基底神经节区梗死后失写症的神经心理学分析

目的:研究基底神经节(BG)区梗死所致汉语失写症的神经心理学特点.方法:采用汉语失写检查法(CAB)测试40例BG区梗死患者的书写能力,计算各项书写得分和失写指数.对失写组和非失写组头颅CT或MRI进行标准化处理,显示病灶并进行二维平面叠加,直观显示其病灶的集中趋势.结果:在40例患者中,左侧BG区损害21例,失写17例;右侧损害19例,失写4例.神经影像学二维叠加显示,BG区梗死致失写的病灶多位于左侧BG区,包括左侧壳核、尾状核头部和尾状核体;而较少位于右侧壳核和右侧尾状核体.BG区梗死所致失写以失语性失写为主,其特点为构字障碍、字词错写和语法错误.结论:BG区梗死可导致失语性失写症,提示BG参与了书写加工过程,是书写这一高级神经功能的皮质下中枢.     

基底节病变患者失语和失写一例

基底节病变患者失语和失写一例林晓东脑皮质下病变引起的言语障碍已有较多报道，认为皮质下结构在言语机能系统中具有重要作用。笔者报道１例因左侧壳核梗塞引起的失语并伴有严重的失写症。患者男性，６９岁，会计，汉族，初中文化，右利。入院前半个月休息时突发头晕，右...     

卒中后抑郁症的发病与病变部位的关系

最有影响、最富有创造性的卒中后抑郁症(PSD)研究者Robinson领导的小组提出这样一种观点:大脑损害的部位是决定卒中患者是否发生抑郁症最重要的因素,并认为重性和轻度抑郁症发生率高与下列部位有关:(1)左半球损害,而不是右半球;(2)左前皮质损害,而不是左后皮质;(3)左前半球损害,而不是右前半球;(4)与其他部位脑损害相比,左前半球皮质或皮质下损害,至少累及左额背外侧,而不是左后皮质、右侧皮质及右侧基底节。本文应用传统的神经病学与放射学脑损害的定位方法,对首次卒中脑血管损害部位与4个月后发生PSD的关系进行探讨。     

脑梗死后运动性失语的局部脑功能活动强度研究

目的利用静息态功能磁共振成像(fMRI)分析脑梗死后运动性失语患者脑功能区域活动强度的变化。方法选择急性缺血性脑卒中后运动性失语患者14例作为病例组,同期健康体检者16例作为对照组,2组采用汉语失语成套测验进行言语行为学测试,计算失语指数(AQ)评分,之后行静息态fMRI检查,记录低频波动振幅(ALFF),以全脑标准化的ALFF(mALFF)用于分析,采用REST软件进行统计分析。结果与对照组比较,病例组左侧小脑半球、右侧颞上回、右侧颞中回、右侧丘脑、右侧海马旁回、右侧中央前回、左侧额中回mALFF值明显增高(P<0.05);左侧中央前回、左侧内侧颞上回、右侧颞极mALFF值明显降低(P<0.05)。病例组所有患者左侧内侧额上回的mALFF值在-0.75~0.83,AQ评分在17~64分,且mALFF值与AQ评分呈正相关(r=0.590,P=0.026)。结论静息状态下,脑梗死后运动性失语患者某些脑区异常激活,为此类患者的诊治提供了思路。     

失语和忽视的恢复

约1／3急性卒中病人会出现失语,失语的恢复受恢复时间、生物学因素、语言和病灶因素的影响。此外,言语治疗和药物治疗对失语的恢复也有一定的促进作用。忽视是一种特殊的注意障碍,约占急性卒中的25％,忽视的恢复受病灶因素、病因、部位、大小和半球以及半球间功能重组的影响,认知康复治疗和部分药物对其恢复有一定的促进作用。     

失语和忽视的恢复

约 1/ 3急性卒中病人会出现失语 ,失语的恢复受恢复时间、生物学因素、语言和病灶因素的影响。此外 ,言语治疗和药物治疗对失语的恢复也有一定的促进作用。忽视是一种特殊的注意障碍 ,约占急性卒中的 2 5 % ,忽视的恢复受病灶因素、病因、部位、大小和半球以及半球间功能重组的影响 ,认知康复治疗和部分药物对其恢复有一定的促进作用。     

