小儿传染性单核细胞增多综合征40例临床分析

目的:了解小儿传染性单核细胞增多综合征(IM)的病原学,为治疗提供依据。方法:40例传单综合征患儿于发病1～2w采静脉血用免疫荧光法和酶联免疫吸附法测血清中的病原抗体。结果:巨细胞病毒抗体检出阳性率最高达60%(24/40),其次为腺病毒和支原体,其抗体检出阳性率分别为22.5%(9/40)、17.5%(7/40),两种或两种以上病原抗体阳性37.5%(15/40)。结论:小儿传单综合征的主要病原为巨细胞病毒,其次为两种或两种以上病原混合感染。     

原发性醛固酮增多症致反复阿斯综合征发作1例

病例女性，51岁，因头昏、心悸5年，反复发作性意识丧失2年，加重5d入院。于5年前出现头昏、心悸，未就诊。2年前出现发作性意识丧失，四肢抽搐，持续10余分钟后自行清醒，醒后对发作情况无记忆，约2～3个月发作一次，多次在外院诊断为“癫痫”，治疗无效。5d前开始发作频率增加，（2～3）次／d，症状同前。入院前刚发作1次，入院时血压120／70mmHg，     

肺炎支原体感染并发传染性单核细胞增多综合征（附5例分析）

目的：探讨小儿肺炎支原体感染并发传染性单核细胞增多综合征（传单）的临床特征。方法：对ELISA方法检测与原体-IgM均≥1∶80,且EB病毒检测病毒衣壳衣原（VCA-IgM、VCA-IgG）,并除外CMV感染可能,而诊断为支原体感染并发传单综合征的5例患儿进行回顾性临床分析。结果：5例均有发热、淋巴结肿大、咽峡炎,肝脾肿大4例,皮疹1例,肺部有改变5例。全部病例仅经红霉素治疗12~21 d痊愈。结论：支原体感染可并发传单综合征,其临床特征主要表现为不规则的中、低热,均有咽峡炎和淋巴结肿大,肝脾肿大及肝功能异常亦多见,使用红霉素规则治疗预后良好。     

淋巴细胞亚群对儿童EB病毒感染所致传染性单核细胞增多症的诊断意义

目的 研究EB病毒(epstein-barr virus,EBV)感染导致传染性单核细胞增多症(infectious mononucleosis,IM)患儿T细胞亚群的变化,为临床诊治提供参考.方法 选择空军特色医学中心2014年10月—2019年10月90例EBV感染致传染性单核细胞增多症患儿作为研究组,以年龄、性别配对的同期健康体检儿童80人作为对照组,空腹抽取外周静脉血CD3+、CD4+、CD8+数量及EBV-DNA水平.结果 病例组CD3+、CD8+高于对照组(P<0.001),差异有统计学意义.结论 儿童感染EBV致IM后机体会产生大量的T淋巴细胞,引起外周血中CD3+、CD8+浓度升高,检测IM患儿外周血淋巴细胞亚群表达变化对IM的诊断及治疗有一定的指导意义.     

创伤后淋巴细胞的活化与全身炎症反应综合征

严重创伤可致淋巴细胞功能受抑,但也可激活淋巴细胞。本文列举了创伤导致淋巴细胞活化的证据。阐述了其与全身炎症反应综合征（SIRS）之间的关系,介绍了其可能的发生机制及尚待解决的问题。     

直背综合征伴室间隔缺损一例

患者,男性15岁,学生.因劳累时胸闷、气促、头晕、乏力6年,加重4个月,于1993年7月16日入院.平时身体素质较差,易患“感冒”.查体:背部平直,生理性后凸消失,胸廓扁平,前后径变窄.心前     

