颅脑创伤后植物状态磁共振影像36例分析

目的:研究颅脑创伤后持续植物状态(PAS)的磁共振影像(MRI)特征。方法:分析36例颅脑创伤后持续植物状态患者MRI资料,按病灶位置、性质大小进行统计处理。结果:所有患者都有脑实质损害,共发现脑软化灶312处,平均每例8.67处,主要分布在大脑皮层、脑室旁白质、基底节、脐肌体、脑干。结论:MRI检查对颅脑创伤后持续植物状态的诊治有重要意义。     

颅脑损伤后持续植物状态36例的促醒治疗

颅脑损伤后持续植物状态的促醒治疗 ,目前尚无成熟方案。国内报告治疗自缢、药物中毒及外伤后持续植物状态 ,1月～ 1ａ促醒率约为 35 % [1] ;国外报告脑外伤后持续植物状态 6月～ 1ａ ,意识恢复率约 1 6 % [2 ] ,疗效均不满意。我科自1997年 1月～ 2 0 0 0年 12月共收治颅脑损伤后持续植物状态患者 36例 ,经综合治疗 ,取得满意疗效 ,现报告如下。1　临床资料　本组 36例 ,其中男 2 8例 ,女 8例 ,年龄 5～ 5 5岁 ,平均 30岁。伤后 2ｈ～ 6个月入院 ,ＧＳＣ评分为 3～ 5分 ,其中原发性脑干伤 16例 ,继发性脑干伤 8例 ,广泛性脑挫裂伤 12例 ,血…     

植物状态患者的脑氢质子磁共振波谱分析

目的 探讨氢质子磁共振波谱(proton magnetic resonance spectroscopy,1H-MRS)技术在植物状态(vegetative state,VS)临床诊断和预后评估中的价值.方法 对20例VS患者和20例年龄匹配的健康志愿者(对照组)行常规MRI检查,并同时行1H-MRS检查,测定双侧额顶叶皮质、白质和丘脑的NAA/Cr、Cho/Cr、NAA/Cho比值.结果 1H-MRS示VS患者的双侧额顶叶皮质、白质和丘脑非直接受损部位的NAA/Cr、NAA/Cho值与正常对照组比较均有显著性差异(P＜0.05);VS组1H-MRS 大多出现Lac的异常表现.结论 1H-MRS可以对VS患者脑部损伤程度和损伤范围提供客观的参考指标.     

高压氧治疗持续植物状态20例

持续植物状态是指患者对外界环境无任何自主反应、意识和精神活动 ,但存在睡眠———睁眼周期 ,仍具有下丘脑、脑干功能 (呼吸、心跳、血压 )等特殊的意识。其临床疗效和预后很差。为探讨提高生存率、改善预后的可能性 ,我们从 1994年起用高压氧治疗 2 0例 ,报告如下。1　临床资料1 1　一般情况　 2 0例中 ,男 15例 ,女 5例 ;年龄156 0岁 ,平均 37岁。病程 35136ｄ ,平均 6 8ｄ。致病原因 :重度颅脑损伤 15例 ,急性重度药物中毒 3例 ,自缢后急性脑缺血缺氧 2例。重型颅脑损伤 15例均经手术治疗 ,术后继续常规治疗 ;其余 5例均行常规救治。均…     

高压氧综合治疗持续植物状态30例疗效分析

目的评估高压氧综合治疗持续植物状态的疗效和探讨最佳治疗方案。方法回顾性分析了1999年—2005年应用高压氧治疗的30例持续植物状态病例,主要分析了原发病因、高压氧治疗次数以及高压氧治疗时机与疗效的关系。结果脑外伤组显效率和好转率明显高于非脑外伤组(P<0.05),开始治疗时间≤30d组及31～60d组好转率明显高于≥61d组(P<0.05)。结论高压氧综合治疗对脑外伤所致持续植物状态患者60d以内开始行高压氧治疗的患者疗效较好。     

颅脑伤后持续性植物状态100例脑组织的核磁共振变化

目的：为了明确创伤性持续性植物状态（PVS）脑损伤的部位、性质和脑组织结构的变化特征。方法：采用MRI对创伤性PVS患者100例进行病灶的定位、定性断定，且进行统计。结果：100例PVS患者中，发现病灶1154处（出血性462处，非出血性692处），每例5－19处，平均约12处病灶。弥漫性脑白质轴索损伤和胼胝体损伤94例，脑干背侧损伤87例，基底节和丘脑损伤分别为52例和32例，大脑皮层伤50例（以额、颞叶居多），海马旁伤47例。结论：创伤性PVS主要是由于弥漫性轴索损伤。统计结果表明，临床与MRI密切结合对确诊脑外伤后PVS有重要意义。     

