Analysis of intracranial pressure

Methods for the acquisition and analysis of intracranial pressure (ICP) signals are reviewed from clinical and technical perspectives. The clinical importance of ICP monitoring is presented, and methods for ICP transduction are briefly discussed. These methods include intraventricular catheters, subarachnoid screws, epidural techniques, and the new fiberoptic ICP measurement systems. Approaches to the visual analysis of the ICP waveform are presented, with special emphasis on the relationship between the ICP waveform and the arterial blood pressure signal. Methods of computer-based ICP analysis are also reviewed, including histogram and systems analysis methods. Methods to predict ICP pressure rises and to estimate intracranial compliance are also discussed. Finally, ICP monitoring is reviewed from the point of view of patient outcome. It is concluded that advanced ICP waveform analysis methods warrant further clinical evaluation to demonstrate their clinical usefulness.     

Differentiation of normal pressure hydrocephalus and cerebral atrophy by computed tomography and spinal infusion test

Summary The diagnostic value of computed tomography (CT) and spinal infusion test (SIT) was investigated in 27 patients with normal pressure hydrocephalus (NPH) and 35 patients with cerebral atrophy. The most consistent CT finding of NPH was dilatation of the temporal horns, that of cerebral atrophy widening of the convexity sulci. However, 43% of patients with cerebral atrophy demonstrated no cortical atrophy. The SIT showed an excellent relation with isotope cisternography and continuous intracranial pressure recording. NPH and cerebral atrophy were correctly differentiated in 71% by CT and SIT. A normal SIT and a CT scan without the typical features of NPH exclude impairment of cerebrospinal fluid absorption. An abnormal SIT and a CT scan showing ventricular enlargement without dilatation of convexity sulci, require isotope cisternography and possibly intracranial pressure recording to determine the degree of the absorption deficit.

---

Zusammenfassung Der diagnostische Wert von Computertomographie (CT) und Spinalen Infusions-Test (SIT) wurde bei 27 Patienten mit Normal Pressure Hydrocephalus (NPH) und 35 Patienten mit zerebraler Atrophie untersucht. Der häufigste CT-Befund des NPH war Erweiterung der Temporalhörner und bei zerebraler Atrophie eine Erweiterung der Konvexitätssulci. Aber 43% der Patienten mit zerebraler Atrophie zeigte keine Rindenatrophie. Der SIT zeigte eine sehr gute Korrelation mit Isotopenzisternographie und kontinuierlicher intrakraniellen Druckmessung. NPH und zerebrale Atrophie wurden korrekt differenziert in 71% mittels CT und SIT. Ein normaler SIT und ein CT-Scan ohne die typischen Merkmale von NPH schließen Liquorrückresorptionsstörungen aus. Ein abnormer SIT und ein CT-Scan, der einen Hydrozephalus ohne Erweiterung der Konvexitätssulci zeigt, erfordern eine Isotopenzisternographie und eventuell intrakranielle Druckmessung zur Ermittlung des Grades der Liquorrückresorptionsstörung.

     

Contrast enhancement of the cerebrospinal fluid on MRI in two cases of spirochaetal meningitis

We report two patients with meningitis due to spirochaetal infection, both of whom showed diffusely enhancing meninges around the brain and spinal cord. In addition, there was enhancement of the cerebrospinal fluid after intravenous administration of Gd-DTPA. Received: 1 March 1998/Accepted: 21 August 1999     

经迷路进路听神经瘤术后脑脊液漏的预防及处理

目的　探讨经迷路进路听神经瘤切除术后脑脊液漏发生的影响因素及处理方法。方法1999年以来采用迷路进路或扩大迷路进路听神经瘤切除术 85例 ,前 4 1例采用传统关闭术腔技术 ,后4 4例对关闭技术进行改良 ,分析其脑脊液漏的发生率。发生脑脊液漏者行保守或手术治疗。结果传统关闭技术组中脑脊液漏的发生率为 19 5 % ( 8 4 1) ,改良关闭技术组中脑脊液漏的发生率为 2 3%( 1 4 4 ) ,两组差异有显著性意义 (P =0 0 13)。传统关闭技术组中脑脊液漏多数发生在大型听神经瘤中 ,其发生率随肿瘤增大有上升的趋势。 9例脑脊液漏的患者中 ,3例经保守治疗 ;6例经手术修补成功 ,其中 5例 1次修补成功。结论　改良关闭术腔技术可显著降低经迷路进路听神经瘤切除术后脑脊液漏的发生率 ,手术修补为终止脑脊液漏的有效措施     

带蒂骨膜瓣修补外伤性脑脊液鼻漏

目的：探讨一种有效的外伤性脑脊液鼻漏修补方法。方法：分析本科收治的6例经颅修补的脑脊液鼻漏，采用带蒂骨膜瓣翻转缝合及EC胶严密封闭漏口。结果：无手术死亡，术后脑脊液漏均停止。通过4个月-2年随访，仅有1例术后3个月轻微复发，保守治疗自愈。结论：该方法取材方便，抗感染能力强，一次手术成功率高。尤其适应于额窦后壁、筛窦顶部骨折或缺损所致的脑脊液鼻漏。     