PC-MRI在Ⅰ型Chiari畸形伴咳嗽性头痛患者脑脊液动力学变化中的应用

【摘要】目的：探讨PC-MRI在Ⅰ型Chiari畸形伴咳嗽性头痛患者脑脊液动力学变化中的应用价值。方法：搜集2020年9月-2023年5月诊断为Ⅰ型Chiari畸形的患者39例,按是否伴有咳嗽性头痛症状,分为症状组23例,无症状组16例,另选取正常对照组18例,所有患者及正常对照人群均完成了PC-MRI的检查;以枕骨大孔水平脑桥腹侧平面为感兴趣区,分别获得症状组、无症状组患者及正常对照组人群脑脊液的头向峰值流速（Vumax）、足向峰值流速（Vdmax）及头向流动时间占比（Tu）、足向流动时间占比（Td）。结果:分别测得症状组、无症状组与正常对照组头向峰值流速（Vumax）为（6.38±0.89）cm/s、(5.92±1.32)cm/s、(4.86±0.90)cm/s,足向峰值流速（Vdmax）为(5.87±1.01)cm/s、(5.71±1.32)cm/s、(4.62±0.83)cm/s ,头向流动时间占比（Tu）为(70.6±4.0)%、(58.7±3.2)%、(58.0±2.8)%,足向流动时间占比（Td）为(28.9±3.4)%、(41.2±3.3)%、(41.9±2.8)%;症状组与无症状组头向峰值流速（Vumax）及足向峰值流速（Vdmax）组间比较没有统计学差异（P>0.05）,而症状组脑脊液头向流动时间占比（Tu）较无症状组增大,足向流动时间占比（Td）较无症状组减小,且组间比较有统计学意义（P＜0.01）;无症状组与正常对照组间只存在脑脊液头向峰值流速（Vumax）、足向峰值流速（Vdmax）的统计学差异（P＜0.01）,而症状组与正常对照组间在脑脊液头向峰值流速（Vumax）、足向峰值流速（Vdmax）、头向流动时间占比（Tu）及足向流动时间占比（Td）方面均存在统计学差异（P＜0.01）。结论：PC-MRI对了解Ⅰ型Chiari畸形伴咳嗽性头痛患者脑脊液动力学变化具有重要价值,有助于了解咳嗽性头痛的病因。     

原发性空泡蝶鞍综合征与头痛程度相关性的MRI研究

目的探讨原发性空泡蝶鞍综合征与头痛程度的关系。资料与方法对140例经临床证实为原发性空泡蝶鞍综合征患者的临床及MRI资料进行综合分析,计算其空蝶鞍分级,采用统计学方法分析其与头痛程度的关系。结果空蝶鞍分级与头痛程度之间差异无统计学意义(P>0.05)。结论空蝶鞍分级与头痛程度之间无明确关系,临床需密切结合其他检验指标综合判断患者病情。     

飞行人员特发性嗜酸性粒细胞增多综合征一例并文献复习

目的 加深对飞行人员特发性嗜酸性粒细胞增多综合征的认识,探讨航空医学鉴定原则. 方法 分析1例运输机通信员特发性嗜酸性粒细胞增多综合征的临床诊断、治疗及健康鉴定情况,复习相关文献. 结果 该飞行人员临床特点主要以脑血管病变为突出表现,嗜酸性粒细胞计数持续性增高;给予激素、免疫抑制剂、中药等治疗后,患者主要临床症状缓解,但遗留左手运动功能障碍,目前仍在治疗中. 结论 特发性嗜酸性粒细胞增多综合征临床表现较为复杂,不易诊断,在飞行人员体检中应引起重视,加深对该病的认识.该病的医学鉴定应根据飞行人员职责、治疗效果及脏器损害情况进行个别评定.本病例的航空医学鉴定结论应为飞行不合格.     

淋巴细胞、血细胞及骨髓细胞检测在鉴别再生障碍性贫血与低增生性骨髓增生异常综合征中应用价值

目的 探讨淋巴细胞、血细胞及骨髓细胞检测在鉴别再生障碍性贫血(AA)与低增生性骨髓增生异常综合征(hypo-MDS)中的应用价值.方法 将安庆市第一人民医院自2014年1月至2019年12月收治的45例AA患者纳入AA组、48例hypo-MDS患者纳入hypo-MDS组,另将25例健康体检志愿者纳入健康组.比较外周血T...     

Self-limited recurrent multifocal neurological symptoms, headache, and cerebrospinal fluid lymphocytic pleocytosis: a benign syndrome with a predilection for young adult men

Two young men, aged 34 and 30 years, developed transient recurrent multifocal neurological symptoms with associated severe headache over a 2-week period. Both had a lymphocytic pleocytosis in their cerebrospinal fluid. Cranial imaging studies were normal. All symptoms resolved without recurrence. Although the cause and pathogenesis are undefined, this self-limited benign neurological syndrome may be more common than previously recognized and has a predilection for young adult men.     

Moyamoya syndrome presenting in an adult with Down syndrome: A case report with a literature review

Moyamoya disease is an unusual occlusive cerebrovascular condition commonly seen in children, marked by stenosis of the internal carotid artery and circle of Willis, causing, cerebral ischemia. Moyamoya syndrome is a Moyamoya-like arteriopathy with risk factors including autoimmune disorders, thyroid disease, sickle cell disease, or Down syndrome. Trisomy 21 is a genetic disorder consistent with specific physical and behavioral characteristics, with intellectual impairment. We describe a rare case of Moyamoya syndrome manifesting as ischemic stroke in an adult with Down syndrome     

A case of spontaneous intracranial hypotension in a 45-year-old male with headache,behavior changes and altered mental status