高压氧综合治疗持续植物状态280例

目的 探讨高压氧(HBO)综合治疗持续植物状态(PVS)的疗效以及影像学在PVS诊断中的意义.方法 对280例PVS患者进行了HBO综合血液磁极化治疗、药物治疗以及影像学等检查.结果 本组治愈85例,占30.4%;好转148例,占52.8%;未脱离PVS 43例,占15.2%,但全身状况改善;死亡4例占1.6%.280例PVS患者脑CT显示多种异常征象;76例MRI检查尚可见到中脑、脑干萎缩;32例脑(SPECT)显像显示脑不同部位血流灌注减低.随PVS的恢复,接受HBO综合治疗20～50次后影像学复查明显好转.结论 HBO综合治疗PVS的治疗方案疗效满意.脑SPECT显像可与CT、MRI互补,并可作为HBO综合治疗PVS判断疗效及预后的指标.     

高压氧综合治疗植物状态患者一例

临床资料:近期,我院高压氧治疗室成功救治一例持续植物状态患者。患者,男,38岁,不慎摔倒,头部撞到地面硬物,在头颅左侧处有一6 cm×5 cm×2 cm椭圆形凹陷;患者当即昏迷,虽经我院外科手术治疗,但患者仍一直昏迷,继尔转入持续植物状态。经临床综合治疗2个月后,开始实施高压氧治疗。入舱前检查:患者外观似乎呈清醒状态,但对周     

21例颅脑损伤后持续性植物状态的临床及神经影像学研究

持续性植物状态 (ｐｅｒｓｉｓｔｅｎｔｖｅｇｅｔａｔｉｖｅｓｔａｔｅ,ＰＶＳ)是指病人完全丧失对自身及周围环境的认知 ,有睡眠 -觉醒周期 ,丘脑下部及脑干的自主功能完全或部分保存 ,这种状态持续 1个月以上[1] 。导致ＰＶＳ的原因很多 ,颅脑损伤是主要原因之一。我科于 1995年 4月～ 1998年 12月共收治 2 1例颅脑损伤后ＰＶＳ患者 ,我们对损伤早期的临床特征、头颅ＣＴ及ＰＶＳ时的头颅ＣＴ、ＭＲＩ进行了分析。报告如下。资料与方法本组病例均符合 1994年美国ＰＶＳ专项研究多学科联合会制定的ＰＶＳ诊断标准[1] 。一、一般资料2 1例…     

磁共振分子影像研究现状及展望

MR分子成像是现代分子生物学与MR影像技术相结合的产物,是利用MRI技术并借助对比剂生化特征,直接或间接反映活体条件下生物细胞内的正常或病理状态下的分子过程.其主要优势在于超高的软组织和空间分辨率,多参数成像和无限的穿透深度,可同时获得三维解剖结构及生理、病理、代谢、血流灌注等信息,因此在分子成像中显示出独特的价值[1].但是MRI的灵敏度较低,需要通过信号扩增系统来提高其灵敏度.     

持续性植物状态(PVS)动物模型的研制(论著)

目的：建立持续性植物状态的动物病理模型。方法：用１８０只新西兰家兔，切除其大脑皮层Ｂｒｏｄｍａｎｎ氏１、２、３、４、５、６、７、２３、２４以及部分３２及５０区。结果：以上手术后的动物在多种生理指标、反射活动、高级神经系统功能活动、昼夜节律以及大脑神经病理学的变化各主要表现方面与临床ＰＶＳ患者十分相似或一致。结论：本实验所建立的动物模型的表现与一般临床ＰＶＳ患者的症状及鉴定标准内容一致。     

溴隐停及美多巴联合治疗脑外伤后迁延性植物生存状态的临床观察

目的研究溴隐停及美多巴联合治疗创伤性脑外伤（TBI）后迁延性植物生存状态（PVS）的临床价值及使用范围。方法对一组连续46例在常规治疗的基础上加用澳隐停及美多巴治疗的PVS病人的一般临床特点和CT特征与治疗结果进行观察分析。结果TBI后的PVS最多见于交通事故性脑外伤。除大脑皮质的损伤外,弥漫性轴素损伤（DAI）、深部核团的损伤、脑干上部的损伤、以及伤后包括基底节在内的弥漫性脑萎缩是PVS的主要病理类型。运用澳隐停及美多巴后,73．9％的PVS病人的意识状态及运动功能得到改善。结论在没有广泛大脑皮质损伤,主要表现DAI和脑深部核团损伤的PVS病人,增强大脑多巴胺系统的功能对PVS病人具有治疗作用。     

