中风后早期癫痫的临床研究

目的：本文对６４例中风后早期癫痫进行临床研究。方法：通过回顾性病历复习和随访观察。结果：中风后早期癫痫的发生率为４．２％，癫痫发作常发和在中风后２４小时内，占７５％。癫痫发作与ＣＴ所见病灶分布密切相关，皮层病灶较皮层下病灶更易发生癫痫。中风后早期癫痫发作与迟发必癫痫关系密切。结论：中风后早期当作是迟发性癫痫的危险因素。     

中风后早期癫痫的临床研究

目的：本文对64例中风后早期癫痫进行临床研究。方法：通过回顾性病历复习和随访观察。结果：中风后早期癫痫的发生率为4．2％,癫痫发作常发生在中风后24h内,占75％。癫痫发作与CT所见病灶分布密切相关,皮层病灶较皮层下病灶更易发生癫痫。中风后早期癫痫发作与迟发性癫痫关系密切。结论：中风后早期癫痫发作是迟发性癫痫的危险因素。     

卒中后早期癫痫的临床分析

目的对卒中后早期癫痫的临床研究。方法通过回顾性病例和随访观察。结果卒中后早期癫痫的发生率为11．94％，癫痫发作常发生在卒中后24h内，占75．5％。癫痫发作与卒中CT所见部位密切相关，皮质病灶较皮质下病灶更易发生癫痫。结论卒中后早期癫痫发作是迟发性癫痫的危险因素。     

脑卒中后继发癫痫的临床分析

目的 探讨脑卒中继发癫痫的临床特征、发病机制及预后。方法 回顾性分析7年来脑卒中860例继发癫痫发作68例的临床资料。结果 卒中后癫痫的发生率为7．91％，早期发作5．08％，晚期发作3．02％，前多见于蛛网膜下腔出血、脑出血、心源性脑梗死；后多见于动脉血栓性脑梗死。结论 脑卒中后癫痫的发生与病灶部位(皮质，／皮质下)有关．病损累及皮层是重要的的致痫因素，多脑叶受累使癫痫发生的危险性增加，血肿刺激和出血后脑水肿、颅内压增高、缺血及缺氧，使大脑皮层神经元大量放电是早期癫痫发作的重要机制，晚期癫痫发作是与胶质细胞增生、疤痕形成、萎缩粘连或中风囊等致痫灶有关。     

脑卒中后癫痫（附98例临床分析）

目的：探讨脑卒中与癫痫的关系。方法：以2187例脑卒中患者进行回顾分析。结果：脑卒中后癫痫发生率为4．48％，以部分性发作为主，皮质病灶较非皮质病灶易发生癫痫，抗癫痫药物疗效满意。结论：癫痫发作是脑卒中患者的常见症状，也是60岁以上老人新发生癫痫的主要病因。     

脑卒中后继发癫(癎)90例临床分析

目的探讨脑卒中后癫痫的临床特点。方法对794例脑卒中病例中90例继发癫痫患者的临床资料进行回顾性分析。结果卒中后癫痫的发生率为11．3％，发作类型以单纯部分性发作最多（42．2％），急性期癫痫发作占78．9％，恢复期癫痫发作占21．1％，卒中后癫痫的发生率在病灶部位间（皮质／皮质下）有显著性差异（P〈0．01）。结论卒中后癫痫的原因与病程和病变部位有关，卒中急性期继发癫痫者预后较差，急性期和恢复期继发癫痫均应给予正规的抗癫痫治疗。     

以癫痫为首发症状的小型脑炎症性病灶

本文报道２３例以癫痫为首发症状的小型脑炎症性病灶的临床资料．本病多发于２０岁以下的儿童和青少年，其临床表现主要为不同类型的癫痫发作；脑ＣＴ改变为大脑某叶局限性不规则低密度区，在此区中心或近皮质处有小的圆形或不规则等密度病灶，增强扫描后病灶呈环形或结节状强化，直径多为１．５ｃｍ左右．经氨苄青霉素和磺胺治疗后，原病灶消失，癫痫发作停止，提示氨苄青霉素及磺胺是治疗本病的最好方法．     

脑卒中与癫(癎)的临床分析

目的探讨卒中后癫痈的临床表现、特点及发病机制。方法对1060例脑卒中病例中102例继发性癫痫患者的临床资料进行回顾性分析研究。结果卒中后癫痫发生率为10％，早期癫痫发作6．04％，晚期癫痫发作3．96％。卒中后癫痫的发生率与病灶部位（皮质下／皮质）差异有统计学意义（P〈0．05），与卒中类型无明显差异。结论脑卒中是癫痫发作的重要病因，皮质病变更易导致癫痫发作。积极控制发作可改善预后。     

