艾滋病合并肺结核的多元化影像学表现

目的：探讨艾滋病合并肺结核的多元化影像学表现。方法：回顾性分析45例艾滋病（acquired immunodetieieney syndrome,AIDS）合并肺结核的影像学资料,CT扫描31例,DR胸片14例,经CT引导下穿刺26例,综合分析艾滋病合并肺结核的影像学表现特征。结果：45例艾滋病合并肺结核患者,病灶累及1个肺段的10例,2个肺段的6例,3—5个肺段的4例,两肺弥漫性分布的20例,肺部无阳性表现者5例,其中病理证实同时合并卡氏肺孢子虫肺炎（pneomoeystis carinii pneumonia,PCP）10例,合并细菌（化脓菌）感染8例,合并真菌感染5例。结论：艾滋病合并肺结核的影像学表现多种多样,同时合并多种病原体感染,病变表现形态多样,影像学表现缺乏特异性,肺部穿刺活检病理证实仍不失为金标准。     

耳垂缺损的不同方法修复效果观察

目的探讨用不同方法行耳垂缺损再造修复的可行性及优缺点。方法1995年1月-2006年7月共收治耳垂缺损患者45例,根据耳垂缺损的大小及对侧耳垂情况分别采用不同的手术方式进行修复再造。对于18例缺损面积较小的耳垂缺损采用耳轮滑行推进皮瓣法修复,15例中等程度缺损患者采用耳后皮瓣法修复,12例完全缺损,或虽不是完全缺损但健侧耳垂较大的患者采用皮肤扩张术 自体肋软骨移植法修复。结果45例患者分别采用上述方法进行再造修复后,耳廓、耳垂形态良好,随访4个月-8年,效果满意。结论对于不同程度的耳垂缺损畸形,应根据具体情况采用相应的修复方法,以达到最佳治疗效果。对于耳垂完全缺损或虽不是完全缺损但对侧耳垂较大的患者,应首选皮肤扩张术 自体肋软骨移植法,以获得形态良好而持久的再造耳垂。     

Frequency of asymptomatic microbleeds on T2*-weighted MR images of patients with recurrent stroke: association with combination of stroke subtypes and leukoaraiosis

BACKGROUND AND PURPOSE: Asymptomatic microbleeds shown by T2*-weighted MR imaging are associated with small-artery diseases, especially with intracerebral hemorrhage. Few studies have focused on the prevalence of microbleeds in patients with recurrent stroke. We investigated frequency of microbleeds in patients with recurrent stroke and association of presence of microbleeds with a combination of stroke subtypes and severity of leukoaraiosis. METHODS: The study population consisted of 102 patients with primary stroke and 54 patients with recurrent stroke. Microbleeds were counted and classified by using T2*-weighted MR imaging with a 1.0-T system. RESULTS: Patients with recurrent stroke showed a significantly higher prevalence of microbleeds (68.5%) than did patients with primary stroke (28.4%) (P <.0001). Among patients with recurrent stroke, the highest frequency of microbleeds occurred in those with intracerebral hemorrhage alone (92.3%), with the next highest frequency occurring in those with a combination of intracerebral hemorrhage and ischemic stroke (76.5%) and then those with ischemic stroke alone (50.0%) (P <.05). Leukoaraiosis was more severe in patients with recurrent stroke than in patients with primary stroke, and correlations between grade of microbleeds and severity of leukoaraiosis were found in patients with primary stroke (r = 0.367, P <.001) and in patients with recurrent stroke (r = 0.553, P <.0001). Logistic regression analysis identified recurrent stroke (odds ratio, 4.487; 95% confidence interval, 1.989-10.120) and leukoaraiosis (odds ratio, 5.079; 95% confidence interval, 2.125-12.143) as being significantly and independently associated with microbleeds. CONCLUSION: Asymptomatic microbleeds are observed to occur frequently in patients with recurrent stroke, either hemorrhagic or ischemic stroke, and are closely associated with the severity of leukoaraiosis.     

