Percheron动脉梗死的临床和影像学特征

目的 探讨Percheron动脉梗死的影像学和临床特征.方法 对10例Percheron动脉梗死患者的临床表现、影像学资料、治疗和预后进行分析.结果 10例患者均急性起病且存在不同程度意识障碍,其中垂直注视麻痹3例,语言障碍3例,肢体无力6例,记忆缺损4例.MRI均显示双侧丘脑梗死,1例可见“中脑V字征”,1例脑血管造影发现Percheron动脉闭塞.10例均病情好转出院,但存在不同程度的后遗症.结论 Percheron动脉梗死极为少见,诊断主要依据临床表现和影像学检查,脑血管造影可确诊本病.     

基底动脉尖综合征的临床表现、治疗及预后分析

目的总结基底动脉尖综合征(TOBS)的临床表现、治疗及预后。方法回顾性分析2009年6月—2014年3月在福建医科大学附属闽东医院住院治疗的15例TOBS患者的临床资料,总结其临床表现、治疗及预后。结果TOBS患者以中老年男性多见,临床主要表现为不同程度的意识障碍、眼球运动障碍、瞳孔改变,CT或MRI可以发现基底动脉顶端血管供血区双侧两处以上梗死灶,以丘脑、中脑多见。患者均行机械取栓、溶栓、抗凝等治疗,预后较好。结论 TOBS临床表现形式多样,病死率较高,早期诊断和及时治疗可明显改善患者预后。     

卵圆孔未闭患者Percheron动脉闭塞致双侧丘脑梗死:1例报道并文献复习

丘脑梗死是一种常见的临床综合征,但双侧丘脑同时梗死相对少见,占全部丘脑梗死的22％～35％[1].Percheron动脉(artery of Percheron,AOP)闭塞所致丘脑梗死是一种特殊的双侧丘脑梗死类型,有数字减影血管造影(digital subtraction angiography,DSA)检查确诊的报道更是罕见.据文献报道,AOP闭塞占所有初次缺血性卒中的0.4％[2],病因多数是心源性栓塞和小血管相关疾病,并且心源性栓塞大多数见于卵圆孔未闭(patent foramen ovale,PFO)患者[3].AOP闭塞大多突然起病,容易误诊为其他疾病.因此,了解该病的流行病学、发病机制、病因、危险因素、临床表现、影像学特点、治疗和转归,重点是注意影像学细节,有助于其诊断和鉴别诊断.本文报道了1例典型PFO引起AOP闭塞致双侧丘脑梗死患者,并复习了国内外近5年的相关文献.     

多巴胺能药物治疗Percheron动脉梗死引起的意识障碍1例

1例72岁女性患者, 因意识不清于发病当天入院, 颅脑磁共振成像显示双侧丘脑急性梗死, 临床诊断为Percheron动脉梗死, 虽给予了强效的抗栓药物治疗, 患者意识水平逐渐加重, 逐渐滴加美多芭和金刚烷胺药物, 患者意识水平逐渐好转, 短期内患者出院。     

基底动脉尖综合征12例临床及影像学分析

目的 探讨基底动脉尖综合征的临床及影像学特征.方法 回顾性分析12例基底动脉尖综合征患者的发病年龄、发病形式、临床表现、影像学特征以及预后.结果 基底动脉尖综合征临床表现复杂多样,常见眩晕、意识障碍、肢体不全瘫痪及眼球运动障碍等.影像学特征常为双侧、幕上、暮下多发性梗死灶,多位于丘脑、中脑、小脑等.本组病例治愈1例,好转7例,死亡4例.结论 基底动脉尖综合征的诊断主要依据是临床及影像学表现,其预后较差.     

