可吸入细颗粒物与阿尔茨海默病的相关性研究进展

阿尔茨海默病（Alzheimer’sdisease,AD）是最常见的认知障碍类型疾病,其病因多元化,近年来一些临床和基础研究的进展提示环境因素,尤其是可吸入细颗粒物在AD的发生中可能起作用,为AD的预防、治疗打开了一扇新的窗户。本文介绍可吸入细颗粒物的概念、可吸入细颗粒物与AD相关性的最新实验及流行病学研究进展,分析可吸入细颗粒物影响认知功能的可能机制,就可吸人细颗粒物与AD的相关性作综述,以期从环境角度探求AD预防及治疗的新思路。     

颈枕交界区硬脊膜动静脉瘘一例

目的分析颈枕交界区硬脊膜动静脉瘘(SDAVF)的临床表现及神经影像特点,为早期诊断提供依据。方法经临床及影像学诊断1例颈枕交界区SDVAF患者的有关临床资料,结合相关文献进行分析。结果 SDVAF是脊髓动静脉性血管畸形的一种类型,发病率较低,早期症状和体征无特异性,容易误诊和漏诊,对高度怀疑本病的患者,应行脊髓MRI、CTA或脊髓血管造影检查。结论对亚急性或慢性病程的颈髓病变患者,需高度警惕SDAVF的可能性,重视影像学检查,早期诊断及治疗可改善预后。     

中枢神经系统感染性疾病的诊疗经验

<正>中枢神经系统(central nervous system,CNS)感染性疾病是全球范围内重要的致残和致死的疾病之一。据世界卫生组织统计,2004年全球大约有70万脑膜炎发生,其中死亡人数约为34万[1]。CNS感染性疾病致病体包括细菌、病毒、真菌、微生物和寄生虫等。大多数情况下放射科医生很难根据异常的影像学表现对CNS感染做出定性     

临床常见脑病的临床及影像学特点分析

目的探讨临床常见的脑病,包括代谢、中毒及放射性脑病等临床常见脑病的临床及影像学表现特点。方法收集作者医院收治的临床常见脑病患者43例,其中中毒性脑病17例(包括装修苯中毒1例、鼠药氟乙酰胺中毒1例、化疗药物中毒5例、有机磷农药中毒4例、一氧化碳中毒5例、海洛因中毒1例)、放射性脑病5例及代谢性脑病21例(包括Wernick脑病2例、低血糖脑病4例、肝性脑病4例、尿毒症性脑病5例、桥本脑病3例、甲基丙二酸尿症1例、卟啉病1例、伴有囊肿及钙化的白质脑病1例),总结分析临床常见脑病的临床及影像学特点。结果 (1)临床表现:不同病因脑病患者多表现为不同程度的认知功能障碍、精神行为异常、言语含糊及计算力减退等,部分患者表现为肢体力弱或无力,少数患者表现为语音障碍、眼球固定、发作性肢体抽搐及腹痛等。(1)表现为认知功能障碍:包括不同程度的反应迟钝伴记忆力减退(脑病中苯中毒1例、有机磷农药中毒2例、化疗药物中毒5例、一氧化碳中毒2例、放射性脑病5例、尿毒症性脑病5例、桥本脑病3例),以及不同程度的意识障碍(有机磷农药中毒2例、一氧化碳中毒3例、低血糖脑病2例、肝性脑病4例);(2)精神行为异常(桥本脑病3例、甲基丙二酸尿症1例);(3)表现为言语含糊伴计算力减退(海洛因脑病1例);(4)部分患者表现为肢体力弱或无力,少数患者表现为语音障碍、眼球固定、发作性肢体抽搐及腹痛等,其中包括放射性脑病3例、低血糖脑病2例、甲基丙二酸尿症1例、卟啉病1例、伴有囊肿及钙化的白质脑病1例表现为肢体力弱,Wernick脑病2例表现为进行性声音嘶哑伴双下肢力弱及眼球固定,苯中毒及鼠药氟乙酰胺中毒各1例表现为发作性肢体抽搐,卟啉病1例表现为发作性腹痛、肢体无力伴言语不清。(2)影像学表现:影像学表现病变主要累及白质、基底节核团,少数可累及脑室旁及导水管区域,仅1例表现为广泛性脑萎缩。病变表现以白质脑病为主者包括苯中毒、鼠药氟乙酰胺中毒、化疗药物中毒、有机磷农药中毒、一氧化碳中毒、海洛因中毒、尿毒症性脑病及桥本脑病患者;伴钙化与囊变的脑白质病患者表现为双侧大脑半球脑白质区多发大小不等囊状病灶;以基底节核团病变为主者包括低血糖性脑病、肝性脑病、卟啉病、有机磷农药中毒性脑病,一氧化碳中毒迟发性脑病及海洛因中毒性脑病;Wernick脑病患者病灶多位于三脑室旁、侧脑室旁及导水管周围;甲基丙二酸尿症1例表现为广泛脑萎缩。结论临床上常见类型的脑病病因多样,均有不同程度的认知功能障碍,影像学表现包括广泛的白质脱髓鞘、皮层萎缩及基底节区病变等,诊断应结合临床、影像学特点及相应的病史进行诊断。     

