癫痫持续状态致交叉性小脑神经机能联系不能2例

交叉性小脑神经机能联系不能(crossed cerebellar di-aschisis,CCD),亦作交叉性小脑性失联络,是指一侧大脑损伤,使皮质-桥脑-小脑通路中断导致对侧小脑可出现代谢及血流量减低的现象[1],多由影像学早期发现.CCD 由Monakow 在1914 年首先提出[2],主要见于大脑半球和丘脑梗死、...     

交叉性小脑功能联系障碍SPECT研究

在１１４７例脑血管病、癫痫及其他脑部疾患进行ＳＰＥＣＴ局部脑血流测定时，发现有３８４例（３３．５％）表现出交叉性小脑功能联系障碍（ＣＣＤ）或灌注低下现象（ＣＣＨ）。在脑梗塞病变时ＣＣＤ或ＣＣＨ现象发生频率明显多于其他脑部疾患。对该现象发生机制进行了探讨，并分析了其出现与幕上病变的部位、大小及临床表现的关系。     

交叉性小脑神经机能联系不能与复发性局灶性癫痫有关

作者报道1例脑MRI有可逆性改变的癫痫患者。32岁孕妇,左侧运动性癫痫23年,止痉药(鲁米那、大仑丁)治疗效果不佳。最近复发性局限性运动性癫痫4天,发作间歇期遗左上肢轻瘫,终止妊娠及眼止痉药后癫痫发作控制,血、脑脊液正常。癫痫发作第4天,脑MRI示右侧大脑后部皮质信号异常,提示脑回肿胀,无白质受累,接受钆(gadolinium)后信号无增大,对侧小脑半球有同样信号特征的损害区。EEG示两侧不对称伴弥漫性慢波背景活动,间歇性周期性右颞顶偏侧痫性放电。脑电描记和临床癫痫发作形式提示病灶在右侧顶叶中部和颞叶。继     

交叉性小脑神经机能联系不能发病机制及临床常见相关疾病

<正>交叉性小脑神经机能联系不能(crossed cerebellar diaschisis,CCD),亦作交叉性小脑性失联络,是指幕上脑组织损害的对侧小脑可出现代谢及血流量减低的现象[1],多由影像学早期发现。由于其临床表现不典型,易被临床医生忽略。早在1870年,Brown-sequard就发现了脑局灶损伤后远隔区域呈现脑功能过度兴奋或抑制的紊乱现象。1914年瑞士神经病学家Volt Monakow等提出神经机能联系不能学说,用     

急性缺血性卒中与神经功能联系不能的研究进展

ＶｏｎＭｏｎａｋｏｗ于 1914年首次提出“局部脑损害可以使结构正常的远隔部位出现短暂的功能抑制 ,且原发损害部位与远隔部位之间有解剖上的纤维联系” ,并将这一现象称之为“神经功能联系不能 (ｄｉａｓｃｈｉｓｉｓ)”。但只是近 2 0年 ,由于神经网络概念和功能神经影像技术的进步才使神经功能联系不能的概念被证实[1] 。尤其在急性缺血性卒中与神经功能联系不能的研究取得了很多进展。一些学者应用这些技术 ,通过对局部脑血容量 (ＬＣＢＶ)、局部脑血流量 (ＬＣＢＦ)、局部脑葡萄糖代谢率 (ＬＣＭＲｇｌｕ)和局部脑氧代谢率 (ＣＭＲＯ2…     

精神分裂症脑神经影像学及神经病理学的研究进展

精神分裂症的病因及发病机制迄今未明。影像学、神经化学、分子生物学等方法的快速发展和应用 ,使人们能够从宏观及微观两个水平 ,对精神分裂症大脑的神经病理学改变有更多认识 ,从而不断加深对精神分裂症病因及发病机制的理解。我们结合精神分裂症脑影像学和尸检大脑神经病理学研究的文献复习 ,对其研究进展作简要论述。一、大体结构改变1 脑室和脑皮质 :精神分裂症患者的脑室扩大和脑体积减小 ,是有关的影像学研究结果一致性很高的发现[1,2 ] 。如在超过 10 0篇CT的研究中 ,75 %报道精神分裂症患者有侧脑室扩大 ,83%报道第 3脑室扩大 ,6 …     

