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Neuropathology of JC virus infection in progressive multifocal leukoencephalopathy in remission
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作者 Karen S SantaCruz Gulmohor Roy +1 位作者 James Spigel Elaine L Bearer 《World Journal of Virology》 2016年第1期31-37,共7页
AIM: To investigate the neuropathology of the brain in a rare case of remission following diagnosis of progressive multifocal leukoencephalopathy(PML).METHODS: Consent from the family for an autopsy was obtained, clin... AIM: To investigate the neuropathology of the brain in a rare case of remission following diagnosis of progressive multifocal leukoencephalopathy(PML).METHODS: Consent from the family for an autopsy was obtained, clinical records and radiograms were retrieved. A complete autopsy was performed, with brain examination after fixation and coronal sectioning at 1 cm intervals. Fourteen regions were collected for paraffin embedding and staining for microscopic analysis. Histologic sections were stained with Luxol blue, hematoxylin/eosin, and immunostained for myelin basic protein, neurofilament, SV40 T antigen and p53. The biopsy material was also retrieved and sections were stained with hematoxylin/eosin and immunostained for SV40 and p53. Sections were examined by American Board of Pathology certified pathologists and images captured digitally.RESULTS: Review of the clinical records was notable for a history of ulcerative colitis resulting in total colectomy in 1977 and a liver transplant in 1998 followed by immune-suppressive therapy. Neurological symptoms presented immediately, therefore a biopsy was obtained which was diagnosed as PML. Immunotherapy was adjusted and clinical improvement was noted. No subsequent progression was reported. Review of the biopsy demonstrated atypical astrocytes and enlarged hyperchromatic oligodendroglial cells consistent with JC virus infection. Strong SV40 and p53 staining was found in glial cells and regions of dense macrophage infiltration were present. On gross examination of the post-mortem brain, a lesion in the same site as the original biopsy in the cerebellum was identified but no other lesions in the brain were found. Microscopic analysis of this cerebellar lesion revealed a loss of myelin and axons, and evidence of axonal damage. This single burned-out lesion was equivocally positive for SV40 antigen with little p53 staining. Examination of thirteen other brain regions found no other occult sites.CONCLUSION: Our study reveals residual damage, rare macrophages or other inflammation and minimal evidence of persistent virus. This case demonstrates the possibility of complete remission of PML. 展开更多
关键词 progressive multifocal LEUKOENCEPHALOPATHY progressive multifocal LEUKOENCEPHALOPATHY JC virus REMISSION DEMYELINATING
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Effects of Comprehensive Rehabilitation on Patients with Progressive Multifocal Leukoencephalopathy Due to Systemic Lupus Erythematosus: A Case Report
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作者 Xiaoli Wu Xueyan Hu +1 位作者 Yuge Zhang Lixu Liu 《Journal of Behavioral and Brain Science》 2023年第8期143-156,共13页
Introduction: Little is known about the feasibility and effectiveness of rehabilitative treatment for systemic lupus erythematosus (SLE) in individuals with progressive multifocal leukoencephalopathy (PML). We describ... Introduction: Little is known about the feasibility and effectiveness of rehabilitative treatment for systemic lupus erythematosus (SLE) in individuals with progressive multifocal leukoencephalopathy (PML). We describe a patient with SLE complicated by PML and ameliorated by comprehensive rehabilitation. We also review the epidemiology, pathology, imaging