小儿脑性瘫痪癫痫风险因素分析

目的探讨小儿脑性瘫痪(cerebral palsy,CP)癫痫的风险因素,为临床治疗提供依据。方法选取我院2011-12-2014-11出生的530例脑瘫患儿进行回顾性资料分析,其中合并癫痫(epilepsy,EP)105例,未合并癫痫425例,汇总其高危因素、影像学资料等,对105例脑瘫合并癫痫患儿的临床发作特点,所属瘫痪类型及智力发育水平进行分析。结果低体质量,颅内出血是脑瘫患儿发生癫痫的风险因素,与未发癫痫组相比差异具有统计学意义(P0.05)。影像学检查中患儿脑部结构畸形,脑软化均为脑性瘫痪患儿发生癫痫的风险因素,与未发癫痫组相比差异具有统计学意义(P0.05)。智力评估中脑瘫合并癫痫患儿智力中发育异常占97.14%,未合并癫痫组智力发育异常占64.94%,智力评估差异有统计学意义(P0.05)。结论小儿脑瘫癫痫风险因素分析提示出生体质量偏低,有颅内出血,脑结构异常,脑软化,智力发育低下的患儿易发生癫痫,临床可针对这一特点进行预见性防治,降低小儿脑性瘫痪癫痫发生率。     

120例脑性瘫痪患儿的脑部CT征象与临床类型的关系

鉴于脑性瘫痪是临床上常见的致残性疾病 ,早诊断、早治疗对患儿的预后密切相关。而脑部CT征象是诊断此症重要依据之一。为此 ,作者对 12 0例脑性瘫痪患儿的脑部CT征象与临床类型的相关性进行了分析 ,并报告于后。1　资料与方法1 1　对象　系 1994年 1月～ 2 0 0 1年 12月在我院门诊及住院患儿 ;均诊断为脑性瘫痪 (符合CCMD - 3诊断标准 )。其中男性 6 8例 ,女性 5 2例 ;年龄 8 12～ 11岁 ,平均为 3 5岁 ;痉挛型 76例 ,运动障碍型 2 2例 ,共济失调型 5例及混合型 17例。1 2　方法　本组患儿经临床医生诊断后均进行脑部CT检查。采用美国G…     

47例脑性瘫痪的影像学改变及其临床意义

脑性瘫痪（cerebral palsy，CP）简称脑瘫，是指出生前到生后1个月内脑发育时期由多种原因引起的非进行性脑损伤所致的综合征，是儿科常见的神经系统疾病，也是导致小儿残疾的主要疾病之一。对CP患儿的颅脑影像学分析有助于其病因诊断、预后判断及治疗指导，笔者对2005年1月至2006年4月在我院康复中心治疗的47例CP患儿影像学资料进行分析，报道如下。     

脑性瘫痪早期诊断与干预

脑性瘫痪是小儿神经系统常见病,如能早期发现并进行早期诊断和干预,就能够减轻患儿残疾程度,以期使他们今后获得独立生活,甚至回归社会的能力。本文介绍34例脑瘫儿早期诊断,早期干预体会。临床资料:自93年8月～99年3月在综合性医院确诊为脑瘫并坚持来中心脑瘫班诊治共34例,其中     

康复锻炼联合神经节苷脂治疗小儿脑性瘫痪的疗效观察

目的：探讨康复锻炼联合神经节苷脂治疗小儿脑性瘫痪的临床疗效。方法选择我院2012—2013年小儿科收治的60例脑瘫患儿的资料，将患儿分为观察组及对照组各30例，2组患儿均采用康复锻炼治疗，观察组加用神经节苷脂注射液静滴，在治疗前及治疗后90 d采用智力量表发展指数（MDI）和运动量表发展指数（PDI）对2组患儿的智力及运动功能进行评定。结果观察组MDQ和PDQ均明显增加，与对照组比较差异有统计学意义（P＜0.05）。结论康复锻炼联合神经节苷脂治疗小儿脑性瘫痪可明显促进患儿智力发育，同时提高运动能力，效果满意，值得临床推广。     

