A sudden bilateral hearing loss caused by inner ear hemorrhage

IntroductionLabyrinthine hemorrhage is a rare cause of sudden deafness and generally concerns only on one side.Case summaryAn 84-year-old man with a past medical history of myelomonocytic chronic leukemia (CMML) suffered from sudden bilateral hearing loss associated with vertigo. The audiogram revealed a left cophosis and a right profound deafness. Videonystagmography showed a left vestibular deficit. The MRI showed a spontaneous strong T1 weighted signal in the left and right labyrinths, corresponding to a bilateral inner ear hemorrhage (IEH). Dizziness resolved rapidly following vestibular physiotherapy, in contrast to hearing which did not improve at all and let the patient isolated in his environment. The patient successfully underwent cochlear implantation so that he could communicate.DiscussionMost IEHs are unilateral and due to anticoagulants treatments and hematological diseases. Only rare cases have described bilateral labyrinth hemorrhage. This is the first case reported of bilateral labyrinth hemorrhage due to CMML.     

脑岀血急性期患者血糖水平与预后临床分析

目的探讨脑出血患者急性期血糖水平与预后的关系。方法采用前瞻性队列研究方法连续登记2010-01—2012-02入住我科脑岀血患者,所有患者入院时行GCS评分及测定出血量,并连续检测入院时及7d内血糖水平,依据平均血糖水平分为4组,采用美国国立卫生院神经功能缺损评分量表(NIHSS)及改良Rankin量表评分(MRS)对患者入院时及1个月后进行评价,并对数据进行分析。结果不同组别之间出血量、GCS评分差异无统计学意义(P>0.05),但1个月后MRS和NIHSS评分改善比较差异有统计学意义(P<0.05),7.8～11.1mmol/L、>11.1mmol/L 2组预后差。结论脑出血患者发病后血糖水平不能反映病情严重程度,但可反映预后转归情况。     

大块脑梗塞中出血性梗塞的病理特点

报告２４例大块脑梗塞的脑局解病例，对其中１６例ＨＩ的病理特点及发生机制进行探讨。结果证实：ＨＩ占本组大块脑梗塞的发生率为７１．４％，脑血栓ＨＩ的发生率为６０％。ＨＩ多发生在梗塞灶的边缘区及皮质区，以小静脉和毛细血管出血为主。ＨＩ的发生与梗塞的体积及动脉血压增高有关。其发生机制可能是周边区或皮质区侧枝循环建立和脑水肿导致静脉回流障碍，血液淤滞所致。本文还证实溶栓治疗与其它治疗比较并未见出血扩大。     

脑出血患者血肿周围水肿形成机制:脑内细胞因子的作用

目的 :探讨脑出血患者脑内炎性细胞因子与血肿周围水肿的形成是否相关。方法 :32例脑出血患者行血肿清除术后 ,留取脑血肿液 ,放免法测定其中肿瘤坏死因子α(TNFα)和白细胞介素 - 6 (IL - 6 )的含量 ,测量术前检查的头 CT上的血肿周围水肿带大小 ,用 SPSS10 0对两者进行相关分析。结果 :脑出血患者脑血肿液中 IL - 6和 TNFα的含量明显高于正常人溶血血清中的含量 (P<0 .0 1) ;脑血肿液中 TNFα和 IL - 6含量与血肿周围水肿带大小呈正相关 (r TNF=0 .5 39,P<0 .0 1;r IL- 6 =0 .5 6 9,P<0 .0 1)。结论 :脑出血患者急性期脑血肿液中 IL - 6和 TNFα含量升高 ;脑内炎性细胞因子可能参与血肿周围水肿的形成     

高血压性脑出血破入脑室的CT和预后

经CT证实的223例高血压性脑出血中,破入脑室者死亡53例,死亡率(48.18％),较未破入脑室者(15.04％)明显为高(P<0.01)。破入脑室组高死亡率是和破入脑室血肿的量、脑室内血肿的分布以及破入途径密切相关。出现高度占位效应、破入脑室的积血量超过20ml、脑室出血呈Ⅳ或Ⅴ型分布则预后极差。     

