易于漏诊？老年人硬膜下血肿

一名84岁的女性病人，有体位性低血压病史，经常跌倒。因两个星期以来意识模糊和精神错乱就诊，她的尿液试纸检查有白细胞和亚硝酸盐，全科医生诊断为继发尿路感染后的谵妄，给予口服抗生素治疗没有好转，为进一步诊治而收入院。     

Subdural haematoma: presentation and diagnosis on medical wards

The twenty-two adult patients with subacute and chronic subdural haematoma seen in Leicester during the last 7 years have been reviewed. The clinical manifestations and results of investigations are described. The diagnostic difficulties which may confront physicians are discussed, with special reference to cases with no history of head injury masquerading as strokes. Stress is laid on the points which help with the differentiation.     

A case of polycythaemia vera presenting with intramuscular chest wall haematoma.

A 40 year old male, previously well, presented with a posterior chest wall haematoma. Computerized tomography and ultrasound showed this to be intramuscular. Haematological indices were consistent with a diagnosis of polycythaemia vera. The haematoma and indices responded to hydroxyurea and venesection. This rare presentation of polycythaemia vera in a young person is described and the haemorrhagic complications of polycythaemia vera discussed.     

Spontaneous intramural duodenal haematoma with transient biliary obstruction and acute cholecystitis

Intramural duodenal haematoma (IDH) is uncommon and usually presents with upper gastrointestinal bleeding. Trauma, anticoagulant therapy, blood coagulation disorders and endoscopic interventions have been reported to cause IDH. IDH secondary to antiplatelet therapy has not been previously reported in the literature. We report IDH secondary to aspirin therapy that was associated with transient obstructive jaundice and acute cholecystitis in a 47-year-old woman. The patient was successfully managed with conservative management.     

Osteogenesis imperfecta in a child presenting with neurological features

A case of osteogenesis imperfecta presenting with a rare neurological complication (spastic paraplegia) is presented. The aetiology of the neurological lesion is discussed.     

主动脉夹层以神经功能缺损为主要症状的病例的诊断分析

目的分析主动脉夹层（AD）部分病例以神经功能缺损为主要症状的病例,从而提高神经内科医师的首诊确诊水平。方法对3例AD的临床表现、辅助检查进行回顾性分析。结果以神经功能缺损为主要症状的主动脉夹层首次就诊于神经内科,临床表现为：偏瘫、精神症状（躁动、谵妄）、截瘫。结论对疑及AD者应尽早行B超、CT或磁共振检查,以便及时明确诊断,化验检查有助于了解病情严重程度、累及脏器情况及观察治疗疗效。     

Proptosis presenting as a delayed sign of frontal extradural haematoma

We report a case of a young man who presented with proptosis as a delayed manifestation of a frontal extradural haematoma (EDH) following a minor head injury. A computed tomography (CT) of the brain done 72 hours after trauma revealed a large extradural haematoma in the right anterior cranial fossa with orbital roof fracture and subperiosteal clot extension into the orbital cavity. Right frontal craniotomy with evacuation of haematoma was done and the proptosis completely resolved after surgery. The clinical course, possible mechanism and management of the patient are discussed.     

氟西汀对脑卒中伴抑郁患者神经功能缺失的影响

目的:探讨抗抑郁药物氟西汀对脑卒中后出现抑郁的患者的神经功能影响,为临床合理用药提供一定的理论依据.方法:选取2015年2月至2016年8月在该院接受诊治的脑卒中后伴有抑郁症的患者80例,随机均分为观察组和对照组两组,对照组给予常规治疗,观察组在常规治疗的基础上加用氟西汀,采用汉密尔顿抑郁量表,神经功能缺损量表、日常生活活动能力评定量表对两组患者进行评价,观察组间差异.结果:经一段时间治疗后,观察组HAMD、SSS得分均显著低于对照组(P＜0.05),ADL得分显著高于对照组(P＜0.05).结论:氟西汀可以有效改善患者脑卒中后的抑郁情况,并且对于其神经功能的恢复具有一定的促进作用,有效改善了患者术后的生活能力,具有一定的推广价值.     

Incidence and prognosis of transient neurological attacks

Michiel J. Bos, MD, MSc; Marie Josee E. van Rijn, MD, PhD; Jacqueline C. M. Witteman, PhD; Albert Hofman, MD, PhD; Peter J. Koudstaal, MD, PhD; Monique M. B. Breteler, MD, PhD

JAMA. 2007;298(24):2877-2885.

Context  Transient neurological attacks (TNAs) are attacks with temporary (<24 hours) neurological symptoms. These symptoms can be focal, nonfocal, or a mixture of both. The prognostic significance of TNAs with focal symptoms (better known as transient ischemic attacks [TIAs]) is well understood. Conversely, hardly anything is known about the prognostic significance of TNAs with nonfocal or mixed symptoms.

Objective  To study the incidence and prognosis of focal TNAs (or TIAs), nonfocal TNAs, and mixed TNAs.

Design, Setting, and Participants  The study population comprised 6062 community-dwelling Rotterdam Study participants who were aged 55 years or older and free from stroke, myocardial infarction, and dementia at baseline (1990-1993). They were followed up for events until January 1, 2005. We analyzed the associations between incident TNAs and subsequent adverse events with age- and sex-adjusted Cox regression models.

Main Outcome Measures  Stroke, ischemic heart disease, or dementia.

Results  During 60 535 person-years, 548 participants developed TNA (282 focal, 228 nonfocal, and 38 mixed). The incidence rate per 1000 person-years was 4.7 (95% confidence interval [CI], 4.1-5.2) for focal TNA, 3.8 (95% CI, 3.3-4.3) for nonfocal TNA, and 0.6 (95% CI, 0.4-0.9) for mixed TNA. Participants with focal TNA were at higher risk of subsequent stroke than participants without TNA (n = 46 vs 540; hazard ratio [HR], 2.14; 95% confidence interval [CI]; 1.57-2.91) but had an equal risk of ischemic heart disease and dementia. Nonfocal TNA patients were at higher risk of stroke (27 vs 540; HR, 1.56; 95% CI, 1.08-2.28) and dementia (30 vs 552; HR, 1.59; 95% CI, 1.11-2.26) than participants without TNA. Mixed TNA patients were at higher risk of stroke (6 vs 540; HR, 2.48; 95% CI, 1.11-5.56), ischemic heart disease (8 vs 779; HR, 2.26; 95% CI, 1.07-4.78), vascular death (8 vs 594; HR, 2.54; 95% CI, 1.31-4.91), and dementia (7 vs 552; HR, 3.46; 95% CI, 1.72-6.98) than participants without TNA.

Conclusion  Patients who experience nonfocal TNAs, and especially those with mixed TNAs, have a higher risk of major vascular diseases and dementia than persons without TNA.