老年人脑梗死后癫(癎)50例临床分析

目的探讨老年人脑梗死后癫痫的临床特点及发病机制。方法对454例老年人脑梗死病例中50例继发癫痫患者的临床资料进行回顾性分析。结果老年人脑梗死后癫痫的发生率为11％，卒中后癫痫的发生率与病灶部位（皮质／皮质下）有显著差异（P〈0．01）。结论脑水肿、缺血缺氧是早期癫痫发作的重要致因素，迟发癫痫是因胶质疤痕中风囊形成所致。建议对迟发性癫痫应进行严格系统治疗。     

卒中后癫痫的临床与机理探讨（附148例报告）

对１４８例卒中后癫痫的临床及发病机理与卒中类型进行分析研究，结果为卒中后癫痫的发生率为６．４％，早期癫痫发作４．３％，迟发性癫痫２．１％。卒中后癫痫的发生率与病灶部位（皮质／皮质下）有明显的相关性（Ｐ＜０．０１），与卒中类型无明显差异（Ｐ＞０．０５）。脑水肿是早期癫痫发作的重要致痫因素，迟发性癫痫可因胶质疤痕形成癫痫灶所致。     

心房颤动引起心源性脑栓塞颅内梗死灶空间分布特点

目的：探讨心房颤动引起心源性脑栓塞颅内梗死灶空间分布特点。方法：回顾性分析66例由心房颤动引起心源性脑栓塞患者早期弥散加权成像（DWI）的特征。结果：66例患者中有1例患者DWI上未见病灶,65例患者DWI上可见本次责任病灶。多发梗死灶患者有21／65例,占32．31％;双侧前循环供血区同时梗死7／21例,占多发脑梗死灶患者的33．33％;45例单独前循环供血区梗死患者中,左侧前循环供血区梗死23／45例（51．11％）,右侧前循环供血区梗死15／45例（33．33％）,脑栓塞以左侧居多;前循环供血区中大脑中动脉（MCA）供血区发生栓塞的概率最大（35／45例,77．78％）,35例大脑MCA供血区梗死患者中,皮质下梗死[9／35例（25．71％）]和皮质-皮质下梗死[22／35例（62．86％）1的患者例数明显多于皮质区梗死[4／35例（11．43％）]患者。结论：心房颤动引起心源性脑栓塞的脑内病灶左侧脑多见,大脑中动脉更易发生,皮质下和皮质-皮质下梗死多于皮质区梗死。     

Stroke in Saudi Arabian young adults: a study of 120 cases

One hundred and twenty cases of stroke occurring in Saudi Arabian subjects aged 15 to 45 years are reviewed. These constituted 12.7% of a group of 946 stroke patients. Males outnumbered females (76/44). The frequency of intracranial hemorrhage, including subarachnoid hemorrhage, was slightly lower than cerebral infarction (41.5 vs 58.5%). The causes of large cerebral infarction were as follows: atherosclerosis 17 (28%), cardiac embolism 12 (19.5%), uncommon and uncertain causes 21 (34.5%). Some unusual causes were encountered such as dissecting arterial aneurysm due to popular healing manoeuvres or to traditional dance, retrograde embolism from a thoracic outlet syndrome or embolism from a fibroelastoma of the mitral valve chorda. Lacunar cerebral infarction was diagnosed in nine cases. Hypertension (25.5%) and arteriovenous malformations (20.5%) were the main causes of cerebral hemorrhage; all subarachnoid hemorrhages except one were due to berry aneurysms. The cause was undetermined in 16% of cerebral infarction and 26% of intracranial hemorrhage. The high frequency of stroke in young Saudi Arabian adults is probably a reflection of the demographic structure of the predominantly young Saudi society. The observed causes were relatively similar to those in industrial societies. Contrary to other developing countries infectious disease no longer seems to be an important cause of stroke. Drug abuse, which is becoming an important cause in Western societies, was encountered in only two of our cases.     

EEG and CT findings in poststroke epilepsy

The present study was undertaken to assess the diagnostic value of CT in patients with poststroke epilepsy, related to EEG in revealing the factors contributing to the development of epileptic fits. The EEG and CT results were evaluated in 50 patients with poststroke epilepsy and compared with those of 50 patients without epilepsy after stroke. Cortical and extensive lesions involving the cortex were more frequent among patients with poststroke epilepsy. Sparing of certain parts of cerebral cortex was observed within vasogenic lesion. This type of change was only found in the poststroke epilepsy group and may be responsible for development of epileptic fits. It seems that CT has a higher diagnostic value than EEG in evaluating the risk of development of poststroke epilepsy.     

