肝移植术后早期并发颅内出血

目的研究肝移植术后并发颅内出血的发病情况、临床和神经影像学特征并探讨可能的危险因素及预后。方法回顾性分析337例、共358次肝移植病例中术后并发颅内出血的临床及神经影像学特征,并与同时期未发生颅内出血的肝移植病例进行比较,探讨其可能的危险因素及预后。结果术后发生颅内出血共8例(2.2%),死亡5例。临床表现为不同程度意识障碍、头痛、失语、偏瘫、呕吐、癫发作等。其头颅CT特点为出血量大、多部位、广泛性出血、以大脑半球实质内出血居多、血肿形状不规则、血肿易扩大或再次出血。术后并发颅内出血的患者年龄、术中低血压、合并细菌或真菌感染及病死率与无颅内出血的肝移植患者相比,差异具有统计学意义(P<0.05)。结论颅内出血是肝移植术后直接影响患者预后的一种严重神经系统并发症。年龄偏大、术中低血压及术后合并感染可能是肝移植术后并发颅内出血的危险因素。     

颅内动脉瘤术后并发症对其预后的影响

目的回顾性分析1994年3月至2004年1月期间因颅内动脉瘤而住院手术的病例，探讨术后并发症对颅内动脉瘤手术预后的影响。方法应用Logist回归模型对465例颅内动脉瘤患者发病时的神经系统体征及术后并发症等指标进行单因素和多因素分析。结果共手术治疗486枚动脉瘤，其中单发动脉瘤患者446例，多发动脉瘤患者19例（40枚动脉瘤）。患者发病时的血糖水平及各种并发症与患者预后有关，而年龄、性别、术前Fisher分级、术前GCS、术后是否静脉使用抗痉挛药物、动脉瘤破裂次数、手术时机、以及术中阻断供血动脉时间等因素与预后无关。本组病死率8、11％，预后良好率74．99％。结论通过对血糖水平、术后并发症等动脉瘤预后相关危险因素的分析可预测动脉瘤患者预后，并有效指导治疗，从而提高临床救治水平。     

小骨窗开颅术与骨瓣开颅术治疗高血压脑出血疗效比较

目的对小骨窗开颅术与骨瓣开颅术治疗高血压脑出血的疗效进行比较。 方法将从化市中心医院自2008年6月至2010年6月收治的56例高血压脑出血患者按随机数字表法分人观察组（行小骨窗开颅术,28例）与对照组（行骨瓣开颅术，28例），比较两组患者手术时间、住院时间、住院期间病死率、再出血发生率、并发症发生率及治疗后半年GOS评分。 结果观察组手术时间及住院时间明显短于对照组，差异有统计学意义(P＜0.05)；观察组与对照组住院期间病死率分别为14.3％、25.0％，差异无统计学意义(P＜0.05)；观察组与对照组并发症发生率分别为25.0％、46.4％,差异无统计学意义(P＜0.05)；观察组治疗半年后GOS评估预后明显优于对照组，差异有统计学意义(P＜0.05)；观察组与对照组再出血发生率分别为10.7％、14.3％，差异无统计学意义（P＞0.05）。结论与骨瓣开颅术相比，小骨窗开颅术治疗高血压脑出血能明显降低病死率及并发症发生率，改善患者预后。     

感染对急性脑梗死患者短期预后的影响

目的探讨急性脑梗死后感染的发生率、危险因素以及对短期预后的影响。方法对确诊急性缺血性脑卒中的住院患者进行评估,入院的第1d记录患者的基本情况、严重程度、生理参数以及实验室检查指标,第7d记录感染和预后。结果共有432例患者纳入研究,79例在7d内出现感染（18．3％）。下列情况更容易发生感染：（1）高龄;（2）大面积脑梗死;（3）入院前无独立生活能力;（4）昏迷;（5）导尿;（6）吞咽困难。脑梗死后感染与住院期间7d的病死率明显相关。结论急性缺血性脑卒中后感染可以影响短期预后。     

高龄颈动脉狭窄患者颈动脉内膜切除术和颈动脉支架成形术的安全性比较简

目的回顾接受颈动脉内膜切除术和颈动脉支架成形术的高龄（≥70岁）颈动脉狭窄患者的临床资料,分析手术安全性。方法共691例颈动脉狭窄患者,121例行颈动脉内膜切除术、570例行颈动脉支架成形术,分析两组患者危险因素、临床特征和术后并发症发生率,评价两种手术方法之安全性。结果术后30d时,两组患者病死率（0．83％对1．05％,P=1．000）、脑卒中（4．13％对1．93％,P=0．258）和心肌梗死（0．83％对0,P=0．175）发生率差异均无统计学意义;但颈动脉内膜切除术组患者术后心脏不良事件（8．26％对1．05％,P=0．000）和脑神经损伤（4．96％对0,P=0．000）发生率高于颈动脉支架成形术组,而窦性心动过缓或低血压发生率低于颈动脉支架成形术组（0对7．54％,P=0．002）。结论高龄患者接受颈动脉内膜切除术或颈动脉支架成形术均有较高的安全性,术前应全面评价患者基础情况,以减少术后并发症发生率。     

