出血性卒中与缺血性卒中危险因素比较

目的探讨不同危险因素对缺血性和出血性卒中发病的影响。方法收集3 102例脑卒中患者的个人疾病史、生活方式、临床检查及生化指标结果等资料,运用Epidata软件建立数据库,采用SAS 9.2进行统计分析。结果脑梗死组发病到入院时间、住院时间、高胆固醇血症、糖尿病史、心脏病史、房颤史、脑卒中史,吸烟的OR值分别是3.36、4.953、3.375、2.224、2.394、2.362、3.573、2.076、2.885。脑出血组呼吸、体温、心率、血压、高血糖、Tbil、高血压史OR值分别是0.824、0.390、0.673、0.425、0.594、0.598、0.934。结论发病到入院时间、住院时间、高胆固醇血症、糖尿病史、心脏病史、房颤史、脑卒中史、吸烟等对脑梗死的影响更大,而呼吸、体温、心率、高血压、高血糖、Tbil、高血压史对脑出血的影响更大。     

脑梗死患者的危险因素临床分析

目的分析脑梗死患者的临床危险因素。方法收集2015-01—2016-01承德市承钢医院治疗的200例脑梗死患者(观察组),以及同期入院就诊的200例无脑梗死患者(对照组),对2组患者的临床危险因素进行对比分析。结果本组患者的临床危险因素有短暂性脑缺血发作、饮酒、房颤、吸烟、高血压、家属史、颈部血管动脉斑块以及性别,其中高脂血症、心脏病、糖尿病、肥胖与脑梗死有相关性(P0.05);2组总胆固醇甘油三酯、低密度脂蛋白胆固醇无明显差异(P0.05);观察组高密度脂蛋白胆固醇水平明显低于对照组(P0.05)。回归分析显示,上述因素均属于脑梗死患者的临床危险因素,差异均有统计学意义(P0.05)。结论脑梗死的危险因素有颈动脉斑块、短暂性脑缺血发作、饮酒、房颤、吸烟、高血压、家族史、性别以及高密度脂蛋白胆固醇。     

进展性脑梗死的相关危险因素分析

目的探讨导致进展性脑梗死的危险因素。方法对我院收治的200例进展性脑梗死患者及同期住院的年龄、性别相当的200例稳定性脑梗死患者的临床和实验室检查做回顾性分析。结果显示高血糖、高血脂、高血压、降压过低或过快、脑血管狭窄、短暂性脑缺血发作、高纤维蛋白原血症等在进展性脑梗死中占较高比例。结论高血糖、高血脂、高血压、降压过低或过快、脑血管狭窄、短暂性脑缺血发作、高纤维蛋白原血症等是进展性脑梗死的危险因素。     

脑梗死复发的危险因素临床分析

目的 了解脑梗死复发的危险因素.方法 对168例初发及再发性脑梗死患者的危险因素从临床和实验室检查作回顾性综合分析.结果 复发性脑梗死患者伴高血压、糖尿病、高脂血症、吸烟 、短暂性脑缺血发作(TIA)高于初次脑梗死,而与年龄、性别及心脏病史无明显关系.结论 高血压、糖尿病、高脂血症、吸烟、TIA史 是脑梗死复发的高危因素.     

卒中前状态和启动因子

脑卒中是在供应脑的血管壁病变或血流障碍基础上发生的急性脑损害 ,基本病因包括高血压性脑小动脉硬化、脑动脉粥样硬化、血管的先天发育异常 ,尚有遗传性疾病、炎症、中毒、代谢等导致的脑血管壁病变。脑卒中的主要危险因素有年龄、性别、高血压、糖尿病、心脏病、短暂性脑缺血发作 (TIA)、颈动脉狭窄、肥胖、吸烟、酗酒等。病因和危险因素的存在是长期的 ,但卒中的发病是短暂、急性的 ,可见卒中的发生是一个从量变到质变的过程。大多数脑卒中是由病因引起血管损害 ,在某些因素作用下引发的 ,说明卒中的发生除有患病基础外 ,还须有促使发…     

颅内血管狭窄与短暂性脑缺血早期发展为脑梗死的相关性

目的研究颅内血管狭窄与短暂性脑缺血早期发展为脑梗死的相关性。方法收集128例于我院确诊为短暂性脑缺血的患者,通过颅脑磁共振弥散加权成像(DWI)判断患者住院1周内有无新鲜脑梗死及计算转化为脑梗死的百分率。通过头颈CT血管造影(CTA)检查所有患者颅内血管的狭窄程度、狭窄数量以及狭窄部位,分析颅内血管异常与短暂性脑缺血转化为脑梗死的相关性。结果 128例短暂性脑缺血患者发展为早期脑梗死的发生率为29.68%,短暂性脑缺血患者的血管狭窄程度与短暂性脑缺血后早期脑梗死发生率呈正相关(P0.001),责任血管狭窄患者的短暂性脑缺血后早期脑梗死发生率显著高于非责任血管狭窄患者(P=0.002);动脉近端狭窄患者的短暂性脑缺血后早期脑梗死发生率显著高于动脉远端狭窄患者(P0.001),颅内动脉狭窄数量与短暂性脑缺血后早期脑梗死发生率相关(P0.001)。结论颅内血管狭窄是短暂性脑缺血早期发展为脑梗死的独立危险因素,通过头颈CT血管造影检查有利于评估短暂性脑缺血患者早期发展为脑梗死的风险。     

