脑梗死大鼠神经功能缺损评分与脑梗死体积的相关性研究

目的:研究经典线栓法制备局灶性脑梗死模型大鼠的神经功能评分与脑梗死面积的相关性。方法:采用Zea Longa法制作大鼠局灶性脑梗死模型,在不同时间段对脑梗死大鼠进行神经功能缺损评分,并用2%TTC(氯化三苯基四氮唑)溶液对脑组织染色,计算脑梗死面积及梗死体积百分比。结果:线栓法制备局灶性脑梗死模型的大鼠24～48 h内神经功能评分降低,但脑梗死体积却增大,神经功能缺损评分与脑梗死体积百分比之间无相关性(r=-0.3762;P=0.88999)。结论:经典线栓法制备的局灶性脑梗死模型(大脑中动脉栓塞)中,尚不能认为大鼠的肢体运动功能与脑梗死体积有相关性。     

Are CT Angiography Source Images Accurate for Evaluating Infarct Volume?

Noncontrast computed tomography (NCCT) has been considered the standard test for determining eligibility for thrombolysis from the beginning of the thrombolytic era. CT angiography (CTA) reveals the cranio‐cervical vessel and the occlusion site. Furthermore, the source image (SI) of the CTA (CTA‐SI) reflects cerebral blood volume and can detect the infarct core as hypoattenuated areas with higher sensitivity than ischemic changes on NCCT. However, it was recently reported that the CTA‐SI using fast acquisition protocol significantly overestimated the infarct core mostly on the basis of the poor collaterals. On the other hand, CTA‐SI using standardized protocol was reported to be good predictor for final infarct extension. Imaging used in the setting of acute stroke should accurately address the presence and size of an irreversible ischemic core. Further studies are required to confirm whether another measure or adjustment in CTA‐SI values can be more reliable for evaluating the infarct core.     

脑梗死和脑出血导致智能障碍的对比研究

本研究采用ＣＣＳＥ和ＦＡＱ２个量表对１１３例脑血管疾病（ＣＶＤ）患者和２３例健康中老年人进行智能测验，其中８２例脑梗死患者和３１例脑出血患者并发智能障碍（ＩＤ）者分别为３７例和１４例，患病率均为４５．１％，３１列脑出血患者中，１１列伴有脑梗死性，其中有８例并发ＩＤ患病率为７２．７％，２０列不伴梗死灶者，有６例并发ＩＤ，患病率为３０％，两者相比差异显著（Ｐ〈０．０５），提示出血性和缺血性ＣＶＤ均可引     

强力霉素对小鼠脑梗塞区白细胞浸润的影响

本文采用光化学诱导小鼠脑梗塞模型来观察强力霉素对脑梗塞区白细胞浸润的影响，结果发现在脑缺血前静脉给予强力霉素能显著降低脑梗塞区的MPO活性，提示强力霉素具有抑制脑梗塞区白细胞浸润的作用。     

Atypical Presentation of Postpartum Cerebral Angiopathy Shown as a Small Penetrating Arterial Territory Infarct with Severe Peri‐Infarct Edema

Postpartum cerebral angiopathy mostly occurs in the large or medium‐sized cerebral arteries. In this case, we aimed to report a case of postpartum cerebral angiopathy presented as an asymmetrical penetrating arterial territory infarct with severe surrounding vasogenic edema. A 26‐year‐old woman admitted because of sudden headache after an attack of seizure. On initial computerized tomography (CT), hypodense lesion in the right basal ganglia was observed. The diffusion‐weighted image on 5th day revealed focal acute ischemic infarction with surrounding extensive vasogenic edema in right basal ganglia. The CT angiography showed multifocal arterial narrowing of intracranial cerebral arteries that completely resolved on the follow‐up study. This case suggested that asymmetrical small penetrating arterial territory infarct can occur as an atypical presentation of postpartum cerebral angiopathy.     

Neuronal Loss in the Pedunculopontine Tegmental Nucleus Ipsilateral to a Massive Cerebral Infarct

This report describes the striking ipsilateral loss of large and medium-sized neurons in the pedunculopontine tegmental nucleus-pars compactus (PPTN-pc) in an 82-year-old man with a massive, long-standing infarct in the left cerebral hemisphere (area of the middle cerebral artery). No pathologic alterations were evident in the remaining neurons. The neurons in the contralateral PPTN-pc were well preserved. Since the PPTN-pc receives inputs from the basal ganglia and the cerebral cortex and sends widespread efferent fibers to the ipsilateral sides of these structures, it could be assumed that the observed loss of neurons is a result of anterograde transneuronal degeneration or of retrograde degeneration.     

