高分辨MR观察语言前感音神经性耳聋患者听皮质

目的 探讨语言前感音神经性耳聋患者听皮质的时间依赖性变化,评价正常听力者和语言前耳聋患者的半球优势.方法 对9～12岁、19～22岁年龄段语言前耳聋患者各20例以及相应年龄组正常听力者各20名行梯度回波MR T1WI薄层采集,分别测量听皮质、颞上回、颞叶的灰质、白质容积以及总容积.结果 9～12岁、19～22岁年龄组语言前耳聋患者与正常听力者双侧Heschl回、颞上回、颞叶的灰质、白质容积以及总容积差异无统计学意义(P>0.05).9～12岁组左、右侧颞叶、颞上回灰、白质容积比亦差异无统计学意义(P>0.05),而左、右侧Heschl回灰、白质容积比差异有统计学意义(P<0.05).19～22岁组左、右侧Heschl回、颞上回灰、白质容积比差异有统计学意义(P<0.05).耳聋患者和正常听力者听觉中枢的左、右侧半球容积差异有统计学意义(P<0.05).结论 与正常听力者相比,耳聋患者Heschl回灰、白质容积比均显著增加;耳聋患者与右利正常听力者听觉中枢的左侧半球容积显著大于右侧半球.     

纯音听力计检查法应注意的问题

纯音听力计是通过音频振荡发生不同频率的纯音,其强度可以调节[1],用于测试听觉范围内不同频率的听敏度,判断有无听觉障碍,估计听觉的程度,对耳聋的类型和病变部位作出初步判断。1临床资料1.1对象:本组病例162例,因自觉听功能障碍来专科门诊检查。通过听力测试按听力曲线分类[1]:①正常听力曲线;②传音性聋;③感音神经性聋;④混合性聋。1.2检查法:包括气导听阈及骨听阈测试两种,一般先测试气导然后测骨导,检查从1000Hz开始,以后按2000Hz、3000Hz、4000Hz、6000Hz、8000Hz、250Hz、500Hz顺序进行。最后,再对1000Hz复查一次,可以1000Hz、40dB的测试声刺激受试耳,此时该耳若能听到测试声则每5dB一档递减直到阈值,否则,递增声强直至阈值。在阈值处,应再降低5dB,确定听不到后仍以阈值声重复确认。临床测试有上升法和下降法2种,可根据经验选用。1.3结果:正常听力曲线38例,传音性聋64例,感音神经性聋23例,混合性聋37例,其中有97%以上与临床诊断相符合,另外3%中的2%是伪聋患者,1%左右为功能性聋患者。2注意的几个问题2.1力求检查的准确性,测试结果出来后,告知到...     

单纯型慢性化脓性中耳炎骨导听阈改变的临床观察

目的 观察单纯型慢性化脓性中耳炎对感音神经性聋的影响。方法 160例(230耳)单纯型慢性化脓性中耳炎患作纯音测听，记录0.25、0.5、1、2、4kHz频率骨导听阈，分为单侧组90例，双侧组70例，将90例单耳患的健耳作为对照组进行相关的比较。结果 单纯型中耳炎230耳和正常耳骨导听力损失程度有显性差异(P＜0．01)；不同病程的中耳炎骨导听力损失程度差异无显性(P＞0．05)；双侧中耳炎高频较单侧中耳炎高频易发生感音神经性聋；不同频率之间的骨导听力损失不同，以高频区的骨导听力损失最大。结论 单纯型慢性化脓性中耳炎可以导致感音神经性聋，在不同频率骨导听力损失不同，以高频听力损失为主。     

活性氧在噪声性聋中的作用机制及治疗进展

<正>噪声性听力损失又称噪声性聋,是一种高频感音神经性耳聋,暴露于过度噪声中是永久性感音神经性听力损伤的主要原因之一,仅次于年龄相关的听力丧失(老年性聋)[1],其纯音测听图常在4000 Hz处有一个典型的切迹[2]。随着时代的进步,噪声性聋也逐渐成为娱乐追求暴露的结果。根据世界卫生组织相关数据统计显示,全球约3.6亿人患有中重度听力损失,占世界人口的5%以上[3]。噪声性聋男性多于女性,可能是由于某些职业男性人数过多导致,且听力丧失的风险随     

3例小儿双耳突聋临床疗效报告

例１：男，８岁。突发双耳聋，不伴耳鸣、眩晕。发病后第二天去当地医院治疗，听力无好转。５天后来我科检查：查外耳道及鼓膜正常，余无特殊。纯音测听为双耳感音神经性聋，显示左耳听力损失平均语言频率为１００ｄＢ，右耳为７０ｄＢ。第１天静滴６％低分子右旋糖酐１０...     