复方寄生流浸膏对高血压动物模型降压作用的研究

为探讨复方寄生流浸膏(主药：桑寄生、淫洋藿、女贞子、生黄芪、泽泻等)治疗高血压的疗效，观察该药单次用药与连续14d用药对自发性高血压大鼠(SHR)和肾性高血压模型犬(RHD)的降压作用，并与牛黄降压丸、硝苯地平胶囊比较。结果：复方寄生流浸膏对SHR和RHD单次给药和多次给药均有显著的降压作用；这种作用起效缓慢，但维持时间相对较长；在一定剂量范围内呈明显的量效关系。提示该药有降压作用。     

Excitatory amino acid levels in cerebrospinal fluid of patients with infantile spasms

Infantile spasm is an age-specific epileptic encephalopathy. Long-term intellectual outcome of affected infants remains poor. The pathogenesis of infantile spasms, as well as the development of mental retardation, remains unclear. Increased excitatory amino acid neurotransmission may play a role in neuronal dysfunction and epilepsy. To study the significance of cerebrospinal fluid excitatory amino acids in infantile spasms, we determined glutamate and aspartate concentrations in cerebrospinal fluid of 13 patients with infantile spasms and 13 controls. The aspartate level in cerebrospinal fluid of the patients with infantile spasms (968 ± 416 nmol/1) was higher than the control group (426 ± 272nmol/l). No difference in the mean glutamate levels was found between the patients (966 ± 395 nmol/1) and the controls (1135 ± 594 nmol/1). The elevated aspartate levels in cerebrospinal fluid of the patients with infantile spasms might be secondary to change in metabolism of aspartate. Aspartate is an excitatory and neurotoxic neurotransmitter, which might have a role in triggering the spasms and the development of neuronal dysfunctions in the patients with infantile spasms.     

心肌灌注显像剂^99mTc—tetrofosmin的临床前研究

对８名健康志愿者进行９９ｍＴｃｔｅｔｒｏｆｏｓｍｉｎ的临床前试验。采用一天或两天显像方案，行９９ｍＴｃｔｅｔｒｏｆｏｓｍｉｎ运动负荷和静息显像。通过采血和留尿测定药代动力学参数；采用全身扫描及感兴趣区等技术进行人体分布、靶／非靶比值、有效显像剂量和显像方案研究；依ＭＩＲＤ法估算各种用药情况下的内照射吸收剂量，进行辐射安全评价。结果：９９ｍＴｃｔｅｔｒｏｆｏｓｍｉｎ符合一次静脉给药的药代动力学二室模型，血药总清除率为１２７０ｍｌ／ｍｉｎ；心肌摄取较高，以百分注射剂量（％ＩＤ）为单位，给药后５分钟和６０分钟，运动负荷显像分别为３４０±０１３和２３６±０１９，静息显像则为３１１±１０２和２２２±０６８，前者摄取略高；在２７０～９２５ＭＢｑ给药剂量范围内，一天或两天方案的平面及ＳＰＥＣＴ显像图同样清晰，肝和肺本底低；内照射吸收剂量符合安全标准。临床前试验证明，９９ｍＴｃｔｅｔｒｏｆｏｓｍｉｎ安全有效，这为临床应用提供了依据。     

乳腺肿块^99mTc—MIBI显像规律与其组织病理学关系的初步探讨

为探讨９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）乳腺显像诊断乳腺癌的临床价值及不同组织病理学特点的显像规律，对８４例乳腺肿块患者行９９ｍＴｃＭＩＢＩ显像检查。肘静脉“弹丸”式注射９９ｍＴｃＭＩＢＩ７４０～９２５ＭＢｑ，动态采集血流相、血池相、５分钟早期摄取相及６０、１２０分钟延迟相图像，并计算病变的早、晚期摄取比值。结果表明：乳腺病变显像特点随组织病理学类型不同而有明显差别。４３例乳腺癌中３７例诊断为阳性，６例假阴性；４１例良性病变中３例有放射性浓集。此法检出乳腺癌的灵敏度、特异性分别为８６０５％和９２６８％。因此，９９ｍＴｃＭＩＢＩ显像对鉴别乳腺良、恶性病变具有重要临床应用价值，但对癌细胞密度低的恶性肿瘤，如硬癌及有多发性坏死而血供不良的恶性肿瘤诊断效果不佳。     

核素显像和B超测算甲状腺重量的对比研究

对照研究核素显像和Ｂ超测算甲状腺重量的相关性，为临床提供较准确及简易的方法。３６３例甲亢病人１３１Ｉ治疗前分别进行γ显像和Ｂ超检查，以测算甲状腺体积（重量），其中６５例弥漫性甲状腺肿合并甲亢病人１３１Ｉ治疗后６个月重复两种检查。３６３例病人显像和Ｂ超测算甲状腺重量相关良好（ｒ＝０９３，Ｐ＜００１），总体上显像所得重量平均值大于Ｂ超值，腺体厚度是影响测算结果的主要因素；１３１Ｉ治疗后腺体厚度缩小最著，显像值大于Ｂ超值更明显。甲状腺重量测算在一定范围内两种方法可互相替代。１３１Ｉ治疗后，Ｂ超测定值为准。存在结节时，以显像为优。