基底节区脑出血患者发生早期神经功能恶化的危险因素分析

目的探讨基底节区脑出血患者发生早期神经功能恶化(END)的危险因素。方法选取于2012年3月—2014年6月神经内科诊治的基底节区脑出血患者82例,根据患者是否发生早期神经功能恶化,分为END组和非END组,其中END组40例,非END组42例,比较2组患者性别、年龄、体质量、高血压、糖尿病、高脂血症、脑卒中史、吸烟史、发病至入院时间、入院卒中量表(NIHSS)评分等一般临床资料和白细胞计数(WBC)、空腹血糖(FPG)、凝血酶原时间(PT)、纤维蛋白(Fib)、活化部分凝血活酶时间(APTT)、同型半胱氨酸(Hcy)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、颅内血肿体积、出血是否破入脑室等实验室、影像学资料,并行多因素Logistic回归模型分析,判定基底节区脑出血患者发生END的独立危险因素。结果 END组患者的入院NIHSS评分、WBC、脑内血肿体积、出血破入脑室比例均高于非END组,且差异具有统计学意义(t=8.863、4.436、2.469、11.149,P<0.05),Logistic回归分析显示白细胞计数(OR=2.008,95%CI 1.068~3.774,P=0.030)、出血破入脑室(OR=3.675,95%CI 1.591~8.486,P=0.002)是基底节区脑出血患者发生END的独立危险因素。结论基底节区脑出血患者白细胞计数越高、出血破入脑室几率越大,早期神经功能恶化的发生率就越高,患者预后便越差。     

腰神经根病致背根神经节受损的实验研究

目的　探讨神经根受压后对背根神经节的影响。　方法　 SD大鼠 50只。参照 Kawakami方法 ,显露左侧 L4～ 6神经根及背根神经节 ,用 4/0肠线于背根神经节头侧端结扎神经根两道打两个结 ,线与神经根相距 3 mm;自身右侧神经根为对照。术后 1、2、4、8和 1 2周 ,分别取 L4～ 6脊髓节段标本 ,依 Gomori法检测抗氟化物酸性磷酸酶 (FRAP)活性 ,并用图像分析。　结果　实验侧术后 4周 ,脊髓后角 FRAP含量开始降低 ,在所观察的 1 2周内 FRAP随时间延长 ,其含量降低 ,与对照侧比较有统计学意义 (P<0 .0 1 )。　结论　腰神经根慢性受压对背根神经节有损害     

亚急性坏死性基底节脑病(附50例临床分析)

目的探讨亚急性坏死性基底节脑病(SNBGE)的病因学、临床特征及其与Leigh's病的关系。方法对50例SNBGE的病因、临床特征、实验室检查及CT/MRI进行分析。结果50例SNBGE均因各种不同病因引起,呈亚临床急性发病,表现锥体外系及锥体系损害等多种多样的症状、体征,头部CT、MRI显示非梗死性双侧基底节对称性坏死、软化,治疗部分有效。结论头部CT、MRI可对SNBGE生前作出诊断,分为原发性(即Leigh's病)和继发性(病因有中毒、缺氧及感染等),临床需与肝豆状核变性、Hallervorden-spatz病(HSD)等鉴别。     

Cellular and subcellular localization of neurokinin-1 and neurokinin-3 receptors in primate globus pallidus

The primate globus pallidus receives massive innervations from GABAergic striatal neurons that co-release the neuropeptide substance P (SP). To expand our knowledge regarding SP interaction at pallidal level, we used single and double antigen retrieval methods to study the cellular and subcellular localization of SP and its high-affinity receptors neurokinin-1 (NK-1R) and neurokinin-3 (NK-3R) in the globus pallidus of the squirrel monkey (Saimiri sciureus). At the light microscopic level, a large number of neurons and fibers located in both the external (GPe) and internal (GPi) segments of the globus pallidus expressed NK-1R or NK-3R immunoreactivity. At the electron microscopic level, both NK-1R and NK-3R were mainly associated with intracellular sites or located at extrasynaptic positions on the plasma membrane. Presynaptic axon terminals forming symmetric and asymmetric synapses occasionally contained NK-1R and NK-3R. Neurokinin receptors were also observed in a proportion of SP-immunoreactive axon terminals, but these terminals preferentially expressed NK-3R. The pattern of distribution of NK-1R and NK-3R in GPe and GPi indicates that SP effects at pallidal level are mediated through postsynaptic receptor as well as presynaptic autoreceptors and heteroreceptors. These morphological data suggest that, either alone or in conjunction with GABA, SP could have a wide range of effects at pallidal level. This neuroactive peptide may influence in a significant manner the integration and treatment of neural information that flows through the basal ganglia.     

