绞股兰治疗氯丙嗪所致白细胞减少2例报告

绞股兰治疗氯丙嗪所致白细胞减少２例报告东风汽车公司茅箭医院（４４２０１２）姜学军，李新胜１病例报告例１，女，３４岁，住院号１２８７。体检内科和神经系统未见异常。诊断为精神分裂症。给予氯丙嗪治疗５００ｍｇ／日，二个月后血象由入院时的４．３×１０９／Ｌ降...     

显微外科治疗儿童髓母细胞瘤

目的 用显微技术切除儿童髓母细胞瘤，砬少手术并发症，提高术后生存质量。方法 对３４例儿童髓平细胞瘤的临床资料进行分析。结果 ３４例均采用显微手术治疗，全切２７例，次全切除４例，部分切除３例，手术死亡２例，死亡率为５．９％，获随该列，临床治愈２４例，着状改善６例，５年生存率为５０％。结论 微创的显微外科技术是保证减少术后并发症，获得良好预后的关键。对于大多数患儿，建议术后辅以放疗。     

CT导向局部穿刺治疗小脑脓肿

我科在１９９０年１月至１９９８年１月期间，经ＣＴ导向局部穿刺治疗小脑脓肿３４例，均取得了良好的效果，现报告如下。临床资料本组共３４例，男性１５例，女性１９例。年龄８～６９岁，平均年龄３４岁。其中有中耳炎病史１８例，其他部位感染史７例，先心病史３例，其...     

冰盐水反复灌洗法治疗脑出血34例

用冰盐水反复灌洗法治疗高血压性脑出血，治疗组３４例内科保守疗法加ＣＴ定位，细锥钻颅，冰生理盐水３０ｍｌ稀释尿激酶１万单位反复灌洗血肿腔；另３４例内科保守疗法作对照。ＣＴ结果显示治疗组血肿抽吸比较彻底，无再出血后７天，３５天神经功能改善综合评分均明显优于对照组。提示冰盐反复灌洗法治疗脑出血方法简便，疗效高，副作用少。     

脑立体定向术治疗震颤麻痹和扭转痉挛34例报告

脑立体定向术治疗震颤麻痹和扭转痉挛３４例报告中国人民解放军第２９１医院胡占广，杜正光，陈良军，陈文元我院从１９８８年以来对３４例病人进行了脑立体定向手术，报告如下。本组男２９例，女６例。年龄２７～６６岁，病程２～２７年。临床症状：双侧肢体震颤者１６例...     

高压氧治疗糖尿病并发椎-基底动脉供血不足的疗效评价

椎－基底动脉供血不足（ＶＢＩ）是糖尿病常见脑血管并发症。我院应用高压氧（ＨＢＯ）综合治疗糖尿病并发ＶＢＩ４２例，并与一般常规治疗３４例临床疗效作观察比较，同时还观察了椎－基底动脉（ＶＢＡ）血流速度及血液流变学的变化。１临床资料１．１一般资料 ７６例均为我院住院及门诊患者，全部病例均由经颅多普勒（ＴＣＤ）检查证实。随机分为高压氧综合治疗组（ＨＢＯ组）４２例，单纯药物治疗组（对照组）３４例。ＨＢＯ组４２例，男２９例，女１３例；平均５１．２±８．３４岁；胰岛素依赖性糖尿病（ＩＤＤＭ）６例，非胰岛素依赖…     

低分子右旋糖酐治疗缺血性脑血管病致急性肾功能衰竭34例临床分析

低分子右旋糖酐治疗缺血性脑血管病致急性肾功能衰竭３４例临床分析赵仁亮孙建平王春霞赵振霄１９９１年１月～１９９６年１２月，我们共收治因静脉滴注低分子右旋糖酐（低右）治疗缺血性脑血管病（ＩＣＶＤ）而导致的急性肾功能衰竭（ＡＲＦ）患者３４例，现报道如下。资...     

脑胶质瘤长期存活因素分析（附34例报告）

脑胶质瘤长期存活因素分析（附３４例报告）郎国林，刘永吉，张世刚，王宏武我们对存活超过５年的３４例脑胶质瘤患者进行存活因素分析，以期探讨进一步延长脑胶质瘤病人存活时间经验。一、临床资料及方法自１９７９年以来我们对脑胶质瘤病人开展多学科治疗，多数病人是手...     

