分支动脉粥样硬化病和腔隙性脑梗死临床差异meta分析

目的 比较分支动脉粥样硬化病（branch atheromatous disease,BAD）和腔隙性脑梗死（lacunar i nfarcti on,LI）之间的临床差异。 方法 检索国内外数据库,查找分支动脉粥样硬化病和腔隙性脑梗死相关文献,使用RevMan 5.2进 行数据处理,对文献进行meta分析。 结果 在中国人群中BAD患者年龄小于LI患者（MD -2.70,95%CI -4.29～-1.11,P＜0.01）;在日本 人群中BAD患者年龄大于LI患者（MD 2.58,95%CI 0.75～4.41,P＜0.01）。BAD患者的高脂血症患病 率更高（OR 1.26,95%CI 1.03～1.55,P =0.03）。行敏感性分析后发现,BAD患者糖尿病（OR 1.28, 95%CI 1.02～1.61,P =0.03）、入院时美国国立卫生研究院卒中量表（national institutes of health stroke scale,NIHSS）评分（MD 0.76,95%CI 0.50～1.02,P＜0.01）和预后情况（OR 0.54,95%CI 0.38～0.77, P＜0.01）在BAD和LI患者之间存在差异性显著。 结论 BAD患者糖尿病、高脂血症发病率显著高于LI患者,其早期神经功能和预后情况均差于LI患者。 中国人群中BAD和LI患者的年龄分布特征与和日本人群相反。     

不同动脉病变导致的皮质下小的梗死的临床特点分析

目的 探讨不同病因导致的皮质下小的梗死( SSI)的临床特点.方法 收集连续住院的SSI患者118例,据急性缺血性脑卒中病因分型SSS-TOAST诊断标准分为动脉粥样硬化性组(大动脉组)和小动脉病变组(小动脉组).应用美国国立卫生院神经功能缺损评分(NIHSS)评分对所有患者的神经系统缺损程度评价.按照临床表现,分为纯运动性卒中、纯感觉性卒中、感觉运动性卒中、构音障碍、共济失调轻偏瘫、面舌综合征、构音障碍-面轻瘫综合征,无症状性及混合型等.结果 118例患者中,大动脉组26例、小动脉组75例.大动脉组患者NIHSS评分为(5.15±3.62)分,小动脉病变组为(3.97±2.87)分,两组间评分差异无显著统计学意义(P=0.175).SSI的临床表现以各种不典型综合征为表现的混合型最多见,其次为构音障碍-面轻瘫综合征.不同病因组间在临床表现上的差异无显著统计学意义(P =0.283).结论 动脉粥样硬化性和小动脉病变性SSI的临床特点无显著差异.     

症状性颅内外动脉重度狭窄或闭塞的轻型卒中患者的临床特点及预后

目的探讨症状性颅内外动脉重度狭窄或闭塞的轻型卒中患者的临床特点及预后。方法 288例轻型卒中患者[美国国立卫生研究院卒中量表(NIHSS)评分≤3分]根据脑梗死溶栓(TICI)系统分级,将0~1级定义为症状性动脉重度狭窄或闭塞。采集患者完整的临床资料,于出院时行NIHSS评分、发病90 d时行改良的Rankin量表(mRS)评分。症状首发5 d内原有神经功能缺损症状加重、NIHSS评分增加值≥2分为早期神经功能恶化;90 d mRS评分≥3分为预后不良。结果根据TICI分级,本组中66例患者(22.9%)为症状性动脉重度狭窄或闭塞的轻型卒中患者。与不伴症状性动脉重度狭窄或闭塞组比较,症状性动脉重度狭窄或闭塞组轻型卒中患者入院时NIHSS评分、空腹血糖及大动脉粥样硬化型比例明显增高(P0.05~0.01);早期神经功能恶化、预后不良的比例及出院时NIHSS评分、发病90 d时mRS评分明显增高(均P0.01)。多因素Logistic回归分析显示,症状性动脉重度狭窄或闭塞是轻型卒中早期神经功能恶化(OR=7.4,95%CI:3.4~15.9,P0.01)及预后不良(OR=7.8,95%CI:4.0~15.2,P0.01)的独立危险因素。结论症状性动脉重度狭窄或闭塞的轻型卒中患者发生早期神经功能恶化和预后不良比例较高,不应被视为"轻型卒中"。     

分支动脉粥样硬化病附3例报告及文献复习

目的：探讨分支动脉粥样硬化病（BAD）的发病机制、临床特征和影像学诊断,并与腔隙性脑梗死相鉴别,提高对BAD的认识.方法：分析3例BAD患者的临床表现和影像学特征,并结合文献复习进行研究.结果：3例BAD患者临床分别表现为短暂脑缺血发作、纯运动型腔隙综合征和运动感觉型腔隙综合征; MRI水平位断层均显示侧脑室旁呈连续3~5个层面的斑点（片）状长T1、长T2信号,冠状位可见纵长形似＂逗号＂样的＂巨大腔隙梗死＂灶.结论：BAD是一种新型脑梗死,对临床疑似腔隙性脑梗死尤其是＂巨大腔隙性梗死＂而又不能完全符合诊断标准的病例,建议作头颅MRI冠状位检查以提高对BAD的诊断,有利于进一步治疗.     

