行走不稳及恶心,未呕吐,休息后症状无缓解,入院前1 h患者头晕程度加重,持续存在,且出现右肢乏力、麻木,右上肢持物欠稳,右下肢站立费劲,伴有吐词不清,双眼球向     

典型“心型”影像征的双侧延髓内侧梗死1例

<正>1病例介绍患者男,57岁,主因"言语不清、行走不稳4 d"于2014年1月10日入院。患者4 d前无诱因突发言语不清、构音障碍,自觉下肢无力、行走不稳,无法站立,有双手麻木感,伴有头晕,无视物旋转感,无恶心、呕吐,伴有饮水呛咳,轻度吞咽困难,咽喉部有异物感,无呼吸困难,无头痛。双下肢无力症状加重,呛咳明显,就诊     

颅内多发占位病变的病例讨论

病例资料患者住院号：209×××,男性,46岁。汉族。工商业者,浙江省金华人。因头晕全身无力27 d,加重伴意识障碍17 d,于2010年7月9日入住浙江大学医学院附属邵逸夫医院神经内科。现病史患者于27 d前（2010年6月12日）开始出现头晕伴全身无力,开车时脚踩刹车无力。22 d前喝酒后无力更加明显,伴行走不稳,头部胀痛较剧,伴恶心、呕吐。病情进行性加重。     

以孤立性眩晕发病进展为多颅神经核损害的脑桥被盖梗死1例

正1病例介绍患者女性,55岁。因"头晕2周,加重伴视物成双、言语含糊1周"于2017年8月9日入院。患者于入院前2周活动中出现头晕,头部昏沉感,持续性,伴恶心,呕吐一次,无其他伴随症状,至中关村医院急诊就诊,行颅脑计算机断层扫描(computed tomography,CT)检查未见明显异常。入院前1周患者头晕加重,步态不稳,需搀扶行走,并出现复视,言语含糊不清,写字时笨拙,右耳闷胀感,听力较前下降,症状持续     

抗amphiphysin抗体阳性副肿瘤性小脑变性一例

临床资料 患者男,55岁,主因“行走不稳10 d,头晕5d”于2011年7月24日入我院.患者入院前10 d无明显诱因出现走路不稳及写字拿笔不稳,6d前突发头晕,恶心、呕吐、视物旋转及视物成双,持续约10 min.此后在卧位坐起时出现头晕,行走不稳渐加重.头颅MRI未见明显异常,对症治疗未见明显好转.     

以头晕、行走不稳为首发症状的胼胝体梗死1例报告

胼胝体病变临床表现差异较大,首发症状缺乏特异性,极易导致漏诊、误诊.本文通过1例以头晕、行走不稳为首发症状的胼胝体梗死患者来例证,并讨论胼胝体梗死的一些表现,提高对胼胝体梗死的认识,以防止误诊漏诊. 1病历资料 患者,女,56岁,农民,因"头晕,行走不稳2d,加重6h"来诊.患者于2d前外感后出现头晕,行走不稳,双下肢无力感,严重时站立困难,症状呈阵发性加重,头晕呈非旋转性,无恶心呕吐,无吞咽困难及饮水呛咳,无复视,无明显偏侧肢体活动障碍,在开始发病的2d中,曾小便失禁一次,后未再出现小便失禁,无大便失禁.     

Technical recommendations and interpretation guidelines for electroencephalography for premature and full-term newborns

Electroencephalography (EEG) of neonatal patients is amongst the most valuable diagnostic and prognostic tool. EEG recordings, acquired at the bedside of infants, evaluate brain function and the maturation of premature and extremely premature infants. Strict conditions of acquisition and interpretation must be respected to guarantee the quality of the EEG and ensure its safety for fragile children. This article provides guidance for EEG acquisition including: (1) the required equipment and devices, (2) the modalities of installation and asepsis precautions, and (3) the digital signal acquisition parameters to use during the recording. The fundamental role of a well-trained technician in supervising the EEG recording is emphasized. In parallel to the acquisition recommendations, we present a guideline for EEG interpretation and reporting. The successive steps of EEG interpretation, from reading the EEG to writing the report, are described. The complexity of the EEG signal in neonates makes artefact detection difficult. Thus, we provide an overview of certain characteristic artefacts and detail the methods for eliminating them.     

Social gating and pedagogy: Mechanisms for learning and implications for robotics

It seems self-evident that human responsiveness to social input enhances learning, yet the details of the social forces at play are only beginning to come into focus. Recent research on language and cognitive development in preschoolers and infants illuminates mechanisms such as social gating and natural pedagogy, and specific ways in which they benefit learning. We review such advances and consider implications of this research for designing robotic systems that can harness the power of social forces for learning.     