脑梗死和脑出血导致智能障碍的对比研究

本研究采用ＣＣＳＥ和ＦＡＱ２个量表对１１３例脑血管疾病（ＣＶＤ）患者和２３例健康中老年人进行智能测验，其中８２例脑梗死患者和３１例脑出血患者并发智能障碍（ＩＤ）者分别为３７例和１４例，患病率均为４５．１％，３１列脑出血患者中，１１列伴有脑梗死性，其中有８例并发ＩＤ患病率为７２．７％，２０列不伴梗死灶者，有６例并发ＩＤ，患病率为３０％，两者相比差异显著（Ｐ〈０．０５），提示出血性和缺血性ＣＶＤ均可引     

The arterial lesions underlying cerebral infarction

The arterial lesions underlying cerebral infarction were reviewed by studying the pathological materials in the National Cardiovascular Center. The major clinical cate-gories of arterial lesion (i.e. atherothrombotic, cardio-embolic and lacunar strokes) were reviewed. Arterial lesions underlying striatocapsular infarction were reviewed separately. In order to analyze the mechanisms of the development of cerebral infarction, full postmortem ex-amination of patients dying shortly after the onset of stroke is necessary. Therefore, arterial lesions observed in acute stroke patients were the topic of this review. Two mech-anisms are responsible for atherothrombotic stroke: re-duced perfusion due to obstructive changes in the arteries and embolism. Cardioembolic stroke includes a special clinicopathological entity, cerebral infarction associated with non-bacterial thrombotic endocarditis. The mechan-isms of development of lacunar stroke are not studied sufficiently because the analysis of arterial lesions respons-ible for lacunes requires meticulous effort to examine serial sections of specially prepared specimens. Embolism of the middle cerebral artery (MCA) and abnormalities of the internal carotid artery (ICA) and MCA are responsible for striatocapsular infarction. The author emphasizes the need for postmortem examination of stroke patients, especially those dying shortly after the onset of stroke.     

中国大陆妊娠相关性脑卒中314例临床资料分析

目的：探讨中国大陆地区妊娠相关性脑卒中和蛛网膜下腔出血的危险因素及临床特点。方法：计算机检索中文生物医学数据库（CBMdisc）、万方数据库、维普数据库及中国知网数据库,检索年限均为2000年1月至2012年6月,对中国大陆地区已发表的与妊娠相关的脑卒中文献进行总结分析。结果：检索到18篇文献中314例符合纳入标准的病例。314例中脑出血179例,脑梗死110例,蛛网膜下腔出血25例。于妊娠晚期脑出血为102／179例,发病率为57．0％;妊娠中期脑梗死49／110例,发病率为44．5％;蛛网膜下腔出血25例,占总发病数的8．0％。子痢前期／子痫导致的脑出血42．4％（76／179例）;动脉瘤破裂导致的蛛网膜下腔出血56．0％（14／25例）;心源性栓塞导致的脑梗死29．1％（32／110例）。结论：妊娠相关性脑卒中好发于妊娠晚期及产褥期。脑梗死好发于妊娠中期,脑出血好发于妊娠晚期。脑出血常见病因为子痫前期／子痫,蛛网膜下腔出血常见病因为动脉瘤破裂（多发于妊娠晚期）,脑梗死则为心源性栓塞。     

心源性脑梗死的影像表现

目的：评价CT和MRI-DWI在心源性脑梗死诊断中的临床应用价值。方法选择临床资料完整的89例心源性脑梗死患者的首次和治疗中复查影像表现进行回顾性分析。结果（1）首次影像学检查表现：单发47例,多发42例。C T检查57例,超急性期2例,急性期21例,亚急性期34例;M RI-DWI检查32例,超急性期15例,急性期10例,亚急性期7例。多呈片状、斑片状分布于皮质或（和）皮质下区,CT呈低密度灶,T2 WI呈高信号,DWI呈异常高信号,范围较 T2 WI大。大梗死灶（面积＞3 cm2）55个,小梗死灶（1.5～3.0 cm2）42个,腔隙性梗死灶（＜1.5 cm2）63个。（2）栓塞的血管分布：颈内动脉系统受累73例,其中大脑前动脉18例,大脑中动脉55例;椎基底动脉系受累11例,颈内动脉与椎基底动脉同时受累5例。（3）出血性脑梗死的影像表现：72例治疗中复查检出出血性脑梗死34例,1～3 d检出5例,3～7 d 9例,7～14 d 17例,14 d以上3例;影像表现为在片状梗死区内斑点、片状,血肿样出血灶或多处皮质区梗死灶内出血征象,斑点片状28例,血肿样6例,中心型10例,边缘型19例,混合型5例。结论 C T和M RI能够为心源性脑梗死的诊断、随访复查及判断预后提供更多直接可靠的影像学依据,DWI比CT与常规MRI在超急性期脑梗死治疗决策的确立中更具临床应用价值。     