清创后Ⅰ期植骨治疗慢性骨髓炎的远期疗效

目的 探讨清创后Ⅰ期植骨治疗慢性骨髓炎的远期效果.方法 1999年3月-2003年5月,79例(28例骨不连)慢性骨髓炎患者接受清创后Ⅰ期自体、同种异体或混合骨移植治疗.随访时间60～111个月,平均77个月.结果 79例患者中,6例(8%)患者感染复发,其中自体骨移植2例,异体骨移植3例,混合骨移植1例.三种植骨方法感染复发率差异无统计学意义.28例骨不连患者,27例(96%)感染治愈并获得骨愈合,其中自体骨移植(23例)和异体骨移植(2例)均获得骨愈合,无感染复发;混合骨移植3例,2例骨愈合,1例感染复发伴骨不连.结论 清创后Ⅰ期骨移植治疗慢性骨髓炎可以获得90%以上的感染治愈率及骨愈合率,感染复发多在术后1年内,远期疗效稳定.     

Nuclear magnetic resonance (NMR) imaging in white matter disease of the brain using spin-echo sequences

Attention is drawn to the use of nuclear magnetic resonance (NMR) spin-echo sequences in the recognition of white matter disease of the brain. In 5 patients with multiple sclerosis, 8 lesions were seen with postcontrast x-ray computed tomography (CT) (37.5 g of iodine), 33 with inversion-recovery (IR) scans, and 47 with spin-echo (SE) scans. Partial volume effects were less of a diagnostic difficulty with SE scans than with IR scans. Extensive areas of abnormal white matter were seen with CT, IR, and SE scans in a patient with leucodystrophy associated with congenital muscular dystrophy. In a patient with adrenoleucodystrophy focal lesions were seen with CT, IR, and SE scans. In addition, loss of gray-white matter contrast was seen in both occipital lobes with IR scans. Extensive areas of white matter involvement were also seen in a case of Binswangers disease.     

不稳性寰椎骨折的外科治疗策略

目的 探讨枕颈或寰枢椎内固定融合技术治疗不稳性寰椎骨折的临床疗效和应用价值.方法 对2004年10月-2009年3月收治的不稳性寰椎骨折38例进行回顾性分析,其中6例寰椎爆裂性骨折合并寰枕关节不稳(5例行C0～C2固定融合术,其中1例同时合并有C7椎体压缩性骨折行C0～C3固定融合术),7例典型的Jefferson骨折,3例半环骨折,8例寰椎骨折合并Ⅱ型齿状突骨折,3例寰椎骨折合并Hangman骨折(其中2例Levine-Edwards Ⅲ型行C0～C3固定融合术,1例Ⅱ型行C1～C2固定融合术),3例寰椎骨折合并下颈椎损伤,6例寰椎横韧带断裂(Dickman Ⅰ型)伴寰枢关节不稳,2例寰椎粉碎性骨折合并寰椎侧块内侧骨性结构附着处横韧带撕裂(DickmanⅡ型).5例行C0～C2固定融合术,3例行C0～C3固定融合术,30例行C1～C2固定术并行自体髂骨植骨融合.结果 所有患者术后均获得随访,平均随访时间为28个月(12～46个月).临床症状均得到不同程度的改善.平均手术时间135 min(80～190 min),平均失血量460ml(200～3 300 ml),平均透视时间60 s.38例患者术中均未发生神经、椎动脉和其他手术相关并发症.全部患者均于术后3 d颈托固定后下地行走;术后脊髓损伤症状无加重.3例因电刀灼伤C1～C2间血管静脉丛导致出血,行止血纱布、脑棉片填塞止血,未出现颅脑缺血症状.复查X线片和CT未发现上颈椎失稳或复位丢失,螺钉位置良好,无松动、断钉,寰枢椎或枕颈部均获骨性融合.在晚期随访中,4例(11%)有颈部疼痛和僵硬感,1例枕神经痛.结论 对具有不稳定性寰椎骨折或合并寰椎横韧带损伤的患者,采用枕颈或寰枢椎内固定融合技术及短期外固定对于重建上颈椎永久稳定性是较好的手术方式,并且能阻止神经和脊髓功能的进一步损伤.

