急性脑出血早发癫痫临床观察

目的：探讨急性脑出血早发癫痫对预后的影响。方法：对328例急性脑出血中60例早发癫痫患者临床资料进行回顾性分析。结果：早发癫痫与脑出血的部位有关，以脑叶出血发生率高，发作类型以部分性发作多见，早发癫痫的脑出血病死率31．0％，而无癫痫发作的脑出血病死率为12．0%，两者有非常显著差异（P〈0．01），急性脑出血有无早发癫痫还影响致残和生存质量下降（P〈0．01）。结论：急性脑出血继发癫痫，特别是早发癫痫者对预后有显著影响，在治疗脑出血同时应进行抗癫痫治疗，采取更积极方法以降低病死率、致残率。     

颅脑损伤开颅术后早期癫痫的临床分析

外伤后癫痫 (Posttraumaticseizures)是脑损伤后常见的一种并发症 ,它可导致严重后果 ,尤其在术后早期 ,常加重脑水肿 ,脑损伤 ,使病情恶化 ,影响预后。按其发作可分为早期 ,即发生在伤后 7d内 ,发生在伤后 7d以后即为晚期[1] 。本文分析我院 1995年 5月～ 2 0 0 1年 5月收治的 2 86例颅脑损伤开颅术后患者 ,术后早期癫痫发作 79例。就其临床特点 ,影响发病因素进行探讨。1　资料和方法1 1　一般资料　颅脑损伤开颅术患者 2 86例 ,男 189例 ,女97例 ,年龄 4～ 76岁。平均 32 .4岁 ,车祸伤 2 39例 ,坠落伤 4 7例 ,其中开放伤 38例。幕上损伤…     

脑电图监测对重型颅脑损伤后癫痫的诊断价值

目的：探讨重型颅脑损伤后早期癫痫的发生率及预防治疗。方法对６７例重型颅脑损伤病人入ＩＣＵ后立即行连续脑电图监测至伤后７天。结果１６例经脑电图确诊为外伤性早期癫痫,诊断率为２３．８８％。临床观察到６例有癫痫发作,其中２例脑电图先出现癫痫波形,而后出现临床癫痫发作,临床诊断率为９．００％,结论对重型颅脑损伤病人行连续脑电图监测可大大提高早期癫痫的诊断率。脑电图显示有癫痫波型者,应预防应用抗癫痫药,以防     

视屏重放式携带式脑电图监测系统

英国牛津Park儿童医院设有英格兰国家儿童癫痫中心.该中心收治各年龄组的各种癫痫病的儿童.如癫痫发作控制不良,还有与该病和其治疗有关的教育或行为问题.脑电图(EEG)当然是对这些儿童进行基础研究的重要组成部分.但是常规EEG检查难以发现由于精神和环境因素而诱发的癫痫,特别是对在家庭或学校出现细微的非痉挛性发作行为改变.多年来,为了解决上述诊断上的问题而使用了遥测EEG检查.但传递范围有限,不能对于在家庭和学校的儿童进行调查.近年来蒙特利尔神经病学研究所(Ives.1976)和在Bethesda的国立神经病学、语言障碍与卒中研究所(NINCDS)(Sato et al.1976)研制出携带式小盒式监测系统.能连续记录脑电图数小时甚至数天.能在各种实际生活状态中作良好的记录,并能快速重放.为了更有效而省时地进     

无菌性脑膜炎急性期继发癫痫的特点及危险因素

目的分析无菌性脑膜炎急性期继发癫痫发作的临床特点和危险因素。方法回顾性分析资料完整的急性无菌性脑炎患者138例，其中脑膜炎后癫痫患者21例，无癫痫发作者117例，系同期住院患者。病例和对照采用统一的调查表，用Microsoft Access2002建立数据库，共51个主项内容，部分主项有下属分项。总结癫痫发作的临床特点，对研究资料进行单因素分析和多因素非条件Logistic回归分析。结果全面发作14例（66．7％）。发病2周内出现抽搐者17例（81．0％）。经分析筛选出脑脊液蛋白含量升高、颅内压升高、脑电图低波幅3个因素为脑膜炎后继发癫痫的独立危险因素。结论无菌性脑膜炎后急性期癫痫以全面发作为主，多发生在发病2周内。脑脊液蛋白含量、颅内压升高和脑电图低波幅是癫痫发作的独立危险因素。     