Percheron动脉梗死两例报道并文献复习

Percheron动脉（AOP）是一种罕见的丘脑供血血管变异，AOP闭塞可引起双侧丘脑梗死，其临床表现多样，最常见的为意识障碍、记忆力障碍及垂直凝视麻痹。由于本病较为罕见且临床表现复杂多样，因此给临床诊治带来了许多困难。本文报道2例AOP梗死患者，并对其临床及影像特征进行分析，以期为临床医师提供参考。     

急性双侧脑梗死的病因分型及发病机制分析

目的探讨急性双侧脑梗死的病因分型及发病机制。方法选择经磁共振弥散加权成像(DWI)证实为急性双侧脑梗死的患者55例,根据梗死灶分布进行分组,双侧前循环梗死12例(前循环组),双侧后循环梗死28例(后循环组),一侧前循环合并对侧后循环梗死15例(合并组)。按照TOAST分型标准,分析不同病因及发病机制在各组的分布差异。结果 55例患者中,病因分型依次为大动脉粥样硬化42例,心源性栓塞9例,小动脉闭塞1例,其他和不明原因型3例。与后循环组比较,前循环组和合并组大动脉粥样硬化(21.4%、23.8%vs 54.8%)、心源性栓塞(33.3%、22.2%vs 44.4%)显著降低,差异有统计学意义(P<0.05)。发病机制依次为动脉-动脉栓塞20例,低灌注/栓子清除障碍15例,心源性栓塞9例,血栓形成4例,血管变异合并动脉-动脉栓塞4例,机制不明3例。与后循环组比较,前循环组和合并组动脉-动脉栓塞(10.0%、15.0%vs 75.0%),心源性栓塞(33.3%、22.2%vs44.4%)明显降低,而低灌注/栓子清除障碍(40.0%、46.7%vs 13.3%)明显升高,差异有统计学意义(P<0.05)。结论急性双侧脑梗死患者主要病因分型为大动脉粥样硬化和心源性栓塞,主要发病机制为动脉-动脉栓塞、心源性栓塞和低灌注。     

脑动脉夹层所致急性脑梗死/短暂性脑缺血发作患者的临床及影像学特征研究

目的探讨脑动脉夹层所致急性脑梗死/短暂性脑缺血发作(TIA)患者的临床及影像学特征。方法选取2013年6月—2018年5月北京友谊医院神经内科收治的脑动脉夹层所致急性脑梗死/TIA患者18例,回顾性分析其临床资料,包括性别、年龄、夹层类型、夹层部位、夹层动脉瘤发生情况、脑血管病高危因素、临床表现、梗死部位、梗死机制、影像学表现、治疗方法及预后等。结果 (1)18例患者中男14例,女4例;年龄32~78岁,平均年龄(60.7±14.2)岁;夹层类型:自发性脑动脉夹层17例,创伤性脑动脉夹层1例;夹层部位:颈动脉夹层10例,椎-基底动脉夹层8例;发生夹层动脉瘤3例;16例有脑血管病高危因素。(2)临床表现:2例TIA患者以头痛起病,16例急性脑梗死患者发病前无任何先兆症状;16例急性脑梗死患者中出现肢体无力9例,头晕8例,肢体麻木6例,构音障碍6例,吞咽障碍2例,头痛2例,意识障碍2例,视力障碍1例。(3)梗死部位:16例急性脑梗死患者中前循环梗死9例,后循环梗死7例;梗死机制:栓塞性梗死9例,穿支闭塞性梗死4例,血流动力性梗死3例。(4)影像学表现:18例患者中14例行头颈部CT血管成像(CTA)检查,11例行数字减影血管造影(DSA)检查,2例行磁共振血管成像(MRA)检查;共发现狭窄6例,闭塞5例,"新月征"5例,"动脉瘤"样改变3例,典型"鼠尾征"2例,"双腔征"1例,"串珠"样改变1例。(5)治疗方法:18例患者中15例采用抗血小板治疗,1例采用抗凝治疗,1例采用动静脉联合溶栓治疗,1例采用动脉溶栓治疗;预后:2例患者死亡,余16例患者随访3~6个月,其中1例椎动脉夹层患者出现复发性脑梗死。结论脑动脉夹层所致急性脑梗死/TIA以青中年多见,以自发性脑动脉夹层为主并常伴有脑血管病危险因素,但无特异性临床表现,起病初期可无临床症状或仅表现为单纯头颈部疼痛,影像学表现以闭塞及狭窄最常见,一般采用积极抗凝或抗血小板治疗,预后较好。     