Abstract：

Objective To evaluate the clinical effect and safety of the occiput-cervicle or C1-C2 internal fixation and bone graft fusion in treatment of the unstable atlas fracture.Methods A retrospective study was performed in 38 patients with unstable atlas fractures treated by the occiput-cervicle or C1-C2 internal fixation and bone graft fusion from October 2004 to March 2009.Six patients with comminuted atlas fracture combined with instability of the occipito-atlantoid articulations were treated with occiput-C2 fusion(five patients)and with occiput-C3 fusion(one patient).There were seven patients with typical Jefferson fractures,three with semiring fractures,eight with atlas fractures combined with Anderson type Ⅱ odontoid process fractures,three with atlas fractures combined with Hangman's fractures (two patients with Levine and Edwards type Ⅲ Hangman's fractures were treated with occiput-C3 fusion and one patient Levine and Edwards type Ⅱ Hangman's fracture was treated with C1-C2 fusion),three with atlas fracture combined with lower cervicle injury,six with rupture of transverse ligament combined with instability of atlanto-axial joint(Dickman transverse ligament type Ⅰ injury)and two with comminuted fracture of the lateral mass associated with bony avulsion of the medial tubercle and transverse ligament(Dickman transverse ligament type Ⅱ injury).Of all,five patients were treated with occiput-C2 fusion,three treated with occiput-C3 fusion and 30 treated with C1-C2 fusion.Results All the patients were followed up for a range of 12-46 months(average 28 months),which showed improvement of clinical symptoms in some extent postoperatively.The operation time ranged from 80 to 190 min ates(average 135 minates),with intraoperative blood loss for 200-3 300 ml(average 460 ml)and average fluoroscopic time for 60 seconds.There were no neurological deficits,vertebral artery related complications or other complications in all the patients during the surgical operation.No neurological deficit was aggravated after the patient's mobilization with brace three days after operation.The enous plexus of blood vessel at C1-C2 rupture induced by the use of electrocautery was found in three patients who showed no cerebral hemodynamic deficit after hemostasis with hemostatic sponge and cotton piece.The follow-up X-ray and CT manifested osseous fusion in all the patients,with no looseness or breakage of the screws.The late follow-up showed pain associated with movement and limited range of motion in four patients(11%)and occipital neuralgia in one.Conclusions An occiput-cervicle fixation fusion or a C1-C2 fixation fusion combined with short external fixation can reestablish the upper cervical stability and prevent further injury of the spinal cord and nerve function and hence is an ideal option for C1 burst fracture with or without rupture of the transverse ligament.     

GrauerⅡ型齿状突骨折治疗方式选择及疗效分析

目的 探讨GrauerⅡ型(ⅡA、ⅡB、ⅡC型)齿状突骨折治疗方式的选择及临床疗效。 方法 本组共40例新鲜齿状突骨折患者,按照Grauer分型：ⅡA型7例,ⅡB型18例,ⅡC型15例;5例伴有不完全性脊髓损伤。7例ⅡA型患者先行枕颌带或颅骨牵引,后改用头颈胸石膏或支具外固定;15例ⅡB型患者行前路齿状突中空螺钉内固定;15例ⅡC型、3例严重移位ⅡB型患者经后路行寰枢椎椎弓根钉棒系统内固定植骨融合术。 结果 40例患者随访6～ 24个月。7例ⅡA型患者经保守治疗3-6个月骨折愈合。15例ⅡB型患者螺钉位置良好,未出现脊髓损伤,其中14例术后3～6个月骨性愈合,愈合率93.3％;15例ⅡC型、3例严重移位ⅡB型患者术中未出现椎动脉和脊髓损伤,后路植骨3～6个月骨性融合;复查内置物位置良好,无变形、松动或断裂;5例伴有脊髓不全损伤患者术后脊髓神经功能均有不同程度改善。 结论 Grauer分型中ⅡA型齿状突骨折可以保守治疗,ⅡB型(无移位或经牵引复位)宜行前路齿状突中空螺钉内固定术,ⅡC型及严重移位ⅡB型则应经后路行寰枢椎椎弓根钉棒系统内固定植骨融合术治疗。     

