老年人颅脑外伤后缺血性脑卒中发作特点及治疗

目的探讨老年人颅脑外伤后缺血性脑卒中发作特点及个性化治疗方案。方法针对7例颅脑外伤后急性期出现缺血性脑血管病症状的老年患者，通过脑血管造影检查分析其发病原因并根据不同的脑血管特点决定治疗方案。结果大多数患者（6／7）受伤前已存在不同程度的颅内外血管狭窄、血管壁溃疡以及附壁血栓形成等改变，提示脑缺血发作主要与这些病变为基础的脑血流下降、血栓脱落等因素密切相关。而外伤后脑灌注降低、脑血管痉挛是脑缺血发作的诱发因素。结论老年人外伤后的缺血性脑卒中发作主要与原有的脑血管基础疾病有关，预防和治疗老年人外伤后缺血性脑卒中发作，应基于这些病变特征并选择个体化治疗方案。     

瞬目反射及脑干听觉诱发电位对脑干梗死疗效的评价

目的探讨瞬目反射和脑干听觉诱发电位对脑干梗死患者疗效的评价作用。方法40例经临床症状、体征定位于脑干髓内并经头部MRI检查明确诊断的脑干梗死患者(脑桥梗死31例、中脑梗死4例和延髓梗死5例),分别计算治疗前后瞬目反射各成分的平均潜伏期;观察脑干听觉诱发电位波形及各波潜伏期、峰间期的变化。结果经治疗后40例患者临床症状及体征均有不同程度改善,治疗前后瞬目反射各成分平均潜伏期之间差异无统计学意义(P>0.05);3例脑桥梗死患者R1波恢复正常,临床基本痊愈。治疗前后脑干听觉诱发电位各波潜伏期及峰间期比较,差异亦无统计学意义(P>0.05);治疗后中脑梗死及脑桥梗死患者各有2例恢复正常,临床症状明显好转。结论瞬目反射与脑干听觉诱发电位均能敏感地反映脑干功能的变化,与临床表现具有一致性,但在发病15d内大部分病例的电生理活动不能恢复正常。     

磁共振扩散加权成像技术在颅内囊性病变鉴别诊断中的应用

目的探讨磁共振扩散加权成像（DWI）技术对颅内囊性病变中表皮样囊肿、蛛网膜囊肿、脑脓肿及囊性坏死性脑肿瘤（单发囊性转移瘤、神经上皮肿瘤）的鉴别诊断价值。方法对2004年5月-2006年5月行神经外科手术治疗并经病理证实的50例颅内囊性病变患者的磁共振扩散加权成像资料进行回顾性分析．其中表皮样囊肿10例、蛛网膜囊肿10例、脑脓肿10例、单发囊性转移瘤8例及神经上皮肿瘤12例，均进行常规MRI平扫及DWI检查，生成DWI图及表观扩散系数（ADC）图，观察囊变区信号特征并测量该区的表观扩散系数值。结果（1）表皮样囊肿在扩散加权成像显示为高信号，其表观扩散系数图显示为低或稍低信号，表观扩散系数测量值为（0．924-0．12）×10^-3mm^2／s，蛛网膜囊肿扩散加权成像显示为低信号，表观扩散系数图呈高信号，测量值为（3．094-0．21）×10^-3mm^2／s；两组表观扩散系数测量值差异有统计学意义（t=22．278，P=0．000）。（2）脑脓肿之囊变区于扩散加权成像显示为高信号，表观扩散系数图呈低及等信号，表观扩散系数测量值为（0．524-0．08）×10^-3mm^2／s；单发囊性转移瘤和神经上皮肿瘤之囊变区在扩散加权成像上显示为低信号，表观扩散系数图显示为高信号。表观扩散系数测量值为（2．354-0．41）×10^-3mm^2／s，与脑脓肿组相比差异有统计学意义（t=13．939，P=0．000）。结论不同颅内囊性病变在磁共振扩散加权成像上的表现特点及病灶囊变区表观扩散系数测量值的变化。具有诊断与鉴别诊断价值。     

MR扩散加权成像鉴别脑结核瘤及高级星形细胞瘤和脑转移瘤的价值

目的探讨MR扩散加权成像（DWI）在脑结核瘤、高级星形细胞瘤和脑转移瘤鉴别诊断中的价值。方法14例脑结核瘤、15例脑高级星形细胞瘤和21例脑转移瘤患者，在术前或接受治疗前行常规MRI和DWI。测量并计算3种疾病瘤体、瘤周围水肿带的平均表观扩散系数（ADC）值和病灶与对侧相应部位正常脑白质区ADC值的比值（rADC值）。结果脑结核瘤瘤体平均ADC值和rADC值分别为（1．2±0．2）×10^-3mm^2·s^-1和1．6±0．3，高级星形细胞瘤瘤体平均ADC值和rADC值分别为（0．8±0．1）×10^-3mm^2·s^-1和1．1±0．1，转移瘤瘤体平均ADC值和rADC值分别为（0．8±0．1）×10^-3mm^2·s^-1和1．0±0．2。3种疾病瘤体平均ADC值（F=33．57，P〈0．01）之间和rADC值（F=33．27，P〈0．01）之间差异均有统计学意义。脑结核瘤瘤周水肿带平均ADC值和rADC值分别为（1．8±0．1）×10^-3mm^2·s^-1和2．5±0．2，脑高级星形细胞瘤瘤周水肿带平均ADC值和rADC值分别为（1．4±0．2）×10^-3mm^2·s^-1和1．8±0．3，脑转移瘤瘤周水肿带平均ADC值和rADC值分别为（1．9±0．2）×10^-3mm^2·s^-1和2．3±0．5。3种疾病瘤周围水肿带平均ADC值（F=23．17，P〈0．01）之间和rADC值（F=5．94，P〈0．01）之间差异均有统计学意义。结论结合MRI、DWI检测方法，根据病灶瘤体和瘤周水肿带的ADC和rADC值可帮助鉴别脑结核瘤、脑高级星形细胞瘤和脑转移瘤。     

Least-square conformal brain mapping with spring energy

The human brain cortex is a highly convoluted sheet. Mapping of the cortical surface into a canonical coordinate space is an important tool for the study of the structure and function of the brain. Here, we present a technique based on least-square conformal mapping with spring energy for the mapping of the cortical surface. This method aims to reduce the metric and area distortion while maintaining the conformal map and computation efficiency. We demonstrate through numerical results that this method effectively controls metric and area distortion, and is computational efficient. This technique is particularly useful for fast visualization of the brain cortex.     