低体温疗法治疗急性大面积脑梗死的护理

我科自１９９７年６月至１９９９年８月共收治急性大面积脑梗死３４例，采用低体温疗法加常规治疗，取得较好效果，现报告如下。１临床与方法１．１临床资料 ３４例急性大面积脑梗死患者均符合中华神经科学会脑血管疾病分类诊断要点［１］，均经头颅ＣＴ或 ＭＲＩ确诊，其中男２４例，女１０例，年龄５５～７８岁，平均６６．５岁。１．２分组疗法 患者随机分为治疗组与对照组，治疗组１８例，男１３例，女５例，年龄５５～７６岁，平均６５．５岁；对照组１６例，男１１例，女５例，年龄５６～７８岁，平均６７岁。两组患者均采用常规治疗…     

颅脑损伤后并发中枢性肺水肿34例临床分析

目的：对３４例颅脑损伤后并如枢性肺水肿（ＣＰＥ）进行临床分析并提出相应治疗措施。方法：对１９９３年１月至１９９９年１月收治的３４例ＣＰＥ进行回顾性分析及结合文献进行复习，结果：颅脑损伤后ＣＰＥ起病急骤。治疗困难。早期诊治和呼吸监护能降低死亡率。结论：颅脑损伤后ＣＥ的诊治在于早期诊断，及时治疗及相应的呼吸监护。     

儿童和成人抗N-甲基-D-天冬氨酸受体脑炎的临床特征

目的比较分析儿童和成人抗N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体脑炎在临床表现、辅助检查及免疫治疗等方面的异同。方法纳入34例抗NMDA受体脑炎患者,收集其临床资料,按发病年龄和住院科室分为儿童组和成人组,并对治疗前、后和随访(6个月~24个月)后进行改良Rankin量表(modified Rankin Scale,m RS)评分评估功能恢复结局。结果经分析19例儿童和15例成人的临床资料,儿童组和成人组发生中枢性通气不足分别有1例和10例,成人组中枢性通气不足发生率比儿童组高(P0.05);儿童组和成人组并发继发性癫痫分别为1例和11例,并发癫痫持续状态分别为0例和5例,成人组并发继发性癫痫和癫痫持续状态比儿童组多见(P0.05)。常规脑电图检查中,儿童组中有16例检出"δ"波,成人组有1例,儿童组"δ"波检出率更高(P0.05)。成人组2例女性合并可疑卵巢畸胎瘤;儿童组无合并肿瘤情况。儿童组和成人组免疫治疗方案中最常使用大剂量甲强龙冲击治疗;儿童组(17例)使用静脉用丙种球蛋白冲击治疗比成人组(8例)多见(P0.05);儿童组和成人组使用血浆置换例数比和免疫抑制剂(环磷酰胺)例数比分别为(0:5)和(1:7),成人组使用血浆置换及免疫抑制剂更多见(P0.05)。儿童组和成人组发病至就诊的平均时间分别为(14.47±8.39)d和26d,确诊的平均时间分别为(25.42±14.36)d和(40.13±14.14)d,儿童组发病至就诊、确诊的平均时间短于成人组(P0.05);儿童组有5例住重症监护室(ICU),比成人组(10例)少(P0.05);出院时儿童组和成人组m RS评分分别为(2.26±1.56)分和(3.67±1.59)分,儿童组低于成人组(P0.05)。结论成人抗NMDA受体脑炎临床症状相对复杂,病情较重,短期预后相比儿童差。     

Herpes simplex virus (HSV) DNA in microglial nodular brainstem encephalitis

Thirty-four brains with microglial nodular brain stem encephalitis were retrospectively investigated for herpes simplex virus (HSV) and cytomegalovirus (CMV) by in situ hybridization (ISH) with biotinylated cDNA probes, and by immunocytochemistry with polyclonal and monoclonal antibodies on formalin fixed paraffin embedded serial tissue sections. In 16 cases (47%), HSV DNA was found by ISH in the nuclei of neurons in microglial nodules or in the adjacent parenchyma of the brainstem, and more rarely at various cerebellar and telencephalic sites. None of the 34 cases was labeled for CMV DNA and none revealed HSV or CMV antigens. Ten control brains without microglial nodules were not labeled. This study suggests an HSV etiology for many cases with microglial nodular brainstem encephalitis.     