咽扩约肌成形术治疗腭咽闭合不全临床研究

目的　了解咽扩约肌成形术对腭裂术后腭咽闭合不全的治疗作用。方法　选择腭裂修复术后 1年以上 ,经语音训练仍有语言障碍 ,分别令其朗读《汉语腭裂字表》同时录音 ,然后 7名听力语音正常的医护人员试听录音并计算正确率 ,正确率在 70 %以下患者 3 0例 ,分别行咽扩约肌成形术治疗。结果　术前语音正常 0人 ,基本正常 0人 ,中度发音异常1 1人 ,明显发音异常 1 4人 ,严重发音异常 5人。术后语音正常 1 6人 ,基本正常 1 1人 ,中度发音异常 2人 ,明显发音异常1人 ,严重发音异常 0人。结论　咽扩约肌成形术能使腭裂术后仍有腭咽闭合不全患者语音明显改善。     

多层螺旋CT曲面重建在先天性外耳道闭锁中面神经管异常的研究

目的用多层螺旋CT(MSCT)曲面重建(CPR)技术研究先天性外耳道闭锁中面神经管的异常。方法对15例(17耳)先天性外耳道闭锁患者进行多层螺旋高分辨率CT(HRCT)扫描,图像后处理在Philips Mx8000工作站进行。结果17耳中,外耳道狭窄2耳,外耳道膜性闭锁2耳,骨性闭锁13耳。外耳道先天性胆脂瘤及耳后瘘管1耳。鼓室畸形3耳。听小骨先天畸形7耳。内耳畸形1耳。面神经管异常17耳。其中面神经管总长度变短11耳,面神经管走行异常5耳,面神经管位置异常9耳,面神经管管径变细1耳,面神经管分叉1耳。结论MSCT高分辨率扫描加CPR技术能清晰显示先天性外耳道闭锁患者中面神经管的异常,有利于临床医生术前详尽了解面神经管的行程,减少不必要的面神经意外损伤。     

肿瘤相关性皮肌炎的~(18)F-FDG PET-CT影像特点

目的：探讨肿瘤相关性皮肌炎的18F-FDGPET-CT影像特点。方法：回顾性分析9例皮肌炎合并恶性肿瘤患者的临床资料和18F-FDGPET—CT显像资料,采用Mann-WhitneyU秩和检验对恶性肿瘤病灶与骨骼肌的SUVmax的相关性进行统计学分析。9例中胆囊癌3例,肺癌2例,卵巢癌、食管癌、结肠癌及恶性淋巴瘤各1例。结果：所有恶性肿瘤病灶的18F-FDG摄取较高,SUVmax为7．26±5．48;7例患者18F-FDGPET—CT显像示全身骨骼肌弥漫性对称性轻度摄取增高,SUVmax为3．45±0．81,与恶性肿瘤问差异有统计学意义（Z=-2．910,P=0．004）。同机cT扫描还发现1例合并间质性肺炎,3例合并肺部感染。结论：肿瘤相关性皮肌炎的18F-FDGPET-CT表现有一定特征性,认识其影像学表现,有助于提高对此病的诊断准确性。     

