侧脑室实性血管母细胞瘤1例并文献复习

目的 探讨侧脑室实性血管母细胞瘤(HBS)的临床特点与治疗方法 .方法 回顾分析1例目前国内外年龄最小的侧脑室实性血管母细胞瘤患者的临床资料;并复习相关文献.结果 患者为女性,15岁;表现间断性头痛3个月,头痛加重伴发热1周;查体无异常神经系统体征.头颅MRI检查示,右侧脑室体部不规则形实性混杂信号影,增强扫描病灶呈明...     

米氮平引起入睡前睡眠瘫痪1例

1病例患者男,62岁.主诉情绪低落、兴趣减退、少眠、自杀观念1年余诊断为抑郁症入院.既往有椎管狭窄切除术史并遗留有行走不便.既往无睡眠瘫痪史.给予米氮平治疗.当晚10:00服用米氮平15 mg,约11:30分患者出现全身肌肉松弛,不能翻身,不能动弹,呈瘫痪状,上肢略轻.当时患者意识清晰,无任何不适感,持续约30 min后入睡,4h醒后症状消失.考虑为米氮平不良反应,第2天晚米氮平减量至7.5 mg,上述症状再次复现,但程度较前次为轻.给予停用米氮平,换文拉法辛缓释片后上述症状未再出现.但患者因服用文拉法辛缓释片后出现恶心、呕吐,拒绝服药,7d后再次给予米氮平15 mg,入睡前又出现上述症状,与首次发病症状相同,停药后即消失.目前服用帕罗西汀,病情稳定.     

左侧大脑半球梗死致吞咽障碍动态观察1例

卒中后出现吞咽障碍通常被认为是脑干或双侧皮质延髓束损伤所致,而单侧半球损伤后导致吞咽障碍较少.本文报道1例单侧大脑半球梗死导致吞咽障碍患者的动态观察结果并分析其发生机制.     

鼻咽癌放射治疗后引起脑干梗死1例并文献复习

目的探讨鼻咽癌放射治疗后所致脑干梗死的临床特点。方法报道1例鼻咽癌放射治疗后9年出现脑干梗死的患者,结合复习文献对该病的临床表现、影像学特点以及可能的发病机制予以分析。结果患者男性,42岁。急性起病,临床表现为左侧肢体无力和复视,既往有鼻咽癌放射治疗史,无明显血管危险因素。头颅MRI示脑干梗死,CTA示双侧大脑后动脉管腔狭窄。结论该患者脑干梗死可能与鼻咽癌放射治疗相关。     

进行性核上性瘫痪1例报告

进行性核上性瘫痪（PSP）为少见的神经变性疾病,现报告1例如下。     

双侧延髓内侧梗死1例及文献复习

<正>1病例资料患者女,54岁,以"进行性四肢麻木无力、饮水呛咳3d"为主诉于2016-08-15入我院神经内科。患者3d前腹泻后出现全身酸痛,随之四肢麻木,远端为重,伴四肢无力,饮水呛咳、吞咽困难、颈部发硬、气短,至县医院住院治疗,查头颅CT未见明显异常,以"吉兰-巴雷综合征"为诊断,予以营养神经等对症治疗,患者自觉症状进行性加重,遂来我院。行磁共振示双侧延髓内侧急性梗死。既往高血压史8a,冠心     

双侧延髓内侧梗死的临床分析(1例报道并文献复习)

目的探讨双侧延髓内侧梗死(Bilateral medullary infarction,BMI)的临床特点。方法通过计算机检索中国知网、万方数据库,收集1990年1月-2012年12月间在我国各种期刊上公开发表的关于双侧延髓内侧梗死的病例报道文献,并回顾分析本文作者诊治的1例双侧延髓内侧梗死患者的临床资料。结果从169例延髓内侧梗死的文献中筛选出符合双侧延髓内侧梗死的文献共12篇,累计病例14例。文献中14例患者病情呈阶梯样加重者7例(50%),加重持续数小时至数天(2h～7d)。首发症状以头晕起病者最常见9例(9/14,64.3%),其次为言语不清、四肢无力各为6例(42.9%)。临床表现以四肢瘫、延髓麻痹为主,部分病例伴有感觉障碍。14例患者均出现不同程度的四肢瘫痪,其后依次为构音障碍者11例(78.6%)、吞咽困难及眼震各8例(57.1%)、呼吸肌受累6例(42.9%)、舌肌瘫痪5例(35.7%,其中4例为伸舌不能)。感觉障碍分别为浅感觉异常者4例(28.6%)、深感觉减退者2例(14.3%)。意识障碍少见:嗜睡者2例(14.3%)、余12例患者意识清楚。本文报道的1例病例以发作性眩晕为首发症状,10余小时后相继出现言语不能、四肢瘫、球麻痹等,病情呈进行性加重持续数日。14例患者头部MRI均显示双侧延髓腹侧靠近中线部位有异常信号;8例行头部MRA检查:显示一侧椎动脉纤细或未显影者4例(44%)、单侧椎动脉局限性狭窄者2例(22%)、1例为基底动脉中下段及双椎动脉未显影、1例正常;1例DSA显示左椎动脉V4段严重狭窄,远端基底动脉显影不良,左侧脊前动脉未显影。本例患者MRI可见双侧延髓病变呈"Y"字型改变,以DWI为著,矢状位示病变位于桥延交界处;MRA右侧椎动脉较左侧细。结论 BMI临床表现复杂、多样,发病后早期诊断有一定困难。结合头部MRI检查,尤其是早期DWI联合T2WI、Flair成像可提高正确诊断率。     