表现为多脑神经损害的神经系统副肿瘤综合征1例报告

神经系统副肿瘤综合征 (NPS)仅表现为多脑神经损害者较少见 ,现报告 1例如下。1　病例　男 ,6 3岁。因“双耳听力进行性下降伴耳鸣 2月余”于 2 0 0 0年 6月 2日入院。患者于 2 0 0 0年 3月中旬出现左耳听力下降 ,数天后右耳听力也开始下降 ,伴双耳持续轰鸣声耳鸣 ,时有头昏 ,无视物旋转 ;4月下旬左耳听力完全丧失 ,并出现双眼视物模糊、左眼视力明显下降 ,夜间行走需人搀扶 ,视力左眼 0 4 ,右眼 1 0。头颅MRI示 :“双侧半卵圆区、左侧基底节区多发性腔隙性脑梗死” ,未给予特殊处理。至 5月中旬右耳听力也完全丧失 ,并逐渐出现左侧面部…     

交叉性失语的研究进展

交叉性失语是一组由于右利手者右侧大脑半球损伤引起的获得性语言障碍综合征,在卒中患者中的发病率为0.38%～4.6%,包括镜像失语与非典型失语,口语表达障碍多数为非流利性失语。交叉性失语的发病机制目前仍存在争议,越早进行康复训练,预后越好。本文从交叉性失语的发病机制、临床特点、影像学检查及康复训练的研究进展进行综述,以提高临床医师的重视,从而为交叉性失语的诊治提供理论依据。     

Transient Crossed Cerebellar Diaschisis Following Thalamic Hemorrhage

This report concerns a 65-year-old right-handed woman with cerebral hemorrhage who presented with mild right-sided hemiparesis. Computed tomography (CT) revealed hematoma in the left thalamus and compression of the posterior limb of the internal capsule by a brain edema surrounding the lesion. 99mTc-hexamethylpropyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) images obtained 4 days after onset showed hypoperfusion in the left thalamus containing a hematoma as well as contralateral cerebellar hypoperfusion to the supratentorial lesion, which is well recognized as crossed cerebellar diaschisis (CCD) after stroke. CT 14 days after the onset revealed reduction of the brain edema of the posterior limb of the internal capsule accompanied by gradual neurological improvement. SPECT obtained 14 and 28 days later showed that CCD had disappeared. In this case report, the authors discuss the disappearance of CCD due to transient edematous compression of the internal capsule following thalamic hemorrhage on serial 99mTc-HMPAO SPECT scans. CCD was possibly caused by the lesion confined to the posterior limb of the internal capsule, which anatomically constitutes the cerebropontocerebellar pathway.     

Crossed Cerebellar Diaschisis: The Role of Motor and Premotor Areas in Functional Connections

The authors assessed the relationship between crossed cerebellar diaschisis (CCD) and cortico–pontine cerebellar pathway (CPCP) damage in 29 chronic supratentorial infarct patients to elucidate the role of motor and premotor areas for functional cerebra–cerebellar connections. The CCD rate was calculated from side–to–side cerebellar count differences on ¹²³I–IMP singlephoton emission computerized tomography images. Neuronal damage was estimated by the three scores of computed tomography density from equal to normal brain tissue (score 0) to equal to cerebrospinal fluid (score 2) in the 4 major regions on CPCP; frontal association, motor and premotor, sensory and parietal associations, and the posterior limb of the internal capsule. Two–factor factorial ANOVA by the score and the region revealed significant differences of the CCD rate in the score factor (score 0 or 1 vs. score 2, p=<O.O5) and the independency of these two factors. Categories determined by the scores in each region were analyzed by multiple stepwise regression analysis using the theory of quantification I, in which significant correlation only between CCD and the necrotic density (score 2) in motor and premotor areas were demonstrated (r=0.515, p=<0.05). The authors conclude that neuronal loss in motor and premotor areas seem to contribute significantly to functional cerebro–cerebellar disconnections.     

老年性痴呆与血管性痴呆的^18F—FDG PET显像分析

目的 比较老年性痴呆（AD）和血管性痴呆（VD）^18F-FDG PET显像特征,为诊断和治疗提供帮助。方法 将受者分为3组：其中AD组14例,VD组6例,正常对照组6例。静脉注射^18F-FDG 185－370MBq,40min后采用PET扫描仪行脑显像。结果 正常对照组双侧各脑叶和小脑的葡萄糖代谢分布对称。VD组6例,病灶呈非对称性分布于脑叶皮层,其中4例病灶波及多叶及丘脑和基底节,并出现交叉性小脑失联络。AD组的双侧顶叶、颞叶的代谢明显减少（P＜0．001,P＜0．05）。结论 AD和VD的PET显像各有其特点,PET能敏感地区分他们。     

Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics

We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis.     