严重多发伤时损伤控制骨科应用41例

目的 探讨严重多发伤时损伤控制骨科（DCO）应用的可行性和疗效。方法对1995年1月-2005年12月应用DCO方法救治严重多发伤41例的临床资料进行回顾性分析。结果29例严重多发伤伴骨盆骨折大出血，均行髂内动脉断血术，其中双侧髂内动脉结扎21例，双侧髂内动脉栓塞术8例，早期骨盆外固定支架使用10例。10例严重多发伤伴开放性股骨骨折初期仅行清创和简单外固定。2例脊柱骨折伴脊髓压迫行简单椎板减压。均在ICU复苏治疗后，再做确定性内固定手术。本组死亡率12％（5／41），死亡组损伤严重度评分（ISS）平均值41．4分，主要死于休克和合并伤。共发生并发症7例，合并急性呼吸窘迫综合征（ARDS）3例，右髂总动脉血栓形成1例，2例膈下脓肿，1例下肢深部感染，均痊愈。结论迅速准确的诊断和一体化治疗，是提高严重多发伤生存率的关键，合理应用DCO是安全有效的方法。     

Correlates of lung/heart ratio of thallium-201 in coronary artery disease

We studied 306 patients with chest pain (262 with coronary artery disease and 44 with no coronary artery disease) to determine which of 23 clinical, exercise, thallium, and angiographic variables best discriminate between patients with increased lung/heart ratios of thallium versus those with normal ratios. Normal lung/heart ratio values were defined using an additional 45 subjects with less than 1% probability of coronary artery disease. The number of diseased vessels was the best discriminator between patients with increased ratios versus those with normal ratios. Double product at peak exercise, number of segments with abnormal wall motion, patient gender, and duration of exercise were also significant discriminators. Using discriminant function analysis these variables could correctly identify 81% of cases with increased lung/heart ratios and 72% of cases with normal ratios. These results indicate that an increased lung/heart ratio of thallium reflects exercise-induced left ventricular dysfunction and affords a better understanding of why this thallium parameter is a powerful prognostic indicator in patients with chest pain.     

Parenchymal abnormalities associated with cerebral venous sinus thrombosis: assessment with diffusion-weighted MR imaging

BACKGROUND AND PURPOSE: The common entity cerebral venous sinus thrombosis is associated with the poorly characterized imaging finding of parenchymal abnormalities; diffusion-weighted imaging has offered some insight into these manifestations. We assessed the relationship between the diffusion constant from apparent diffusion coefficient (ADC) maps in patients with cerebral venous thrombosis (CVT) with follow-up imaging findings and clinical outcome. METHODS: We evaluated the medical records and T2-weighted MR images of 13 patients with CVT complicated by intraparenchymal abnormality. Diffusion-weighted (DW) images and ADC maps were evaluated for increased, decreased, or unchanged signal intensity and were compared with signal intensity of contralateral, normal-appearing brain. In addition, ADCs were obtained in nine pixel regions of interest in abnormal regions in eight of the 13 patients. RESULTS: Eight patients had superficial CVT, and five had superficial and deep CVT. CVT of deep veins was associated with deep gray nucleus and deep white matter abnormalities, whereas superficial CVT was associated with cortical and subcortical abnormalities. Twenty-four nonhemorrhagic lesions were identified in 10 of 13 patients on the basis of follow-up imaging findings. Four patients without seizures had lesions with decreased diffusion that appeared hyperintense on follow-up T2-weighted images, three patients with seizures had lesions with decreased diffusion that resolved, and seven patients had lesions with increased diffusion that resolved. Three of 10 patients had more than one lesion type. No difference was noted in mean ADCs for lesions with decreased diffusion that resolved compared with lesions with decreased diffusion that persisted. CONCLUSION: DW imaging in these patients disclosed three lesion types: lesions with elevated diffusion that resolved, consistent with vasogenic edema; lesions with low diffusion that persisted, consistent with cytotoxic edema in patients without seizure activity; and lesions with low diffusion that resolved in patients with seizure activity. This information may be important in prospectively determining severity of irreversible injury and in patient treatment.     