Spontaneous intracranial hypotension is a rare disease that results from low cerebrospinal fluid (CSF) volume caused by leakage of CSF from the spine in the absence of lumbar puncture, spine surgery, or intervention. The most common presentation is the headache that is usually but not invariably orthostatic. The underlying pathology is a CSF leak resulting from dural weakness involving the nerve root sleeves, ventral dural tears associated with calcified disc herniations, or CSF venous fistula. In severe cases, neuropsychiatric symptoms and changes in mental status may develop. Some case reports also mention gait disturbances, slurred speech, and urinary incontinence. The constellation of neuropsychiatric symptoms similar to behavior variant frontotemporal dementia in the presence of “brain sag” on MRI is known as frontotemporal brain sagging syndrome, first described by Wicklund et al. (4). The disease presents a diagnostic challenge to the primary care physicians, who are the first to see these patients. Brain and spine imaging is key to diagnoses but requires a high index of suspicion, as very rarely are all classic findings of intracranial hypotension present in the same patient. Here we discuss a case of spontaneous intracranial hypotension in a 45-year-old male patient who presented with headache, drowsiness, incoherent speech, behavior symptoms, and altered mental status.     

中西医结合治疗频繁发作性紧张型头痛62例

 目的 观察阿米替林加手法治疗频繁发作性紧张型头痛的疗效.方法 62例频繁发作性紧张型头痛患者随机分成阿米替林组和阿米替林加手法治疗组,两组间在年龄、性别及治疗前2周内头痛程度、头痛的天数及服用止痛剂天数间无显著差异.手法治疗为1周2次,共8次.分别在治疗第2、4周时,比较两组间疗效.结果 在治疗后1～2周内,阿米替林组和阿米替林加手法治疗组头痛平均天数分别为(6.00±2.21)d、(4.19±1.70)d,第3～4周分别为(4.00±1.86)d、(2.16±1.21)d,两组间差异均有统计学意义.在治疗后第3～4周,两组在头痛程度上存在显著差异.治疗后第1～2周服用止痛剂平均天数,治疗组与对照组分别为(1.77±1.23)d、(1.32±1.22)d,两组间存在显著差异,但在治疗后第3～4周时,这种差异消失.结论 手法加阿米替林治疗频繁发作性紧张型头痛具有显著的疗效,且效果优于单纯阿米替林治疗.     

A case report of Wyburn-Mason syndrome and review of the literature

Introduction

Wyburn-Mason syndrome is a distinct congenital neurocutaneous entity comprised of ipsilateral arteriovenous malformations (AVMs) of the midbrain, vascular abnormalities affecting the visual pathway, and facial nevi.

Methods

We report a case and review of the literature of all other reported cases of Wyburn-Mason syndrome (n?=?26) in the English literature since 1973.

Results

In this review, we report on a 4½-year-old boy with Wyburn-Mason syndrome who presented with left retinal and orbital AVMs and a ruptured thalamic AVM. The patient did not respond to light in the left eye and demonstrated a left afferent pupillary defect. He did not have any cutaneous lesions. We also characterize other reported cases of Wyburn-Mason syndrome.

Conclusion

The presentation of patients with Wyburn-Mason syndrome can vary greatly according to the site and the extent of vascular lesions. Intracranial AVMs occasionally hemorrhage with significant morbidity. Treatment is controversial, and patients are typically managed conservatively by observation.

     

Dyke-Davidoff-Masson syndrome: A case report with a literature review

Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon neurological disease defined as cerebral hemiatrophy with a contralateral motor deficit, facial asymmetry, and seizures. Classic imaging findings are cerebral hypoplasia, ventriculomegaly, paranasal sinus hyper-pneumatization, and compensatory osseous enlargement. The diagnosis of DDMS is based on the correlation between clinical and neuroimaging features. The management of DDMS is based on anticonvulsant medication with physiotherapy. We describe an unusual case of DDMS presented with frequent and persistent seizures.     

创伤后多器官功能不全综合征

本文重点阐述创伤后多器官功能不全综合征（MODS）的高危因素、发生机制及普遍的临床特征、诊断指标、分期、预防与治疗。强调应重视MODS的本质及连续变化的过程,其早期变化具有极大的隐蔽性,也正是此期才是治疗的最佳时机;目前的诊断标准并不是治疗开始的依据,只要有产生MODS的诱因和倾向均应及早采取对策。因此,对MODS而言,最好的治疗莫过于预防,预防有事半功倍的效果。     

Arterial spasm as a finding intimately associated with the onset of vascular headache

Summary A patient with migraine headaches of the cluster variant type is presented in whom vasospasm of the middle cerebral artery, the anterior cerebral artery and the internal carotid artery triggered a pain episode identical in character and severity to the headaches which had led to her investigation. Vasospasm associated with the painful phase of headache in this case conflicts with the more accepted theory that the pain phase of a vascular headache is related to vasodilatation of cerebral or extracerebral vessels. The literature is reviewed.