脑卒中后癫痫50例临床研究

目的探讨脑卒中后癫痫的临床特点，癫痫对脑卒中恢复期神经功能康复的影响。方法50例脑卒中后继发癫痫患者进行发作部位、类型、治疗时间及效果等分析，并按病情轻、中、重三组进行功能康复评分。结果脑卒中后癫痫发生率5．1%（50／980），其中早发癫痫72％（36／50），迟发癫痫28％（14／50）。皮层病灶继发癫痫72％（36／50），皮层下病灶继发癫痫占28％（14／50）。早发癫痫中全身发作27例．部分性发作9例，迟发癫痫中全身发作4例，部分性发作10例。癫痫组神经功能缺损评分均差于对照绀组（P〈0．05），结论脑卒中后癫痫皮层病灶多见，早发癫痫以全身发作为主，迟发癫痫以部分发作为主。脑卒中合并癫痫患者的治疗效果差于对照组，抗癫痫治疗有利于神经功能康复。     

Mirror pattern of cerebral artery atherosclerosis in patients with ischaemic stroke

Background and purpose:  Although it has been suggested that bilateral symmetry of atherosclerosis can be found in paired arteries, including external carotid arteries and femoral arteries, it has remained unknown in intracranial arteries. We determined whether bilateral symmetry (a mirror pattern) of atherosclerosis presents in the entire cerebral arterial system.
Methods:  Angiographic findings of 795 consecutive patients with ischaemic stroke, after excluding those with cardiac sources of embolism or other causes of stroke, were reviewed retrospectively. The presence (location) and severity (the degree of stenosis) of atherosclerosis were compared between left and right sides at 26 predetermined arteries/segments.
Results:  We found 2230 lesions in predetermined segments/arteries from 669 patients. Amongst 509 patients with atherosclerotic lesions at two or more arteries/segments, mirror patterns were observed in 312 patients (61.3%). The mirror pattern increased steeply as the number of atherosclerotic arteries increased and was most frequently found in the carotid bulb (C1, 26.7%), followed by the middle cerebral artery (M1, 14.1%). The severity of stenosis was also correlated between left and right sides, and the correlation was highest in the C1 ( r  = 0.40, P  < 0.001). Multiple logistic regression analyses revealed that the mirror patterns of atherosclerosis were more obvious in C1 and associated with a past history of ischaemic stroke and the number of stenotic lesions.
Conclusion:  Atherosclerosis in cerebral arteries may develop and progress in a mirror pattern. In patients with cerebral artery atherosclerosis, the occurrence and progression of atherosclerosis in the contralateral cerebral artery should be considered during follow-up examination.     

Horizontal gaze deviation on computed tomography: the visual criterion and lesion characteristics in ischemic stroke

Horizontal gaze deviation (HGD) on computed tomography (CT) is considered a useful finding for detecting ischemic stroke. To enhance its availability, we studied the criterion suitable for visual determination and lesion characteristics. The clinical records of 327 ischemic stroke patients and 193 non-stroke controls were reviewed with measurements of eye deviation angles on CT. Initially, the HGD criterion defined by the minimum angle in unidirectionally deviated eyes was determined from control data. Subsequently, patients were classified by infarcted arterial territory and stroke subtype, and compared with controls in HGD frequency using Fisher’s exact test. In patients with middle cerebral artery (MCA) stroke, ipsilesional HGD during a week from symptom onset was modeled in a mixed-effects logistic regression analysis. Among the controls, 4.9% were categorized as pathological with a cutoff of 14°. HGD frequency was significantly increased in most stroke subgroups and prominent in MCA cardioaortic embolism (odds ratio and 95% confidence interval, 24.2 [9.6, 66.3]) and posterior inferior cerebellar artery (PICA) stroke (15.6 [3.2, 76.2]). In MCA stroke, ipsilesional HGD probability decreased daily (0.62 [0.48, 0.78]) and increased with cardioaortic embolism (4.12 [1.05, 16.16]) and lenticular nucleus lesions (3.36 [1.18, 9.58]). HGD is judged pathological if both eyes are unidirectionally deviated by ≥?14°. This CT sign is frequent in MCA cardioaortic embolism and PICA stroke but does not necessarily indicate specific lesions. In MCA stroke, HGD is influenced by time, stroke subtype, and lesion location. The criterion and basic information on lesion characteristics may enhance the availability of HGD.