脑小血管病总体负担对大脑中动脉供血区分支动脉粥样硬化病预后的影响

目的探讨脑小血管病(CSVD)总体负担对大脑中动脉供血区分支动脉粥样硬化病(brach atheromatous disease,BAD)预后的影响。方法收集2015-01—2019-03于南通大学第二附属医院神经内科住院治疗的大脑中动脉供血区BAD患者。应用美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、改良的Rankin量表(Modified Rankin Scal,mRS)评估患者90 d后的神经功能缺损的情况,以mRS2分为预后不良。收集预后良好组和预后不良组的人口统计学和临床资料,应用3.0T磁共振(T_1加权成像、T_2加权成像、液体衰减反转恢复序列、弥散加权成像、磁敏感成像、血管成像)对所有入选患者进行CSVD影像学总体负担评估,计算CSVD总体负担评分。采用多因素Logistic回归分析确定可以影响患者预后的因素。结果共纳入BAD患者121例,男69例(57%),女52例(43%),年龄49～81(64.97±7.34)岁,NIHSS评分(7.10±2.12)分。其中预后良好组73例(60.3%),预后不良组48例(39.7%)。预后不良组高血压占比高于预后不良组[81.2%对73.9%,χ~2=2.954,P0.05];预后不良组基线收缩压高于预后良好组[(156.6±25.4)mmHg对(145.3±28.5)mmHg,t=2.602,P0.05];预后不良组空腹血糖高于预后良好组[(7.52±2.64)mmol/L对(6.11±2.32)mmol/L,t=2.965,P0.05];预后不良组CSVD总体负担评分明显高于预后良好组[(3.56±0.62)分对(1.48±0.93)分;t=-13.669,P0.05]。在校正混杂因素后,多因素回归分析显示,CSVD总体负担的评分与BAD患者的预后(OR=3.126,95%CI 1.289～10.783;P0.05)具有独立相关性。结论 CSVD总体负担是影响大脑中动脉供血区BAD预后的独立危险因素。     

伴皮质下梗死和脑白质病的常染色体显性遗传性脑动脉病

伴皮质下梗死和脑白质病的常染色体显性遗传性脑动脉病(Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy, CADASIL)是指一种非动脉硬化性、 非淀粉样血管病性的常染色体显性遗传性脑血管病.     

孤立性皮质下梗死病灶位置与早期神经功能恶化的相关性研究

目的 探讨孤立性皮质下梗死的病灶位置与早期神经功能恶化(END)的相关性。方法 收集我院入院诊断为孤立性皮质下梗死的患者,依据梗死位置不同将患者分为近端梗死组和远端梗死组。在入院当天及之后3 d内对患者采用美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损程度评估,若入院后72 h内NIHSS评分增加2分或以上,我们称其发生了END。比较这两组患者的基本资料以及END的发生率,最后筛选出初期预测END的独立危险因素。结果 符合入组标准的有422例,其中239例近端梗死组中有68例发生了END,183例远端梗死组中有13例发生了END。END组的年龄、男性比例、低密度脂蛋白胆固醇水平、卒中史、近端梗死、载体动脉狭窄率均显著高于非END组,且具有统计学意义。Logistic回归分析显示,年龄、男性、卒中史、近端梗死、载体动脉狭窄是END的独立危险因素。结论 近端梗死的孤立性皮质下梗死患者更易发生END,应引起临床上的关注。     

穿支动脉粥样硬化性疾病的诊治进展

穿支动脉粥样硬化性疾病（branch atheromatous disease,BAD）是引起急性孤立性皮层下梗死的常见且重要的病因,尤以亚洲人群多见。与脑小血管病所致腔隙性梗死比较,BAD相关梗死灶直径、形态学分布具有一定的特征性。BAD相关卒中急性期更易出现症状波动或神经功能恶化,早期预后不良。目前BAD仍缺乏统一的临床影像诊断标准,使得BAD临床研究及精准诊疗面临挑战。近期应用高分辨及高场强磁共振技术可同时显示载体动脉管壁和穿支动脉形态,未来有望突破BAD的发病机制研究的瓶颈。本文对BAD临床影像特征、诊断标准及防治策略等进行综述,以期提高临床医师的重视和认知水平。     