缺血性卒中后非流利型失语患者局部一致性变化：静息态功能性磁共振成像研究

目的 探讨缺血性卒中后非流利性失语患者静息态功能磁共振成像（functionalmagnetic resonance imaging fMRI）的脑功能特点.方法 对17例缺血性卒中后非流利性失语患者以及19名年龄、性别和受教育程度均匹配的健康对照者进行静息态fMRI检查,采用局部区域一致性（regional homogeneity,ReHo）分析方法计算静息态下脑区的ReHo情况.结果 与对照组比较,患者组左侧额上回、右侧额下回、右侧脑岛以及右侧缘上回ReHo值增高,右侧小脑半球、左侧颞上回、颞中回以及右侧颞下回脑区ReHo值降低.结论 在静息状态下,缺血性卒中后非流利性失语患者存在多个脑区ReHo异常,这种异常改变可能与其功能损伤后修复的代偿作用有关.     

左侧颈动脉与右侧颈动脉粥样硬化及脑卒中严重程度比较分析

目的 探讨颈动脉粥样硬化和脑卒中的严重程度及其发生率在左侧与右侧大脑半球的差异.方法 选取2020年1～10月北大医疗鲁中医院神经内科收治的脑卒中患者707例,其中脑出血121例,脑梗死586例.依据病灶部位将脑出血患者分为左侧半球6 2例,右侧半球5 9例;脑梗死患者分为左侧半球脑梗死患者3 6 9例,右侧半球386...     

肝细粒棘球蚴病下腔静脉 肝静脉CT成像的评估价值

目的 探讨使用CT成像评估肝细粒棘球蚴病病灶与下腔静脉、肝静脉关系的准确性。 方法 100例肝细粒棘球蚴病患者行腹部CT三期扫描,得到下腔静脉、肝静脉三维重建图像,观察棘球蚴病病变与下腔静脉、肝静脉的关系,将结果与术中结果对比,分析使用CT成像评估肝细粒棘球蚴病病灶侵犯下腔静脉、肝静脉的可靠性。结果 CT成像评估血管推移、伴抱球征、界限不清楚、血管狭窄等与术中所见一致。有4例患者CT成像判断为病灶与下腔静脉界限清楚,而术中示病灶与血管有一定黏连。对于有血管狭窄判断为受侵犯的结果中,有3例为过度诊断。结论 肝静脉、下腔静脉CT成像能清晰显示肝棘球蚴囊肿与肝静脉、下腔静脉的空间位置关系。     

头针围刺法配合体针治疗脑血管意外后遗症

本组男29例,女21例;年龄30～72岁。病程半个月～1年。完全性瘫痪21例,不完全性瘫痪29例。其中伴完全性失语8例,言语不清、口角歪斜、舌体发麻35例,头晕站立不稳、平衡失调7例。 治疗方法:患者取坐位或平卧位,消毒后取病灶所在的部位周圈(直径可根据病灶大小决定)进行围刺,针尖方向均向病灶中心斜刺,一般用1.5     

原发性进行性失语的磁共振研究(附一例病例分析)

目的报道1例原发性进行性失语患者的脑内影像学特点,以探讨原发性进行性失语患者常见的病变部位,脑内血流量、代谢及语言功能区之间联系纤维的变化。方法利用西门子3.0T磁共振仪对1例确诊失语类型为感觉性失语的原发性进行性失语患者进行(1)常规磁共振;(2)磁共振灌注成像;(3)磁共振波谱分析;(4)磁共振扩散张量成像分析。结果常规磁共振成像显示左侧额叶及颞叶萎缩,功能磁共振显示左侧颞叶和额叶前部代谢较对侧明显减低,左侧颞极及额前部的血流量较对侧减低;左侧皮质脊髓束部分各向异性值及追踪到的纤维束较对侧减少,Broca区与Wernicke区之间的联系纤维与对侧相比减少。结论原发性进行性失语病变的部位主要在左侧颞叶、额叶,与对侧相应区域对比呈现低灌注、低代谢状态,Broca区与Wernicke联系纤维减少。     

General and specific brain regions involved in encoding and retrieval of events: what, where, and when.