characteristics, and treatment of PML. Patient Concerns: We found a patient with SLE with PML improved by multidisciplinary rehabilitation techniques. Diagnoses, Interventions, and Outcomes: We diagnosed a PML with a 13-year history of SLE and lupus nephritis after longtime immunosuppressive therapy. The patient underwent a comprehensive, multifaceted rehabilitation program, including drug therapy, integrated physical therapy, occupational therapy, acupuncture, music therapy, computer-aided cognitive rehabilitation training, and behavioral management training. This rehabilitation program improved her motor function and activities of daily living. Conclusions: Her condition improved in the short term through comprehensive rehabilitation, including physical, speech, and cognitive therapy. Therefore, we recommend comprehensive rehabilitation to improve the function and activities of daily living in patients with PML. 展开更多
关键词 progressive multifocal Leukoencephalopathy Systemic Lupus Erythematosus REHABILITATION PROGNOSIS Case Report
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Unusual MR Feature Presenting Discrete Involvement of Pyramidal Tract in Progressive Multifocal Leukoencephalopathy: A Case Report
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作者 Maki Umino Masayuki Maeda +3 位作者 Nobuyoshi Matsushima Ai Itoh Akira Taniguchi Hidekazu Tomimoto 《Open Journal of Medical Imaging》 2012年第3期100-102,共3页
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease caused by reactivation of JC virus in immunocompromised patients. To date, PML with discrete involvement of the pyramidal tract has been desc... Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease caused by reactivation of JC virus in immunocompromised patients. To date, PML with discrete involvement of the pyramidal tract has been described in only two patients. This report describes an additional case with PML showing discrete involvement of the pyramidal tract on T2-weighted images and FLAIR images. 展开更多
关键词 progressive multifocal LEUKOENCEPHALOPATHY PYRAMIDAL TRACT MRI
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Cerebral Localization of Chronic Lymphocytic Leukemia Simulating Progressive Multifocal Leukoencephalopathy: The Lessons from a Case
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作者 T. M. Sandouno S. Chebrek +10 位作者 C. Tchonko G. Pichancourt L. Giovannetti H. Zerazhi Romain Appay H. Lepidi H. Bachir S. Hamaz H. B. Alaoui K. Serraj B. Slama 《Case Reports in Clinical Medicine》 2020年第4期96-106,共11页
Background: Central neurological involvement is the most frequent extra hematological manifestation of chronic lymphocytic leukemia;it is multifactorial and rarely due to a cerebral localization of the disease. We rep... Background: Central neurological involvement is the most frequent extra hematological manifestation of chronic lymphocytic leukemia;it is multifactorial and rarely due to a cerebral localization of the disease. We report a case of cerebral localization of chronic lymphoid leukemia whose clinical and radiological aspects were very suggestive of progressive multifocal leukoencephalopathy. Case Presentation: A 65-year-old patient who was HIV-negative (human immunodeficiency virus), had consulted for bilateral axillary, cervical and inguinal lymphadenopathy associated with major asthenia and hyper lymphocytosis (lymphocyte count was 11 giga/l). Chronic lymphocyticleukemia with TP53 mutation was diagnosed and treatment with Ibrutinib 420 mg/day was initiated. After 2 months of treatment, the evolution was marked by the onset of neurological disorders whose clinical-radiological presentation and temporal evolution had led to the diagnosis of progressive multifocal leukoencephalopathy. In the absence of virological evidence