颈动脉狭窄的诊断方法与介入治疗

研究[1]表明,颈部动脉狭窄是缺血性脑卒中的独立危险因素。美国国立神经疾病和卒中研究所的资料[2]显示,脑梗死中23%为腔隙性脑梗死,其12%归因于颈动脉病变。颈内动脉狭窄程度是区分有无脑卒中风险和影响预后的标志之一。北美有症状颈动脉内膜切除试验协作组(North AmericanSym     

缺血性卒中患者颅内动脉狭窄的相关危险因素分析

目的 探讨颅内动脉狭窄的狭窄程度、相关危险因素与缺血性脑卒中的关系,为缺血性卒中的防治提供重要依据.方法 90例缺血性卒中患者根据全DSA检查结果分为非狭窄组(狭窄<30%)与颅内动脉狭窄组(狭窄≥30%或闭塞),分析颅内动脉狭窄程度与年龄、性别、高血压、糖尿病、高脂血症、冠心病、家族史、总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白胆同醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白 A1(ApoA1)、载脂蛋白B(ApoB)、血清脂蛋白(Lpa)等相关危险因素的关系.结果 (1)本组患者颅内动脉狭窄发生率为67.78%,发生率最高为大脑巾动脉,其次颈内动脉颅内段和椎基底动脉颅内段,发生率最低为大脑后动脉.(2)有高血压、糖尿病的缺血性卒中患者容易发生颅内动脉狭窄,其同归系数、OR值、P值分别为1.659、5.256、0.002,1.657、5.241、0.046.(3)颅内动脉狭窄组HDL-C含量[(0.99±0.30)mmol/L]比非狭窄组[(1.30±0.50)mmol/L]明显降低,差异有统计学意义(t=3.603,P=0.001).(4)年龄、性别、吸烟、既往卒中史、脑血管病家族史、TC、TG、LDL-C、ApoA1、ApoB、Lpa在两组间比较差异无统计学意义(P>0.05).结论 缺血性卒中患者颅内血管狭窄的主要危险因素有高血压、糖尿病,保护因素有HDL-C.     

缺血性脑血管病患者脑动脉狭窄的分布特征及其危险因素分析

目的 探讨缺血性脑血管病患者脑动脉粥样硬化性狭窄闭塞的分布特点,分析并比较颅内、外动脉粥样硬化性狭窄的危险因素.方法 对206例连续行主动脉弓及全脑血管造影检查的缺血性脑血管病患者的临床与血管造影资料进行分析,比较不同动脉病变类型患者间的危险因素的差异.结果 206例患者中,131例存在脑动脉狭窄或闭塞.脑动脉狭窄的好发部位主要为颈内动脉起始部和椎动脉起始部,颅外动脉病变(EAD)的发生率为71.0%,颅内动脉病变(IAD)的发生率为67.9%.青年患者大部分为单纯IAD,主要累及大脑中动脉(MCA);而中年及老年患者以颅内外病变并存比例最高,病变最好发于颈内动脉起始部.吸烟对于颅内、外动脉狭窄的影响较大,血脂异常、同型半胱氨酸血症对于颅内动脉狭窄的影响较大,高龄、高血压、冠心病和糖尿病对颅外动脉狭窄的影响较大.结论 颅外动脉粥样硬化性狭窄闭塞病变的发生率高于颅内.不同动脉粥样硬化性病变类型患者的危险因素有所不同.     

进展性脑梗死的相关因素分析

目的探讨进展性脑梗死的相关因素。方法回顾性分析进展性脑梗死的临床资料,观察其既往史、体温、血压、血糖、血脂、纤维蛋白原、感染及动脉狭窄程度,并与同期非进展性脑梗死42例患者进行比较。结果进展组患者糖尿病史、高血压史、短暂性脑缺血发作(TIA)史明显高于非进展组(P<0.05);进展组收缩压明显低于非进展组;空腹血糖、纤维蛋白原水平明显高于非进展组(P<0.05));进展组感染的发病率明显高于非进展组(P<0.05);进展组颈内动脉中、重度狭窄患者明显多于非进展组。结论高血压、糖尿病、TIA发作史、感染、颈内动脉狭窄是脑梗死进展的危险因素,当患者收缩压降低、脉压减小时应引起高度重视。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.