癫痫持续状态126例临床分析

自 198 7年～ 1999年 12月共接收癫痫住院病人 5 48例 ,其中持续状态 12 6例 ,占 2 3%。现将此 12 6例 15 0例次癫痫持续状态分析如下。1　临床资料和方法本组 12 6例 ,男性 74例 (5 8 7% ) ,女性 5 2例 (4 1 3% ) ,男 :女为 1 42 :1。发病年龄 2～ 18岁 ,平均 33岁。发生癫痫持续状态共 15 0例次。其中一次者 6 4例 ,二次以上者 6 2例 ,有 8例在 10～ 15年间发作 5次癫痫持续状态。持续时间最短者 1小时 ,最长者 15天。本组 12 6例病人发作癫痫持续状态 15 0例次 ,其中全面发作强直—阵挛者 78例(5 2 2 % )部分感觉发作 12例 (7% ) ,复杂…     

46例癫痫患者发作间期~(18)F-FDG PET显像结果分析

目的　探讨18F 脱氧葡萄糖 (FDG)PET对发作间期癫痫灶的诊断价值。方法　 4 6例癫痫患者于发作间期进行CT和 (或 )MRI、头皮EEG及18F FDGPET检查。结果　 4 6例患者中 86 95 %(40例 )PET显像有异常代谢灶 ,其中低代谢灶 3 1例 ,高代谢灶 9例。而CT和 (或 )MRI仅 5 6 5 2 % (2 6例 )异常 ,EEG 82 60 % (3 8例 )异常。 9例示局限性高代谢区患者 1周后在确认检查前后 12h均未发作的前提下再次行PET检查 ,结果发现其中 7例同一部位出现低代谢区 ,另 2例代谢也有所降低。结论　18F FDGPET对发作间期癫痫灶的诊断价值明显优于CT和 (或 )MRI和头皮EEG ,尤其在发作间期和发作期各检查 1次 ,或延长发作后检查时间 ,可提高灵敏度和特异性及诊断准确性。     

癫痫的X刀治疗

目的 探讨X刀治疗继发性癫痫(SEp)和原发性颞叶癫痫(ITLEp)的方法。方法 使用24hEEG、CT、MRI对继发性癫痫灶定位，应用X刀损毁致痫灶治疗SEp40例；毁损剂量20～30Gy。应用X刀毁损杏仁核治疗ITLEp病人30例；毁损剂量140Gy；准直仪7～10mm；采用140Gy一次和分两次毁损治疗(每次间隔24h)。结果 40例SEp病人和30例ITLEp病人X刀治疗后4～24个月随访：50例病人癫痫发作完全停止(SEp32例，ITLEp18例)；20例病人发作减少50％以上；无并发症发生。结论 应用X刀毁损SEp致痫灶及杏仁核，可安全有效地治疗SEp和ITLEp。     

24 h动态脑电图对儿童癫痫的诊断价值

目的：比较动态脑电图（AEEG）与普通脑电图（EEG）在诊断癫痫中的作用和价值.方法：将178例患儿分成癫痫组（134例）与发作性疾病组（44例）,所有患儿均先做EEG后再做AEEG.在做AEEG期间,让家属详细记录患儿24 h的各项活动、睡眠时间、临床症状的表现时间;通过回放24 h脑电记录,分析各种状态下脑电图;比较AEEG和EEG在癫痫组的阳性率.结果：AEEG出现痫性痫样放电几率明显高于EEG;痫样放电在清醒和睡眠状态下有显著差异P＜0.01.结论：AEEG作为长程EEG监测对小儿癫痫的诊断和鉴别诊断起着重要作用,对癫痫的临床分型、指导用药有一定的价值.     