Todd瘫痪1例

1临床资料 患者,男,55岁,农民。因“意识丧失、四肢抽搐4h”于2009-8-17上午11时入院。患者于入院4h前被家属发现神志不清,双眼球上窜,牙关紧闭,四肢抽搐,舌咬伤,口唇发绀,小便失禁。症状持续约30S后自行缓解。未予特殊处置,此后上述症状反复发作2次,家属急送我院就诊。急查颅脑CT检查示双侧大脑半球及双侧基底节区多发低密度灶,结合临床考虑CO中毒性脑病。     

Todd瘫痪1例

1临床资料 患者,男,55岁,农民。因“意识丧失、四肢抽搐4h”于2009-8-17上午11时入院。患者于入院4h前被家属发现神志不清,双眼球上窜,牙关紧闭,四肢抽搐,舌咬伤,口唇发绀,小便失禁。症状持续约30S后自行缓解。未予特殊处置,此后上述症状反复发作2次,家属急送我院就诊。急查颅脑CT检查示双侧大脑半球及双侧基底节区多发低密度灶,结合临床考虑CO中毒性脑病。     

1例马凡综合征所致脑栓塞分析并文献回顾

1 临床资料 男性,39岁,主因突发言语不清,右侧肢体无力3d于2010年7月22日收入首都医科大学宣武医院.患者3d前晨起穿衣时突感右侧肢体无力,抬起不能,言语含糊不清;同时伴剧烈头痛,其部位不能详述,无头晕无恶心呕吐.急至当地医院,给予对症治疗（诊断及用药不详）,病情无明显改善.既往确诊马凡综合征12年,10年前行主动脉瘤及主动脉瓣换瓣手术,一直服用华法林治疗;5年前发现腹主动脉瘤,未予处理.无高血压糖尿病及烟酒史.无明确家族史.     

表现为桶人综合征的脊髓梗死(附1例报告并6例文献复习)

目的探讨以桶人综合征(MIBS)为临床表现的脊髓梗死(SCI)的临床和影像学特征。方法回顾分析收治的1例脊髓梗死患者的临床表现,影像学特征,治疗过程及临床预后,并对文献报告的6例进行综述。结果脊髓梗死可表现为桶人综合征,对于急性起病,双上肢瘫痪,伴有根痛症状的患者,需警惕脊髓梗死的诊断。结论脊髓梗死相对罕见,可以表现MIBS,临床容易漏诊误诊,磁共振检查有助于早期诊断。应提高对本病的认知。     

Wallenberg's syndrome caused by a brain tumor--a case report and literature review

we report a patient with Wallenberg's syndrome caused by glioma of the lateral medulla oblongata, and review the literature for Wallenberg's syndrome associated with neoplastic disease. A 46-year-old man was admitted because of progressive dysphagia and vertigo. Neurological examination revealed atypical symptoms and signs of Wallenberg's syndrome on the right side, hypalgesia on the second and third divisions of the left trigeminal nerve, paresis of the right palate and uvula, and ataxia of the right extremities. Although CT showed no abnormality in the posterior fossa, MRI demonstrated a mass with abnormal signal intensities in the right dorsolateral portion of the medulla. Biopsy specimens showed astrocytoma (grade III). Based on the present case and a review of 10 previously reported cases of Wallenberg's syndrome caused by neoplastic disease, the clinical features of this syndrome are characterized by gradual development and steady progression of symptoms, non-classical or atypical symptomatology, numerous additional symptoms and signs depending on the site and size of tumors, and poor prognosis.     