穿支动脉粥样硬化性疾病的诊治进展

穿支动脉粥样硬化性疾病（branch atheromatous disease,BAD）是引起急性孤立性皮层下梗
死的常见且重要的病因,尤以亚洲人群多见。与脑小血管病所致腔隙性梗死比较,BAD相关梗死灶直
径、形态学分布具有一定的特征性。BAD相关卒中急性期更易出现症状波动或神经功能恶化,早期预
后不良。目前BAD仍缺乏统一的临床影像诊断标准,使得BAD临床研究及精准诊疗面临挑战。近期应
用高分辨及高场强磁共振技术可同时显示载体动脉管壁和穿支动脉形态,未来有望突破BAD的发病
机制研究的瓶颈。本文对BAD临床影像特征、诊断标准及防治策略等进行综述,以期提高临床医师
的重视和认知水平。     

高分辨核磁共振对脑桥梗死不同病灶形态类型的病因机制研究

目的探讨急性孤立性脑桥梗死患者的梗死病灶形态与病因机制关系。方法回顾性纳入2016年3月～2019年2月广东省中医院收治的25例急性孤立性脑桥梗死患者,根据核磁共振弥散加权成像(DWI)梗死病灶形态类型分为脑桥旁中梗死(PPI)和脑桥深部小梗死(SDPI)。两组患者均在急性起病10 d内接受基底动脉的3. 0T高分辨核磁共振成像(HR-MRI)检查,依据HRMRI基底动脉管壁与穿支动脉的特点区分不同的梗死病因机制,分为分支动脉粥样硬化病(BAD)和腔隙性梗死(LI)。比较两种分型方法是否存在差异性。结果 DWI梗死灶形态分型显示,PPI组有15例(60. 0%),SDPI组有10例(40. 0%); HR-MRI的病因机制分型显示,BAD组有23例(92. 0%),其中15例均表现为脑桥旁正中梗死,8例表现为脑桥深部小梗死,LI组有2例(8. 0%);两种影像学分型比较,差异有统计学意义(P <0. 05)。结论 PPI与分支动脉粥样硬化所致的发病机制一致,SDPI需进一步接受高分辨核磁共振检查以明确梗死发病机制。     

Clinical Features and Treatment Outcomes of Seronegative Pediatric Autoimmune Encephalitis

Background and PurposeNew diagnostic criteria for pediatric autoimmune encephalitis (AIE) have been introduced recently. A substantial proportion of cases of pediatric AIE are diagnosed as seronegative based on these criteria, and so the clinical characteristics of this group remain to be investigated.MethodsThis study included 46 pediatric patients younger than 18 years with suspected AIE. Clinical features, laboratory or radiological findings, and treatment outcomes were compared between seronegative and seropositive patients.ResultsNine (19.6%) of the 46 patients were diagnosed as seropositive AIE. All of the patients with seropositive AIE had anti-N-methyl-D-aspartate receptor antibodies. Commonly identified neuropsychiatric symptoms were altered mental status, cognitive dysfunction, seizure, speech dysfunction, and psychotic disorder in both the seronegative and seropositive groups. Immunotherapy produced favorable treatment outcomes in both the seropositive (n=7, 77.8%) and seronegative (n=35, 94.6%) AIE patients. Treatment outcomes for first-line immunotherapy were better in seronegative AIE than seropositive AIE patients (p=0.003), and hence a smaller proportion of seronegative patients required second-line treatment (p=0.015).ConclusionsPediatric seronegative AIE patients showed clinical presentations similar to those of seropositive AIE patients, with favorable treatment outcomes after immunotherapy.     

Differences in Clinical Characteristics and Surgical Outcomes of Patients with Ischemic and Hemorrhagic Pituitary Adenomas