长春西汀致严重腹泻1例

1 病历摘要 男，55岁。主因左耳听力突然下降5d，于2005年11月29日来我科就诊。查体：心、肺、腹未见异常，既往有高血压史。双耳鼓膜正常，纯音测听示左耳中、重度感音神经性聋，右耳听力正常。诊断：左耳突发性耳聋，给予长春西汀（常春欣）100ml（长春西汀20mg，葡萄糖5g）静脉滴注，每日1次，患者带药回当地治疗。用药2d后，并出现严重腹泻，水样便，不伴恶心、呕吐，不伴纳差，轻度腹痛，自行停药，未行其他治疗，症状逐渐消失。     

耳聋的临床诊断与治疗

耳聋是听觉传导路发生器质性或功能性病变致不同程度听力损害(hearing impairment)的总称,程度较轻的亦称重听,显著影响社交能力者称为聋,因听觉障碍难以用语言进行正常人际沟通者称为聋哑或聋人.按耳聋发生部位与性质,一般将耳聋分为传导性聋、感音神经性聋和混合性聋.感音神经性聋按病变部位可再分为中枢性聋、神经性聋和感音性聋,但中枢性聋罕见,单纯的神经性聋少见,感音性聋最为常见.一般情况下.临床仍将三者合称感音神经性聋[1].因此,耳聋可能是原发疾病,也可能是某些疾病的症状.临床实践中,由于患者或患儿家长讲述不清、医师认识不足或疾病处于不同发展阶段等因素,易导致误诊误治,甚至引起医疗事故.为提高耳聋临床诊治水平,本文根据笔者长期临床经验和科研成果,结合复习近年文献,就耳聋的I临床诊断与治疗相关问题提出个人看法,供同道们参考与讨论.     

流行性腮腺炎并发感音神经性耳聋患者的护理体会

目的 探讨流行性腮腺炎并发感音神经性耳聋的预后与护理.方法 总结8例流行性腮腺炎并发感音神经性耳聋临床治疗护理.结果 流行性腮腺炎并发耳聋以单耳全聋多见,预后较差,良好的心理护理对患者今后的生活起到积极作用.结论 流行性腮腺炎并发感音神经性耳聋重在预防,发病初期及时正确用药是治疗成功的关键.     

高压氧结合药物治疗突发性耳聋20例的临床疗效分析

突发性耳聋 ,简称暴聋 ,是一种较常见的突然发生的感音神经性耳聋 ,以冬季多见 ,脑力劳动比体力劳动者发病率高[1] 。我院于 1999年 9月 2 8日至 2 0 0 0年 5月对 2 0例临床确诊的突发性耳聋采用高压氧结合药物治疗 ,取得了满意的效果 ,现报告如下。1　临床资料和方法1.1　一般资料　本组 2 0例中 ,男 14例 ,女 6例 ,年龄 12～ 6 2岁 ,平均 35 .1岁。单侧耳聋 17例 ,双侧耳聋 3例 ,伴耳鸣 8例 ,眩晕恶心、吐 2例 ;单侧耳聋男性左耳右耳比为 7∶8,女性左耳右耳比为 3∶2 ,病程 1/ 2～ 36 5ｄ ,均经临床确诊。其中轻中度耳聋 8例 ,中重度耳聋 …     

耳聋的鉴别诊断

耳聋是听觉系统障碍所致的听力减低。轻者为重听,重者为耳聋。因两者之间无明显分界故概称为聋。根据发病的时间分为先天性聋和后天性聋;根据病变部位可分传音性聋、感音神经性聋和混合性聋;根据病变性质可分器质性聋和功能性聋。一、先天性聋出生后即有听力障碍者称为先天性聋。分传音性聋和感音神经性聋,前者因外耳及中耳病变所引起;后者因耳蜗、听神经和听中枢病变所     

High frequency rTMS modulation of the sensorimotor networks: behavioral changes and fMRI correlates