Interstitial brachytherapy in the management of persistent head and neck disease after definitive external beam radiation therapy

PurposePersistent disease after definitive external beam radiation therapy for head and neck (H&;N) malignancies negatively impacts survival. In this series, the effectiveness of low-dose-rate brachytherapy in the management of persistent H&;N disease is explored.MethodsAll patients who received brachytherapy for persistent H&;N disease between 1987 and 2002 were identified. Tumor and treatment characteristics and toxicities were recorded. Progression-free survival and overall survival estimates were generated. The influence of prognostic factors was determined.ResultsTwelve patients were analyzable. Brachytherapy was given curatively (n = 4) in patients not amenable to surgery or in combination with surgical dissection to avoid carotid resection (n = 8). Seven patients had disease progression with a median time to progression of 11 months (95% confidence interval: 0–22.9). The only negative prognostic factor was time to re-treatment (brachytherapy >4 months) after definitive treatment (p = 0.003). Overall survival at 1 and 5 years was 50% and 21%, respectively. Toxicity was limited to one major complication (fistula) and five minor toxicities: low-grade radionecrosis (n = 2), cellulitis (n = 1), and wound dehiscence (n = 2).ConclusionIn patients with persistent disease, brachytherapy is an appealing re-treatment alternative. When combined with neck dissection, brachytherapy yields less morbidity than the surgical alternative of carotid resection.     

Cognitive impairment after traumatic brain injury: a functional magnetic resonance imaging study using the Stroop task

The anterior cingulate cortex (ACC) plays a key role in cognition, motor function, and emotion processing. However, little is known about how traumatic brain injury (TBI) affects the ACC system. Our purpose was to compare, by functional magnetic resonance imaging (fMRI) studies, the patterns of cortical activation in patients with cognitive impairment after TBI and those of normal subjects. Cortical activation maps of 11 right-handed healthy control subjects and five TBI patients with cognitive impairment were recorded in response to a Stroop task during a block-designed fMRI experiment. Statistical parametric mapping (SPM99) was used for individual subjects and group analysis. In TBI patients and controls, cortical activation, found in similar regions of the frontal, occipital, and parietal lobes, resembled patterns of activation documented in previous neuroimaging studies of the Stroop task in healthy controls. However, the TBI patients showed a relative decrease in ACC activity compared with the controls. Cognitive impairment in TBI patients seems to be associated with alterations in functional cerebral activity, especially less activation of the ACC. These changes are probably the result of destruction of neural networks after diffuse axonal injury and may reflect cortical disinhibition attributable to disconnection or compensation for an inefficient cognitive process.     

Intra-epiphyseal stress injury of the proximal tibial epiphysis: Preliminary experience of magnetic resonance imaging findings

Stress induced injuries affecting the physeal plate or cortical bone in children and adolescents, especially young athletes, have been well described. However, there are no reports in the current English language literature of stress injury affecting the incompletely ossified epiphyseal cartilage. We present four cases of stress related change to the proximal tibial epiphysis (PTE) along with their respective magnetic resonance imaging (MRI) appearances ranging from subtle oedema signal to a pseudo-tumour like appearance within the epiphyseal cartilage. The site and pattern of intra-epiphyseal injury is determined by the type of tissue that is affected, the maturity of the skeleton and the type of forces that are transmitted through the tissue. We demonstrate how an awareness of the morphological spectrum of MRI appearances in intra-epiphyseal stress injury and the ability to identify concomitant signs of stress in other nearby structures can help reduce misdiagnosis, avoid invasive diagnostic procedures like bone biopsy and reassure patients and their families.     

Intracerebral extravasation of contrast medium after head injury

Summary A case of intracerebral extravasation of contrast medium is reported. In cases of head injury this occurrence is rare and is manifested by persistent images on both frontal and lateral views of the angiogram. This indicates severe cerebral trauma with active hemorrhage and the prognosis is generally bad. A possible mechanism seems to be contrecoup.