尼莫地平对急性脑梗死患者自由基和临床转归的影响

目的　观察尼莫地平在脑缺血及再灌注损伤中抑制自由基生成的作用及其临床疗效。方法　 5 1例急性脑梗死 ( ACI)急性期患者随机分为治疗组和对照组 ,分别检测各组超氧化物歧化酶 ( SOD)、丙二醛 ( MDA)、谷胱甘肽 ( GSH)值并观察临床神经功能缺损恢复情况。结果　与对照组相比 ,治疗组疗效出现时间显著提前 ,神经功能缺损明显改善 ,自由基生成明显减少。结论　尼莫地平治疗 ACI可显示早期疗效 ,可能与抑制自由基生成有关。     

重度子痫前期及子痫合并颅脑疾病33例诊治分析

目的探讨重度子痫前期及子痫合并颅脑疾病的病因、临床表现、诊断、治疗原则及预后。方法回顾性分析33例重度子痫前期及子痫合并颅脑疾病住院病人的临床资料。结果33例中CT或MRI检查发现19例脑出血患者,出血量在30ml以下者11例,给予保守治疗。血肿量大于30ml的患者8例,其中出血量超过60ml,并伴脑疝形成的4例,3例行血肿清除术及去骨瓣减压术,1例放弃治疗;其余4例1例行脑室外引流,3例行颅内血肿微创引流术。剖宫产25例,阴道产8例,其中利凡诺引产8例,新生儿死亡5例,死胎6例,其余均存活,存活的最小新生儿胎龄28周,重约685g。8例肾功能不全者经血液透析后6例临床治愈,2例经对症处理后治愈。14例脑梗死患者均给予扩管、小剂量脱水、低分子右旋糖苷等保守治疗,均未手术干预。33例孕妇中恢复良好26例,3例轻、中度偏瘫,2例癫痫,1例不全失语,1例放弃治疗自动出院。结论子痫前期及子痫具有易发生肝肾损害、脑卒中等危险因素,出现神经系统症状时应及时行头颅CT或MRI检查,明确诊断后配以脑卒中相应治疗措施,及时终止妊娠,积极治疗重度子痫前期及子痫。     

TCD Systolic Spikes in a Malignant MCA Infarct

Introduction  Malignant MCA infarction results in significant space occupying effect and intracranial pressure (ICP) increment. Due to the high mortality rate in such patients, the term malignant MCA infarction was coined. Methods  We studied a patient who developed a sudden onset of slurred speech, right hemiplegia, and decreased level of arousal. Two days later CT scan showed a massive cerebral infarct, involving the left MCA territory. Results  A transcranial Doppler exam showed a normal flow pattern in the right hemisphere, but in the left hemisphere systolic spikes without diastolic flow were observed in internal carotid artery, anterior cerebral artery, as well as in the MCA. Conclusions  The pathophysiologic mechanisms leading to BD might asymmetrically begin in cerebral hemispheres in malignant MCA infarcts.     

动脉硬化性脑梗死与HLA—I类基因的关联性研究

目的 探讨动脉硬化性脑梗死（ABI）与人类白细胞抗原（HLA）系统的相关性,方法 采用微量淋巴细胞毒分型方法,对我国北方汉族人群39例ABI患者和41例健康对照组的HLA－A,B,C各等位基因共计66个位点进行检测分析。结果 ABI组HLA－A30基因频率较对照组显著增加（RR＝10．36,P＜0．01）,其他HLA－A,B,C基因频率未见与ABI明显相关,结论 HLA－A30基因可能为AB1的易感基因,其可能与ABI致病基因有连锁不平衡或作为免疫应答基因而导致ABI发生,HLA－A30基因可视为ABI高危险性遗传标志。     

Post-Stroke Cognitive Impairment is Frequent After Infra-Tentorial Infarct

Background and purposePost-stroke cognitive impairment is a common and well-known consequence of supra-tentorial infarct, but its prevalence and severity after infra-tentorial infarct is unclear. We compared the frequencies and prognostic value of domain-specific cognitive deficits after supra-tentorial and infra-tentorial infarct.MethodsIn a consecutive cohort of patients with first-ever stroke (N = 244) admitted to Helsinki University Hospital, 37 patients had an infra-tentorial infarct. Patients were assessed with a comprehensive neuropsychological examination 3 months post-stroke covering 9 cognitive domains and functional disability was assessed at 15 months with the modified Rankin Scale.ResultsThere were no statistically significant differences between the frequencies of cognitive deficits in patients with infra-tentorial vs supra-tentorial infarct. Altogether 73% of patients with infra-tentorial infarct and 82% of patients with supra-tentorial infarct had impairment in at least one cognitive domain. Further 42% of patients with infra-tentorial infarct and 47% of those with supra-tentorial infarct had deficits in 3 or more cognitive domains. In patients with infra-tentorial infarct, visuo-constructional deficits were significantly associated with functional disability at 15 months (OR 9.0, 95%CI 1.3–62.5, p = 0.027). In patients with supratentorial infarct, executive deficits (OR 2.9, 95%CI 1.5–5.8, p = 0.002) and visuo-constructional deficits (OR 2.9, 95%CI 1.5–5.7, p = 0.001) showed associations with functional disability at 15 months.ConclusionCognitive deficits are as common in patients with infra-tentorial infarct as in those with supra-tentorial infarct, and it is important to recognize them to meet the needs of rehabilitation.     