Remembering an event involves not only what happened, but also where and when it occurred. We measured regional cerebral blood flow by positron emission tomography during initial encoding and subsequent retrieval of item, location, and time information. Multivariate image analysis showed that left frontal brain regions were always activated during encoding, and right superior frontal regions were always activated at retrieval. Pairwise image subtraction analyses revealed information-specific activations at (i) encoding, item information in left hippocampal, location information in right parietal, and time information in left fusiform regions; and (ii) retrieval, item in right inferior frontal and temporal, location in left frontal, and time in anterior cingulate cortices. These results point to the existence of general encoding and retrieval networks of episodic memory whose operations are augmented by unique brain areas recruited for processing specific aspects of remembered events.     

Nouns and verbs are retrieved with differently distributed neural systems.

In a task designed to elicit the production of verbs, the patients known as AN-1033 and Boswell consistently produced the correct target words, performing no differently from normal controls. However, in a similar task designed to elicit the production of nouns, both patients performed quite defectively, and their scores were many SDs below those of controls. Language processing was otherwise normal--i.e., there were no impairments in grammar, morphology, phonetic implementation, or prosody; reading and writing were normal. In a third patient (KJ-1360), we obtained the reverse outcome--i.e., retrieval of common and proper nouns was preserved, but verb retrieval was defective. Together, the findings in the three patients constitute a double dissociation between noun and verb retrieval. In AN-1033 and Boswell, the lesions are located outside the so-called language areas (left frontoparietal operculum, posterior temporal region, inferior parietal lobule), where damage is associated with aphasia. The region of damage shared by the two patients is in left anterior and middle temporal lobe. This sector of left hemisphere contains systems for the retrieval of nouns that denote concrete entities. We propose that those systems are not essential for the retrieval of verbs and not involved in the vocal implementation of word forms. Those systems perform a two-way lexical-mediation role for concrete nouns and promote the reconstruction of a word form after the processing of sensory-motor characteristics of the entity denoted by that word. The findings in patient KJ-1360, whose lesion is in left premotor cortex, suggest that equivalent mediation systems for verbs are located in the left frontal region.     

Frontal Assessment Battery and brain perfusion images in amnestic mild cognitive impairment

Aim: Some patients with mild cognitive impairment (MCI) may have impaired frontal lobe function. To assess the frontal lobe functions of subjects with MCI using the Frontal Assessment Battery (FAB) and to identify the brain regions responsible for FAB performance. Methods: Based on the FAB score cut‐off of 12/13, 38 MCI subjects were divided into a high FAB group (n = 20) and a low FAB group (n = 18). They underwent single photon emission computed tomography (SPECT) and we analyzed the data by the 3‐D stereotactic surface projection method. Results: No significant differences in neuropsychological tests including memory, language and praxis, and depression scores were found between high and low FAB groups. Although both groups showed decreases in the regional cerebral blood flow (rCBF) of the parietotemporal and frontal regions, the low FAB group demonstrated significant decreases in the rCBF of the left lateral frontal and right medial frontal regions compared with the high FAB group. Conclusion: Our results indicate that some patients with amnestic MCI have frontal lobe dysfunction, assessed by the FAB. SPECT study suggests that the FAB mainly reflects the function of some regions of the left lateral frontal and right medial frontal areas. Geriatr Gerontol Int 2011; 11: 77–82.     

Selective atrophy of left hemisphere and frontal lobe of the brain in old men

In this study, volumes of the whole brain, hemispheres, and frontal lobes of young and elderly adults were quantified by an automated method. Effects of age, sex, and side on absolute and relative volumes of the brain structures were evaluated. Compared with the young group, elderly participants showed a 15% volume loss in the whole brain and hemispheres, and a 22% volume loss in the frontal lobes. The relative volume of the left hemisphere in the elderly group decreased more than that of the right hemisphere. Elderly men showed significantly greater left hemisphere and left frontal lobe volume losses than did elderly women, indicating that the larger left hemisphere relative volume reduction is largely contributed to by selective atrophy of the left frontal lobe volume in elderly men. These results may reflect age- and sex-related functional deterioration in the left brain.     