高温高湿环境下颅脑火器伤亚低温治疗的实验研究

目的 观察早期亚低温治疗高温高湿环境下犬颅脑火器伤的疗效。方法 选杂种犬60只，制作出高温高湿环境下（气温39°C±0．5℃．相对湿度80％-85％）颅脑火器伤的动物模型，随机分为亚低温组和对照组，每组30只犬。亚低温组在术中采用静脉内输入1．2℃±0．34℃冷冻生理盐水．输液量为体重的5％，术后采用降温毯降温，体温控制在33～35℃，持续48h。对照组按常规治疗。Powlab／8SP生理记录仪动态监测生命体征变化和记录两组动物的生存率，分析比较二组的治疗结果。结果 亚低温组动物生命体征平稳，死亡率40％（12／30）；对照组动物生命体征紊乱，死亡率70％（21／30），两组死亡率差异显著（P〈0．05）。结论 早期亚低温治疗高温高湿环境下颅脑火器伤可以降低动物的死亡率。     

Effect of AVP on brain edema following traumatic brain injury

Objective: To evaluate plasma arginine vasopressin (AVP) level in patients with traumatic brain injury and investigate the role of AVP in the process of brain edema. Methods: A total of 30 patients with traumatic brain injury were involved in our study. They were divided into two groups by Glasgow Coma Scale: severe traumatic brain injury group (STBI, GCS≤8) and moderate traumatic brain injury group ( MTBI, GCS >8). Samples of venous blood were collected in the morning at rest from 15 healthy volunteers (control group) and within 24 h after traumatic brain injury from these patients for AVP determinations by radioimmunoassay. The severity and duration of the brain edema were estimated by head CT scan. Results: plasma AVP levels (ng/L) were (mean±SD): control, 3. 06±1. 49; MTBI, 38. 12±7. 25; and STBI, 66. 61±17. 10. The plasma level of AVP was significantly increased within 24 h after traumatic brain injury and followed by the reduction of GCS, suggesting the deterioration of cerebral injury (P<0. 01). And the AVP level was correlated with the severity (STBI r =0.919, P < 0.01; MTBI r = 0.724, P < 0.01) and the duration of brain edema (STBI r = 0. 790, P < 0. 01; MTBI r = 0. 712, P<0.01). Conclusions: The plasma AVP level is closely associated with the severity of traumatic brain injury. AVP may play an important role in pathogenesis of brain edema after traumatic brain injury.     

首次CT检查阴性的颅脑损伤54例临床分析

目的分析颅脑损伤首次CT检查阴性而复查CT阳性的表现和原因。方法通过对首次CT检查阴性而复查CT阳性的54例颅脑损伤患者（研究组）的临床资料进行回顾性分析总结,并与同期收治的325例首次CT及复查CT均为阴性的颅脑损伤患者（对照组）作比较。结果研究组首次CT检查阴性而复查CT阳性表现为迟发性血肿、脑挫裂伤、脑积水、硬膜下积液、弥漫性脑肿胀、外伤性脑梗塞等,可由不同原因引起。结论熟悉本类颅脑损伤首次CT检查阴性,而复查CT阳性的表现及原因,对于指导检查及治疗,改善病人预后有重要意义。     

+10 Gz重复暴露大鼠脑差异表达基因cDNA文库的构建

目的构建＋10Gz重复暴露大鼠脑差异表达基因的消减cDNA文库。方法本实验用SD大鼠，分别提取暴露组与对照组的总RNA，并分离纯化mRNA，应用抑制性消减杂交技术分离＋10GI重复暴露大鼠脑差异表达基因eDNA片段并建立消减eDNA文库；利用PCR对随机挑选的75个白色菌落进行插入片段的验证，对其中70个克隆进行eDNA斑点杂交验证。结果所构建的eDNA文库扩增后包含约400个白色克隆和100个兰色克隆，随机挑选75个白色克隆入质粒载体后共获得70个阳性克隆。结论应用抑制性消减杂交技术成功构建了＋10Gz重复暴露大鼠脑差异表达基因消减eDNA文库，为进一步筛选和克隆脑损伤相关基因奠定了基础。     

Adult medulloblastoma: review of 13 cases with emphasis on MRI

Medulloblastomas are generally associated with childhood, but 14–30% occur in adults, accounting for 1% of adult central nervous system tumors. While approximately one third of adult medulloblastomas present as vermian tumors similar to those seen in childhood, the majority differ substantially from the childhood variety. In this series of 13 patients, 5 had lateral, seemingly extra-axial masses in the cerebellopontine angle or at the tentorium, simulating meningiomas or acoustic neuromas, but angiographic hypovascularity in 2 of the latter suggested a diagnosis other than meningioma. Of 4 paramedian tumors, 3 diffusely infiltrated the cerebellar white matter, showed little or no gadolinium enhancement and were not associated with hydrocephalus. Hydrocephalus was present in less than half of our patients; in childhood the reported incidence is 85–100%. A possible association with pregancy was noted.