隐源性卒中病因学最新研究进展

隐源性卒中是指尚未明确病因的缺血性卒中 , 随着医学技术的发展, 越来越多引起隐源性 卒中的病因被发现, 如反常栓塞、 主动脉粥样硬化、 脑动脉夹层、 高同型半胱氨酸血症、 阻塞性睡眠 呼吸暂停低通气综合征、 偏头痛、 遗传性单基因病等。 本文就隐源性卒中病因学最新进展做一综述, 以增进临床医师对其了解, 以便早发现、 尽早进行防治, 以降低卒中发病率。     

卵圆孔未闭与隐源性卒中的研究进展

经过全面筛查,仍有约40%找不到明确病因的缺血性卒中为隐源性卒中。卵圆孔未闭可引 起反常栓塞,进而发生缺血性卒中。近年来发现,部分隐源性卒中可能由卵圆孔未闭导致。本文将从 检查方法、作用、机制及治疗等方面对卵圆孔未闭与隐源性卒中的研究现状进行介绍。     

125例青年缺血性脑卒中的病因及危险因素分析

目的 探讨青年缺血性脑卒中的病因及危险因素.方法 应用TOAST标准对125例青年缺血性脑卒中患者进行病因学分型,分析常见的危险因素.结果 本组患者TOAST分型构成情况是大动脉粥样硬化型为22.4％,心源性栓塞型为12.0％,小动脉闭塞型为17.6％,其它明确病因型为6.4％,病因不明型为32.3％;危险因素构成比由高到低依次是饮酒为43.2％,高血压病为40.8％,吸烟为32.8％,血脂异常为28.8％,脑血管病家族史为25.6％,糖尿病为14.4％.结论 青年缺血性卒中以不明原因型和大动脉粥样硬化型所占比例较高;饮酒、高血压病、吸烟、血脂异常、脑血管病家族史、糖尿病为青年缺血性脑卒中的主要危险因素.     

青年缺血性脑卒中的病因及危险因素分析

目的分析青年缺血性脑卒中的病因及危险因素。方法回顾性分析我院2012-10—2014-10収治的96例青年缺血性脑卒中患者的临床资料,并随机抽取同期住院的老年脑卒中患者100例进行对照,分析青年缺血性脑卒中的病因及危险因素。结果青年组与老年组危险因素比较发现,高血压、高脂血症、吸烟、饮酒所占的比例最高,考虑动脉粥样硬化仍是青年缺血性脑卒中的主要致病原因。2组经TOAST病因学分型后发现,病因主要是大动脉粥样硬化型(分别为42.7%和47.0%),其次为小动脉闭塞型(分别为27.1%和33.0%),老年组心源性栓塞型高于青年组(分别为16.0%和6.2%),而青年组的其他病因型及不明原因型高于老年组(分别为17.7%、6.3%和2.0%、2.0%)。结论对于缺血性青年卒中患者,需完善各项检查,以便于寻找病因,排除危险因素,为患者提供病因学及个性化治疗方案,以改善患者的生命质量。     

肺动静脉瘘与缺血性卒中

肺动静脉瘘为隐源性卒中的危险因素，特别是在中青年人群中。但由肺动静脉瘘引起缺 血性卒中的比例极少，因此关于肺动静脉瘘和缺血性卒中的现有文献有限，且多为病例报道。多发性 肺动静脉瘘患者缺血性卒中的患病率高达到60%。因此，临床应警惕肺动静脉瘘这一缺血性卒中的 特殊病因，尤其是在病因不明的青年缺血性卒中患者中。     

卵圆孔未闭与缺血性卒中的关系

正随着缺血性卒中分型理论在国内的普及[1-2],人们越来越重视针对卒中病因的筛查和研究。病因不同,缺血性卒中二级预防的策略就可能不同,如心源性卒中侧重于抗凝治疗,而大动脉粥样硬化性卒中则强调抗血小板聚集。近年,所谓隐源性卒中的病因研究,在国内逐渐受到重视。本文将简要介绍隐源性卒中研究中所涉及的相关问题,重点阐述卵圆孔未闭(patent foramen ovale,PFO)在缺血性卒中发病中的     

青年缺血性卒中患者危险因素分析

目的探讨国人青年缺血性卒中患者的病因学及危险因素。方法以2002年1月至2007年6月期间入住河北医科大学第三医院神经内科的青年缺血性脑卒中患者作为研究对象,依据改良的TOAST病因分型法作为分型标准确定患者的卒中亚型,并分别计算各缺血性卒中危险因素的构成比。结果本组患者改良的TOAST亚型构成比例为动脉粥样硬化脑梗死型44.12%,小动脉病变型30.39%,心源性栓塞型6.86%,其它病因明确型5.88%,不明病因型12.75%;青年缺血性卒中患者危险因素构成比由高到低分别为高血压病69.61%、吸烟58.82%、高脂血症43.14%、饮酒39.22%、脑血管病家族史24.51%、糖尿病20.59%。结论国人青年缺血性卒中患者中动脉粥样硬化脑梗死型和小动脉病变型仍占较大比例;高血压病、吸烟、高脂血症及饮酒是青年型缺血性卒中的主要危险因素。     

青年缺血性卒中45例病因及危险因素分析

目的 探讨青年脑卒中患者的病因及危险因素.方法 回顾性分析45例青年缺血性卒中患者的临床资料,并与33例中老年缺血性卒中资料进行比较分析.结果 青年卒中组病因及危险因素依次为高血压、高血脂、动脉粥样硬化、吸烟、饮酒、高纤维蛋白原血症、高同型半胱氨酸血症,糖尿病,偏头痛,动脉夹层,卵圆孔未闭,大动脉炎.两组比较,青年组高脂血症、偏头痛、动脉夹层具有显著性统计学意义.结论 青年卒中病因及危险因素与中老年组不完全相同,积极治疗高血脂症、偏头痛及动脉夹层,对青年缺血性卒中的预防意义更大.     

41例青年缺血性脑卒中病因、危险因素及影像学特点探析

目的 探讨青年缺血性脑卒中的常见病因、危险因素及影像学特点.方法 回顾性分析41例18-44岁青年缺血性脑卒中患者病例资料,按TOAST分类探讨各病因、危险因素并分析其影像学特点.结果 明确病因的青年缺血性脑卒中患者,病因依次为脑动脉粥样硬化、感染性/非感染性脑血管炎、心源性脑栓塞、小动脉闭塞、血管畸形和颅内血管瘤,常见危险因素包括血脂异常、Lp(a)升高、吸烟、高血压、心脏疾病和糖尿病史,ESR、hsCRP升高对卒中的发生有激发作用.影像学表现的特点与病因类型关系密切,有助于卒中的病因诊断和二级预防.结论 青年缺血性脑卒中病因及危险因素多样,脑动脉粥样硬化和脑血管炎较常见,明确病因有赖于完善各项检查.     

青年缺血性脑卒中的病因学分型及危险因素分析

目的 探讨青年缺血性脑卒中病因学分型及危险因素.方法 应用TOAST标准对127例青年缺血性脑卒中患者进行病因学分型,分析常见的危险因素.结果 本组大动脉粥样硬化型为29.1％,心源性脑栓塞型为9.4％,小动脉闭塞型为17.3％,其他病因型为11.8％,病因不明型为32.3％；危险因素由高到低分别为血脂异常57.6％、高血压病43.1％、饮酒40.1％、吸烟35.4％、糖尿病17.2％、脑血管病家族史14.8％.结论 青年缺血性脑卒中以不明原因型和大动脉粥样硬化型比例高；血脂异常、高血压病、吸烟及饮酒是常见的危险因素.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.