动态脑电图监测对脑损伤后早期癫痫诊疗的意义

脑电图(EEG)作为脑功能直接的反映,能客观敏锐地窥知脑的功能状态.脑电图监测具有无创、安全、便捷及可动态监测等优点,易于推广应用,脑电图在临床上的应用越来越广,尤其在癫痫的辅助诊断方法中,脑电图是最重要、最有价值和最方便的手段之一.笔者通过对142例急性颅脑创伤(TBI)患者的诊治和随访,探讨动态脑电图监测在急性颅脑创伤患者伤后癫痫诊断和治疗的应用价值.     

中青年与老年人群脑叶出血特点分析(附620例报告)

目的探讨脑叶出血患者的临床特点,并分析中青年与老年人群脑叶出血的病因、临床表现及预后。方法收集解放军总医院神经内科连续收治的620例自发性脑出血患者,记录以下指标:性别,年龄,危险因素,病因,发病早期伴随症状,Glasgow昏迷量表评分和神经功能缺损评分,出血部位和出血量,住院期间并发症和治疗结果。将患者分为脑叶出血组(n=73)与非脑叶出血组(n=547),比较两组各指标的差异。在脑叶出血患者中,以60岁为界分为中青年(<60岁)组(n=27)和老年(≥60岁)组(n=46),比较两组各指标的差异。结果脑叶出血组与非脑叶出血组患者的性别构成无统计学差异。脑叶出血在各年龄段脑出血患者中所占比例呈U形分布,30岁以下及90岁以上比例最高,60至69岁比例最低。出血部位以顶叶最多见。与非脑叶出血组比较,脑叶出血组有高血压病史者较少,癫痫发生率较高,两组病损程度和治疗结果无统计学差异。在脑叶出血患者中,中青年组和老年组的病因均以高血压为最多,但中青年组的病因种类较多,脑淀粉样血管病引起的脑叶出血只见于老年组。中青年组癫痫发作(18.5%)和意识状态完全正常(GCS=15分)的患者比例(55.6%)高于老年组(分别为...     

Das Schädel-Hirn-Trauma des Kindes

Our contribution reviews the diagnostic algorithm of head injuries in children. According to the Heidelberg consensus on head injury, patients should be divided into three risk groups. In low-risk patients clinical observation is the method of choice and radiological examinations are usually unnecessary. Patients at medium risk should be observed carefully. Sometimes neurosurgical consultation or CT is necessary. High risk patients in most instances need CT and neurosurgical consultation. Skull X-ray is helpful only in selected cases. A simple fracture as demonstrated by skull X-ray has no therapeutic consequence. However, normal findings in skull X-ray do not exclude intracranial injury. CT is the method of choice to detect intracranial hemorrhage, epi- or subdural hematoma and cerebral contusion. If patients present with severe clinical deficits, CT allows characterization of lesions and initiation of specific therapy.     

Complications of missile craniocerebral injuries during the Croatian Homeland War

OBJECTIVE: Complications of penetrating craniocerebral injuries in war can be early (during the first week after wounding) or late (after that period). Postoperative hematomas, infections, seizures, and cerebrospinal fluid fistulas (CSFFs) are counted among the early complications, whereas foreign bodies migrating intracranially, seizures, infections, and posttraumatic hydrocephalus represent late complications. A total of 176 patients with well-defined head injuries from missiles, sustained during the Croatian Homeland War (1991-1995), developed a total of 61 (34.5%) complications. METHODS: A retrospective statistical analysis of the medical records of the patients in our series was performed to determine the risk factors for the onset of complications, which have unfavorable effects on outcomes. RESULTS: There were a total of 28 (15.9%) infections (deep or superficial), 21 (11.9%) cases of CSFFs, 9 (5.11%) cases of early epilepsy, and 3 cases of post-traumatic hydrocephalus. A total of 47.6% of patients with CSFFs developed intracranial infections. Of eight patients with meningoencephalitis, five had CSFFs and four had intracranially retained foreign bodies. Only one patient developed a cerebral abscess. Two patients died because of infectious complications (13.3%). Post-traumatic hydrocephalus (1.7%) required shunt placement. For 60% of patients with deep-seated intracranial infectious complications and 76% of patients with CSFFs, reoperations had to be performed, whereas this was the case for only 8% of patients without infections (chi2 = 43.6, p = 0.00001). CONCLUSIONS: Intracranially retained foreign bodies, wound age, wound site, and operations performed outside the neurosurgical services were the main risk factors for the development of complications. Complications themselves exerted a very unfavorable influence on outcomes. The development of complications reflects very reliably the neurosurgical technique applied.     

