一氧化碳中毒迟发性脑病21例临床分析

目的：探讨一氧化碳中毒迟发性脑病的发病机制及治疗。方法：回顾性分析21例一氧化碳中毒迟发性脑病的临床资料。结果：21例患者一氧化碳中毒后均以痴呆、震颤麻痹和精神症状为主，MRI提示大脑白质内弥漫性病变，BEAM表现为弥散的慢活动。治疗主要给于激素、高压氧、自由基清除剂治疗。结论：一氧化碳中毒迟发性脑病的治疗愈后与昏迷时间长短、年龄有关。     

Cerebrovascular dementia; correlation of computed and histopathologic findings

Computed tomography is often insensitive to such lesions as atrophic demyelination, enlarged perivascular spaces and infarction in the periventricular white matter. In attempt to better understand the discrepancy between the pathologic and X-CT findings, the author correlated areas that had focal, patchy on X-CT and brains with gross and microscopic findings. Patients with cerebral strokes had larger volume infarcts characterized centrally by necrosis, axonal loss, and demyelination. The progressive subcortical vascular encephalopathy (Binswanger's disease) is characterized by ischemic demyelinization of white matter provoked by hypertensive vascular changes in small vessels and is usually accompanied by multiple lacunar infarcts in a periventricular area and the basal ganglia. Small, deep hemispheric infarcts may be of no clinical significance unless a sufficient aggregate of these occurs. It should be pointed out that many small infarcts are clinically silent, and chronic multifocal ischemia may be responsible for observed senescent changes in cerebral tissue. The extension of the infarcted area might be most important in the development of cerebrovascular dementia. Mixed forms of degenerative dementia and any type of cerebral vascular disease are common and account for 10-20% of all dementias.     

Computed tomography of Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease (CJD), one of the transmissible spongiform encephalopathy, affects gray matter primarily. Degeneration of the white matter is uncommon and when it occurs is usually mild, and limited in distribution. Mizutani separated the "panencephalopathic type" of CJD from the other type, because this panencephalopathic type has extensive white matter changes, that could not be explained simply as secondary to cortical degeneration. This communication discusses six necropsy cases of CJD. In four cases of panencephalopathic type, out of our cases, there were extensive changes of cerebral white matter in addition to severe loss of neurons and hypertrophic astrogliosis in cortex and basal ganglia. Computed tomography demonstrated diffuse low attenuation areas in the white matter with marked atrophy of the cortex, brainstem and cerebellum.     

电离辐射对大鼠脑皮质牛磺酸、谷氨酸及其谷氨酸阳性神经元的影响

目的 探讨电离辐射对大鼠脑皮质内谷氨酸(glutamate,Glu)、牛磺酸(taurine,Tau)水平和谷氨酸阳性神经元的影响。方法 雄性SD大鼠45只随机分为3组,头部分别给予0、10、20 Gy ⁶⁰Coγ射线照射。照射后12h测定脑皮质谷氨酸(Glu)、牛磺酸的含量以及神经细胞内游离Ca²⁺浓度([Ca²⁺]i),同时观察大鼠脑皮质Glu阳性神经元以及神经细胞凋亡情况。结果 随着照射剂量的增加,脑皮质内Glu含量升高,Tau含量减少,Glu/Tau比值逐渐上升,细胞内游离Ca²⁺浓度([Ca²⁺]i)升高,Glu阳性神经元数量增加,细胞凋亡数量上升,并与电离辐射呈一定的量效关系。结论 上述结果提示Glu产生的神经毒作用参与了电离辐射对中枢神经系统的损伤过程。     

磁共振弥散加权成像在一氧化碳中毒迟发性脑病诊断中应用研究

目的:探讨磁共振弥散加权成像诊断一氧化碳中毒迟发性脑病的应用价值。方法:回顾性分析2017年5月~2018年10月本院诊治的36例一氧化碳中毒迟发性脑病患者(观察组)及36例单纯一氧化碳中毒患者(对照组)的病例资料,所有患者均行磁共振弥散加权成像检查,比较两组影像学表现及双侧大脑皮层半卵圆中心表现弥散系数(ADC)值。结果:观察组患者各时间段ADC均值均低于对照组,差异有统计学意义(P<0.05);MR影像学表现中一氧化碳中毒患者两侧大脑皮层、苍白球及皮层下区T1WI呈等信号,T2WI呈高信号,同时所有异常信号均出现两侧对称性改变;一氧化碳中毒迟发性脑病患者MR影像学表现为脑实质伴有异常信号灶,主要以基底节区病变为主,且呈稍长T1、T2信号,DWI序列检查,部分患者病变区信号偏高。结论:磁共振弥散加权成像在一氧化碳中毒迟发性脑病患者诊断中具有较高的临床应用价值,其可通过DWI判断病情,且能够与单纯一氧化碳中毒患者进行有效区分。     