脑性瘫痪儿童父母心理健康状态调查

目的 了解脑性瘫痪儿童父母心理健康状态。方法 采用临床症状自评量表(SCL—90)对43例脑瘫患儿父母的心理状态进行调查，并与对照组和全国常模进行比较。结果 脑瘫患儿父母SCL—90的躯体化、抑郁、焦虑、偏执和敌对明显高于对照组和全国常模。提示 脑瘫患儿父母存在不健康的心理状态，临床医生在对脑瘫的治疗中还应注意对患儿父母的心理指导。     

脑性瘫痪儿童父母心理健康状态调查

目的 了解脑性瘫痪儿童父母心理健康状态。方法 采用临床症状自评量表(SCI-90)对43例脑瘫患儿父母的心理状态进行调查,并与对照组和全国常模进行比较。结果 脑瘫患儿父母SCL-90的躯体化、抑郁、焦虑、偏执和敌对明显高于对照组和全国常模。提示 脑瘫患儿父母存在不健康的心理状态,临床医生在对脑瘫的治疗中还应注意对患儿父母的心理指导。     

游戏在脑瘫康复训练中的应用

目的探讨在脑性瘫痪康复训练中以游戏的方式进行训练所取得的效果。方法将20例脑瘫患儿实施以游戏的方式进行训练。结果以游戏的方式对脑瘫患儿进行康复训练可激发脑瘫患儿参与训练的积极性,提高疗效。结论有利于脑瘫患儿把学到的技能得到巩固和强化,转移应用到生活中去。     

急性颅脑损伤术后并发脑梗死21例诊治分析

目的总结颅脑外伤术后并发脑梗死的原因及临床诊治。方法回顾性分析21例CT证实为颅脑外伤术后脑梗死病人的临床资料。结果伤后随访1年，GOS预后评分：恢复良好2例，中残4例，重残3例，植物生存1例，死亡3例。结论颅脑外伤术后可能发生脑梗死，大面积脑梗死致死、致残率高，术后应常规进行颅内压监护、及时复查CT，应早期发现，充分减压，及早采用综合治疗。     

局部注射疗法对脑瘫患儿下肢痉挛状态的疗效观察

目的探讨局部注射疗法治疗痉挛型脑性瘫痪的临床疗效。方法将96例下肢痉挛型脑性瘫痪患儿随机分为两组。A组：药物局部注射（治疗组）54例，隔天1次，10次为一疗程；B组：上田敏法(对照组)42例，1次／d，20d为一疗程。结果治疗前后两组疗效比较有显著性差异，治疗组疗效显著高于对照组。结论局部注射疗法使局部组织新陈代谢活跃，再生过程加强，肌肉软化松解，从而达到降低肌张力的目的，为下肢痉挛型脑瘫患儿又开辟了一条新的治疗途径。     

Computed tomography of cerebral palsy: evaluation of brain damage by volume index of CSF space

Between 1976 and 1978, we examined 110 Japanese children with cerebral palsy using a CT 1000 and a CT 1010 (EMI). In 92% of all patients, there were abnormal findings. Cortical atrophy was seen in 51%, ventricular dilatation in 86%, localized low density areas in 22%, brain anomalies in 10% and asymmetry of cerebral hemisphere in 31%. In spastic hemiplegia, the characteristic CT revealed asymmetrical ventricular dilatation without cortical atrophy and localized low density areas in the cerebral hemisphere contralateral to the palsy. In spastic tetraplegia, CT revealed moderate to marked diffuse cerebral atrophy or brain anomalies. In athetosis, CT revealed normal or slight cerebral atrophy. In 60 cases where a CT 1010 was used, we calculated the volume index of CSF space by computer, Eclipse S/200, and analyzed the relationship between the clinical features of cerebral palsy and the volume index of CSF space.     