穿支动脉区脑梗死部位分布的临床研究

目的探讨急性脑穿支动脉闭塞或狭窄所致急性脑梗死的部位分布。方法回顾性分析解放军总医院2008年4月~2013年12月神经内科收治的急性穿支动脉区脑梗死患者369例。根据磁共振弥散加权成像检查确定脑梗死部位,总结分析穿支动脉区脑梗死的部位分布。结果369例患者中,其中放射冠和半卵圆中心23例(6.2%),基底节129例(35.0%),内囊59例(16.0%),单侧丘脑45例(12.2%),中脑11例(3.0%),脑桥78例(21.1%),延髓18例(4.9%),双侧丘脑(Percheron动脉病变)6例(1.6%)。结论穿支动脉区脑梗死最常见于基底节,其次为脑桥。延髓、中脑和双侧丘脑等少见部位的穿支动脉区脑梗死也应该受到重视。     

急性脑梗死合并不宁腿综合征的临床分析

目的探讨急性脑梗死合并不宁腿综合征(RLS)的临床表现及预后分析。方法选择我院神经内科住院的160例老年急性脑梗死患者中合并新发RLS患者20例,收集所有患者临床资料,治疗前进行国际不宁腿严重程度量表(IRLS-RS)、汉密尔顿焦虑量表、汉密尔顿抑郁量表及匹兹堡睡眠质量指数量表评定。脑梗死3个月后进行预后分析。结果老年急性脑梗死患者中合并RLS的发生率为12.5%,男8例,女12例,脑梗死后出现RLS时间为1～3d。头颅MRI检查急性脑梗死部位:大脑皮质3例(15.0%),基底节区8例(40.0%),脑桥4例(20.0%),丘脑3例(15.0%),内囊2例(10.0%)。一侧脑梗死病灶,表现为双下肢的RLS症状15例(75.0%);表现为对侧下肢的RLS症状5例(25.0%)。与治疗前比较,治疗后患者IRLS-RS分级明显减轻(P=0.000),情感障碍和睡眠障碍比例明显降低(20.0%vs 85.0%,20.0%vs 85.0%,P0.01)。结论老年脑梗死合并RLS发生率高,女性稍多于男性,而且出现时间早;基底节区、脑桥梗死病灶易出现RLS,也可见于皮质、丘脑、内囊,以双侧下肢症状多见;易并发焦虑、抑郁的情感障碍及睡眠障碍;多巴胺受体激动剂治疗为主,预后好。     

急性心肌梗死合并室间隔穿孔患者的临床特点及预后因素分析

目的总结分析急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床特点。方法纳入首都医科大学附属北京朝阳医院1999年1月至2018年10月共收治AMI 16038例,其中合并VSR患者44例,对这44例AMI合并VSR患者的临床资料进行回顾性分析。结果44例AMI合并VSR患者中男性24例(54.5%),女性20例(45.5%),平均年龄(71.0±6.5)岁;前壁心肌梗死患者(包括累及前壁的心肌梗死)35例(79.5%),非前壁心肌梗死9例(20.5%)。手术治疗9例,其中7例为室间隔缺损介入封堵术,2例外科手术(1例为室间隔修补术+冠状动脉旁路移植术+室壁瘤切除术,1例为室间隔修补术+冠状动脉旁路移植术+瓣膜修补术)。术后心功能改善情况均较显著,除2例封堵术患者院内死亡外,其余手术患者生存期均大于1年。结论VSR是AMI少见但严重的并发症,手术治疗的近期预后明显优于非手术治疗,介入封堵治疗在改善症状及预后等方面发挥出日益重要的作用。     

