颅内静脉窦血栓的临床特征分析

颅内静脉窦血栓是指因多种因素所诱发的脑静脉系统血管病,包括皮质静脉、硬膜静脉窦和深部静脉窦血栓[1]。由于颅内静脉、静脉窦结构相对复杂且相互交通或吻合,因此临床表现复杂多样且缺乏特异性[2],所以临床中极易导致误诊或漏诊现象发生而延误最佳治疗时机,影响预后,甚至造成患者死亡。现对48例颅内静脉窦血栓者临床特征及相关治疗回顾性分析如下。     

颅内静脉窦血栓形成的治疗进展

颅内静脉窦血栓形成(cerebral venous and sinus thrombo-sis,CVST)是缺血性脑血管病的一种少见类型,占全部脑卒中不足1%[1]。其病因复杂,起病形式多样,常被误诊漏诊。病情可在数小时或数天内迅速变化.近年来随着临床医生对该病的重视,神经影像技术以及神经介入放射学技术的飞[2]     

应用核磁黑血血栓成像联合头部增强MRV诊断的颅内枕窦及边缘窦血栓形成1例报告

正颅内静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)是一种罕见的卒中形式,好发于年轻女性~[1]。临床常见颅内静脉窦血栓形成部位为上矢状窦、下矢状窦、橫窦、直窦、乙状窦、海绵窦~[2],临床上常用诊断手段为头部MR静脉成像(magnetic resonance venography,MRV)/CT静脉成像(computed tomographic venography,CTV)[1]。但对于特殊部位的CVT患者,常规的检查手段极易漏诊误诊,从而延误治     

产褥期颅内静脉窦血栓形成10例护理体会

颅内静脉窦血栓形成(cranial venous sinus thrombosis,CVST)是颅内静脉系统血流堵塞所导致的闭塞性脑血管病,为产褥期较少见的危重并发症之一,诱因有长期服用避孕药物、妊高症、感染、剖宫产、高龄产妇等,发生于产后1个月内,有一定的致残和致死率[1]。我科2002-01—2012-12收治产褥期颅内静脉窦血栓形成患者10例,经及时诊治、精心护理均治愈出院,现将护理体会报告如下。     

球囊扩张成型与取栓治疗颅内静脉窦血栓疗效分析

目的探讨球囊扩张成型与取栓治疗颅内静脉窦血栓的疗效和安全性。方法 24例经DSA检查证实颅内静脉窦血栓形成患者,采用颅内静脉窦内球囊扩张成型及取栓手术,使静脉窦即时再通,术后抗凝治疗6个月。结果 24例上矢状窦及横窦血栓患者,微导管与微导丝配合,逆行进至上矢状窦中前1/3处,直径5mm球囊沿微导丝进至该处。充盈球囊,透视监视下回拉球囊,使闭塞的静脉窦再通。临床症状均得到改善。术后随访12-48个月,平均随访30.3个月,随访期间,未见血栓再发者。结论颅内静脉窦球囊扩张成型与取栓治疗是颅内静脉窦血栓安全、有效的治疗手段。     

妊娠相关颅内静脉及静脉窦血栓形成诊治现状

正颅内静脉及静脉窦血栓形成(CVST)是多种病因导致的颅内静脉系统血管病。由于其临床表现缺乏特异性,多表现为一种或多种高颅压相关的临床症状,如头痛、急性或亚急性神经功能缺损、癫痫发作、意识障碍,易被误诊漏诊[1]。CVST占所有脑卒中的0. 5%～1%,发病人群多为青年,尤其好发于中青年女性。既往研究[2-5]结果提示,CSVT患者平均发病年龄37岁,女性发病率为男性的3倍多,其中59%的CVST患者处于围产期。迄今为止,关于妊娠相关的CVST(PRCVST)     