血管性痴呆的扩散张量成像研究

目的应用扩散张量成像(DTI)技术,探讨皮质下缺血性血管性痴呆(SIVD)患者脑白质变化的特点及不同脑区DTI参数改变与认知的关系。方法对34例SIVD患者(SIVD组)及26例健康老年人(对照组)行DTI扫描,测量双侧前额叶、额叶深部、眶额内侧、下额叶、颞叶、顶叶、枕叶白质及T_2WI高信号区、T_2WI高信号周围正常白质区的分量各向异性(FA)、主各向异性(PA)及表观弥散系数(ADC)值。结果对照组左侧前额叶白质PA值大于右侧,ADC值小于右侧。SIVD组双侧前额叶、双侧额叶深部、下额叶、眶额内侧的FA值及PA值明显下降,平均ADC值升高;双侧顶叶的FA值下降,平均ADC值升高;双侧颞叶、枕叶平均ADC值升高;左侧下额叶、眶额内侧白质的FA与PA值较右侧小;左侧下额叶ADC值较右侧大。病变区及病变周围区的FA和PA值小于正常区,ADC值大于正常区。前额叶FA与简易智能状态检查表评分呈正相关。结论 SIVD患者脑白质FA、PA和ADC改变具有区域选择性,前部及左侧脑区损伤明显,后部及右侧相对保留白质的完整性。DTI是研究SIVD脑白质损伤的一种理想的方法。     

CT血管成像与图像融合在颅内静脉畸形诊断中的应用

目的探讨使用螺旋CT在脑血管动脉期和静脉期扫描与图像融合技术在颅内静脉畸形（intracranial venous malformation，IVM）中的诊断价值。方法采用8排螺旋CT进行头部螺旋容积扫描，层厚1．25mm，间隔0．625mm，管电压120kV，管电流120～150mA。经静脉注射非离子型对比剂（碘帕醇，碘含量370mg／m1），注射速度为3．5～4．0ml／s，总量为80～100ml；动脉期延迟时间18～22S，静脉期延迟时间33～39S。分析10例IVM的CT平扫、动脉期、静脉期的影像表现，利用“血管生长（add vessel）”法及电子切割法对图像进行处理，采用多平面体积重组、容积重建及图像融合技术对IVM进行三维重建。结果10例IVM患者中，单发7例，多发3例。IVM位于小脑半球6例，其中3例5处引流至一侧横窦，2例3处分别引流至岩下窦及大脑大静脉，1例引流至直窦；IVM位于额叶和颞叶各1例，引流静脉汇入大脑内静脉和岩上窦；IVM位于基底核2例，引流静脉经大脑大静脉引入直窦及窦汇。CT平扫：2例患者表现为条状、点状的略高密度影，3例患者伴发小脑出血，5例患者CT平扫未发现明显异常。动脉期：8例IVM的髓静脉及“中央静脉”密度淡薄，2例几乎看不到病灶，10例的影像学结果均未显示IVM的引流静脉“海蛇头”特征。静脉期：2．例因引流静脉的走行和扫描平面关系，“海蛇头”征显示不明显，另8例不仅清晰显示病灶，而且还显示病灶的“海蛇头”特征。采用容积重建、图像融合技术，均可清晰完整地显示颅内静脉畸形的组成及引流静脉全程的三维影像。结论多排螺旋CT在诊断IVM中，脑静脉期血管成像优于动脉期，而静脉系统与病灶容积重建、图像的融合，是显示IVM的有效重建方法。     

Rheumatoid leptomeningitis: rare complication of rheumatoid arthritis

Rheumatoid leptomeningitis is a rare complication of rheumatoid arthritis (RA). We describe a woman with rheumatoid leptomeningitis presenting with acute-onset behavioral changes and consciousness disturbance in the early stage of RA. On fluid-attenuated inversion recovery images or diffusion-weighted images, high-signal-intensity lesions in the subarachnoid spaces of the right frontal lobe were observed. Biopsies of brain tissues and the dura mater located in the right frontal lobe were obtained. On the basis of the findings of histopathological analysis, a diagnosis of necrotizing granulomas involving the leptomeninges consistent with rheumatoid leptomeningitis was made. An early diagnosis of rheumatoid leptomeningitis and immediate initiation of treatment may prevent neurological sequelae.