Repetitive transcranial magnetic stimulation (rTMS) to the primary motor cortex (M1) may induce functional modulation of motor performance and sensory perception. To address the underlying neurophysiological modulation following 10 Hz rTMS applied over M1, we examined cortical activation using 3T functional magnetic resonance imaging (fMRI), as well as the associated motor and sensory behavioral changes. The motor performance measure involved a sequential finger motor task that was also used as an activation task during fMRI. For sensory assessment, current perception threshold was measured before and after rTMS outside the MR scanner, and noxious mechanical stimulation was used as an activation task during fMRI. We found that significant activation in the bilateral basal ganglia, left superior frontal gyrus, bilateral pre-SMA, right medial temporal lobe, right inferior parietal lobe, and right cerebellar hemisphere correlated with enhanced motor performance in subjects that received real rTMS compared with sham-stimulated controls. Conversely, significant deactivation in the right superior and middle frontal gyri, bilateral postcentral and bilateral cingulate gyri, left SMA, right insula, right basal ganglia, and right cerebellar hemisphere were associated with an increase in the sensory threshold. Our findings reveal that rTMS induced rapid changes in the sensorimotor networks associated with sensory perception and motor performance and demonstrate the complexity of such intervention.     

震动触觉刺激fMRI评价先天性耳聋婴幼儿听觉及语言中枢功能的可行性

目的 评价震动触觉刺激fMRI在先天性极重度耳聋婴幼儿听皮质、语言中枢功能检测中的可行性。方法 选取先天性极重度感音神经性耳聋患儿19例(聋儿组)及听力正常幼儿7名(对照组),分别采集轴位SE T1WI、GRE-EPI fMRI以及全脑三维扫描影像。采用组块设计方法分别给予右小腿近踝部震动触觉刺激。所有图像均采用统计参数图5(SPM5)进行后处理,利用SPM5二次统计模块进行聋儿组与对照组的组内分析和组间比较。结果 聋儿组患儿在给予右小腿近踝部震动触觉刺激时,双侧颞横回、颞上回(BA41区、BA42/22区)可见明显激活。对照组在给予相同刺激时听觉中枢激活不明显。语言中枢包括额中回、额下回、颞上回、颞中回、角回,可见明显激活。聋儿组与对照组进行组间比较发现,聋儿组数据减去对照组数据时可见激活的脑区主要有双侧颞横回、双侧颞上回。结论 震动触觉刺激fMRI可用于评价先天性感音神经性耳聋婴幼儿听觉及语言相关脑区功能。     

Cervical spinal cord BOLD fMRI study: modulation of functional activation by dexterity of dominant and non-dominant hands

The objective of this study was to investigate the effect of dexterity on the magnitude of signal changes in functional magnetic resonance imaging (fMRI) in the cervical spinal cord with unilateral finger-tapping. Right-handed healthy volunteers were investigated with blood oxygenation level-dependent (BOLD) fMRI. Spinal cord BOLD functional MR images were acquired from 10 healthy right-handed volunteers who performed four sessions of unilateral finger-tapping tasks: left sequential (LS), right sequential (RS), left interleaved (LI), and right interleaved (RI) tasks. Our results from the difficulty measurement test showed that finger-tapping in interleaved order was more difficult than in sequential order. For the functional activation, seven out of 10 subjects had activation in all four fMRI sessions (two of the subjects who showed no detectable activation had problems in volume registration). The mean contrast value of the activation area inside the entire cervical spinal cord was significantly higher in performing LS than RS tasks. The increase in the mean contrast value was because the less skilled and competent right hemisphere required additional processing power for doing the left hand task than the left hemisphere required in doing the right hand task. The analysis of the interleaved finger-tapping tasks did not show any significant difference in the results. This was probably because the interleaved task was similarly challenging for both hands, and required high dexterity. Therefore, differences in activity between the left and right hands were less apparent. Our results showed the modulation of activation intensity in the spinal cord by the dexterity.     