in the cerebrospinal fluid analysis, a stereotactic biopsy of the brain lesions had been performed, making it possible to formally rule out this infectious hypothesis and to demonstrate cerebral invasion by tumour cells. Immuno-chemotherapy combining Rituximab-Cyclophosphamide-Doxorubicin-Vincristine-Prednisone-Ibrutinib (RCHOP-Ibrutinib) with intrathecal chemotherapy resulted in a very good clinical-radiological response. Conclusion: The appearance of neurological manifestations in the context of chronic lymphocytic leukemia must systematically lead to a search for a cerebral localization of the disease. In the absence of virological evidence in the cerebrospinal fluid, any suspicion of progressive multifocal leukoencephalopathy in this context should lead to the histological study of brain lesions. 展开更多
关键词 progressive multifocal LEUKOENCEPHALOPATHY Chronic LYMPHOCYTIC LEUKEMIA John Cunningham Virus CEREBRAL LOCALIZATION Ibrutinib
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Pontocerebellar Progressive Multifocal Leukoencephalopathy. Radiological, Clinical, Histological and Immunohistochemical Findings in a Hematological Patient
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作者 Javier Ortiz Juan Carlos Paniagua +5 位作者 Isidro Cavaco Raquel Rivas Andrea Jimenez Luis Chinchilla Elisa Muñoz María Dolores Ludeña 《Open Journal of Pathology》 2023年第4期177-183,共7页
Objective: To describe the radiological, histological and immunohistochemical findings in a case of Progressive Multifocal Leukoencephalopathy (PML) affecting the cerebellar peduncles in a patient with chronic lymphoc... Objective: To describe the radiological, histological and immunohistochemical findings in a case of Progressive Multifocal Leukoencephalopathy (PML) affecting the cerebellar peduncles in a patient with chronic lymphocytic leukemia. Patient and Methods: Magnetic Resonance Imaging (MRI), histological picture (H.E., Kluver-Barrera) and immunohistochemical picture (GFAP, neurofilaments, CD68, JC virus) were obtained. Results: 1) Magnetic resonance imaging: Asymmetric and progressive lesions on middle cerebellar peduncles, that were hyperintense in T2/FLAIR, extended towards the pons, had no mass effect and were unmodified after intravenous contrast. 2) Histology: Marked reactive gliosis with cytopathic changes suggesting viral infection, plus demyelination areas with axonal preservation. 3) Immunohistochemistry: Marked positivity for viral (polyoma and JC virus) markers in glial cells showing cytopathic changes. Conclusions: The importance of histological and immunohistochemical diagnosis in everyday assistance;of the collaboration between clinicians, radiologists and pathologists;and the validity of postmortem studies as a key element for research and clinical quality assessment must be stressed. 展开更多
关键词 progressive multifocal Leukoencephalopathy JC Virus IMMUNOHISTOCHEMISTRY
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A case of atypical progressive multifocal encephalopathy mimicking acute ischemic stroke:case report and review of literature
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作者 Maria Teresa Infante Giovanni Novi +4 位作者 Riccarda Gentile Laura Malfatto Lucio Castellan Carlo Serrati Laura Barletta 《Neuroimmunology and Neuroinflammation》 2017年第10期211-215,共5页