自发性蛛网膜下腔出血MSCTA检查的临床价值

目的 探讨多层螺旋CT血管造影(MSCTA)对自发性蛛网膜下腔出血病因诊断的临床价值。方法 经CT平扫诊断为自发性蛛网膜下腔出血39例，进行MSCTA检查及三维图像后处理，并均与DSA检查对照，适合介人治疗的病例，进行介人栓塞治疗。结果 全部39例自发性蛛网膜下腔出血的病例共检查出动脉瘤23例，脑动静脉畸形1例，脑动脉硬化1例，未见异常14例。其中颈内动脉动脉瘤5例，前交通动脉动脉瘤7例，大脑中动脉动脉瘤5例，大脑前动脉动脉瘤1例，基底动脉动脉瘤1例，椎动脉动脉瘤1例，多发动脉瘤1例，23例患者中共检出24个动脉瘤，有1例为2个动脉瘤。脑血管病变的阳性率为64．3％。结论 MSCTA检查是自发性蛛网膜下腔出血病因检查的一种简单、快速、无创及有效的方法。     

An easy-to-use method for detecting fetal hemoglobin--a test to identify bleeding from vasa previa

BACKGROUND: Vasa previa is a rare but potentially dangerous fetal condition that may occur during pregnancy. Ideally, all cases such cases are detected antenatally, but many present as late vaginal hemorrhaging. At the current time, there is no test for fetal hemoglobin (HbF) in general use. METHODS: A modified method of identifying HbF is presented. Five milliliters of 0.14 M NaOH was combined with 50 microl of a mixture of fetal and maternal blood. After 2 min, it was judged if the solution still had a red tone or not. The sensitivity of this method for detecting HbF was assessed. RESULTS: All 15 clinical personnel could identify both 69% and 34% HbF mixed with adult hemoglobin (100% sensitivity), 14 out of 15 could identify 17% HbF (93% sensitivity), and 12 out of 15 could identify a mixture containing 8% HbF (80% sensitivity). CONCLUSION: Our rapid, simple test for HbF was at least as sensitive as slower, more cumbersome alkali denaturation tests in common use. It could prove to be a lifesaving tool in ruling out vasa previa bleeding in cases of unclear late pregnancy hemorrhages.     

经外侧裂-岛叶与经皮质入路血肿清除术治疗高血压性基底节出血的比较

目的 比较经外侧裂-岛叶入路与经皮质入路行血肿清除术治疗高血压性基底节区脑出血的疗效.方法 回顾性纳入经外侧裂-岛叶入路与经皮质入路行血肿清除术治疗高血压性基底节区脑出血患者.比较2组人口统计学和基线资料以及术后3个月时的转归情况(改良Rankin量表评分0～3分为转归良好,≥4分为转归不良)和病死率.结果 共纳入68例(经外侧裂-岛叶入路40例,经皮质入路28例)高血压脑出血患者.2组人口统计学和基线资料均无显著性差异(P均＞0.05).术后3个月时,经外侧裂-岛叶和经皮质入路组转归良好率分别为52.50％(21/40)和21.43％(6/28),前组显著性高于后组(x2=6.642,P=0.010);经外侧裂-岛叶入路组和经皮质入路组病死率分别为2.50％ (1/40)和21.43％(6/28),前组显著性低于后组(Fisher精确检验,P=0.017).结论 高血压性基底节区出血采用经外侧裂-岛叶入路进行血肿清除的临床疗效优于经皮质入路.     

脑小血管病与认知损害

脑小血管病(small vessel disease,SVD)是指累及颅内小动脉、微动脉、前毛细血管和小静脉的疾病,影像学分型主要包括脑白质病变、腔隙性梗死和脑微出血,被认为是认知功能损害或血管性痴呆的独立危险因素.SVD病变部位、数量和体积均会影响认知损害的程度和表现.     

十二指肠球部Dieulafoy病1例

<正>病例:患者男,61岁,因"黑便2 d,呕血伴晕厥2 h"于2012年12月1日就诊于含山县人民医院消化内科。患者2 d前起在无明显诱因的情况下解黑便,约3~5次/d,每次量约100~150 g,粪质稀软,无其他明显不适,误认为系由饮食所致,未作处理。入院前2 h,患者突然呕血2次,总量约600~700 mL,夹杂暗红色血凝块,晕厥2次,伴全身大汗、心悸、头晕、口干以及尿量减少,遂收治入院。患者既往无消化性溃疡史,否认肝炎、肺结核等传染病史,否认外伤、手术史,否认输血史,有少量烟酒嗜好。入院查体:体温36.2℃,脉搏92次/min,呼吸21次/