Crossed Cerebellar Diaschisis Related to Recurrent Focal Seizures

Summary: After several days of recurrent focal motor seizures in a 32-year-old pregnant woman, a brain magnetic resonance imaging (MRI) scan showed signal abnormalities restricted to cerebral cortex and contralateral cerebellum that did not enhance after gadolinium administration. Maximal EEG dysfunction and seizure onset correlated anatomically with the area of image change. An aggressive medication regimen and termination of the pregnancy resulted in seizure control, reversal of postictal neurologic deficit, and improvement or resolution of the MRI and EEG abnormalities in 6 weeks. We concluded that the sequence of events suggested the reversible MRI lesions to be the result of repetitive seizure activity and that both localization and resolution of the lesions may be explained by reversible excitotoxic cell damage due to seizure-related excessive synaptic discharge.     

Crossed cerebellar diaschisis secondary to refractory frontal seizures in childhood

We report a girl with refractory partial seizures since 7 years of age, secondary to right frontal cortical dysplasia, who developed MRI and SPECT abnormalities in the contralateral hemicerebellar cortex. These became more marked, leading to left hemicerebellar atrophy. Crossed cerebellar diaschisis has been described mostly in hemispheric stroke and supratentorial tumours, but less often in epilepsy. It is usually a transient phenomenon. This report shows that crossed cerebellar diaschisis can develop within two years of seizure onset and evolve over time.     

Crossed cerebellar diaschisis in intracarotid sodium amytal procedures: a SPECT study

Eight patients with drug-resistant complex-partial seizures were subjected to left- and right-sided intracarotid sodium amytal (ISA) procedures during preoperative investigations for surgical treatment. Regional changes of cerebral and cerebellar blood flow during barbiturization were measured by [99mTc]-HMPAO-SPECT. Crossed cerebellar diaschisis (CCD) was observed in 13 out of 16 tests (81%) as well as ipsilateral cerebral hypoperfusion (87%). Thus CCD occurred more frequently in ISA procedures than in previously studied patients with cerebral infarctions and tumors. Since intracarotid injections of sodium amytal lead to hypoperfusion mainly in those areas of the brain that are supplied by the middle cerebral artery, functional suppression of these regions is supposed to be one of the main preconditions of CCD. Our findings suggest that CCD as demonstrated by the SPECT-technique is a common phenomenon in ISA procedures.     

Cerebellar apparent diffusion coefficient changes in patients with supratentorial ischemic stroke

Liu Y, Nuutinen J, Laakso MP, Karonen JO, Könönen M, Vanninen E, Kuikka JT, Vanninen RL. Cerebellar apparent diffusion coefficient changes in patients with supratentorial ischemic stroke.
Acta Neurol Scand: 2010: 122: 316–322.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To evaluate apparent diffusion coefficient (ADC) in cerebellar subregions in patients with stroke. Materials and methods – The total counts and ADCs were bilaterally measured on cerebellar white matter, gray matters of medial (G1), intermediate (G2), and lateral zones (G3) on SPECT and ADC maps from 20 patients with supratentorial ischemic stroke within the first 48 h and on day 8 after onset. ADCs were also obtained from 15 age‐matched controls. Results – Within 48 h, the ADCs were significantly increased bilaterally in the G3, and tended to be increased bilaterally in the white matter and G1, and contralateral G2 compared with controls. On day 8, the ADCs were significantly increased in all contralateral cerebellar subregions and in ipsilateral G1 and G2, and tended to be increased in ipsilateral G3. The ADC value was significantly higher in contralateral than in ipsilateral white matter on day 8. The interhemispheric asymmetry indices (AIs) of ADC and SPECT were significantly associated with each other in G2 and G3 within 48 h, but not on day 8. The AIs of ADC and SPECT were significantly related to each other in the G3 within 48 h and on day 8. Conclusions – Supratentorial ischemic stroke may cause mild cerebellar vasogenic edema.