大面积梗死急性缺血性卒中患者血管内治疗的有效性和安全性研究

目的 观察低ASPECTS评分的大面积梗死患者血管内治疗的有效性和安全性,并探讨预后的影响 因素。 方法 从急性缺血性卒中血管内治疗关键技术及急救流程改进研究-前瞻性、多中心、登记研究 （endovascular treatment key technique and emergency work flow improvement of acute ischemic stroke, ANGEL-ACT）中筛选接受血管内治疗,且ASPECTS/后循环ASPECTS（post-circulation ASPECTS,pc- ASPECTS）＜6分的大面积脑梗死患者,分析影响患者预后的因素。有效性终点为术后90 d预后良好 （mRS 0～3分）,安全性终点包括术后24 h内症状性颅内出血（symptomatic intracranial hemorrhage,sICH） 和术后90 d全因死亡。 结果 共纳入121例患者,其中男性89例（73.55%）,中位年龄62.0（54.0～72.0）岁,失访6例,纳 入统计分析的共115例患者。术后90 d预后良好53例（46.09%）,基线低NIHSS（OR 0.908,95%CI 0.841～0.980,P =0.0130）和闭塞血管再通成功（OR 13.676,95%CI 1.396～134.004,P =0.0247）是术 后90 d预后良好的独立预测因子。术后24 h内发生sICH 21例（18.26%）,穿刺至再通时间长（OR 1.009, 95%CI 1.002～1.017,P =0.0163）和病变血管合并串联狭窄（OR 4.202,95%CI 1.457～12.119,P =0.0079） 是术后24 h内sICH的独立预测因子。术后90 d全因死亡23例（20.00%）,基线高NIHSS（OR 1.089, 95%CI 1.014～1.170,P =0.0186）和术后24 h内sICH（OR 4.688,95%CI 1.382～15.898,P =0.0132）是术 后90 d全因死亡的独立预测因子。 结论 大面积梗死的急性缺血性卒中患者接受血管内治疗虽然风险较高,但术前严格地筛选低 NIHSS患者,术中尽量获得闭塞血管再通成功能够使患者获益。     

腔隙性脑梗死所致抑郁的相关因素分析

目的探讨腔隙性脑梗死所致抑郁的相关因素。方法采用头颅CT或MPI确定诊断和病灶定位，并以SDS、ADL及NFA分别对患者进行测试，然后分析其发生抑郁的相关因素。结果本组腔隙性脑梗死所致抑郁的发生率为38．04％；与发生抑郁的相关因素有：梗死病灶系多发、且多分布于皮层下，存在脑室扩大，神经功能缺陷较重以及日常生活能力差等。结论腔隙性脑梗死所致抑郁是临床常见病，且为生物、心理因素协同作用所致。     

脑梗死体积与外周血淋巴细胞DNA损伤的关系

目的探讨脑梗死体积与外周血淋巴细胞DNA损伤的关系。方法按梗死灶体积将60例急性脑梗死患者分为小、中和大梗死组,每组20例。应用单细胞凝胶电泳(彗星实验)检测各脑梗死组和20名正常对照者(正常对照组)外周血淋巴细胞核尾部DNA的百分比,并进行比较。结果碱性彗星试验中,各脑梗死组的淋巴细胞核尾部DNA百分比显著高于正常对照组(均P<0.01);小、中梗死组淋巴细胞核尾部DNA百分比显著低于大梗死组(均P<0.01)。中性彗星试验中,中梗死组和大梗死组的淋巴细胞核尾部DNA百分比显著高于正常对照组(均P<0.01);大梗死组明显高于小、中梗死组(均P<0.01)。结论脑梗死体积可能可以反映外周血淋巴细胞DNA损伤程度。     

预防及超早期应用尼莫同对小鼠局灶性脑梗死的影响

目的观察尼莫同超早期给药对小鼠局灶性脑梗死的影响.方法经右侧颈总动脉将尼龙单丝线栓至大脑中动脉造成永久性缺血模型.经尾静脉及腹腔注射尼莫同,TTC染色、图像分析仪测定脑梗死体积.结果单纯缺血组各时间点脑梗死体积最大,缺血前预防给药组各时间点脑梗死体积最小,缺血后即刻给药组各时间点脑梗死体积介于二者之间.结论小鼠大脑中动脉闭塞后其局灶性脑梗死体积于术后第3天达高峰.缺血前预防给药组、缺血后即刻给药,尼莫同均可使梗死体积减少.     