颅脑损伤术后脑积水危险因素的探讨

目的探讨颅脑损伤术后发生脑积水的危险因素及预防策略。方法回顾2008年10月～2010年3月间收治的312例开颅手术的颅脑损伤患者临床资料,按有、无脑积水分组,对照分析性别、年龄、GCS评分、脑疝、脑挫裂伤及梗死体积、蛛网膜下腔出血、血肿位置、伤后手术时间、术后颅内压等对脑积水发生的影响。结果 312例中发生脑积水31例,未发生脑积水281例。通过χ2检验、Fish确切检验单因素分析发现并发脑积水的影响因素为:患者年龄、入院GCS评分、脑疝、脑组织挫裂伤及梗死体积、血肿位置、弥漫性蛛网膜下腔出血、术后颅内压,而与性别、伤后至第一次手术时间无关。Logistic回归分析上述影响因素发现,脑疝、脑组织挫裂伤及梗死体积、蛛网膜下腔出血与术后脑积水密切相关,而GCS评分、血肿位置、颅内压与术后脑积水相关无统计学意义。结论脑疝、脑组织挫裂伤及梗死体积、弥漫性蛛网膜下腔出血是颅脑损伤术后发生脑积水的主要危险因素,争取脑疝形成前手术、改善手术技巧、引流血性脑脊液可能减少脑积水发生率。     

格拉斯哥记分3～5颅脑创伤的临床救治及探讨

目的：探讨特重型（CCS3～5）颅脑伤患者的救治策略，并分析相关因素。方法：对156例患者进行综合治疗，注重伤后救治的连续性、各个治疗环节的衔接、以及并发症防治。强凋早期足量应用甘露醇和手术指征的选择。结果：死亡率为42．3％（66／156）。存活患者按COS评分，恢复良好13例（14．4％）。中度残废32例（35．6％），重度残废40例（44．4％），持续植物生存5例（5．6％）。结论：严格按照综合治疗原则实施，可在一定程度上降低特重型颅脑损伤的死亡率。     

Frontal sinus fractures: evaluation of CT scans in 132 patients.

PURPOSE: To determine the frequency of detection of frontal sinus fractures on initial CT scans of patients with intracranial injuries, and to characterize associated injuries. METHODS: The initial head CT scans in 132 patients with clinical or radiographic evidence of a frontal sinus fracture were retrospectively reviewed to further characterize the fracture. Additional radiographic studies and medical records were reviewed to determine associated injuries, therapy, clinical outcome, and complications. RESULTS: In 90% (124) of the patients, the frontal sinus fractures were visualized on initial head CT scans that were obtained to evaluate suspected intracranial injury. Complex fractures involving both the anterior and posterior wall of the sinus accounted for 65% of cases (86 patients), whereas fractures of the anterior wall only or posterior wall only occurred in 24% (32) and 11% (14) of patients, respectively. Significant intracranial hemorrhage occurred in over 90% of patients with fractures involving the posterior wall. CONCLUSIONS: In general, fractures that involved the posterior wall had more complications and a worse clinical outcome than fractures that only involved the anterior wall; nearly all frontal sinus fractures can be detected on head CT studies in patients with intracranial injuries.     