中枢神经系统血管母细胞瘤的年龄分层分析

目的 探讨不同年龄段的中枢神经系统（CNS）血管母细胞瘤（HB）的临床特征、预后及其影响因素。方法 回顾性分析2016年1月至2022年1月手术治疗的86例CNS-HB的临床资料。根据初次手术年龄分为四个年龄段（≤20岁、21~40岁、41~60岁和≥61岁），分析不同年龄段临床特征、预后差异。结果 CNS-HB以颅内压增高症状为主，其次是小脑症状。肿瘤主要位于幕下，其中小脑占65.6%、脑干占17.7%，其次是脊髓（11.5%），幕上极少（5.2%）；实性肿瘤43例（44.8%），囊性肿瘤53例（55.2%）。年龄≤20岁组病程[（1.68±1.87）个月]较年龄≥61岁组[（26.50±50.66）个月]明显缩短（P<0.05）。年龄≤40岁病人VHL病发生率较年龄>40岁病人明显增高（P<0.05）。不同年龄段病人的肿瘤部位、肿瘤性质均无明显差异（P>0.05）。术后41例（42.7%）出现坠积性肺炎，年龄越大，发生肺炎的几率越高（P<0.001）。术后15例（15.6%）出现颅内并发症，实性肿瘤及脑干肿瘤病人术后颅内并发症发生率明显高于囊性肿瘤或肿瘤位于其他部位病人（P<0.05）。末次随访，预后良好78例（81.3%），预后不良8例（18.7%）。多因素logistic回归分析显示男性、肿瘤位于脑干以及实性肿瘤是CNS-HB预后不良的独立危险因素（P<0.001）。结论 年轻HB病人的病程较短，而老年HB病人术后并发症发生率较高，但是年龄不是HB病人预后不良的危险因素，肿瘤部位及肿瘤性质与HB病人不良预后有关。40岁以下病人VHL病发病率较高，建议年轻病人积极进行VHL病的筛查。     

神经外科术后患者颅内感染的危险因素分析

目的分析神经外科术后患者颅内感染的危险因素,为术后颅内感染提供预防措施。方法回顾性选取我院神经外科2010-01—2014-06手术患者100例,按照是否发生术后感染分为颅内感染组和非颅内感染组。对比分析2组患者一般情况及手术情况,同时对于可能的危险因素进行单因素Logistic分析。结果颅内感染组年龄、住院时间、术前院内等待时间、手术时间、再次手术率、脑室外引流和术后脑脊液漏发生率均显著高于非颅内感染组(P0.05);颅内感染组的GCS评分显著低于非颅内感染组(P0.01)。年龄≥45岁、住院时间20d、术前院内等待时间7d、手术时间4h、GCS评分9分、CSF分流术、再次手术、脑室外引流和术后脑脊液漏均为术后颅内感染的危险因素(P0.05)。结论对于神经外科年长、手术复杂、术后住院时间长、出现并发症的患者,应予以积极的综合预防措施,以降低术后颅内感染发生率。     

蛛网膜下腔出血再出血临床特点和危险因素分析

目的探讨引起蛛网膜下腔出血（SAH）再出血的临床特点和危险因素及预防措施。方法回顾分析两院神经内科11年收治的385例SAH患者和84例SAH再出血患者的临床表现和可能的危险因素。结果（1）再出血组发生率17．9％，高峰在发病后2周内再出血多发生在冬季；（2））再出血组平均年龄比SAH组低9．01岁，男比女多，为2．1：1；（3）再出血组病死率高达72．6％，比SAH组明显增高（21．30％）（P〈0．01）；（4）再出血组中动脉瘤占72．06％，再出血多因动脉瘤破裂所致；（5）高血压病、激动、长期的烟酒史和感染等均是再出血间接危险因素。结论治疗SAH期间和SAH恢复期，需对再出血可控危险因素及时干预，对动脉瘤早期手术是防止再出血的关键。     

急性脑梗死合并2型糖尿病患者预后的影响因素

目的观察急性脑梗死合并2型糖尿病患者的临床特征,并分析其预后影响因素。方法选择我院收治的172例急性脑梗死合并2型糖尿病患者作为研究对象,根据患者的预后情况分为预后良好组和预后不良组,观察比较2组患者的临床资料(性别、年龄、吸烟史、饮酒史、高血压、冠心病、心房颤动、复发性脑卒中及住院期间并发症)和实验室检查指标[入院白细胞计数、随机血糖、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)],并分析急性脑梗死合并2型糖尿病患者预后的影响因素。结果预后良好141例(预后良好组),占82.0%,预后不良31例(预后不良组),占18.0%。预后良好组年龄、高血压、住院期间并发症发生率及入院白细胞计数显著低于预后不良组(P0.01);经多元Logistic回归分析发现,高龄、住院并发症发生率及入院白细胞计数高为急性脑梗死合并2型糖尿病患者预后不良的独立危险因素(P0.05)。结论急性脑梗死合并2型糖尿病患者年龄越大、住院并发症发生率及入院白细胞计数越高,其预后不良的发生率越高,加强对住院期间并发症的干预能一定程度改善患者预后。     

高血压病患者急性心肌梗死静脉溶栓临床研究

目的：探讨静脉溶栓对高血压病（EH）患者急性心肌梗死（AMI）的疗效和近期预后的影响。方法：108例（溶栓治疗38例和常规治疗70例）有EH病史的AMI临床资料进行对照分析。结果：血管再通率为65．7％，血管再通组患者较血管未通及常规治疗组患者左心功能的各项参数均有改善（P＜0．05~0．01），住院期间并发症和严重心律失常的总发生率降低（P均＜0．05）。结论：提示对EH患者AMI早期、适当的静脉溶栓治疗可缩小梗塞范围，减少并发症，降低急性期病死率。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.