散发性钩端螺旋体脑动脉炎性脑梗塞

对98例年轻脑梗塞患者行头颅CT及血清凝溶试验或钩体抗体检测，其中13例确诊为散发性钩端螺旋体脑动脉炎性脑梗塞（占13．26％），并对其临床表现，头颅CT，流行病学特点进行分析，提示当年轻人突然出现中枢神经系统症状并符合脑血管解剖定位时，无论是否来自疫情流行区，均应尽早行血清凝溶试验，以免漏诊。     

单侧性动眼神经麻痹的临床分析

目的回顾分析本科3年来收治20例单侧性动眼神经麻痹的患者,探讨其病因、治疗及预后。方法20例患者分析其临床症状,均作CT检查,进一步DSA脑血管造影,并根据诊断进行针对性处理。结果20例患者中14例为脑血管检查阳性,其中11例为后交通动脉瘤,10例经手术或介入治疗痊愈,1例破裂出血死亡。其余2例为海绵窦硬脑膜动静脉瘘,其中1例经介入治疗痊愈,1例未作治疗。另1例为后交通动脉赤腹样扩张,未作特殊治疗。结论DSA脑血管造影对病因诊断有确诊价值,动眼神经麻痹伴蛛网膜下腔出血或剧烈头痛应高度怀疑后交通动脉瘤或其他脑血管病变,早期造影及治疗极为必要。     

Neuronal migration disorders in cerebral palsy

We retrospectively analyzed 58 autopsy cases of cerebral palsy which were clinically diagnosed at the Aichi Prefecture Colony Hospital. Most of the cases of cerebral palsy had brainweights that were 60–70% of the normal brainweight for their ages. However, approximately 20% of the brains were not small, especially in cases over 20 years of age. The brains of cerebral palsy cases showed wide morphological variation, and were classified into thinned cerebral mantle type (10 cases), hydrocephalus type (three cases) and microgyria-pachygyria type (45 cases). Macroscopic morphometric analysis was performed in the brains of the microgyria-pachygyria type using the coronal whole brain sections through the mammillary bodies stained with Klüver-Barerra (KB) stain, and compared with the brains of four cases of the Fukuyama type congenital muscular dystrophy (FCMD), two cases of lissencephaly, and nine cases of non-neural diseases as controls. The morphometric values of the coronal sections in the cerebral palsy cases showed diminished white matter with more dilatated ventricles compared with the control brains. This tendency was stronger in the brains of spastic cerebral palsy cases than in the brain of athetotic cerebral palsy cases. Cerebral palsy, in terms of the morphological complexity of the cerebrum as determined by the morphometric analysis, was situated between FCMD and lissencephaly. Although microscopic analysis of cerebral palsy brains was limited to 19 cases, there were four brains with heterotopic gray matter, three brains with cortical folding, a sign of cortical dysplasia, and three brains with neuronal cytomegaly. In addition, more than half of the brains showed disorganization of lamination in the cortex with disorientation of neurons. These findings suggest that some cases of cerebral palsy may result from disrupted neuronal migration during cortical development.     

Epilepsy in children with cerebral palsy

To study the spectrum of epilepsy in children with cerebral palsy, 105 consecutive children with cerebral palsy and active epilepsy, between 1 and 14 years of age, were studied prospectively. A detailed history and examination, electroencephalography (EEG), and computed tomography (CT) were done in all cases. The social quotient was assessed using the Vineland Social Maturity Scale. A retrospective cohort of 452 cases of cerebral palsy was studied to find the prevalence of epilepsy in cerebral palsy. A control group of 60 age-matched children with cerebral palsy but no epilepsy was also studied for comparison of the social quotient. Of the 105 children, 65 were male, 40 of 105 (38%) had a history of birth asphyxia. The mean age of onset of seizures was 18.9 months; 64 (60.95%) had seizure onset before 1 year of age. Children with myoclonic seizures (P < .05) and infantile spasms (P < .01) had seizure onset significantly early in life. Generalized seizures were the most common, followed by partial seizures, infantile spasms, and other myoclonic seizures. Seizures were controlled in 45 (58.1%) children, and polytherapy was required in 40 children. EEG and CT abnormalities were seen in 70.5% and 61% of the children. Seizure control was achieved in 74% of the patients with a normal to borderline social quotient compared with 48.7% with a social quotient less than 70. Social quotient values had a positive correlation with age of onset of seizures (P < .01) and with better control of seizures (P < .01). Of the cohort of 452 children, 160 (35.4%) had epilepsy. The maximum incidence (66%) was seen in children with spastic hemiplegia, followed by quadriplegia (42.6%) and diplegia (15.8%). Epilepsy in cerebral palsy is seen in about one third of cases; it is often severe and difficult to control particularly in children with mental retardation.     