Progressive multifocal encephalopathy (PML) is a rare but often fatal infectious brain disease caused by the reactivation of John Cunningham polyomavirus. Reactivation occurs in immunocompromised individuals with AIDS... Progressive multifocal encephalopathy (PML) is a rare but often fatal infectious brain disease caused by the reactivation of John Cunningham polyomavirus. Reactivation occurs in immunocompromised individuals with AIDS and leukemia, on chemotherapy or being treated with immunosuppressant drugs (e.g. monoclonal antibodies). Cases of PML have been described in patients treated with natalizumab, efalizumab and rituximab used, respectively, for the treatment of (1) multiple sclerosis, (2) psoriasis and (3) haematological malignancies or systemic autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus). The authors describe an unusual case of acute brainstem and cerebellar PML following chemotherapy for chronic lymphatic leukemia diagnosed 4 years before the onset of PML in a 75-year-old man. The patient was treated with high dose chemotherapy and rituximab with complete response. The onset of symptoms of PML was very rapid and occurred after more than two years from last rituximab infusion;patient had a sudden neurological deterioration, with rapid progression to death in about a month from the onset of symptoms. Lesions were localized in the cerebellum, brainstem and such pattern has been reported in very few cases in the literature. 展开更多
关键词 progressive multifocal ENCEPHALOPATHY RITUXIMAB IMMUNOSUPPRESSION
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Progressive Multifocal Leukoencephalopathy—A Case Report in an Immunocompetent Patient
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作者 Ana Faceira Daniela Magalhaes +3 位作者 Filipa Ceia Joao Nuak Carina Reis Susana Ferreira 《Advances in Infectious Diseases》 2018年第1期10-16,共7页
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major oppo... Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major opportunistic infection associated with HIV infection. We report a case of a previously healthy patient who was diagnosed with PML. 展开更多
关键词 IMMUNOSUPPRESSION IMMUNOCOMPETENT JC Virus progressive multifocal Leukoencephalopathy
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COMBINATION OF TRADITIONAL CHINESE AND WESTERN MEDICINE IN TREATING ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY
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作者 鲍丽玲 成霄黎 任佩贤 《Journal of Traditional Chinese Medicine》 SCIE CAS CSCD 1993年第4期268-276,共9页
Acute posterior multifocal placoidpigment epitheliopathy (APMPPE),origi-nally described by Gass in 1968,is general-ly recognized as having a self-limited natu-ral course and good prognosis,thoughchronic progression ca... Acute posterior multifocal placoidpigment epitheliopathy (APMPPE),origi-nally described by Gass in 1968,is general-ly recognized as having a self-limited natu-ral course and good prognosis,thoughchronic progression can lead to severe visualimpairment.A case associated with fatalcerebral vasculitis has been reported in re- 展开更多
关键词 multifocal prognosis progression STEROIDS minutes RADIX retina routine NODULES TREATING
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Corneal Wavefront Aberrations in Patients Wearing Multifocal Soft Contact Lenses for Myopia Control
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作者 Frank Spors Donald J. Egan +3 位作者 Jie Shen Lance E. McNaughton Stuart Mann Neil M. Patel 《Open Journal of Ophthalmology》 2012年第3期45-53,共9页
Purpose: The purpose of this study was to evaluate the change in corneal wavefront aberrations in young adults who have been fit with multifocal soft contact lenses for myopia progression control. Findings have been a... Purpose: The purpose of this study was to evaluate the change in corneal wavefront aberrations in young adults who have been fit with multifocal soft contact lenses for myopia progression control. Findings have been analyzed for statistical significance and clinical relevance and compared to reportedly successful Orthokeratology outcomes. Methods: The dominant eye of 40 participants (27 women, 13 men;mean age 27.3 ± 3.2 years;range 23 to 39 years) was fit with Proclear