Hippocampal hypocellularity in the Ts65Dn mouse originates early in development

Ts65Dn, a well-characterized animal model for Down syndrome, has three copies of the distal end of mouse chromosome 16 and therefore has segmental trisomy for orthologs for nearly half of the genes located on human chromosome 21. Ts65Dn mice have learning and memory impairments, especially in tasks involving the hippocampus. Previous studies have shown that older adult Ts65Dn mice have structural abnormalities in the hippocampus including fewer granule cells in dentate gyrus and more pyramidal cells in the CA3 subfield of cornus ammonis. However, it is not clear whether those changes are secondary to the age-related neurodegeneration of the basal forebrain cholinergic neurons that project to the hippocampus or if they originate earlier during hippocampal development. To address this question, we performed a quantitative study of the hippocampal volume and the numbers of granule cell and pyramidal neurons in young (postnatal day 6, P6) and adult (3-month-old) mice using the optical fractionator method. At P6, Ts65Dn mice had 20% fewer granule cells in dentate gyrus than did euploid littermates. Similarly, compared to euploid, P6 trisomic mice showed an 18% reduction in mitotic cells in the granule cell layer and the hilus, where granule cell precursors divide to generate the internal granule cell layer. Granule cell hypocellularity persists in 3-month-old Ts65Dn mice before the onset of cholinergic atrophy. The hypocellularity seen in the trisomic adult hippocampus originates early in development and may contribute to specific cognitive deficits in these mice.     

Intra-Articular Ganglia of the Knee Joint Associated With the Anterior Cruciate Ligament: A Report of 4 Cases in 3 Patients

Intra-articular ganglia are rare and mostly incidental findings on magnetic resonance imaging (MRI) and arthroscopy. We present 4 cases of intra-articular ganglion cysts associated with the anterior cruciate ligament (ACL) in 3 patients. The most commonly occurring symptoms were pain aggravated after stressing activities and limited knee range of motion. In 1 patient, ganglion cysts appeared in both knees with a time difference of 1 year. An MRI revealed typical signs of ganglion cysts in the substance of the ACL. Arthroscopy was performed for further evaluation and treatment. Histologic examination of the tissue removed revealed the presence of features consistent with ganglion cysts. Therefore, in the case of chronic knee discomfort with nonspecific clinical signs and symptoms and without a clear cause, an intra-articular ganglion cyst should be considered as causing pathology. An MRI is the most sensitive and specific method for diagnosis. However, the relatively slow progression of symptoms may delay the patient’s decision to seek medical attention. Delayed diagnosis makes arthroscopic total resection of the ganglion technically demanding or not possible at all, and extensive debridement of the ACL may be required.     

开颅血肿清除和硬通道穿刺治疗基底节区高血压脑出血的疗效对比

目的：对比开颅血肿清除和硬通道穿刺治疗高血压基底节区脑出血的效果及预后。方法回顾性分析2005年1月～2013年12月我科192例高血压脑出血的临床资料,其中开颅血肿清除术（开颅组）和穿刺引流术（微创组）各96例。2组年龄、性别、血肿侧别及Glasgow昏迷评分差异无显著性（P＞0．05）。对比2组术中出血量、术后残余血肿量、手术时间、住院时间和术后3周及6个月的临床疗效。结果与开颅组比较,微创组手术时间短[中位数31（24～39） min vs．152（131～170）min,Z＝-11．975,P＝0．000],术中出血少[30例0 ml、66例＜5 ml vs．（332．4±20．2）ml],术后住院时间短[中位数14（10～17）d vs．64（44～75）d,Z＝-44．217,P＝0．000],但术后残余血肿量多[中位数13（8～17）ml vs．7（4～12）ml, Z＝-11．573,P＝0．000]。治疗3周后,微创组Glasgow 预后评分高[中位数4（2～4）分 vs．3（1～4）分,Z＝-8．215,P＝0.000],Barthel指数高[（59．9±4．5） vs．（54．9±4．9）,t＝7．370,P＝0．000]。治疗6个月,微创组Glasgow预后评分高[中位数3（2～4）分vs．2（1～4）分,Z＝-7．448,P＝0．000],Barthel指数高[（64．3±8．4） vs．（59．7±6．8）,t＝4．156,P＝0．000],2组病死率差异无显著性（P＞0．05）。结论微创颅内血肿硬通道穿刺引流术在一定程度上明显优于开颅血肿清除术,值得临床推广应用。     