急性脑梗死合并医院内获得性肺炎后血栓调节蛋白变化及其与血浆TNF-α的相关性

目的:观察脑梗死合并医院内获得性肺炎患者血栓调节蛋白含量的变化及其与血浆肿瘤坏死因子的相关性,探讨脑梗死合并医院内获得性肺炎对脑梗死后内皮细胞损伤和凝血机制的影响。方法:初发脑梗塞患者分为单纯脑梗塞组(24例)和脑梗塞合并医院内获得性肺炎组(16例)。健康对照13例。脑梗死发病后第1、3、5、7、14、21天分别采血。血栓调节蛋白(TM)检测采用ELISA法。TNF-α检测采用放免法。结果:1血栓调节蛋白(TM):脑梗死合并医院内获得性肺炎后第1周、14天TM与单纯梗死组相比下降(P<0.05);21天与单纯梗死组无统计学差异但高于健康对照组。2肿瘤坏死因子(TNF-α):单纯脑梗死组与脑梗死合并医院内获得性肺炎组第1天无统计学差异,两组均高于健康对照组。脑梗塞合并医院内获得性肺炎发生第1周和14天TNF-α明显增高,高于单纯脑梗死组(P<0.05);21天虽然HAP已控制TNF-α仍高于单纯梗死组(P<0.05)。3脑梗死合并HAP组TM与TNF-α有相关性。随着TNF-α增高,血栓调节蛋白有下降趋势,两者相关关系以Gompertz曲线拟合满意,在高浓度TNF-α时TM降低较快,而低浓度TNF-α时TM降低较慢。结论:脑梗塞合并医院内获得性肺炎后血浆TNF-α增高,可能导致脑血管内皮细胞的损伤和抗凝机制的抑制,表现为血栓调节蛋白的下调。这可能是获得?     

缺血性脑血管病梗死模式的分类及病因、发病机制研究进展

缺血性脑血管病的梗死模式具有多样性,根据梗死数目可分为无梗死、单发梗死和多发 梗死。单发梗死主要根据病灶的位置和大小进行分类,多发梗死则根据血管的供血范围进行分类。 单发梗死和多发梗死的不同梗死模式分别与不同的病因和发病机制相关。     

腔隙性脑梗死患者的智能障碍

采用韦氏成人智力量表对186例腔隙性脑梗死患者进行测定，结果表明腔隙性脑梗死损害部位不同，其智能损害程度差异较大。左侧半球病变更易造成智能障碍，尤其左侧基底节及颞叶；多发病灶者其智能损害较单发病灶者重，单发的皮质下腔隙性梗死也可造成明显智能缺损。性别、年龄、职业与腔隙性脑梗死后引发的智能障碍无相关性，但受教育程度的高低与智能障碍的程度呈负相关。笔者认为提高国民文化素质，积极预防和治疗脑血管病，是减少和防治脑血管性痴呆发生的关键。     

Association of Initial Infarct Extent and Progressive Motor Deficits in Striatocapsular Infarction

Background and purpose

Progression of motor deficits in the acute period is frequently observed in patients with subcortical striatocapsular infarctions. Therefore, we sought to determine the factors associated with early motor progression in patients with infarcts confined to the striatocapsular region.

Methods

We studied 80 consecutive patients with striatocapsular-region infarction, as defined by clinical and MRI criteria, within 24 hours after stroke onset. Motor progression was defined as an increase of >2 points in the motor items of the National Institutes of Health Stroke Scale (NIHSS) within 7 days of stroke onset. The study population was divided into patients with and without motor progression, and risk factors, clinical features, and brain MRI/magnetic resonance angiograpy (MRA) findings were compared between these groups.

Results

Motor progression was observed in 40% of the 80 patients. The independent variables associated with motor progression were a history of hypertension (OR=7.8, 95% CI=1.5-39.8, p=0.013) and an initial infarct extent of ≥15 mm (OR=9.2, 95% CI=1.8-45.7, p=0.006). However, there were no differences in the initial NIHSS score, other stroke risk factors, vascular stenosis pattern, or cardioembolic source.

Conclusions

Early motor progression in patients with striatocapsular-region infarction is associated with the initial extent of the lesion. However, the stroke mechanism and vascular stenosis did not differ between the motor progression and stable groups.