2型糖尿病患者下丘脑功能连接的静息态功能磁共振研究

目的利用静息态功能磁共振技术探索2型糖尿病(T2DM)患者下丘脑与其他脑区功能连接的改变,明确T2DM是否损伤下丘脑的相关功能连接。材料与方法本研究共纳入59名T2DM患者及49名对照组志愿者,通过德国西门子MR仪采集T1WI、T2WI、T2压水序列、高分辨率3D T1WI结构像和静息态功能数据,计算下丘脑与全脑体素的功能连接值并进行组间比较,然后提取组间存在显著差异脑区的功能连接平均值并对其与临床数据进行相关性分析。结果 T2DM患者左、右侧下丘脑与右侧桥脑、左背外侧前额叶、眶额皮层、左顶下小叶、右侧枕中回间的功能连接强度均低于正常组(P0.05)。除此之外,左侧下丘脑与左侧梭状回、右侧颞下回、左侧楔前叶间的功能连接强度显著减低,左侧下丘脑与左侧岛叶间的功能连接强度显著增高(P0.05);右侧下丘脑与左侧舌回、右侧中央前回/右侧中央后回间的功能连接强度显著减低(P0.05)。相关性分析结果显示左侧下丘脑-左背外侧前额叶间功能连接强度的减低与糖化血红蛋白值存在负相关性(r=–0.24,P=0.04)。结论 T2DM损害了下丘脑与多个脑区的功能连接,其中同侧下丘脑与背外侧前额叶间功能连接减低与糖尿病严重程度相关。静息态功能磁共振能够反映2型糖尿病的严重程度。     

Cerebro-muscular and cerebro-cerebral coherence in patients with pre- and perinatally acquired unilateral brain lesions

The cerebral networks involved in motor control were analyzed in four young hemi-paretic patients (21-25 years) with pre- and perinatally acquired brain lesions (3 with left periventricular brain lesions, 1 with left schizencephaly) by means of MEG source coherence analysis. Previous TMS and fMRI studies on the same patients had investigated their residual ability to move the paretic hand by means of a reorganized primary motor cortex (M1) representation in the contralesional hemisphere. The purpose of this study is to identify the effects of such a cerebral reorganization and the related dynamic aspects which allow the patients to move the paretic arm. Patients underwent a pinch grip task (1-N isometric contraction) using their paretic and non-paretic hands in alternation. MEG signals were recorded using a whole-head 151-channel magnetoencephalograph. EMG was simultaneously recorded as a reference for coherence calculations. 3D coherence mapping was performed in the beta frequency range (14-30 Hz). This approach confirmed the relocation of motor functions from the lesioned (left) to the contralesional (right) hemisphere. In case of left, non-paretic pinch grip, coherent activity originated from contralateral (right) M1 exclusively. In the case of right (paretic) grip, coherent activity in ipsilateral M1 as well as significant coherence of ipsilateral cerebellum with both muscle activity and M1 itself was detected in 3 out of 4 subjects. As expected, the patient with no cerebellar involvement during paretic hand contraction showed the worst motor performance in the grip task. Coupling direction analysis demonstrated that throughout pinch grip the coupling direction goes from M1 to cerebellum. The present study verified the assumption that the intact hemisphere takes over motor control from the paretic (ipsilateral) hand in the presence of early unilateral brain lesion. Moreover, the role of cerebellum in motor deficit compensation and its close interaction with ipsilateral primary motor cortex was studied in detail.     

2型糖尿病伴轻度认知功能障碍患者脑静息态功能MRI研究

目的探讨2型糖尿病(T2DM)伴轻度认知功能障碍(MCI)患者脑静息态脑功能局部一致性(Re Ho)及分数低频波动振幅(f ALFF)的改变特点。材料与方法共纳入21名T2DM伴MCI患者(D-MCI组)及25名年龄、性别、受教育水平相匹配的对照组志愿者(HC组),通过3.0 T MR仪采集T2WI、FLAIR、三维T1WI结构数据和静息态功能数据,分别计算静息态Re Ho值和f ALFF值并进行组内和组间比较,然后提取组间存在显著差异脑区的Re Ho/f ALFF值与临床数据做相关分析。结果 D-MCI组存在多个右侧额上回亚区、部分小脑Re Ho值显著增高,双侧内侧眶额部额上回、右侧额中回、右侧颞下回、左侧枕中回及右侧舌回Re Ho值显著减低;而左侧颞下回、双侧扣带回前部f ALFF值显著增高,右侧舌回f ALFF值显著减低。D-MCI组Hb A1c与扣带回前部f ALFF值(r=-0.482,P=0.027)、Mo CA评分与左侧颞下回f ALFF值(r=-0.547,P=0.010)呈显著负相关。结论 T2DM伴MCI患者存在认知控制网络、视觉信息处理、语义认知等多个相关脑区的异常活动,这些异常活动可部分阐释T2DM患者伴发MCI的神经生理基础。     