创伤性局部脑水肿CT动态变化的研究

目的了解外伤后局部脑水肿发生发展的动态变化的规律。方法选择本院1998～2002年进行过多次头部CT扫描的脑外伤病人120例，记录每次CT扫描多项影像学及相关临床指标，并对这些指标进行统计分析。结果本组96.7％的病人CT上显示局部水肿，水肿多在伤后7h出现，9d达到水肿高峰，其形态有向圆锥形发展的趋势，并有皮层回避的特点。结论外伤后局灶性脑水肿普遍存在。灰质和白质在组织结构、血供等方面的差异可能是引起水肿圆锥形态和皮层回避的原因。了解这些规律对于预计水肿的发展趋势，指导临床治疗有重要意义。     

颅脑磁共振T1WI高信号病变影像诊断

目的：探讨颅脑MRI T1WI高信号病变影像表现,结合文献讨论其发生机制和病理改变。方法：回顾性分析63例颅脑MRI TIWI高信号病变的影像表现,包括脑出血、黑色素瘤、糖尿病脑病、缺血缺氧性脑病、亚急性期脑梗死、颅内囊肿及脂肪瘤。结果：脑出血T1WI以高信号为主,T2WI呈低或高信号,磁敏感加权成像（SWI）呈低信号;黑色素瘤T1WI呈高信号,T2WI呈等或低信号,无灶周水肿;糖尿病脑病可见双侧或单侧基底节区T1WI高信号,T2WI信号正常或轻度降低。脑缺血缺氧性疾病高信号主要位于侧脑室旁白质,弥散加权成像（DWI）呈高信号。亚急性期脑梗死高信号主要位于脑灰质,呈片状或脑回样高信号;颅内囊肿主要见于脑室内和鞍区,T1WI以高信号为主,T2WI呈高或/和低信号。脂肪瘤位于大脑镰旁,压脂像呈低信号。结论：含正铁血红蛋白、黑色素、脂质、蛋白及矿物质病变在T1WI上可呈高信号,熟悉这些病变化学组成及其对T1时间的影响有助于鉴别诊断。     

经颅多普勒对CO中毒后迟发性脑病的诊断价值

目的探讨经颅多普勒（TCD）对一氧化碳中毒后迟发性脑病的脑动脉血流速度及血管阻力变化的应用价值。方法应用经颅多普勒（TCD）对28例一氧化碳中毒后迟发性脑病患者的大脑中动脉（MCA）血流进行检测,观察频谱形态,并对其收缩期流速（Vp）、舒张末期流速（Vd）、平均血流速度（Vm）、阻力指数（RI）、搏动指数（PI）进行治疗前后的对比分析。结果治疗前双侧MCA流速均较对照组减低,比较差异有统计学意义（P〈0．05）;治疗后,双侧MCA流速均较治疗前有增高（P〈0．05）,与对照组比较差异无统计学意义（P〉0．05）。结论经颅多普勒（TCD）可作为一氧化碳中毒后迟发性脑病治疗前后观察脑动脉血流速度及血管阻力状态变化的检测方法。     

Similarity between the effects of carbon-ion irradiation and X-irradiation on the development of rat brain

