以精神障碍为首发症状的脑血管病1例

1病例患者男,68岁,于2周前突然表现话多,说以前的事,烦躁,易怒。患者听见公安员要抓他,不让孙子出门,称有坏人,以命令性的口气与家人说话,以自我为中心,有时不认识人,有冲动、伤人、毁物行为,否认有病。患高血压3年,服药治疗。病前性格外向、固执。否认阳性家族史。门诊诊断躁狂发作服碳酸锂无效。入院体检:血压22/12kPa。意识模糊,眼球活动欠灵活,伸舌偏左,余无明显阳性体征。精神检查:意识呈波动性障碍,定向欠准确,有时不认识家人,有幻觉妄想,计算理解力差,情感不稳定,烦躁,易怒,无自知力。经颅多普勒超声示:脑动脉硬化;脑动脉供血不足。…     

以癫为首发症状的脑血管病53例临床分析

目的分析以癫为首发症状的脑血管病的临床特点。方法通过对近年来收治的以癫为首发症状的53例脑血管病患者的临床表现,头颅MRI检查结果进行分析,探讨其发作类型、发病机制与病变部位、性质的关系。结果以癫为首发症状的脑血管病的临床发作类型与病变部位有关。结论脑血管病急性期癫发作具有特殊性。     

以癫为首发症状的急性脑血管病50例临床分析

目的研究急性脑血管病癫发作的相关因素及以癫为首发症状的急性脑血管病患者的近期预后。方法对50例以癫为首发症状的急性脑血管病的临床资料进行回顾分析。结果癫的发生与病变部位有关,以癫为首发症状者的脑卒中预后不良。结论卒中累及大脑皮质易继发癫,应积极抗癫治疗,改善预后。     

以癫痫为首发症状的急性脑血管病46例临床分析

本文分析以癫痫为首发症状的46例急性脑血管病的临床资料，以探讨年龄、民族、脑血管病变部位和脑血管病变性质不同时癫痫检出率的差异，比较是否以癫痫为首发症状的急性脑血管病患者近期预后的差别。     

以癫痫为首发症状的急性脑血管病34例临床分析

脑血管病是继发性癫痫的常见原因之一，继发性癫痫可发生于脑血管病的任何时期，甚至为其首发症状，造成临床诊断困难，现将我们诊治的以癫痫为首发症状的急性脑血管病34例报告如下。     

以视力障碍为首发症状的脑血管病临床特征分析

目的分析以视野缺损、视力下降为首发症状的脑血管病的临床特征,以减少临床误诊率。方法对40例以视力障碍为首发症状的脑血管患者的临床资料、诊疗经过及疾病转归进行全面分析。结果双眼同时视物不见、双眼片侧视物不见、双眼先后视力下降、单眼视力下降为患者就诊主诉。经完善检查后确诊前循环脑梗死8例,后循环脑梗死18例,颈动脉闭塞4例,烟雾病6例,脑血管畸形4例。单眼功能障碍主要为前循环障碍引起;后循环病变多表现单或双侧枕颞叶梗死,脑干梗死和基底动脉尖综合征。结论在脑血管病中以视力障碍为首发症状的病因中有前循环障碍、后循环障碍,单眼视力障碍多为前循环病变,是颈内动脉缺血或闭塞的眼部表现;双眼同时病变主要为后循环障碍累及枕颞叶所引发。     

以癫为首发症状的急性脑血管病41例临床分析

继发性癫的原因很多,脑血管病是常见原因之一,但以癫为首发症状的急性脑血管病容易造成临床误诊。现将我院诊治的以癫为首发症状的急性脑血管病41例报道如下。1临床资料1.1一般资料我院于1995-05~2006-05收治急性脑血管病756例,均经头颅CT证实,符合全国第四届脑血管病学术会议修定的诊断标准。其中以癫为首发症状41例,男16例,女25例,年龄35~87岁,脑出血10例,脑梗死21例,蛛网膜下腔出血(SAH)6例,混合性卒中4例。既往均无癫发作史及癫家族史。有高血压病史35例,糖尿病史9例,高血脂症20例。均为急性起病,有诱发因素21例,劳累起病…     