更昔洛韦钠与普通更昔洛韦治疗小儿病毒性脑炎疗效观察

目的观察更昔洛韦钠(荷普欣)及普通更昔洛韦治疗小儿病毒性脑炎的临床疗效。方法将40例病毒性脑炎患儿随机分成更昔洛韦钠组(治疗组)和普通更昔洛韦组(对照组),每组20例,所有病人都采用静脉给药,对2组患儿治疗效果进行观察。结果更昔洛韦钠治疗小儿病毒性脑炎头痛、呕吐、抽搐、意识恢复的时间较普通更昔洛韦对照组明显缩短,两者比较有显著差异(P<0.05),更昔洛韦钠组比普通更昔洛韦组不良反应少且程度轻(P<0.05)。结论更昔洛韦钠治疗小儿病毒性脑炎疗效显著,作用迅速,安全性好,不良反应小,值得临床推广。     

神经元特异性烯醇化酶对病毒性脑炎患者脑损伤的监测和评估

目的通过测定病毒性脑炎(VE)患者治疗前和治疗后脑脊液(CSF)中神经元特异性烯醇化酶(NSE)含量,探讨NSE含量变化对VE病情监测及预后评估价值。方法收集2010年6月-2011年12月河北医科大学第二医院神经内科住院患者60例,并将60例患者参照黄如训主编的《临床神经病学》提出的诊断标准进行分组:VE组40例和非VE组20例。结果 VE组治疗前CSF中NSE平均含量值为14.71±2.37μg/L,VE组治疗后CSF中NSE平均含量为12.12±2.38μg/L,非VE组中NSE平均含量值为6.26±2.34μg/L,两组间比较,P0.05。结论病毒感染中枢神经系统后,使脑神经细胞变性、死亡,对患者神经系统功能造成不可逆性的损伤;动态观察CSF中NSE水平含量变化对VE患者的病情监测及预后评估有重要意义。     

脑脊液、血清免疫球蛋白及脑脊液寡克隆区带对自身免疫性脑炎的诊断意义

目的：探讨脑脊液、血清免疫球蛋白及脑脊液寡克隆区带（OCB）对自身免疫性脑炎（AE）的诊断意义。方法前瞻性收集2014年3月～2016年3月 AE 患者12例，以同期病毒性脑炎（VE）28例，多发性硬化（MS）16例为对照。 AE 患者予以 AE 抗体筛查，测定3组 CSF 中 IgG 及血清 IgG 、IgA 、IgM 浓度，计算 IgG 指数，检测血清及脑脊液 OCB 。所有入组患者均予以 MR 及脑电图等检查。结果 AE 及 MS 组 IgG 指数及 CSF － IgG 均高于 VE 组，AE 组高于 MS 组（P ＜0．05）；AE 及 MS 组血清 IgG 均高于 VE 组，IgM 低于 VE 组（P ＜0．05），AE 组与 MS 组差异无统计学意义（P ＞0．05）；3组患者血清 IgA 水平差异无统计学意义（P ＞0．05）；脑脊液 OCB 阳性率，VE 组7．14％，MS 组62.50％，AE 组91．67％，AE 组高于 MS 组、VE 组（χ2＝13．75，P ＜0．05）。 IgG 指数＞0．7百分率，VE 7．14％，MS 组62．50％，AE 组91．66％，3组比较差异有统计学意义（χ2＝25．61，P ＜0．05）。3组 MR影像学表现，VE 多累及颞叶、额叶，AE 多累及颞叶、顶叶、枕叶、脑岛，多呈双侧对称性或多发性。 MS多分布在脑室周围白质、视神经、脊髓、脑干和小脑。结论 AE 患者鞘内蛋白合成增加，脑脊液 OCB及 IgG 指数对 AE 早期的诊断有一定意义。     