颌面部骨折并颅颈交界区损伤的CT诊断

目的 探讨颌面部骨折合并颅颈交界区损伤的影像学特点及多层螺旋CT诊断。方法 收集10例颌面部外伤合并颅颈交界区损伤的螺旋CT重建扫描资料，比较常用影像学检查手段的诊断价值。结果 上、下颌骨双骨折并颧弓骨折者5例，下颌骨骨折5例。其中3例合并颞颌关节脱位，3例合并有轻、中度颅脑损伤。合并颅颈交界区损伤有：枕颈脱位2例，枕骨髁撕脱骨折2例，寰枢椎旋转性半脱位6例，结论 颌面部外伤骨折合并上颈椎损伤多为韧带型损伤，影像学特点为小片的撕脱性骨折及枕颈半脱位、寰枢椎旋转性半脱位；多层螺旋CT重建技术是诊断本病的最佳方式；提高对本病的警惕，重视颅颈交界区解剖标志间关系的画线测量是防止漏诊的关键。     

艾滋病25例临床分析

目的总结艾滋病的临床特征,以提高对其感染的认识。方法25例艾滋病及其并发症的临床表现和实验室资料进行回顾分析。结果全组病例均有发热、消瘦、乏力、食欲减退,咳嗽20例,气急18例,腹泻10例,发绀18例,淋巴结肿大10例,卡波肉瘤2例,肺部湿啰音22例,心动过速25例,脾肿大5例,外生殖器溃疡8例,尖锐湿疣5例,CD4+T淋巴细胞减少22例。并发症:肺结核8例,细菌性肺炎12例,肺部真菌感染4例,卡氏肺囊虫肺炎1例,马纳菲青真菌感染1例。肺部感染具多样性、混合性、播散性和难治性的特点,死亡22例,自动出院3例。结论艾滋病及其并发症的临床表现具有多样性,静脉注毒传染与性传染基本各占一半。     

高压氧联合放射治疗对食管癌患者survivin蛋白表达的影响

目的 探讨食管癌患者survivin蛋白的表达及高压氧联合放射治疗对survivin蛋白表达的影响。方法 应用免疫组织化学SP法检测65例食管癌患者及20名正常人食管黏膜组织survivin蛋白表达情况。结果 食管癌患者survivin蛋白表达率为70.8％ (46/65),正常人食管黏膜组织中表达率为5％ (1/20)。survivin蛋白的表达与肿瘤的淋巴转移关系密切,有淋巴转移的患者survivin蛋白阳性率与无淋巴转移的患者比较差异有统计学意义(P＜0.05)。食道癌患者高压氧联合放射治疗与单纯放射治疗比较,临床症状有所改善,survivin蛋白阳性表达率降低,差异有统计学意义(P＜0.05)。结论 survivin蛋白阳性表达与食管癌的生长及转移有关,参与食管癌的发生发展。高压氧与放射治疗联合应用可提高临床疗效。     

Spin-echo anatomy of the larynx with magnetic resonance at 1.5 T

The larynges of 8 healthy and informed volunteers were studied with a superconductive MR unit at 1.5 T together with those of 10 patients with extralaryngeal pathologic conditions. The study was performed with round surface coils (5") and with dedicated sellar coils in the anterior neck. Slices were 5 mm thick, and acquired on the coronal, axial, and sagittal planes, with T1-weighting; axial scans were repeated in the same locations with double echoes, with proton-density and T2-weighting. Five patients underwent additional scans after Gd-DTPA. The larynx of a semi-frozen cadaver was examined with sellar surface coils, on similar scanning planes and with similar pulse sequences to those described above; the larynx was removed, investigated with mammographic technique, and subsequently analyzed with thin CT slices and a high-resolution reconstruction algorithm for the study of laryngeal cartilage. Axial anatomical sections were then compared with MR and CT scans, and the anatomical structures were recognized on the triplanar MR scans of a volunteer's larynx. Besides MR anatomy of supporting laryngeal structures, the authors describe in detail the muscles, plicae, spaces and cavities which can be identified on the various planes, together with the changes in signal after Gd-DTPA.     