中青年起病的多巴反应性肌张力障碍5例的护理

目的探讨中青年多巴反应性肌张力障碍(DRD)的临床特点及诊治。方法对5例成年起病的DRD临床资料进行分析,并与儿童型DRD及帕金森病的临床表现进行比较。结果本组5例经积极配合治疗及护理,预后良好。结论中青年DRD是成年后起病,以震颤、肌张力障碍等类帕金森病症状为表现的一种较为罕见的遗传性运动障碍性疾病,早期诊治,加强护理宣教和康复训练,预后良好。     

同心圆硬化的临床表现及影像特点分析

目的总结同心圆硬化（BCG）的临床表现及影像特点。方法对7例均为临床、影像和（或）病理证实的BCG进行分析，总结其临床、影像特点。结果中青年起病，性别差异不明显。多以淡漠、反应迟钝起病，病变多为多发，且病灶较大，但症状及体征相对少。磁共振成像（MRI）检查均可见同心圆改变。结论同心圆硬化是一种特殊类型的脱髓鞘病，发病机制不明，诊断主要依靠MRI检查，激素治疗有效，预后良好。     

急性脑梗死并发急性坏死性胰腺炎一例

患者男,53岁.因"右侧肢体无力、言语不清1 h"于2007年12月29日急诊入院.既往有长期大量饮酒史,脂肪肝,发病前晚饮酒,约100 g.入院体检:BP 180/90mm Hg(1mm Hg=0.133 kPa),心肺腹未见异常.言语不清,右上肢肌力2-级,右下肢肌力3-级.血常规及凝血3项正常,头颅CT未见异常.发病2 h给予注射用重组组织纤维蛋白溶酶原激活剂(rt-PA)50 mg静脉溶栓.溶栓后肌力改善.     

肛门括约肌肌电图在鉴别诊断多系统萎缩、帕金森病及晚发型脊髓小脑共济失调中的作用

目的 分析多系统萎缩(multipe system atrophy,MSA)、帕金森病(Parkinson's disease,PD)、晚发型脊髓小脑共济失调(1ate-onset spinocerebellar ataxia,LOSCA)患者的肛门括约肌肌电图(external anal sphincter electromyography,EAS-EMG)的差异等电生理改变特点,为临床鉴别诊断提供依据.方法 分别对88例MSA、69例原发性PD、18例LOSCA患者的电生理检查结果进行回顾性分析.结果 EAS-EMG检查中MSA组有84例(95.5%)患者存在不同程度的神经源性受损,表现为运动单位电位(MUPs)平均时限[(12.92±2.59)ms]显著延长、平均波幅[(648.6±251.0)μV]增高、多相波百分比(42.6%±21.2%)增加、异常自发电位与卫星电位多见,与PD[(8.99±0.47)ms、(470.0±91.9)μV、24.2%±11.0%]及LOSCA组[(9.04±0.62)ms、(493.1±113.7)μV、22.0%±12.1%]相比差异有统计学意义(Welch值分别为:94.240、18.093、26.710,均P=0.000).PD及LOSCA组EAS-EMG检查未发现有神经源性受损,也未见自发电位与卫星电位.结论 MSA临床表现可与PD及LOSCA相似,有时容易相互误诊,EAS-EMG检查可提高MSA的正确诊断率,尤其与PD、LOSCA进行鉴别诊断时有较大价值.