The effects of carbon-ion irradiation and X-irradiation on the development of rat brain were compared. Twenty pregnant rats were injected with bromodeoxyuridine (BrdU) at 9 pm on day 18 of pregnancy and divided into five groups. Three hours after injection (day 19.0) one group was exposed to 290 MeV/u carbon-ion radiation by a single dose of 1.5 Gy. Other groups were exposed to X-radiation by 1.5, 2.0 or 2.5 Gy, or sham-treated, respectively. Fetuses were removed from one dam in each group 8 h after exposure and examined histologically. Extensive cell death was observed in the brain mantle from the irradiated groups. The cell death after 1.5 Gy carbon-ion irradiation was remarkably more extensive than that after 1.5 Gy X-irradiation, but comparable to that after 2.0 Gy or 2.5 Gy X-irradiation. The remaining rats were allowed to give birth and the offspring were sacrificed at 6 weeks of age. All of the irradiated offspring manifested microcephaly. The size of the brain mantle exposed to 1.5 Gy carbon-ion radiation was significantly smaller than that exposed to 1.5 Gy X-radiation and larger than that exposed to 2.5 Gy X-radiation. A histological examination of the cerebral cortex revealed that cortical layers II-IV were malformed. The defect by 1.5 Gy carbon-ion irradiation was more severe than that by the same dose of X-irradiation. Although the BrdU-incorporated neurons were greatly reduced in number in all irradiated groups, these cells reached the superficial area of the cortex. These findings indicated that the effects of both carbon-ion irradiation and X-irradiation on the development of rat brain are similar in character, and the effect of 1.5 Gy carbon-ion irradiation compares to that of 2.0-2.5 Gy X-irradiation.     

超声辐照兔外阴皮肤的病理学转归

目的:探讨超声治疗外阴白色病变的机制。方法:实验兔随机分成辐照组4组(每组10只)及对照组(10只)。辐照组以CZF-1超声治疗仪样机对兔外阴皮肤真皮层进行连续直线辐照,功率4W,4组分别于辐照后1、4、7和14天取材,对照组不辐照立即取材。作光镜、电镜检查。结果:超声辐照后第1天外阴充血水肿,皮肤完整,稍硬,增厚感,皮温升高。第4天外阴充血水肿消失,仍然稍硬,皮温正常。第7天后外阴外观正常,皮肤色泽及质地同辐照前。组织学变化:超声辐照后第1天,表皮完好,真皮乳头层水肿,轻度充血。第4天充血水肿消退,可有慢性炎性细胞浸润。第7天后可见新生毛细血管增生。第14天与正常外阴皮肤一致。超微结构变化:第1、4、7天可见血管内皮细胞线粒体肿胀、微吞饮小泡数量多,成纤维细胞线粒体肿胀、粗面内质网扩张,神经纤维内线粒体肿胀。结论:提示超声有利于微血管、胶原纤维和神经末梢的增生与修复。推测超声用于外阴白色病变临床治疗是有效和安全的。     

1,2-二氯乙烷对血脑屏障的损伤作用

目的 探讨1,2-二氯乙烷对血脑屏障的损伤作用.方法 用1,2-二氯乙烷静式呼吸道急性染毒复制大鼠急性中毒性脑病模型,用硝酸镧染色法测定脑组织的含水量并检测血脑屏障的通透性;同时在体外培养脑微血管内皮细胞和神经胶质细胞,用1,2-二氯乙烷对生长良好的脑微血管内皮细胞和神经胶质细胞染毒,在光镜和电镜下观察细胞形态学特征.结果 （1）脑组织主要表现为细胞外水肿,镧示踪法检测到血脑屏障有镧颗粒的大量渗漏.（2）中高剂量染毒组大鼠大脑皮质含水量较对照组明显升高,并且随着染毒后时间的延长更趋严重;大脑髓质含水量仅在染毒后观察6 h组有统计学意义（P＜0.05）.（3）1,2-二氯乙烷能破坏脑微血管内皮细胞和神经胶质细胞的正常形态学结构,且对神经胶质细胞的损伤表现得较早、较严重.结论 1,2-二氯乙烷可造成血脑屏障的损伤,引起血管源性脑水肿.     