Pharmacotherapy for the soul and psychotherapy for the body

The "mind-body" dualism has shaped the development of psychiatry. At the very beginning psychiatry was related to the mind and the rest of the medicine to the body. The main reasons for such division were lack of biological evidence for psychiatric disorders and wrong beliefs about demonic origins of "lunacy". But although the development of science offered more than enough biological evidence to understand brain as an organ of origin for psychiatric disorders, the dualism of mind and body remained alive even in the modern classification systems. One of the consequences was another dualism that differ biological (e.g. pharmacotherapy) from psychological therapy (e.g. psychotherapy) as completely different approaches. The purpose of this article is to offer enough evidence to reframe the existing dualisms into a different paradigm. In every illness both mind and body can be affected to a different extent. Which part of an illness is body and which part is mind is often difficult to differentiate even when we compare a person with broken leg with a person with acute stress reaction. For that reason it might be an over-simplification to differentiate sharply between biological and psychological therapies. The evidence show that psychotherapy influences biology of the brain and that pharmacotherapy influences psychological, social and developmental dimensions of the diseased person as well as overall well-being and functionality. In the era where medicine discovered psychology and psychiatry discovered biology, the debates and divisions that steam out of past dualisms should end. Every practising physician regardless of the medical discipline uses in everyday practice both biological and psychological approaches to help the patient successfully.     

Astrocyte-neuron metabolic relationships: for better and for worse

In recent years, previously unsuspected roles of astrocytes have been revealed, largely owing to the development of new tools enabling their selective study in situ. These exciting findings add to the large body of evidence demonstrating that astrocytes play a central role in brain homeostasis, in particular via the numerous cooperative metabolic processes they establish with neurons, such as the supply of energy metabolites and neurotransmitter recycling functions. Furthermore, impairments in astrocytic function are increasingly being recognized as an important contributor to neuronal dysfunction and, in particular, neurodegenerative processes. In this review, we discuss recent evidence supporting important roles for astrocytes in neuropathological conditions such as neuroinflammation, amyotrophic lateral sclerosis and Alzheimer's disease. We also explore the potential for neuroprotective therapeutics based on the modulation of astrocytic functions.     

Subsystems of sensory attention for skilled reaching: vision for transport and pre-shaping and somatosensation for grasping, withdrawal and release

Skilled reaching is a forelimb movement in which a subject reaches for a piece of food that is placed in the mouth for eating. It is a natural movement used by many animal species and is a routine, daily activity for humans. Its prominent features include transport of the hand to a target, shaping the digits in preparation for grasping, grasping, and withdrawal of the hand to place the food in the mouth. Studies on normal human adults show that skilled reaching is mediated by at least two sensory attention processes. Hand transport to the target and hand shaping are temporally coupled with visual fixation on the target. Grasping, withdrawal, and placing the food into the mouth are associated with visual disengagement and somatosensory guidance. Studies on nonhuman animal species illustrate that shared visual and somatosensory attention likely evolved in the primate lineage. Studies on developing infants illustrate that shared attention requires both experience and maturation. Studies on subjects with Parkinson's disease and Huntington's disease illustrate that decomposition of shared attention also features compensatory visual guidance. The evolutionary, developmental, and neural control of skilled reaching suggests that associative learning processes are importantly related to normal adult attention sharing and so can be used in remediation. The economical use of sensory attention in the different phases of skilled reaching ensures efficiency in eating, reduces sensory interference between sensory reference frames, and provides efficient neural control of the advance and withdrawal components of skilled reaching movements.     

Guidelines for collecting and maintaining archives for genetic monitoring

Rapid advances in molecular genetic techniques and the statistical analysis of genetic data have revolutionized the way that populations of animals, plants and microorganisms can be monitored. Genetic monitoring is the practice of using molecular genetic markers to track changes in the abundance, diversity or distribution of populations, species or ecosystems over time, and to follow adaptive and non-adaptive genetic responses to changing external conditions. In recent years, genetic monitoring has become a valuable tool in conservation management of biological diversity and ecological analysis, helping to illuminate and define cryptic and poorly understood species and populations. Many of the detected biodiversity declines, changes in distribution and hybridization events have helped to drive changes in policy and management. Because a time series of samples is necessary to detect trends of change in genetic diversity and species composition, archiving is a critical component of genetic monitoring. Here we discuss the collection, development, maintenance, and use of archives for genetic monitoring. This includes an overview of the genetic markers that facilitate effective monitoring, describes how tissue and DNA can be stored, and provides guidelines for proper practice.