大鼠上矢状窦闭塞后磁共振影像及病理研究

颅内静脉窦血栓为脑血管病的特殊类型,呈缓慢发病,临床表现不具特征性,极易延误诊断和治疗,病死率达5.5%～30.0%犤1犦。为了提高临床医师对颅内静脉窦和静脉闭塞性疾病的认识水平,笔者以上矢状窦为例,设计了大鼠脑静脉窦闭塞动物模型,以观察颅内静脉窦闭塞后局部脑血流量(re-gi     

颅脑损伤继发颅内静脉窦血栓形成的诊断和治疗

<正>颅脑损伤所致的颅内静脉窦血栓形成(cerebralvenous sinus thrombosis,CVST)发病率占颅脑损伤的6.1%~15.9%[1,2],男性多发[1]。因其临床表现高度多变而无特异性,且常被原发伤症状所掩盖,特别是血栓较小或存在硬膜外血肿时[3],容易被误诊、漏诊,死亡率较高。早期诊断和及时有效治疗是改善CVST患者预后的关键[4]。本文复习国内外的相关文献,对颅脑损伤继发CVST的诊断及治疗进行综述。     

颅内静脉窦损伤修补方法探讨(附84例分析)

颅内静脉窦损伤是颅脑创伤疾病中的一种急危重症,一旦发生致命性出血,将会造成术中病人的生命危险,即使是肿瘤类疾病术中静脉寞因肿瘤的切除而需切除部分静脉窦壁时[1],其静脉窦壁损伤的修复虽不复杂但也会使术者较为棘手.本文探讨1991年10月至2007年8月我院治疗84例颅内静脉窦损伤类型及修补方法.     

脑干海绵状血管瘤诊疗进展

<正>脑干海绵状血管瘤(Brain stem cavernous malformation,BCM),是一种神经外科少见疾病。约占颅内海绵状血管瘤的9%~35%[1],约占脑干占位性病变的1/3[2]。中脑、脑桥、延髓均可发生BCM。其中,脑桥是最好发部位,其次为中脑、脑桥延髓结合部[3]。研究表明:BCM年出血率和再出血率分别为5%和30%[1],其中,年龄<35岁和病变直径>1     

18q缺失综合征一例：四年长程随访及文献复习

18q缺失综合征是由于第18号染色体长臂部分缺失所引起的疾病。该综合征以女性好发,发病与母亲年龄无关。临床主要表现为出生时低体质量,严重智力障碍;特征性面部畸形;小头畸形、眼裂水平位、眼窝内陷、鲤鱼状嘴;耳轮过度发育,形成深沟;两乳头距离远;手指细长但指尖隆起,形如垂滴的水珠;约有50％的患者骨、关节畸形,且指端螺纹明显多于正常人;男性患者可有小阴茎、隐睾;女性外生殖器发育不良等。     

Differential protein expression in substantia nigra induced by 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine in a mouse model of chronic Parkinson’s disease*★

BACKGROUND： To date, a complete protein expression profile of the midbrain substantia nigra in a mouse model of chronic Parkinson＇s disease, induced by 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine （MPTP）, does not exist. In addition, there are no reports of analysis of differential protein expression. OBJECTIVE： To separate and evaluate MPTP-induced differential protein expression through the use of proteomics in the substantia nigra of a mouse model of chronic Parkinson＇s disease. DESIGN： Randomized controlled animal study. SETTING： Department of Neurology, the First Affiliated Hospital, Chongqing Medical University. MATERIALS： Sixteen 8-10-week old, healthy, male, C57BL mice, weighing 20-25 g, and of clean grade, were provided by the Experimental Animal Center of Chongqing Medical University. The experimental animals were disposed according to ethical criteria. MPTP was provided by Sigma Company, USA; Pdquest 2D image analysis software and gelatum/irradiance image analysis system （ChemiDoc XRS） by Bio-Rad, USA; and Voyager DE-PROMALD1-TOF-MS mass spectroscopy analyzer by AB1 Company, USA. METHODS： This study was performed in Chongqing Neurological Laboratory between November 2006 and July 2007. Mice were randomly divided into model and control groups, with 8 mice in each group. Mice in the model group were received a subcutaneous injection of MPTP （25 mg＆g）, twice a week, for five successive weeks, to establish a chronic Parkinson＇s disease model. Mice in the control group received the same volume of a subcutaneous saline injection at the same time points. Mice were sacrificed by anesthesia to rapidly obtain the midbrain for protein separation of the substantia nigra. MAIN OUTCOME MEASURES： （1） 2-ED handbook （Bio-Rad Company） was referenced for two-dimensional electrophoresis, （2） PDQUEST8,0 analytical electrophoresis pattern was adopted to evaluate differential protein expression. （3） Peptide mass finger print map and data were retrieved on http：//www.pros     