可逆性大脑后部白质脑病综合征16例的临床分析

目的探讨可逆性大脑后部白质脑病综合征的病因和临床特点,寻找早期诊断和治疗方法。方法选取该院2010．02～2013-02收治的16例可逆性大脑后部白质脑病综合征患者,回顾性分析其病因、临床表现特点、治疗及预后。结果16例患者中男6例,女10例。病因：高血压脑病7例（其中合并肾功能不全4例）,子痫4例,多发性大动脉炎2例,血栓性血小板减少性紫癜1例,系统性红斑狼疮1例,右颈内动脉内膜剥脱术后1例。临床表现以头痛、谵妄、意识障碍、癫痫发作性抽搐、视幻觉为主。头颅MRI检查可见大脑半球后部白质为主的T1加权呈短信号及12加权呈长信号的病灶,常双侧对称。经及时适当的脱水、降颅压,改善循环和高压氧等治疗,全组16例中,症状与体征消失者14例（87．5％）,明显好转者2例（12．5％）。结论可逆性大脑后部白质脑病综合征是一种具有自身病因、临床表现特点的临床综合征,经及时有效治疗,大多预后较好。     

电针双侧肢体对脑梗死偏瘫患者的疗效分析

目的观察电针双侧肢体与电针患侧肢体治疗脑梗死偏瘫临床效果是否存在差异,以指导临床康复。方法将60例脑梗死偏瘫患者随机分为两组。A组为电针患侧肢体组,B组为电针双侧肢体组。两组均给予脑梗死常规治疗及患侧肢体康复治疗,发病3d左右病情稳定不再进展后给予电针治疗。治疗前分别予以记录简式Fugl-Meyer评定值(FMA)、改良Barthel指数评定值(MBI)以及测定血清神经元特异性烯醇化酶(NSE)浓度值。电针一个疗程10d后再次记录上述指标的变化情况。结果 FMA,两组治疗前后比较有统计学意义(P<0.05)。FMA差值,两组疗效比较存在统计学意义(P<0.05)。MBI,两组治疗前后比较有统计学意义(P<0.05)。MBI差值、血清NSE浓度,两组治疗后比较存在统计学意义。结论电针双侧肢体组较电针患侧肢体组对患侧肢体功能和日常生活能力改善更明显。电针双侧肢体组较电针患侧肢体组治疗后血清NSE浓度低。脑梗死偏瘫在临床电针治疗中,对健侧肢体治疗很重要,电针双侧肢体较传统的电针患侧肢体疗效更好。     

Delayed manifestation and slow progression of cerebral infarction caused by polycythemia rubra vera

BACKGROUND: Polycythemia rubra vera is often found after the manifestation of cerebral infarction, though the pathogenesis is still controversial. We present a case of cerebral infarction secondary to polycythemia rubra vera, which presented a slow expansion on magnetic resonance imaging despite severe hemiplegia. This case suggests a possible mechanism for development of cerebral infarction in polycythemia rubra vera. METHODS: This case report was conducted in a university hospital. Magnetic resonance imaging and diffusion-weighted imaging were performed to assess the evolution of infarction, and the total blood volume and cerebral blood flow were determined with the use of isotopes, Cr and Tc, respectively. Phlebotomy was performed, but intervention was not applicable. The manual muscle test and sensory disturbance were assessed by the same physiotherapist throughout the clinical course. RESULTS: A 64-year-old male patient with polycythemia rubra vera had a cerebral infarction. A subtle change was observed on CT scan on the third day after the onset of infarction, and a small signal was demonstrated on magnetic resonance imaging on the fourth day. The cerebral infarction expanded slowly in size and reached a maximum on day 24. A diagnosis of cerebral infarction secondary to polycythemia rubra vera was made, and treatment by phlebotomy, hydration, and hydroxyurea was begun. Though the hemiplegia remained, he became ambulatory with a brace, as do patients with atherosclerotic infarction. CONCLUSIONS: It is suggested that the delayed manifestation and slow expansion of cerebral infarction caused by elevated hematocrit might be derived from a pathogenesis different from atherosclerotic infarction.     