Cranial trauma: the predictability of the presentation symptoms as a screening for radiologic study]

A prospective study was performed on 4,262 consecutive patients who had had skull examinations for recent head trauma. Clinical signs and symptoms and patient history were correlated with skull fractures and intracranial sequelae as identified on CT studies, in order to evaluate the predictive value of each clinical finding and to identify high-yield referral criteria. Ninety-seven skull fractures (3%) and 32 intracranial sequelae (0.7%) were observed. All the intracranial complications were observed in patients with fractures and with altered consciousness of some degrees (Glasgow Coma Scale score less than 13). Most patients were asymptomatic (41%) or showed "low risk" symptoms (29%): among them, neither fractures nor complications were observed. High-risk clinical signs, mainly expressing basilar fractures (as rhinorrhea, otorrhea, focal neurologic signs, retroauricular hematoma) demonstrated high predictive value (100%) for intracranial sequelae. Other "moderate risk" findings for intracranial injury--i.e. loss of consciousness at any time, antegrade or retrograde amnesia, multiple trauma, and possible skull penetration--showed a high correlation with skull fractures and a slightly lower one with intracranial sequelae. The most predictive finding for brain injury was the depressed level of consciousness: brain injuries were never observed in fully conscious patients; in altered consciousness with GCS 15-13 we observed 4% of skull fractures with no sequelae; at GCS values 12-9, 61% of skull fractures and 20% of sequelae were present, whereas at GCS less than 8, 100% of complicated fracture were observed. The finding of skull fracture showed 33% of predictivity for brain damage, which was, however, always associated with "high or moderate risk" clinical signs. Therefore, the authors suggest some guidelines for the management of patients with recent head trauma, including referral criteria for X-rays or CT studies, based on signs and symptoms with high, intermediate and low risk of developing intracranial sequelae.     

自发性颅内出血死亡的多因素回归分析

 目的 探讨自发性颅内出血(spontaneous intracerebral hemorrhage, SIH)患者30 d内死亡的危险因素。方法 回顾性分析2012-01至2016-01医院收治的SIH患者324例。30 d内死亡82例,为死亡组,其余242例存活患者为存活组,统计分析两组患者入院时主要临床特征。单因素和多因素logistic回归分析显示格拉斯哥昏迷评分降低、糖尿病、小脑出血、出血量增加和脑室出血等死亡的危险因素。结果 与存活组比较,死亡组年龄显著偏大[(54.38±12.47)岁 vs (51.73±11.94)岁, P=0.028];高血压病显著增加(68.29% vs 55.79%, P=0.047),;糖尿病显著增加(46.34% vs 27.69%, P=0.002);吸烟率显著增加(35.37% vs 21.07%, P=0.009);小脑出血率显著增高(20.73% vs 8.68%, P=0.003);脑室出血率显著增高(74.39% vs 54.96%, P=0.002);手术率显著降低(20.73% vs 37.19%, P=0.006);出血量显著增多[(110.98±36.96)ml vs (77.04±31.81)ml, t=4.922, P=0.000];格拉斯哥昏迷评分显著降低(7.52±2.70 vs 9.54±2.06,t=4.207, P=0.000)。结论 格拉斯哥昏迷评分降低、糖尿病、小脑出血、出血量增加和脑室出血是SIH患者30 d内死亡的危险因素。
     

132例颅脑损伤死亡病例临床分析

目的　总结颅脑创伤死亡病例的特点及相应的救治经验。方法　对 1 32例死亡病例的一般资料、临床表现、死亡时间及原因分别进行分析。结果　颅脑损伤的主要死亡原因是严重的脑损伤及颅内血肿、各种原因的延误及严重的并发症等。但分析伤后不同时期死亡原因有显著差别 ,据此将颅脑损伤死亡时间划分为 3个时期 (急性期、过渡期、衰竭期 )。结论　组织院前急救、尽早发现并清除颅内血肿、防治并发症及营养支持是降低颅脑创伤病死率的主要措施