8个家族性特发性基底节钙化家系患者的临床研究

目的探讨8个家族性特发性基底节钙化(familial idiopathic basal ganglia calcification,FIBGC)家系患者的临床特点。方法收集8个FIBGC家系患者的临床资料,分析患者的临床检验结果、头颅CT及MRI改变、发病年龄、临床表现与患者基底节钙化体积(the volume of basal ganglia calcification,VBGC)的关系。结果家系患者和健康成员血清钙、铝、砷、钴、镁、磷、铁、甲状旁腺激素和降钙素的值比较均无显著性差异(P0.05)。8个家系包括两个近亲结婚的家系均呈现常染色体显性遗传;运动受损患者的病情严重程度与基底节区钙化的病灶大小相关;精神症状的患者有无症状与VBGC的大小无关;运动受损与精神症状的患者间发表年龄(43.954±2.473 vs.31.319±10.156 y,t=4.438,P=0.001)和VBGC(1.748±0.622 vs.0.392±0.276 cm3,t=2.518,P=0.028)比较有统计学差异。结论 8个FIBGC家系患者呈现常染色体显性遗传的特点,运动受损的患者基底节区钙化的病灶大,发病年龄较晚;精神症状的患者基底节区钙化的病灶小,发病年龄较早。     

Effects of movement imitation training in Parkinson's disease: A virtual reality pilot study

BackgroundHypometria is a clinical motor sign in Parkinson's disease. Its origin likely emerges from basal ganglia dysfunction, leading to an impaired control of inhibitory intracortical motor circuits. Some neurorehabilitation approaches include movement imitation training; besides the effects of motor practice, there might be a benefit due to observation and imitation of un-altered movement patterns. In this sense, virtual reality facilitates the process by customizing motor-patterns to be observed and imitated.ObjectiveTo evaluate the effect of a motor-imitation therapy focused on hypometria in Parkinson's disease using virtual reality.MethodsWe carried out a randomized controlled pilot-study. Sixteen patients were randomly assigned in experimental and control groups. Groups underwent 4-weeks of training based on finger-tapping with the dominant hand, in which imitation was the differential factor (only the experimental group imitated). We evaluated self-paced movement features and cortico-spinal excitability (recruitment curves and silent periods in both hemispheres) before, immediately after, and two weeks after the training period.ResultsMovement amplitude increased significantly after the therapy in the experimental group for the trained and un-trained hands. Motor thresholds and silent periods evaluated with transcranial magnetic stimulation were differently modified by training in the two groups; although the changes in the input–output recruitment were similar.ConclusionsThis pilot study suggests that movement imitation therapy enhances the effect of motor practice in patients with Parkinson's disease; imitation-training might be helpful for reducing hypometria in these patients. These results must be clarified in future larger trials.     

Changes in the basal ganglia and thalamus following reperfusion after complete cerebral ischaemia

We report specific changes bilaterally in the basal ganglia and thalamus following reperfusion after complete cerebral ischaemia. A 69-year-old man, resuscitated after cardiac arrest, showed symmetrical lowdensity lesions in the head of the caudate nucleus and lentiform nucleus on CT. MRI revealed methaemoglobin derived from minor haemorrhage in the basal ganglia and thalamus, not evident on CT. We suggest that this haemorrhage results from diapedesis of red blood cells through the damaged capillary endothelium following reperfusion.