Effects of ultrasound energy on total peripheral artery occlusions: initial angiographic and angioscopic results

Ultrasonic energy has been shown to ablate atherosclerotic plaques and arterial and venous thrombi. We used an ultrasonic angioplasty device developed by our group in ten patients with totally occluded femoral artery during surgical bypass. Ultrasonic angioplasty was performed with a 130-cm long and 0.8-cm diameter titanium probe with a 2- or 2.5-mm titanium ball-tip. In one patient, angioplasty could not be performed. Angiographic and angioscopic examination were performed before and after angioplasty in nine patients. Before ultrasound recanalization, angioscopic examination showed that the proximal end of the occlusion was formed by atheromatous material in 3 cases, red thrombus in 3 cases, amd white thrombus in 3 cases. After ultrasound recanalization, angioscopy showed residual stenosis at the site of entry in only one case. In three other cases, the artery was free of residual stenosis without persistent clot. In the five other patients, a residual stenosis was present beyond the proximal occlusion point with some fibrin mesh and small clots. At angiography, flow was restored in 4 cases; in 4 patients flow rate of entry was slow in the distal segment; and in 1 patient, the distal arterial bed could not be opacified. Altogether, ultrasonic angioplasty was able to recanalize a complete occlusion in nine out of ten patients, with partial or complete dissolution of clots and with no complication. At its present stage of development, adjunctive balloon angioplasty would be needed in most cases to obtain unrestricted flow and unsignificant residual stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

特发性大脑中动脉夹层三例报告

目的通过对大脑中动脉夹层发病机制及影像学的研究，可进一步了解其发病规律和影像学特点。方法比较3例大脑中动脉夹层患者的MRI、脑血管造影结果及1例尸体解剖资料。结果3例患者均以频繁脑缺血起病，其中1例患者的病情进行性加重，最后死亡。另外2例患者经脑血管造影，1例尸体解剖证实为大脑中动脉夹层，2例患者经动脉支架治疗后效果较好。结论大脑中动脉夹层发病较少见，对于原因不明的大脑中动脉狭窄患者，应首先想到此病，并给予积极治疗。     

Refractory unstable angina. Emergency treatment by coronary artery angioplasty under aortic counterpulsion

We report our experience of 15 transluminal coronary angioplasties performed in an emergency in 13 patients (mean age 67 +/- 8 years) with refractory unstable angina. The procedures were conducted under diastolic counterpulsation effected by means of an intra-aortic balloon. The angina was of the threatening infarction type on 11 occasions and of the threatening extended infarction on 4 occasions. Electrocardiographic abnormalities were recorded in the anterior (11 cases) or in the inferior (4 cases) territory. Three patients had a very alarming haemodynamic status, with acute pulmonary oedema in two and cardiogenic shock in one. After intra-aortic counterpulsation was installed and the clinical signs were stabilized, coronaro-ventriculography was performed, leading to a decision of immediate angioplasty since age, underlying diseases, myocardial function and diffused lesions made most of the patients unsuitable for surgery. In multiple vessel patients electric and angiographic data were used to locate the tight stenosis (92% in all cases) responsible for the acute coronary ischaemia. The stenosis was found to affect the anterior interventricular artery in 9 cases, the circumflex artery in 2 cases, the right coronary artery in 2 cases and a saphenous shunt on the anterior interventricular artery in 2 cases. Immediate arteriographic and clinical success was obtained in 12 out of 15 cases (80%); there were 3 failures with 2 transmural infarctions. Later on, 2 patients underwent aorto-coronary bypass and 1 died of myocardial failure and pulmonary superinfection 3 weeks after the procedure. Ten of our 13 patients were stabilized and were discharged under medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