浓缩铀脑内照射对新生大鼠脑发育的生化影响

为研究浓缩铀对新生大鼠脑发育的影响 ,给新生大鼠侧脑室内注射不同剂量的浓缩铀 2 μl (分别含2 3 5U 0、1、5和 10 μg)后 ,观察其对早期体格生长、行为发育的影响。以放射自显影示踪术观察脑内放射性核素行径定位 ,放射免疫技术检测超氧化物歧化酶 (SOD)、内皮素 (ET)的含量变化。结果显示 ,放射性核素行径主要定位于细胞核 ,在细胞浆和细胞间隙中亦有呈现 ;新生大鼠出现生长延迟及神经行为异常 ;随着浓缩铀剂量的增加 ,大鼠的小脑、皮质、海马、间脑中SOD、ET的含量有变化 ,小剂量组SOD和ET增升 ,而大剂量组却呈明显的抑制。结果提示 ,从生物化学角度表明 ,在新生大鼠中α辐射体浓缩铀对发育脑的损伤具有神经细胞的敏感性、易脆性和代偿性特征。     

Hydrocephalus in mice following X-irradiation at early gestational stage: possibly due to persistent deceleration of cell proliferation

The pathogenesis of X-ray-induced congenital hydrocephalus was studied. Pregnant mice were irradiated at 1.4 Gy on gestational day 7 (G7). Four hours after irradiation, extensive cell death was evident in the neuroepithelium and underlying mesoderm of the head region, and proliferating cell nuclear antigen (PCNA)-immunoreactive cells almost disappeared. Embryos with thinner lamina terminalis of the telencephalon, when compared with that of the control, were found in the irradiated group on G9. As early as G11 in some irradiated embryos the telencephalic wall was thinner and lateral ventricles were larger than those of the control. The choroid invagination from the lamina terminalis began on G11 in the control brain, but not in the affected brain. During the following development, fetuses with readily apparent hydrocephalus were consistently found among irradiated fetuses. In these brains the brain mantle was thinner, the corpus striatum and thalamic regions were smaller, and lateral ventricles were larger than those of the control. Even on G11 and G13 the frequencies of PCNA-positive cells in the brain mantle and other brain regions were lower in the hydrocephalic brain than those of the control, suggesting a decelerated proliferation of successive cell generations following exposure to X-rays. The cerebral aqueduct was open in the hydrocephalic brain during the fetal period when the lateral ventricles were dilated. The head was vaulted after birth but the cerebral aqueduct was not completely occluded even in these animals. These findings suggested that cell death in the neuroepithelium followed by a persistent deceleration of neural cell proliferation, resulting in the hypoplasia of brain parenchyma with compensatory ventricular dilatation, is important for the establishment of hydrocephalus.     

CTP联合3D-ASL技术对高原红细胞增多症脑部血流动力学的探讨

目的 研究高原红细胞增多症(HAPC)CT脑灌注(CTP)的变化/核磁共振质子自旋标记技术(3D-ASL)的应用价值并进行对比研究.方法 用多层螺旋CT(MDCT)研究22例不同程度高原红细胞增多症患者的CT脑灌注的变化;CT全脑灌注技术与核磁共振质子自旋标记技术(3D-ASL)在高原红细胞增多症脑部血流动力学改变中的...     

Dependence of malformation upon gestational age and exposed dose of gamma radiation

In order to evaluate the importance of gestational age and the dose-incidence relationship by gamma radiation, pregnant ICR mice at gestational days from 2.5 to 15.5 days post-coitus (p.c.) were exposed to a single dose of 2.0 Gy and also at day 11.5 after conception, which was the most sensitive stage for the induction of major congenital malformations. The animals were sacrificed on day 18 of gestation and the fetuses were examined for mortality, growth retardation, changes in head size and other morphological abnormalities. The only demonstrable effect of irradiation during the pre-implantation period was an increase in prenatal mortality. Resorptions were maximal on exposure at day 2.5 after conception. The pre-implantation irradiated embryos which survived did not show any major fetal abnormalities. A small head, growth retardation, a cleft palate, dilatation of the cerebral ventricle, a renal pelvis, and abnormalities of the extremities and tail after exposure were prominent during the organogenesis period, especially on day 11.5 of gestation. As for the dose-incidence relationship, the incidence of a small head, growth-retarded fetuses, a cleft palate, dilatation of cerebral ventricle and abnormalities of the extremities in live fetuses rose as the radiation dose increased. The result indicated that the late period of organogenesis in the development of the brain, skull and extremities of a mouse was a particularly sensitive phase. The threshold doses of radiation that induced a cleft palate and dilatation of the cerebral ventricle, and abnormal extremities were between 1.0 and 2.0 Gy, and between 0.5 and 1.0 Gy, respectively.     