Study of CT and etiology In 11B cases of eoute headache without hemlplegla

objectal To study the relation between CT and etiology of acute headache without hemiplegia. Methods 118 cases of acute headache without hemiplegia were studied with CT scan. The patients with normal CT were diagnosed with lumbar punc -tura or diagnostic standard for establishing disease. Results The first three etiologies were cerebrovescular disease (65 cases, 55%), migraine (25 cases, 21%), meningitis and encephalitis (19 cases, 155. 9%). 53% of patients with subarachnoid hemorrhage(SAH) was diagnosed in CT unnormal group, and 12.4% of patients with Sall was showed by lumbar puncture in CT normal group(P＜0. 001). CT was normal in 18% of patients with a definite SAH(7/39). The positive rates of intracranial infection in CT normal group(by lumbar puncture) was reearkably higher than in CT unnormal group (18/58 versus 2/60, p＜0.005), Conolusion CT is more sensitive to intracranial hemorrhage, tumor and infarction. SAH of a negative Ctscan is not rare. CT is far inferior to lumbar puncture in meningitis or encephalitis.     

Herpes encephalitis is a disease of middle aged and elderly people: polymerase chain reaction for detection of herpes simplex virus in the CSF of 516 patients with encephalitis. The Study Group.

OBJECTIVE--To assess the diagnostic potential of the polymerase chain reaction (PCR) in herpes simplex virus (HSV) encephalitis. METHODS--Samples of CSF from 516 patients with encephalitis were studied for HSV-DNA by PCR. RESULTS--Samples taken one to 29 days from the onset of symptoms from 38 patients (7.4%) were positive, 32 (6.2%) for HSV-1 and six (1.2%) for HSV-2. At follow up, eight of 28 patients studied were still HSV-PCR positive. A diagnostic serum:CSF antibody ratio to HSV but not to other viruses was detected in 25 of the 38 HSV-PCR positive patients thus supporting the initial PCR findings. Patients positive by HSV-PCR were concentrated in the age group > or = 40 years, and especially in patients aged 60-64 years, of whom nine of 24 (37.5%) were positive. The HSV-PCR was negative in all other patients with encephalitis of known or unknown aetiology. This group included 34 patients with a diagnostic serum:CSF antibody ratio to other viruses. A dual infection, HSV and another microbe, was considered possible in seven patients. CONCLUSIONS--The HSV-PCR is a rapid and useful diagnostic method during the early phase of encephalitis. It may be useful in monitoring the efficacy of treatment and allowing the recognition of new features in the appearance of herpes encephalitis. The HSV-PCR test and antibody determinations from serum and CSF are complementary methods, which should both be applied in pursuit of clinical laboratory diagnosis of these conditions.     

Detection of specific IgM in the CSF for early and rapid diagnosis of herpes simplex virus encephalitis

A capture-ELISA for detecting IgM in CSF was developed for the purpose of rapid and early diagnosis of herpes simplex virus (HSV) encephalitis. In 37 cases with sporadic HSV encephalitis the CSF IgM was measured. In 13 cases the results were positive, in the others it was negative. 17 cases with other central nervous system disorders were taken as control group in which only one case with Guillain-Barré syndrome showed positive test and all the others were HSV antibody negative except one with IgG positive in CSF who had undergone a brain operation two weeks prior to the test.     

Acute non-herpetic viral encephalitis of juvenile onset: analysis of 11 cases based on initial clinical symptoms]

We investigated clinical features of juvenile patients presenting non-herpetic viral acute encephalitis (4 men and 7 women, aged of onset; 23.7 +/- 3.3 years) without malignancy and immunodeficiency. We divided the patients into two groups according to initial neurological symptoms: psychiatric symptoms mimicking schizophrenia (group P, n=5), seizure (group S, n=6), and compared clinical manifestations among the two groups. Symptoms frequently seen in initial phase of the illness were neck stiffness (4 cases, 36%), involuntary movement (7 cases, 64%) and convulsion (8 cases, 73%). There were no significant difference among the groups except seizure. Patients in group P had more CSF cells and CSF lymphocytes compared with other groups (p < 0.05 and p < 0.01, respectively). Abnormal intensities in T2-weighted magnetic resonance images were found in 4 cases (36%). The term from the onset to leaving hospital of group P (213 +/- 227 days) was longer than that of group S (98 +/- 85 days), although it did not reach a significant difference. These findings indicate that juvenile acute non-herpetic encephalitis initially presenting psychiatric symptoms was serious and had relatively poor prognosis.