A patient with headache, right upper extremity and right hemithorax hypothermalgesia

We present a case of partial Wallenberg syndrome also called partial lateral medullary syndrome, a hemorrhagic or ischemic stroke of the area fed by the posterior inferior cerebellar artery and the clinical manifestation depends on the extension of the lesion: dorsal-ventral, medial-lateral and rostrocaudal. Five types have been described. Our patient had headache, hoarseness, right upper extremity, right hemithorax and right upper gluteal hypothermalgesia implicating the involvement of the cervical, the thoracic and part of lumbar fibers of the left lateral spinothalamic tract and the ambiguous nucleus; an entity not described before. The imaging done to our patient disclosed the dissection of the left vertebral artery. He was treated with anticoagulation with gradual improvement in his symptoms.     

以头晕头痛为临床表现的颈静脉球瘤1例报告

颈静脉球瘤(glomus jugulare tumor,GJT)是发生在颅底颈静脉孔内及其附近的肿瘤,亦可见于中耳鼓室、颈动脉间隙和颈动脉分叉处.1941年Guild[1]在颈静脉球顶和中耳鼓岬发现一种血管性结构,命名为血管球体(glomus body).GJT由Rosenwasser于1945年首先报道,当时命名为颈动脉体样瘤,1951年Guild将其命名为"颈静脉球瘤"并沿用至今.其发生率占全身肿瘤的0.03%,头颈部肿瘤的0.06%[2].肿瘤性质为良性,但生长方式类似恶性,颅内外广泛生长,颅神经常受侵犯.首诊科室往往在五官科、神经科.本病临床非常少见,我们报告近期临床工作中诊断的1例GJT患者,以期提高大家对该病的认识.     

发作性头痛与慢性头痛患者神经心理学与注意功能影响的初步研究

目的：探讨发作性头痛与慢性头痛患者注意功能影响的临床表现及其可能的作用机制。方法：通过纳入18例发作性头痛（episodic headache,EH）患者、20例慢性头痛（chronic headache,CH）患者和21例健康对照人群,分别进行神经心理学评估,包括简易精神状态评估量表（mini mental state exam,MMSE）、蒙特利尔认知评估量表中国北京版（Beijing Chinese version of Montreal Cognitive Assessment,MoCA?C）、数字广度测试（digit span test,DS）、额叶功能评定量表（frontal assessment battery,FAB）、医院焦虑抑郁量表（hospital anxiety and depression subscales,HADS）和匹兹堡睡眠量表（Pittsburgh sleep quality index,PSQI）和注意力网络测试（attention networks test,ANT）,并进行对比分析。结果：CH组的MoCA-C（P值均< 0.001）、DS（P=0.002或P=0.004）、HADS（焦虑：P < 0.001或P=0.002;抑郁：P < 0.001或P=0.001）、PSQI（P < 0.001或P=0.001）评估结果均与健康对照组或EH组存在显著差异。CH组和健康对照组的FAB评估结果亦存在显著差异（P=0.021）。ANT测试结果显示3组间的警觉、定向效率和正确率无显著差异,但CH组的平均反应时间较健康对照组或EH组明显延长（P=0.002或P=0.035）,执行控制效率较健康对照组明显降低（P=0.042）。结论：头痛损害注意功能,而CH组损害更明显,主要表现为CH患者执行注意力相关任务的平均反应时间延长、执行控制功能降低,提示CH损害了注意网络-执行功能,该功能的损害可能是头痛损害注意功能的关键机制之一。     

One hemodialysis patient with headache, blurred vision, and hypotension induced by pituitary prolactinoma

We reported a rare case of a dialysis patient coincident pituitary prolactinoma with calcification. A 55-year-old woman who had undergone hemodialysis for 8 years was admitted to the nephrology unit because of headache, blurred vision, and hypotension. Physical examination was normal; endocrinological examination demonstrated elevated serum levels of prolactin (>4240 mIU/L), but other hormonal profiles, such as growth hormon, adrenocorticotropic hormone, thyroid stimulating hormone, free triiodothyronine, free thyroxine, follicle-stimulating hormone and luteinizing hormone, were absolutely or relatively lower. A cranial computed tomography (CT) suggested saddle area a high-density screenage with an anteroposterior diameter of 1.0 cm. A cerebral magnetic resonance scan confirmed the pituitary adenoma accompanied with calcification. Contrast-enhanced T1-weighted images revealed a less enhancing tumor, 14 mm wide round lesion with a high intensity signal. It enlarges the sella turcica, but the optic chiasma is not displaced. We suggest that in the differential diagnosis of any hemodialysis patient with severe headache, hypotension, and visual disturbances, this syndrome should be considered as prompt pituitary adenoma.

     

地塞米松治疗SAH头痛对比研究

目的 :探讨蛛网膜下腔出血头痛的发生机制及治疗方法。方法 :将患者随机分为 3组 ,A组为鞘内注射地塞米松 ,B组静脉滴注地塞米松 ,C组单纯应用甘露醇 ,治疗后根据脑压值、CT、脑脊液RBC、WBC和蛋白含量的变化进行疗效判定。结果 :A组总有效率 10 0 % ,B组 30 .0 % ,C组 2 7.2 % ,A组与B、C2组比较有显著性差异 (P <0 .0 0 5 )。结论 :除高颅压外 ,脑膜和脑血管壁的炎性反应可能是SAH头痛的主要原因 ,鞘内注射地塞米松治疗SAH头痛效果显著。     

地塞米松治疗外伤性蛛网膜下腔出血致严重头痛临床疗效观察

目的:观察地塞米松治疗外伤性蛛网膜下腔出血致严重头痛疗效。方法:将104例外伤性蛛网膜下腔出血(Traumatic subarachnoid hemorrhage,tSAH)后严重头痛患者随机分为治疗组52例和对照组各52例,治疗组采用静脉滴注地塞米松2.5~5.0 mg,2次/d;对照组给予口服布洛芬胶囊,餐前顿服0.3 mg,2次/d,两组均连用10 d,观察疗效。结果:治疗组总有效率94.2%,对照组总有效率61.5%,两组总有效率比较差异有统计学意义(P<0.05)。结论:采用小剂量地塞米松静脉推注治疗外伤性蛛网膜下腔出血后严重头痛疗效明显优于对照组布洛芬,疗效显著且安全可靠。