微创手术治疗慢性硬膜下血肿的临床分析

目的 总结分析微创引流手术(使用YL-1型一次性颅内血肿穿刺粉碎针)联合尿激酶技术治疗慢性硬膜下血肿的效果.方法 对48例慢性硬脑膜下血肿患者根据头颅CT扫描结果,采用局部麻醉下微创血肿腔置入YL-1型一次性颅内血肿穿刺粉碎针引流,若血肿中有血凝块,则分次血肿腔注入尿激酶溶解血肿液引流的方法治疗.并对治愈出院患者进行随访,总结治疗效果.结果 48例患者均获得随访,平均随访3个月,全组患者均取得较满意治疗效果,与手术相关并发症发生率为 2.08％(1/48),为非张力性气颅1例.结论 采用微创引流手术(使用YL-1型一次性颅内血肿穿刺粉碎针)联合尿激酶技术治疗慢性硬膜下血肿,能取得较钻孔引流术单纯微创冲洗引流更好的治疗效果.     

Scorpion venom heat-resistant protein decreases immunoreactivity of OX-42-positive microglia cells in MPTP-treated mice*☆

BACKGROUND： Microglia function as the immune surveyors of the brain under normal physiologica conditions. However, microglia become activated in response to brain injuries and immunological OBJECTIVE： To explore the influence of scorpion venom （SV） heat-resistant protein on frontal cortex and hippocampal microglia cells in a mice model of Parkinson＇s disease. DESIGN, TIME AND SETTING： Randomized, controlled, cellular immunity study. The experiment was performed at the Physiology Department Laboratory in Dalian Medical University between June 2005 and July 2008. MATERIALS： Ninety-six healthy, C57B1/6 mice; 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine （MPTP） from Sigma, USA; SV heat-resistant protein （Experimental Base Institute in Dalian Medical University）. The mice were randomly divided into four groups （n = 24）： normal control, negative control, model, and SV heat-resistant protein. METHODS： Mice in the model and SV heat-resistant protein groups were subcutaneously injected with MPTP （20 mg/kg） to model Parkinson＇s disease, while the normal control and negative control groups were injected with physiological saline in the neck for 8 successive days. In addition, mice in the model and normal control groups were intraperitoneally injected with physiological saline 2 hours following administration, while SV heat-resistant protein and negative control groups were injected SV heat-resistant protein （0.01 mg/kg）. MAIN OUTCOME MEASURES： lmmunoreactivity of microglia cells in MPTP-treated mice. RESULTS： Compared with normal control mice, MPTP-treated mice displayed increased OX-42 expression in the brain. However, in the SV heat-resistant protein-treated mice, OX-42 expression was decreased, compared to the model group. In the model mouse group, the number of OX-42-positive microglia was increased in the frontal cortex, caudatum, and hippocampal hilus, compared to the normal control mice （P 〈 0.01）. However, in the SV heat-resistant protein-treated mice, the number of O     

脑转移瘤的诊断和外科治疗

目的 总结脑转移瘤的治疗经验.方法 回顾分析76例神经外科收治的临床或病理确诊为脑转移瘤的病例资料.结果 55例接受开颅转移瘤切除术,其中2例死亡;2例行活检术;2例急诊去骨瓣减压术;5例行放化疗;12例对症支持治疗.结论 根据患者病情合理选择外科治疗可以取得较好的疗效.     