Abstract：

Objective To observe the electrophysiological changes, especially in the examination of external anal sphincter electromyography ( EAS-EMG), with those patients diagnosed as multiple system atrophy ( MSA), Parkinson's disease (PD) and late-onset spinocerebellar ataxia (LOSCA) and explore its clinical diagnostic value as well as differential diagnostic value for the three diseases. Methods The clinical data, cranial magnetic resonance imaging (MRI) data as well as results of EAS-EMG for 3 groups patients, including 88-cases MSA, 69-cases PD and 18-cases LOSCA, were analyzed retrospectively.Results EAS-EMG showed that 84 cases (95.5%) in MSA group had varying degrees of neurogenic injury. Meanwhile, mean motor unit potentials (MUPs) duration (( 12.92 ± 2.59)ms), mean MUPs amplitude ( ( 648.6 ± 251.0 ) μV ), and MUPs polyphasicity ( percentage of polyphasic MUPs; 42. 6% ±21.2% ) in MSA group were significantly different from those in PD ( ( 8. 99 ± 0. 47 ) ms, (470. 0 ±91.9) μV, 24.2% ±11.0%) and LOSCA groups ((9.04 ±0.62)ms, (493.1 ± 113.7)μV,22.0% ±12. 1%; Welch:94. 240,18. 093,26. 710,all P =0. 000). The spontaneous potentials and satellite potentials showed more common in MSA group, but not in other groups. Conclusions MSA and PD and LOSCA are easily mutually misdiagnosed because of some similar syndromes, but the method of EAS-EMG could be effective and helpful to enhance accurate diagnostic rate of MSA and its differential diagnosis with PD and LOSCA.     

同心圆硬化12例临床及影像学分析

目的 探讨同心圆硬化的临床表现、影像学特征及其诊断价值.方法 回顾12例同心圆硬化患者(门诊2例,住院10例)的临床表现、实验室检查结果、影像学特点及病理结果,并对患者进行随访.结果 12例患者(男4例,女8例)发病年龄8～54岁(平均36.8岁),多以淡漠少语、反应迟钝起病(7例),病程中其他临床表现以智能减退(10例)、肢体活动障碍(8例)、大小便失禁(7例)、肌力减退(7例)、锥体束征阳性(6例)较多见.8例患者行脑脊液髓鞘碱性蛋白检查,其中7例增高.6例行脑活体组织检查,均可见分层脱髓鞘改变,有炎性细胞浸润.病灶数量1例为单发,11例为多发.4例患者行头颅CT检查,病灶均呈低密度影,增强后无强化.MRI检查均可见圆或类圆形影像,增强扫描8例可见环状或半环状强化,易被误诊为脑肿瘤;3例呈同心圆样强化.结论 同心圆硬化常亚急性或慢性起病,首发症状多为认知功能障碍,易被误诊,头颅MRI有特征表现,有诊断价值,激素治疗有效,预后良好,呈良性临床过程.

Abstract：

Objective To explore the clinical features, imaging and their diagnosis vaule of Baló's concentric sclerosis (BCS). Methods The clinical manifestation, laboratory examination, neuroimaging characteristics, pathology and follow-up of 12 (2 outpatients and 10 inpatients) cases of BCS were analyzed retrospectively. Results The onset age of 12 patients (male 4, female 8) ranged from 8 to 54 years old (mean 36.8 years). Unconcerned and slowness response were common in the disease onset (7 cases).Other symptoms and signs such as hypophrenia ( 10 cases), limitation of limb or hand movement (8 cases),urinary and fecal incontinence (7 cases), hypo-myodynamia (7 cases), positive pyramidal sign (6 cases)were not rare in course of disease. Eight cases underwent the examination of cerebrospinal fluid myelin basic protein, which increased in 7 cases. Demyelinating change and perivascular inflammatory infiltration were shown in 6 brain biopsies. The involvements of multi-lesions were found in 11 cases. Four patients underwent CT scanning and all the cases showed with hypodense lesions and couldn' t be enhanced. On MRI, all cases appeared round or round-like in shape. Enhanced lesions showed ring-like or half-ting-like shape (8 cases) and concentric ring (3 cases). It's easy to be misdiagnosed as brain tumor (8 cases).Conclusions BCS is a kind of demyelinating disease of subacute or chronic onset accompanied with cognitive disorder being the most common initiating symptoms. It's prone to be misdiagnosed. Diagnosis depends on MRI and corticosteroid treatment is effective. BCS has a good prognosis and presents with benign clinical course.