以癫(癎)为首发症状的脑血管病53例临床分析

目的分析以癫癇为首发症状的脑血管病的临床特点。方法通过对近年来收治的以癫癇为首发症状的53例脑血管病患者的临床表现．头颅MRI检查结果进行分析，探讨其发作类型、发病机制与病变部位、性质的关系。结果以癫癇为首发症状的脑血管病的临床发作类型与病变部位有关。结论脑血管病急性期癫癇发作具有特殊性。     

以癫(癎)为首发症状的急性脑血管病50例临床分析

目的研究急性脑血管病癫痫发作的相关因素及以癫痫为首发症状的急性脑血管病患者的近期预后。方法对50例以癫痫为首发症状的急性脑血管病的临床资料进行回顾分析。结果癫痫的发生与病变部位有关，以癫痫为首发症状者的脑卒中预后不良。结论卒中累及大脑皮质易继发癫痫，应积极抗癫痫治疗，改善预后。     

The Influence of Pituitary Adenoma Size on Vision and Visual Outcomes after Trans-Sphenoidal Adenectomy: A Report of 78 Cases

Objective

The aims of this study were to investigate the quantitative relationship between pituitary macroadenoma size and degree of visual impairment, and assess visual improvement after surgical resection of the tumor.

Methods

The medical records of patients with pituitary adenoma, who had undergone trans-sphenoidal adenectomy between January 2009 and January 2011, were reviewed. Patients underwent an ocular examination and brain MRI before and after surgery. The visual impairment score (VIS) was derived by combining the scores of best-corrected visual acuity and visual field. The relationship between VIS and tumor size/tumor type/position of the optic chiasm was assessed.

Results

Seventy-eight patients were included (41 male, 37 female). Thirty-two (41%) patients experienced blurred vision or visual field defect as an initial symptom. Receiver operating characteristic curve analysis showed that tumors <2.2 cm tended to cause minimal or no visual impairment. Statistical analysis showed that 1) poor preoperative vision is related to tumor size, displacement of the optic chiasm in the sagittal view on MRI and optic atrophy, and 2) poorer visual prognosis is associated with greater preoperative VIS. In multivariate analysis the only factor significantly related to VIS improvement was increasing pituitary adenoma size, which predicted decreased improvement.

Conclusion

Results from this study show that pituitary adenomas larger than 2 cm cause defects in vision while adenomas 2 cm or smaller do not cause significant visual impairment. Patients with a large macroadenoma or giant adenoma should undergo surgical resection as soon as possible to prevent permanent visual loss.     

尼莫地平改善脑血管病患者认知功能的有效性观察

目的 该研究旨在观察尼莫地平片对血管性认知损害的短期疗效。方法 前瞻性开放性自身对照研究。64例神经内科门诊脑血管病患者,在常规二级预防药物的基础上,口服尼莫地平60～90 mg/d,12～24周。应用简明精神状态量表（mini mental state examination,MMSE）和北京版蒙特利尔认知评估量表（Montreal cognitive assessment,MoCA）作为认知评估工具,观察治疗前后患者认知功能的变化。结果 三个月治疗后认知成绩总分显著高于治疗前,分别为：MMSE（26.3±2.7）vs（25.6±2.9）,P =0.039;MoCA（20.5±4.6）vs（19.0±4.1）,P =0.000,差异有显著性;治疗后MoCA的记忆分测验成绩显著高于治疗前,分别为（1.8±1.7）vs（1.1±1.2）,P =0.000,差异有显著性。结论 尼莫地平可有效地提高脑血管病患者的认知功能     

Visual Function is Stable in Patients Who Continue Long-Term Vigabatrin Therapy: Implications for Clinical Decision Making