精神分裂症患者重复违法情况调查

目的 调查精神分裂症患者重复违法的情况,探讨精神分裂症患者重复违法的原因.方法 采用非配比成组对照研究方法,以重复违法者为研究组,第一次违法者为对照组.用自编调查问卷对北京市某医院2005～2007年的167份精神障碍鉴定病历进行回顾性调查.结果 在调查的鉴定案例中,29.9％的精神分裂症患者出现重复违法行为.重复违法相关因素方面,研究组28.0％无人监护,高于对照组的12.8％,差异具有统计学意义(x2=5.63,P＜0.05).用药方面,研究组和对照组差异具有统计学意义(Z=2.64,P＜0.01).无人监护是首次违法后出现重复违法情况的危险因素(OR=2.64),持续用药是重复违法的保护因素(OR =0.28).结论 司法鉴定后的精神分裂症患者重复违法比例较高,无人监护是首次违法后出现重复违法情况的危险因素,持续用药和间断用药是重复违法的保护因素.     

Astrocyte reactivity in related brain regions in a mouse model of MPTP-induced Parkinson’s disease

BACKGROUND： Severe injury to dopaminergic neuronal cell bodies and their axon terminals in the substantia nigra pars compacta （SNC） has been observed in both Parkinson＇s disease （PD） patients or in 1-methy-4-phenyl-1,2,3,6-tetrahydropyrindine（MPTP）-induced PD animal models, but only slight injury occurs in the adjacent ventral tegmentat area （VTA）. The mechanisms underlying this selective injury remain poorly understood. OBJECTIVE： To comparatively observe astrocyte reactivity in the SNC, caudate putamen （CPu）, VTA, and frontal association cortex （FrA）.
DESIGN, TIME AND SETTING： A cellular and molecular biology, randomized, controlled experiment was performed at the Institute of Neurobiology, Department of Human Anatomy, Medical School of Nantong University, between December 2006 and September 2008.
MATERIALS： A total of 80 healthy adult male C57BL/6 mice were included in this study. MPTP was purchased from Sigma, USA.
METHODS： Mice were randomly divided into a model group （n = 64） and a sham-operated group （n = 16）. PD was induced in the mice from the model group by intraperitoneal injection of 20 mg/kg MPTP, once every three hours, for a total of 4 times.
MAIN OUTCOME MEASURES： Tyrosine hydroxylase （TH）-immunoreactive neurons and glial fibrillary acidic protein （GFAP）-immunoreactive astrocytes were examined by dual immunofluorescence labeling. GFAP-immunoreactive astrocytes in the CPu and FrA were determined by immunofluorescent staining. GFAP mRNA expression in the SNC, CPu, VTA, and FrA was detected using real-time polymerase chain reaction. TH protein levels in the TH-immunoreactive axon terminals of the CPu and FrA were detected by Western blotting.
RESULTS： Numbers of TH-immunoreactive neurons in the SNC, and TH protein level in the CPu, markedly decreased （by approximately 68%） 1 day after MPTP injection, and gradually increased at 3 days. Simultaneously, astrocyte reactivity was strengthened, in particular at 7 days. However, after MPTP injection, decreases in the numbers of TH-immunoreactive neurons in the VTA, and TH protein levels in the FrA, were less apparent （approximately 15%）. Also, no obvious astrocyte reactivity was observed.
CONCLUSION： In a mouse model of PD, astrocyte reactivity was apparent in the SNC and CPu, but not the VTA or FrA. In addition, astrocyte reactivity was greater in regions where injury to dopaminergic neurons was more severe.     