西安地区急性脑梗死合并心房颤动患者短期预后的影响因素研究

背景急性脑梗死合并心房颤动(AF)患者的临床特征及预后因地理环境、饮食习惯、经济发展水平等差异而不尽相同。目的探讨西安地区急性脑梗死合并AF患者短期预后的影响因素。方法通过西安脑卒中数据库纳入西安市第一医院、西安市中心医院、西安市第九医院和西安市中医医院2015年收治的急性脑梗死合并AF患者260例,根据随访90 d后改良Rankin量表(mRS)评分分为预后良好组(mRS评分0~2分)155例和预后不良组(mRS评分3~6分)105例。比较两组患者临床特征,急性脑梗死合并AF患者短期预后影响因素分析采用多因素Logistic回归分析。结果(1)预后不良组患者糖尿病发生率、肺炎发生率、入院时NIHSS评分4~13分及≥14分者所占比例、白细胞计数高于预后良好组(P<0.05);两组患者年龄、性别、体质指数、心率、文化程度、吸烟情况、饮酒率、有卒中病史者所占比例、高血压发生率及总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、空腹血糖、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、同型半胱氨酸、肌酐、尿素氮、尿酸水平比较,差异无统计学意义(P>0.05)。(2)多因素Logistic回归分析结果显示,糖尿病〔OR=2.47,95%CI(1.10,6.18)〕、肺炎〔OR=3.28,95%CI(1.17,9.22)〕、入院时NIHSS评分高〔OR=18.36,95%CI(4.93,72.74)〕及白细胞计数升高〔OR=1.12,95%CI(1.02,1.30)〕是西安地区急性脑梗死合并AF患者短期预后不良的独立危险因素(P<0.05)。结论糖尿病、肺炎、入院时NIHSS评分高及白细胞计数升高是西安地区急性脑梗死合并AF患者短期预后不良的独立危险因素,临床应及早识别、筛查高危人群并给予有针对性的预防和干预措施,以降低患者短期预后不良发生风险。     

Solitaire支架半释放保护技术治疗急性颈内动脉串联闭塞患者的效果分析

目的 探讨使用Solitaire支架半释放保护(SHARP)技术逆行处理串联闭塞的安全性和疗效.方法 回顾性连续纳入2017年1月至2019年3月陆军特色医学中心神经内科接受血管内治疗的14例急性缺血性卒中颈内动脉串联闭塞患者的临床及影像学资料,且均使用SHARP技术.采用急性卒中Org 10172治疗试验(TOAST...     

Clinical characteristics of postinfarction left ventricular aneurysm with extensive calcification]

The authors experienced 4 cases of calcified postinfarction aneurysm of the left ventricle. They were all male, aged 55 to 71 (mean 64). Risk factor for coronary artery disease was only smoking in 2 patients, but there was none in the others. They had had acute anteroseptal or extensive anterior infarction at age 41-57 years (mean 49.3), and associated major cardiac events 10-22 years (mean 14.5) after acute myocardial infarction. Ventricular tachycardia, congestive heart failure and systemic thromboembolism were seen in 4, 2 and 1 patients respectively. However, none developed angina pectoris. In the 2 patients in whom signal-averaged electrocardiogram was performed, late potential was detected, so it was suspected that ventricular tachycardia could be due to reentry. Left ventricular end-diastolic pressure was elevated in all patients except one and ranged from 11 to 22 mmHg. Left ventricle was dilated in all cases and the end-diastolic volume index ranged from 143 to 503 ml/m2. The left ventricular ejection fraction ranged from 11 to 24%. However, in 2 of the 4 patients, the cardiac index was within normal limits, and evidence of congestive heart failure was absent. In 2 other patients with associated congestive heart failure, cardiac indices were 2.32, 1.56 l/min/m2 respectively. Coronary arteriogram showed a total occlusion in the left anterior descending (LAD) artery in all cases, and only the LAD artery was affected in 2 patients. In the remaining 2 patients, the right coronary arteries also were significantly stenotic or totally occluded, i.e., they had 2-vessel disease.(ABSTRACT TRUNCATED AT 250 WORDS)