Liponeurocytoma of the left lateral ventricle--case report and review of the literature

The reported liponeurocytoma of the left lateral ventricle in a 35-year-old man represents the fifth recorded case of a supratentorial intraventricular liponeurocytoma. In this location, liponeurocytomas are very exceptional, whereas it is the typical site for classic central neurocytomas. Conversely, neurocytomas of the cerebellum are predominantly liponeurocytomas with until now more than 25 reported cases. Thus, cerebellar liponeurocytoma is the most frequent neuroepithelial CNS tumor with adipose-like cells followed by ependymomas with a lipid component and supratentorial intraventricular liponeurocytoma. Adipose-like cells in neurocytomas may originate by lipidization of tumor cells, metaplastic transformation of neuroectodermal cells into fat cells or by true adipocytic differentiation. The present case showed also focal glial differentiation with GFAP-positivity of some tumor cells as often seen in cerebellar liponeurocytomas but much rarer in central neurocytomas. Pathogenetic and nosologic implications of supratentorial intraventricular liponeurocytomas are discussed. Future WHO tumor classification should consider that liponeurocytomas are not restricted to the cerebellum. Reports on cerebellar liponeurocytomas with a less favorable clinical course suggest a WHO grade II for liponeurocytomas.     

Fourth ventricular meningioma: a case report and literature review

A 60-year-old man was admitted with slowly progressive dizziness. Cranial nerve evaluation found no abnormalities. Magnetic resonance imaging revealed a well-circumscribed mass with homogeneous enhancement located in the fourth ventricle. The patient underwent surgery for the removal of the tumor via the bilateral suboccipital approach. Subtotal removal of the tumor was achieved in a piecemeal fashion. Histological diagnosis was meningothelial meningioma. Fourth ventricular meningiomas are extremely rare. We reviewed the literature and discussed the features of fourth ventricular meningiomas.     

Hypothyroidism and cerebral infarction: a case report and literature review

Thyroid hormone has been studied in cardiovascular disease but rarely in cerebrovascular disease (CVD). Recently, hypothyroidism has been suggested to be related to risk factors such as atherosclerosis but not directly to CVD. We reported a 52-year-old woman with acute ischemic stroke, and greatly improved general conditions after thyroid hormone replacement. Hypothyroidism is reported to be one of the causes of hypertension or elevated cholesterol levels, the established risk factors of CVD. Further studies of the possible association of thyroid hormone and CVD are warranted. Thyroid hormone might need to be surveyed in CVD patients especially if there are symptoms and signs of thyroid disorders.     

Fourth ventricular neurocytoma: case report and review of the literature

OBJECTIVES: Central neurocytoma is a tumour that typically occurs in young adults in close association with the lateral and third ventricles of the cerebrum. METHODS: We report the unusual case of a central neurocytoma that developed in the fourth ventricle of a 59-year-old woman and metastasized to the upper cervical canal. Subtotal excision and adjuvant radiotherapy were used to treat the lesion. Microscopic evaluation, discussion of the pathologic differential diagnosis and theories of the histogenesis of the tumour are presented. RESULTS AND CONCLUSIONS: Fourth ventricular neurocytoma is rare and has only been reported twice previously. It appears most likely that this tumour arises from subependymal progenitor cell lines.     

Brain abscess caused by gemella morbillorum: case report and review of the literature

We describe a rare case of cerebral abscess in an immunocompetent 67-year-old male with Gemella morbillorum as the causative agent. Gemella morbillorum is an aerobic gram positive coccus and is deemed to be a normal inhabitant of the oral cavity. The aim of this report is to introduce Gemella morbillorum as the emerging pathogen involved in brain abscesses. To the best of our knowledge only eight cases of Gemella morbillorum brain abscess have been reported in the literature. An exhaustive review of the literature is included with emphasis on the primary source of infection, clinical presentation, radiological diagnosis, and treatment modalities.     

Acute neurological deficits caused by cefipime: a case report and review of literature

Cefepime (Maxipime) is a fourth-generation cephalosporin commonly used to treat a variety of infections. Its controversial side effect profile is not well appreciated by first-line practitioners. We report a case of urinary tract infection treated with cefepime in a 91-year-old woman. The acute onset of conscuous disturbance was noted on the 9th day of cefepime treatment. Computed tomogram and magnetic resonance image of the brain showed no specific findings. The neurological symptoms and signs such us conscious disturbance, ocular bobbing, asterexis disappeared after discontinuation of cefepime. We suggest that physicians should cefepime as a possible cause of reversible neurological deficits.