学习障碍儿童工作记忆缺陷的功能磁共振研究

目的:运用功能磁共振技术研究学习障碍儿童在工作记忆任务时额顶叶功能及结构的缺陷,探讨其发病机理。方法:学习障碍儿童12名及对照组12名以步进式视觉累加实验作为刺激模式,进行血氧水平依赖脑功能成像和弥散张量成像。比较两组额顶叶皮层激活部位、强度及白质兴趣区的部分各向异性值(FA)的差异。结果:①学习障碍组儿童双侧额顶叶皮层激活较正常儿童组弱(P0.05)。②学习障碍组左额顶间白质(0.51±0.05)、左顶叶白质(0.61±0.03)及左额叶白质(0.43±0.04)的FA值低于对照组(P0.05)。③学习障碍组儿童左前额叶背侧区激活像素数量的平均值为136.92±19.68,与左额顶间白质FA值存在相关性(r=0.636,P=0.026);对照组儿童激活像素数量的平均值为165.75±24.33,与左额顶间白质FA值存在相关性(r=0.822,P=0.001)。结论:学习障碍组儿童工作记忆过程中存在额顶叶皮层激活缺陷,与该部位白质成熟度较低有关。这可能提示学习障碍的发病机理。     

急性一氧化碳中毒迟发性脑病的动物模型制备研究

目的建立急性一氧化碳(CO)中毒迟发性脑病的动物模型,为其机制研究提供基础.方法体重240～280 g雄性SD大鼠,分次腹腔注射CO染毒制备模型,动态监测尾血碳氧血红蛋白(HbCO)浓度,确定染毒剂量和间隔 .分别于染毒后1、3、7、14、21 d取脑组织,常规制备石蜡病理切片,行HE、Luxol氏坚牢蓝焦油紫及Tunnel原位末端凋亡染色.结果染毒后,大鼠体内血液HbCO迅速升高,使用分次腹腔注射法,大鼠可维持长时间(＞16 h)高HbCO状态(HbCO＞50%) ;病理学检查显示染毒大鼠除急性脑损伤外,还在染毒1～2周后出现脑细胞凋亡、大脑白质脱髓鞘、大脑基底结区变性坏死等二次损伤改变,与临床病理学特点十分吻合.结论本研究建立了一种较为符合迟发性脑病临床特征的动物模型,该模型的建立将可为深入研究急性CO中毒致迟发性脑损伤的机制提供可靠基础.     

Late postpartum eclampsia 16 days after delivery: case report with clinical, radiologic, and pathophysiologic correlations

BACKGROUND: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. Seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. METHODS: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. RESULTS AND CONCLUSIONS: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. Magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.     

头颈部CTA在诊断脑血管性病变的诊断价值

目的 探讨64排螺旋CT头颈部血管成像(CTA)对脑血管疾病诊断的价值.方法 对临床诊为脑梗死(33例)、短暂性脑缺血发作(46例)、蛛网膜下腔出血(9例)、脑出血(5例)及脑血管畸形(3例)等共计96例脑血管疾病患者行头颈部CTA:应用容积再现、最大密度投影、多平面重组及高级血管分析进行分析、诊断.结果 73例头颈...     

急性一氧化碳中毒后迟发性脑病的临床表现和CT及MRI研究

目的研究急性一氧化碳中毒后迟发性脑病（DEACMP）的临床与CT、MRI表现及其与预后的关系。方法对46例DEACMP患者临床表现、预后、颅脑CT及MRI进行分析。结果DEACMP患者临床表现以精神意识障碍和锥体外系神经损害最为突出。CT的典型表现为双侧大脑白质、两侧或单侧基底节或苍白球低密度改变；MRI异常表现为苍白球变性坏死，双侧大脑白质脱髓鞘，以脑室周围为主，T2加权呈高信号，T1加权呈等信号或低信号，海马区及脑干的病变，后期出现脑萎缩征象。MRI阳性检出率为82．1％，CT阳性检出率为43．2％，MRI敏感性高于CT。结论患者预后与年龄、中毒后昏迷时间的长短和治疗效果有关系，CT、MRI对DEACMP脑损伤的诊断和评价预后均有意义，MRI对DEACMP脑损伤的诊断优于CT。