纹状体内囊梗死上肢运动功能损害的脑桥基底部扩散张量成像

目的应用磁共振扩散张量成像研究纹状体内囊梗死患者脑桥基底部的扩散变化及其与上肢运动功能损害的关系。方法对15例首次急性起病且伴有单侧上肢运动功能损害的纹状体内囊梗死患者,在起病后2周时行DTI扫描,检测两侧脑桥基底部FA、MD值,将两侧FA的不对称指数（AI）与患侧上肢FM功能评分进行相关分析。结果病灶侧脑桥基底部的FA值在起病后2周时较健侧降低,MD无明显改变,AI与患侧上肢的FM评分呈负相关。结论DTI可以早期检测到纹状体内囊梗死患者脑桥基底部的扩散改变,该部位锥体束的完整性与患侧上肢的运动功能关系密切,DTI可以为纹状体内囊梗死的临床评估提供重要的参考指标。     

早期康复改善脑卒中偏瘫患者上肢肌痉挛的疗效分析

目的观察早期康复治疗改善脑卒中致偏瘫患者上肢肌痉挛的疗效。方法选择2008年1月~2009年12月我院神经内科住院治疗的脑卒中偏瘫患者126例,分为治疗组和对照组各63例,两组患者均给予常规脑组织保护治疗及物理治疗(电蜡疗+气压式循环驱动治疗仪),治疗组患者另外每天接受以抗痉挛技术为主的康复训练,采用改良Ashworth量表(MAS)、Fugl-Meyer运动功能积分法(FMA)、改良巴氏指数(Modified Barthel Index,MBI)对临床康复效果进行评定。结果经过综合康复治疗6个月,治疗组MAS、FMA评分均明显优于对照组。结论早期康复治疗可以有效改善脑卒中偏瘫患者的上肢肌痉挛,而且较为持久的功能训练有助于进一步改善痉挛上肢的功能。     

MSCT对OSAHS患者上气道多平面狭窄的评估

目的:探讨MSCT在评估阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道狭窄平面中的价值。方法:对52例临床确诊为OSAHS患者及60例正常对照者进行上气道MSCT扫描,分别测量腭后区、舌后区、会厌后区3个平面气道的最小横截面积及容积,判断OSAHS患者上气道的狭窄平面。结果:测量正常成年人上气道3个平面的横截面积参考值,腭后区为100mm2,舌后区为180mm2,会厌后区为220mm2。本组52例OSAHS患者中单纯腭后区狭窄28例,单纯舌后区狭窄6例,腭后区及舌后区同时狭窄12例,腭后区、舌后区及会厌后区3个层面均狭窄6例。狭窄平面以腭后区最多见,单纯及合并腭后区狭窄约占88.4%;34.6%的患者存在多平面狭窄。结论:MSCT能较全面评估OS-AHS患者上气道情况,为制定手术方案提供重要依据。     

The coordination of upper and lower limb movements during gait in healthy and stroke individuals

Human walking involves coordinated movements of all four limbs. The benefits of incorporating arm movements in gait rehabilitation are not known and difficult to investigate in patient populations with poor balance and reduced walking capacity. This study assessed the effect of supported (SUP) versus unsupported (UNSUP) arm movements on the coordination patterns present during walking in individuals with and without a stroke. Ten high functioning stroke subjects and 10 healthy subjects walked on a treadmill while swinging their arms naturally, and while holding onto handles that were either fixed in place or allowed to slide along horizontal handrails. Full-body kinematics were recorded, and arm-leg coordination was quantified using relative phase index, mean relative phase, and cross-correlation of hip and shoulder angle time series. No differences were observed in any measures of coordination between healthy and stroke subjects, indicating that the ability to coordinate arm and leg movements during walking remains preserved in high functioning stroke individuals. Coordination patterns were also unaffected by the use of sliding handrails, suggesting that this paradigm may be a suitable surrogate for natural arm movements if individuals are unable to walk without an external support. Stroke subjects were able to perform arm movements at a faster walking speed when using the handles than they were able to achieve without the handles, indicating that this paradigm may be useful in encouraging arm movements during gait rehabilitation.     

Quantitative evaluation of brain involvement in ataxia telangiectasia by diffusion weighted MR imaging

OBJECTIVE: To evaluate the value of diffusion weighted imaging (DWI) in diagnosing ataxia telangiectasia (AT) and to investigate the spatial distribution of cerebral microstructural changes caused by the disease. METHODS: Six AT patients (9-13 years) and nine healthy control subjects were examined on 1.5 T scanner. In addition to conventional MR images, DWI were performed with a fat suppressed, multishot spin echo EPI sequence using B values of 0, 500 and 1000 s/mm2. Mean ADC values were measured from 16 different supra and infratentorial location. The difference between controls and AT patients regarding ADC values, and the accuracy, sensitivity and specificity of them in discrimination were analyzed with t-tests, logistic regression analysis, ANOVA and ROC curves. RESULTS: Conventional images of the controls were normal. In AT patients, the only conventional MR abnormality was cerebellar atrophy. The difference between both groups regarding mean ADC values was not significant for any of the cerebral structures. In contrary to cerebrum, cerebellar mean ADC values of patients and controls were statistically different (p < 0.011-0.0001). Patients and controls were classified with 100% accuracy using ADC values of cerebellar white matter and cortex together (p < 0.016). The cut-off ADC value (0.699 mm2/s) for middle cerebellar cortex had produced highest (100%) sensitivity and specificity. There was a difference between superior, middle and inferior cerebellar cortex regarding ADC values (p < 0.026). Superior cerebellar cortex (0.987+/-0.1956 mm2/s) had higher ADC values than the middle and inferior cerebellar cortex. CONCLUSION: DWI provides a supplementary and objective imaging finding in AT. This finding is highly accurate in the radiological discrimination of healthy subjects and AT. Our findings also implicate that AT causes a diffuse atrophy and mostly affects superior part of the cortex.     

Quantitative evaluation of deglutition in the upper esophagus by scintigraphy]

To evaluate the function of deglutition quantitatively, radionuclide transit in the and upper esophagus was examined. Ten ml of water containing 185 MBq 99mTc pertechnetate was put into the mouth and isotopic counts were measured every 0.2 second in the oral cavity, upper and lower cervical esophagus, and upper mediastinum. The subjects were studied twice, once while sitting and once supine. Esophageal transit was evaluated with time-activity curves obtained in each region of interest. In twelve healthy volunteers transit of the radionuclide was significantly delayed in supine position compared with sitting position. Even while the subject was supine, the radionuclide was propelled into the lower cervical esophagus in 0.8 second and upper mediastinum in 1.4 second in the healthy volunteers. In the patient, who had reconstruction of the esophagus through posterior mediastinum, radionuclide transit was not different from that of healthy volunteers. Whereas in the patient, who had the reconstruction through retrosternal space, the transit was remarkably delayed. The esophageal scintigraphy was safe and sensitive enough to evaluated the function of deglutition quantitatively.