Comparisons of right and left hemiparetic cerebral palsy

The purpose of this study was to compare right and left hemiparetic cerebral palsy. Sixty children (34 males, 26 females) with hemiparetic cerebral palsy were recruited. Thirty-two children manifested left hemiparetic cerebral palsy and 28 right hemiparetic cerebral palsy. Low birth weight, seizures, a family history of epilepsy, severity of cerebral palsy, and computed tomographic findings were analyzed. No significant differences were found between the clinical patterns of hemiparesis in both groups. Gestational history, low birth weight, and perinatal pathologies were present in similar percentages in the left and the right hemiparetic cerebral palsy children. Significantly greater numbers of pregnancies (P = 0.003) and deliveries (P = 0.01) were observed in the left hemiparetic cerebral palsy group as compared with the right hemiparetic cerebral palsy group. Similarly, significantly (P = 0.03) lower values of the Apgar score were recorded in the left hemiparetic cerebral palsy group than the right hemiparetic cerebral palsy group. A similar percentage of neuroradiologic abnormalities was detected in both groups. Twenty-six (43.3%) children with hemiparetic cerebral palsy had epilepsy. The incidence of intractable epilepsy was similar in both groups. The results of this study are comparable with earlier reports on hemiparetic cerebral palsy.     

Ataxic cerebral palsy--clinico-radiologic correlations

Clinico-radiologic correlations, using CT, were studied in 29 patients with ataxic cerebral palsy. The scans were normal or only slightly abnormal in 38%, posterior fossa abnormalities occurred in 28%, and 55% had obvious cerebral abnormalities which always involved the parietal lobes. There were only two cases where the changes were confined to the posterior fossa. Hydrocephalus was present in four, and there was one case of a Dandy-Walker malformation. An absolute association with any clinical subtype was unusual. All cases of simple ataxia had an obviously abnormal scan, but the changes were widespread. Where dysequilibrium was present the scans were either normal or showed widespread change. Only 25% involved the vermis. Although there was some association between hydrocephalus and ataxic diplegia, the majority of this subtype had a normal or only slightly abnormal scan. Most were hypotonic docile infants with delayed speech and motor skills, particularly those with posterior fossa abnormality. Although CT did not predict development well, those with lower IQ's were more likely to have obvious CT change. Where obvious supratentorial change was present, 75% had a history of epilepsy. In ataxic cerebral palsy CT findings are common, but variable. CT change correlates better with IQ and epilepsy than clinical subtype.     

Porencephaly and schizencephaly in adopted infants. Frequency ascertainment in a risk group

A formal inquiry on the health state of 1206 legally adopted children from Indonesia revealed cerebral palsy in 9 (0.9% of 1029 responses obtained), including two who had died. CT examination performed in 7 cases was abnormal in all. Four types of lesions were seen: 1. Bilateral full thickness porencephalies (BFTP lesion) in 4 cases, amounting to 0.4% of the total population on which response was obtained. 2. Full thickness porencephaly of the area of one internal carotid artery in 1 case. 3. Schizencephaly-like lesion in 1 case, confirmed by magnetic resonance imaging. 4. Supratentorial midline cyst resulting in hydrocephalus. The frequency of the BFTP lesion found in 4 out of 7 cerebral palsied investigated by CT is remarkable in view of its rarity in radiological studies on cerebral palsy and because of its relationship to prenatal rather than perinatal damage according to previous pathological studies. This is the first systematic study on the neurodevelopmental outcome of a group of adopted babies which indicates an increased risk to specific prenatal brain damage.     

凝视麻痹在急性脑血管病中的临床意义(附104例分析)

目的 提高凝视麻痹在急性脑血管病中临床意义的认识。方法 对104例伴有凝视麻痹的急性脑血管病患者的临床资料进行分析。结果 在104例患者中，男58例，女46例，脑出血的凝视麻痹发生率高于其它脑血管病，尤破入脑室者。伴有凝视麻痹的患者，意识障碍和死亡的发生率增高。结论 伴有凝视麻痹的急性脑血管病患者预后不好。