89例TIA患者颅内—外血管狭窄情况

目的 探讨短暂性脑缺血发作(TIA)与颅内—外血管狭窄的关系.方法 对89例TIA患者行数字减影血管造影(DSA)检查,按照患者TIA发作临床表现分为:颈动脉系组和椎基底动脉系组;按照发作次数分为非频发组(发作次数＜3次)和频发组(发作次数≥3次),比较各组患者颅内—外动脉狭窄的分布情况,比较不同发作频率间和各年龄段间患者颅内—外血管严重狭窄及闭塞的发生情况.结果 (1)本研究共63例患者存在颅内—外动脉狭窄,占70.78％.以颈内动脉颅外段最多,颅内动脉狭窄以大脑中动脉最多.颅内、颅外狭窄动脉比约为1.55∶1.(2)频发组颅内—外血管重度狭窄及闭塞的发生率高于非频发组(P＜0.05).(3)89例TIA患者以50～70岁居多,且重度狭窄及闭塞发生率随年龄增长而呈升高的趋势,但差异无统计学意义(P＞0.05).结论 颅内—外动脉狭窄是发生TIA的重要因素.DSA可以确定短暂性脑缺血发作患者是否存在血管狭窄及狭窄程度,对短暂性脑缺血发作治疗方案的选择起重要作用.     

四肢无力3月余 视物成双2 个月 尿急1 个月简

病历摘要 患者女性,55岁。因四肢无力3月余、视物成双2个月,加重伴尿急1个月,于2013年10月31日入院。患者入院前3个月（2013年7月中旬）出现双下肢肌力减弱、行走易疲劳,尤以上台阶费力,但下蹲后可自行站起,晨起、休息后症状缓解,晚间或活动后症状加重;约2周后（2013年7月底）出现双上肢肌力减弱,抬手臂或梳头无力,能持握碗筷,不伴肢体麻木、肌柬颤等,至当地医院就诊。     

Diagnostic value of fluid attenuated inversion recovery versus T2-weighted image in diffuse axonal injury*★

BACKGROUND：At present, the most common examination modality for diffuse axonal injury （DAI） is CT or MRI. However, both methods exhibit low sensitivity in the diagnosis of DAI lesions. OBJECTIVE： To investigate the value of fluid attenuated inversion recovery （FLAIR） in the clinical diagnosis of DAI, and to compare with T2-weighted images. DESIGN, TIME AND SETTING： This prospective study was based on imaging analysis, and was performed in the First Affiliated Hospital of Chongqing Medical University （Chongqing, China） between October 2002 and April 2004. PARTICIPANTS： Sixty-three patients with craniocerebral injury were admitted to the Department of Neurosurgery at the First Affiliated Hospital of Chongqing Medical University, including 50 males and 13 females. The patients were included in the experiment and were divided into DAI （n=24） and non-DAI （n=39） groups, according to the emergent CT findings and clinical manifestations. METHODS： Both groups underwent MR examinations, including axial and sagittal T1 weighted images （TR = 450 ms, TE = 8-9 ms）, T2-weighted images （TR = 3 600 ms, TE = 100 ms）, and FLAIR （TR = 10 000 ms, TI = 2 500 ms, TE = 40 ms）, 8-mm thick and 2-mm wide, using a GE Sigma MRI device. MAIN OUTCOME MEASURES： The DAI diagnostic rate and lesion-detecting rate of T2-weighted images and FLAIR were determined. RESULTS： All 63 patients were included in the final analysis. The DAI diagnosis rates of FLAIR and T2-weighted images were 88% （21/24） and 62% （15/24）, respectively, of which the difference was statistically significant （P 〈 0.05）. T2-weighted images and FLAIR detected lesions located in the gray matter-white matter junction in parasagittal areas, the corpus callosum, deep periventricular white matter, basal ganglia, internal capsule, hippocampus, cerebellum, and brain stem, with a detailed amount of 123 and 256, respectively. FLAIR was significantly greater than T2-weighted images （P 〈 0.01）. CONCLUSION： FLAIR is superior