PURPOSE: Vigabatrin (VGB) has been shown to cause visual field constriction and other forms of mild visual dysfunction. We determined the safety of continuing VGB therapy in patients who had received prolonged treatment (>2 years) with the drug by serially monitoring changes in visual function over a 1-year period of continued therapy. We also followed up patients who discontinued VGB to see whether alternative therapies are effective. METHODS: Fifteen of 17 patients who continued VGB therapy had visual-function testing (visual acuity, color vision, kinetic and static perimetry) every 3 months for 1 year. Eighteen patients who discontinued VGB were given alternative antiepileptic drugs (AEDs); their seizure responses were measured after > or =3 months of treatment. RESULTS: Patients continuing VGB showed no worsening of visual acuity, color vision, or visual-field constriction beyond that measured in the initial test. Many patients who discontinued VGB had good seizure control with either newer or previously unsuccessful AEDs. CONCLUSIONS: For patients who have an excellent response to VGB and only mild visual changes, continued therapy may be safe with close visual monitoring. Patients who do not have a significant reduction in seizures or who experience considerable visual dysfunction with VGB may respond well to alternative therapies.     

Intractable Epilepsy as the Initial Manifestation of Neurosyphilis

A 29-year-old man experienced intractable partial seizures as the initial manifestation of neurosyphilis. The diagnosis was made after the onset of dementia 9 months later. Both the epilepsy and dementia resolved with penicillin therapy. Syphilis should be considered in patients with adult-onset focal epilepsy, particularly if there is associated dementia. Treatment may be successful even when the diagnosis is delayed.     

脑梗塞为首发症状的原发性血小板增多症

本文报道了３例以脑梗塞为首发症状的，血小板计数在７００×１０９／Ｌ以下的原发性血小板增多症，占脑梗塞总数的０．５８％，以反复发作的ＴＩＡ和多发性脑梗塞为其临床特点，并对其发病机理、诊断和治疗进行了讨论     

脑梗塞为首发症状的原发性血小板增多症

本文报道了7例以脑梗塞为首发症状的,血小板计数在800×10~9/L以下的原发性血小板增多症,占脑梗塞总数的0.98％,以反复发作的TIA和多发性梗塞为其临床特点,并对其发病机理、诊断和治疗进行了讨论。     

以视力障碍为主要表现静脉窦血栓临床特点分析

目的 分析以视力障碍为主要表现的静脉窦血栓形成患者的临床特点,为此类静脉窦血栓形成患 者的诊治提供新思路。 方法 收集2004年1月-2016年7月以“视力障碍”住院的静脉窦血栓形成患者34例。对患者的人口学 资料、临床表现、实验室检查及影像学特征进行归纳总结。 结果 本组34例患者中男性18例（52.9%）,女性16例（47.1%）,平均发病年龄（36.1±12.9）岁,亚 急性起病11例（32.4%）,慢性发病23例（67.6%）。34例患者中感染引发疾病的有5例（14.7%）;非 感染因素29例（85.3%）。临床症状中视力下降29例（85.3%）（双眼视力下降23例,单眼视力下降6 例）,阵发性黑蒙8例（23.5%）,复视1例（2.9%）。伴随头痛9例,眼痛1例,颈痛1例,耳鸣2例,头晕1 例,症状性癫痫2例。主要体征为视盘水肿29例（双眼视盘水肿27例,单眼视盘水肿2例）;静态视 野检查中仅6例（17.6%）正常,18例（52.9%）表现为弥漫性视野缺损或全视野缺损,其中双眼受累11 例（32.4%）,单眼受累7例（20.6%）。33例患者行腰穿检查,颅内压<180 mm H2O者1例（3.0%）,颅内 压180～330 mm H2O者14例（42.4%）,颅内压﹥330 mm H2O者18例（54.5%）。34例患者均行影像学检查, 有7例（20.6%）仅累及1个部位静脉窦,26例（76.5%）累及2个或2个以上部位静脉窦,有12例（35.3%） 出现脑实质或脑膜病变,而多达22例（64.7%）无新发脑实质损害。 结论 以视力障碍为主要表现的脑静脉窦血栓好发于中青年,多隐匿起病,主要临床表现为高颅压, 近一半患者静态视野损害重,血栓好发于横窦和乙状窦,且好发于多个部位静脉窦,多数无明显的 脑实质损害。     

以脑血管病为主体的中心化医疗模式优势研究——基于北京天坛医院脑血管病中心的经验分析

目的 分析以脑血管病为主体的中心化医疗模式在推动学科发展、提高医疗质量等方面的优势,并为医疗机构创新医疗模式提供参考。