ObjectiveIschemia and hemorrhage of pituitary adenomas (PA) caused important clinical syndrome. However, the differences on clinical characteristics and surgical outcomes between these two kinds apoplexy were less reported. MethodsA retrospective analysis was made of patients with pituitary apoplexy between January 2013 and June 2018. Baseline and clinical characteristics before surgery were reviewed. All patients underwent transsphenoidal surgery and were followed up at least 1 year. ResultsTotal 67 cases (5.8%) among 1147 pituitary tumor patients were enrolled, which consisted of 28 (~2.4%) ischemic PA and 39 (~3.4%) hemorrhagic PA. There were more male patients in the ischemic group compared with hemorrhagic group (78.6% vs 53.8%, p=0.043). However, the mean age, tumor size and functional tumor ratio were significant higher in the hemorrhagic group. Headache was more common in ischemic PA (82.1%) than that of hemorrhagic PA (51.3%, p=0.011). Magnetic resonance imaging findings found that mucosal thickening and enhancement of the sphenoid sinus was observed in 15 ischemic PA patients (n=27, 55.6%), but none in patients with hemorrhagic PA (n=38, p<0.0001). It was worth noting that the rate of pre-surgical hypopituitarism in ischemic PA patients were seemed higher than that in hemorrhagic PA patients, but not significant. The two groups got a total tumor resection rate at 94.1% and 92.9%, independently. No significant difference on the operative time, blood loss in operation and complications in perioperative period was observed in two groups. After operation, cranial nerve symptoms recovered to normal at 81.8% of ischemic PA patients and 82.6% of hemorrhagic PA patients. Importantly, the incidence of postoperative hypopituitarism partially decreased in both groups, among which the rate of hypothyroidism in ischemic PA patients significantly decreased from 46.4% to 18.5% (p=0.044). ConclusionPatients with ischemic PA presented different clinical characteristics to the hemorrhagic ones. Transsphenoidal surgery should be considered for the patients with neuro-ophthalmic deficits and might benefit for pituitary function recovery of the apoplectic adenoma patients, especially pituitary thyroid axis in ischemic PA patients.     

Angiographic Features and Clinical Outcomes of Intra-Arterial Nimodipine Injection in Patients with Subarachnoid Hemorrhage-Induced Vasospasm

Objective

The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes.

Methods

We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms.

Results

For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022).

Conclusion

IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.     

Clinical Differences Between Angiographically Negative, Diffuse Subarachnoid Hemorrhage and Perimesencephalic Subarachnoid Hemorrhage

Objective  To identify prognostic factors for vasospasm, hydrocephalus, and clinical outcomes in patients with angiographically negative, non-traumatic, diffuse subarachnoid hemorrhage (d-SAH). Methods  Retrospective review of patients who experienced angiographically negative SAH at our institution over the past 6 years was undertaken. The patients were stratified based on grade at presentation, severity, and pattern of SAH on initial non-enhanced, computed tomography (CT) of the head into perimesencephalic and diffuse subtypes. The patients were further differentiated based on the development of vasospasm, hydrocephalus and required treatments, and clinical outcomes. Patients were excluded if a causative lesion was discovered subsequently. Results  Ninety-four patients with angiographically negative SAH were identified. A total of 31 patients were considered to have the perimesencephalic (p-SAH) subtype, while 63 patients fit criteria for the diffuse (d-SAH) subtype. Compared to the p-SAH subtype, those patients with d-SAH subtype had significantly higher risk for complications related to SAH with an increased incidence of hydrocephalus (50.8% vs. 9.6%), requirement for external ventricular drainage (41% vs. 9.6%), and for the hydrocephalus requiring eventual permanent cerebrospinal fluid diversion (20.6% vs. 0%). Patients with d-SAH were also at an increased risk for symptomatic vasospasm (28.6% vs. 9.6%). Ultimately, only 76% of d-SAH patients achieved complete recovery and independent living, compared to 96.7% of p-SAH patients. Conclusion  The angiographically negative d-SAH pattern is associated with worse presentations and outcome. These patients are at increased risk for vasospasm and hydrocephalus requiring aggressive treatment and should therefore be cared for with a higher level of surveillance.     

脑脊液生化异常与结核性脑膜炎患者病情的关系

目的 :探讨脑脊液生化改变对于结核性脑膜炎 (结脑 )的诊断、病情和预后评估的价值。方法 :回顾性分析 86例结脑患者的脑脊液生化改变与其临床特点的关系。结果 :结脑患者的脑脊液糖降低率为 73 3 % ,氯化物降低率为 72 1% ,蛋白质升高率为89 5 % ;脑脊液生化异常项目越多 ,其临床症状越严重 ,但与预后无明显相关性。结论 :脑脊液生化改变对于结脑的诊断、病情评估仍有一定价值。     

血管母细胞瘤的临床,光镜和电镜特征

本文报告112例血管母细胞瘤的临床、光镜和电镜观察结果。96.4％病例肿瘤位于后颅凹,临床症状以颅压增高和共济失调为主,伴有红细胞增多(18％)、白细胞增多(18.5％)及两者均增多(12.4％)。95例肿瘤肉眼发现为囊性,17例为实质性,光镜下几乎全有囊变。因此,囊变为此肿瘤的基本特征之一。光镜下瘤组织富于血窦,其间充满多角形的间质细胞,具有异形胞核和泡沫状的胞浆。电镜下有多数血管内皮和外皮细胞,以及富含溶酶体和脂滴的间质细胞。