肝癌合并动静脉瘘的介入诊断及治疗

目的 分析肝细胞癌(HCC)合并肝动脉一静脉瘘(HAVS)的诊断及介入处理方法，探讨临床疗效。方法 收治的453例肝细胞癌，33例合并HAVS。根据造影诊断分别进行明胶海绵或弹簧圈堵塞瘘口，合并或单独使用丝裂霉素、卡铂粉、碘油混合乳剂进行瘤体栓塞。此外，对于冈HAVS所致的严重门脉高压反复上消化道出血3例患者，实施了经皮肝穿刺胃冠状静脉栓塞术。结果 肝动脉-门静脉瘘(HAPS)24例，HAVS7例，混合型2例：HAVS经处理瘘口达到完全栓塞后行肝动脉化疗栓塞(TACE)时，26例丝裂霉素、卡铂、碘油乳剂均能较好地沉积在瘤体内其余7例瘤体内栓塞剂沉积不好其中3例反复上消化道出血的患者经皮肝穿刺胃冠状静脉栓塞术后1d出血停止。结论 对于肝细胞癌合并HAVS患者，数字减影血管造影(DSA)是必要的检查手段，栓塞治疗是有效的治疗方法。     

CT evidence of intracranial contusion and haematoma in relation to the presence, site and type of skull fracture

The skull films and CT scans of 1383 patients with acute head injury transferred to a regional neurosurgical unit were reviewed. Of the 850 patients with a skull fracture, contusion and/or haematoma was found in 71%, compared with 46% of the 533 patients with no fracture. Thirty-nine per cent of patients had neither contusion nor haematoma, and 21% had neither skull fracture nor contusion/haematoma. Haematomas occurred more frequently in association with lateral and occipital fracture than with frontal fracture, but the incidence of contusion was similar for all fracture sites. Linear fractures were more often associated with extra- and subdural haematomas than were depressed fractures. Intracranial damage associated with depressed fractures was localized more frequently than with linear fractures. Frontal fractures were rarely associated with posterior damage alone, but with occipital fractures anterior contusion was more frequent than posterior. Damage associated with lateral fracture was solely contralateral in 26%. Skull fracture was present in 77% of patients with contusion, 87% of those with an extradural, 72% with a subdural, and 66% with an intracerebral haematoma (70% of all those with an intracranial haematoma).     

Shape mapping of the hippocampus in young children with autism spectrum disorder

BACKGROUND AND PURPOSE: We hypothesized the occurrence of characteristic hippocampal-shape alterations in young children with autistic spectrum disorder (ASD) who also exhibit deficits on neuropsychologic tests of medial temporal lobe (MTL) function. MATERIALS AND METHODS: Coronal 3D MR images were acquired from 3- to 4-year-old children with ASD (n = 45) and age-matched children with typical development (n = 13). Children with ASD were further subclassified into those with autism disorder (AD, n = 29) or pervasive developmental disorder-not otherwise specified (PDD-NOS) (n = 16). Variations in hippocampal shape were evaluated by using large-deformation high-dimensional brain mapping. RESULTS: Hippocampal shape measures distinguished children with ASD from those with typical development; within the ASD sample, children with AD were distinguished from those with PDD-NOS. Hippocampal-shape alterations in children with ASD were correlated with degree of mental retardation and performance deficits on tests of MTL function. CONCLUSIONS: Children with ASD exhibited an alteration of hippocampal shape consistent with inward deformation of the subiculum. This pattern of hippocampal-shape deformations in the children with ASD was accentuated in the more severely affected subgroup of children with AD and was associated with deficits on neuropsychologic tests of MTL but not prefrontal function. Hippocampal-shape deformation in the children with ASD was observed to be similar to a pattern of hippocampal shape deformation previously reported in adults with MTL epilepsy. Although the children with ASD, and those with AD in particular, PDD-NOS are at high risk for epilepsy as they enter adolescence, the specificity and causal relationship of this pattern of hippocampal-shape deformation to the development of seizures is not yet known.