Object naming is a more sensitive measure of speech localization than number counting: Converging evidence from direct cortical stimulation and fMRI

Using direct cortical stimulation to map language function during awake craniotomy is a well-described and useful technique. However, the optimum neuropsychological tasks to use have not been detailed. We used both functional MRI (fMRI) and direct cortical stimulation to compare the sensitivity of two behavioral paradigms, number counting and object naming, in the demonstration of eloquent cortical language areas. Fifteen patients with left hemisphere lesions and seven healthy control subjects participated. Patients had both preoperative fMRI at 3 T and direct cortical stimulation. Patients and controls performed object naming and number counting during fMRI at 3 T. Laterality indices were calculated from the fMRI maps for the Number-counting>Object-naming and Object-naming>Number-counting contrasts. The same number-counting and object-naming paradigms were tested during awake craniotomy and assessed for sensitivity to speech disruption. In all patients during intraoperative cortical stimulation, speech disruption occurred at more sites during object naming than during number counting. Subtle speech errors were only elicited with the object-naming paradigm, whereas only speech arrest and/or hypophonia were measured using the number counting paradigm. In both patients and controls, fMRI activation maps demonstrated greater left lateralization for object naming as compared to number counting in both frontal and temporal language areas. Number counting resulted in a more bihemispheric distribution of activations than object naming. Both cortical stimulation testing and fMRI suggest that automated speech tasks such as number counting may not fully engage putative language networks and therefore are not optimal for language localization for surgical planning.     

Dynamic Spatial Coding within the Dorsal Frontoparietal Network during a Visual Search Task

To what extent are the left and right visual hemifields spatially coded in the dorsal frontoparietal attention network? In many experiments with neglect patients, the left hemisphere shows a contralateral hemifield preference, whereas the right hemisphere represents both hemifields. This pattern of spatial coding is often used to explain the right-hemispheric dominance of lesions causing hemispatial neglect. However, pathophysiological mechanisms of hemispatial neglect are controversial because recent experiments on healthy subjects produced conflicting results regarding the spatial coding of visual hemifields. We used an fMRI paradigm that allowed us to distinguish two attentional subprocesses during a visual search task. Either within the left or right hemifield subjects first attended to stationary locations (spatial orienting) and then shifted their attentional focus to search for a target line. Dynamic changes in spatial coding of the left and right hemifields were observed within subregions of the dorsal front-parietal network: During stationary spatial orienting, we found the well-known spatial pattern described above, with a bilateral hemifield representation in the right hemisphere and a contralateral preference in the left hemisphere. However, during search, the right hemisphere had a contralateral preference and the left hemisphere equally represented both hemifields. This finding leads to novel perspectives regarding models of visuospatial attention and hemispatial neglect.     

Unilateral hemispheric lesions disrupt parallel processing within the contralateral intact hemisphere: an auditory fMRI study

Evidence from activation studies suggests that sound recognition and localization are processed in two distinct cortical networks that are each present in both hemispheres. Sound recognition and/or localization may, however, be disrupted by purely unilateral damage, suggesting that processing within one hemisphere may not be sufficient or may be disturbed by the contralateral lesion. Sound recognition and localization were investigated psychophysically and using fMRI in patients with unilateral right hemisphere lesions. Two patients had a combined deficit in sound recognition and sound localization, two a selective deficit in sound localization, one a selective deficit in sound recognition, and two normal performance in both tasks. The overall level of activation in the intact left hemisphere of the patients was smaller than in normal control subjects, irrespective of whether the patient's performance in the psychophysical tasks was impaired. Despite this overall decrease in activation strength, patients with normal performance still exhibited activation patterns similar to those of the control subjects in the recognition and localization tasks, indicating that the specialized brain networks subserving sound recognition and sound localization in normal subjects were also activated in the patients with normal performance, albeit to an altogether lesser degree. In patients with deficient performance, on the other hand, the activation patterns during the sound recognition and localization tasks were severely reduced, comprising fewer and partly atypical activation foci compared to the normal subjects. This indicates that impaired psychophysical performance correlates with a breakdown of parallel processing within specialized networks in the contralesional hemisphere.