Multifocal center distance lenses (Coopervision, Pleasanton, USA) having a variety of distance powers and reading additions. Refractive errors were limited to a range of –6.00 D up to +1.00 D of sphere, and no greater than –1.00 D of cylinder. Corneal wavefront measurements were performed over 6 mm diameters with a Zeiss Atlas 9000 corneal topographer (Zeiss Meditec, Dublin, USA) prior to, and following lens fitting. Data were converted into rectangular Fourier optics terms M, J0, J45 and RMS values for each reading addition were statistically analyzed. Following evaluation of statistical significance and clinical relevance, results were compared to published data from successful Orthokeratology treatments. Results: Statistically significant changes in higher order aberrations were detected for lenses of all reading additions. Lens groups with higher Add-powers demonstrated stronger changes with increased significance. Final RMS values relating to 2nd, 3rd and 4th Zernike Orders reached clinical significance with a wavefront error of 0.10 μm, the equivalent of 0.25D. Moreover, as Add-powers increased, 3rd and 4th order aberrations likewise showed an increase. Pre-fitting astigmatism values accounted for the highest recorded aberrations and remained predominantly unchanged. Conclusion: Proclear Multifocal center-distance contact lenses were found to increase higher order wavefront aberrations in a manner dependent on their Add-power. In comparison to successful Orthokeratology outcomes, the amounts of resulting aberrations are notably different. 展开更多
关键词 multifocal Soft Contact Lenses Wavefront Aberrations MYOPIA MYOPIA Progression CONTROL ORTHOKERATOLOGY ZERNIKE Polynomials
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系统性红斑狼疮患者应用靶向B细胞治疗后发生中枢神经系统病变文献病例分析 被引量:1
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作者 姜莉 贾倩 +3 位作者 厉彦山 王莉莉 李红 李尊忠 《实用药物与临床》 CAS 2024年第3期207-211,共5页
目的探讨系统性红斑狼疮(SLE)患者经靶向B淋巴细胞生物制剂治疗后发生中枢神经系统不良反应的临床特征。方法检索国内外相关数据库(截至2023年5月),收集系统性红斑狼疮患者经贝利尤单抗、利妥昔单抗治疗后发生中枢神经系统病变的病例报... 目的探讨系统性红斑狼疮(SLE)患者经靶向B淋巴细胞生物制剂治疗后发生中枢神经系统不良反应的临床特征。方法检索国内外相关数据库(截至2023年5月),收集系统性红斑狼疮患者经贝利尤单抗、利妥昔单抗治疗后发生中枢神经系统病变的病例报告类文献,提取患者的基本信息、贝利尤单抗或利妥昔单抗用药情况(用法用量、单用或联用、联用方案等)、中枢神经系统病变发生时间、临床表现、影像学特征、临床治疗及转归等,并进行描述统计分析。结果检索到进行性多灶性脑白质病(PML)患者14例,发病年龄(50.71±11.45)岁;可逆性后部脑病综合征(PRES)患者24例,发病年龄(30.67±14.93)岁。纳入有详细病例报道的患者共7例,7例患者均未合并HIV感染、恶性肿瘤及其他自身免疫性疾病。7例患者均经磁共振检查确诊,均未行脑组织活检。临床表现:癫痫5例,视物模糊或视力丧失3例,构音障碍或失语2例,头痛2例,昏迷1例,血压升高4例。最终7例患者中1例死亡。结论应用靶向B细胞治疗后,SLE患者中枢神经系统副作用多发生在疾病活动期且合并使用其他免疫抑制剂时。患者的临床表现容易与神经精神狼疮混淆,导致病情延误,提示在使用靶向B细胞生物制剂治疗时,应评估SLE患者发生中枢神经系统副作用的潜在风险。 展开更多
关键词 靶向B细胞治疗 系统性红斑狼疮 进行性多灶性脑白质病 可逆性后部脑病综合征 药物不良反应
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4个常染色体显性遗传性脑动脉病伴皮层下梗死和白质脑病(CADASIL)家族的临床表现 被引量:16
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作者 吕鹤 姚生 +5 位作者 张巍 王朝霞 黄一宁 牛小媛 张茁 袁云 《北京大学学报(医学版)》 CAS CSCD 北大核心 2004年第5期496-500,共5页
目的 :报道我国 4个常染色体显性遗传性脑动脉病伴皮层下梗死和白质脑病 (CADASIL)家族的临床特点。方法 :收集 4个通过病理和基因检查确诊为CADASIL的先证者及其家族成员的临床资料 ,对 4个先证者做心电图检查 ,2个先证者进行周围神经... 目的 :报道我国 4个常染色体显性遗传性脑动脉病伴皮层下梗死和白质脑病 (CADASIL)家族的临床特点。方法 :收集 4个通过病理和基因检查确诊为CADASIL的先证者及其家族成员的临床资料 ,对 4个先证者做心电图检查 ,2个先证者进行周围神经电生理检查。结果 :4个家族共调查 83个家庭成员 ,总共 2 9人出现神经系统损害的临床症状。每个家族中连续数代均有发病者 ,男女均受累及 ,符合常染色体显性遗传特点 ,所有患者均无常见的脑血管病的危险因素 ,发病年龄为 2 8~ 70岁 ,以 4 0~ 5 0岁为主。主要临床表现为发作性头晕、轻偏瘫 ,发病同时或短期内出现智能下降。所有患者均无偏头痛发作。 1个先证者出现手套和袜套样痛觉减退 ,2个先证者周围神经电生理检查结果异常。所有先证者心电图检查均未见异常改变。结论 :我国CADASIL患者早期可以主要表现为椎 基底动脉系统缺血的症状 ,智能下降可以在疾病早期发生 ,偏头痛可能不是我国患者的主要表现。本病可出现周围神经的损害。 展开更多
关键词 先证者 CADASIL 患者 白质脑病 常染色体显性遗传性脑动脉病 皮层下梗死 周围神经 中国 结论 收集
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不同多焦点人工晶状体植入术后视觉效果的比较 被引量:11
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作者 屈思萌 陈琛 +4 位作者 林珊 邸红莲 李莉 王玉芬 韦秋红 《国际眼科杂志》 CAS 北大核心 2018年第3期486-490,共5页
目的:比较不同多焦点人工晶状体(MIOL)植入治疗白内障术后患者的视觉质量。方法:选取2016-02/2017-06于本院行白内障超声乳化摘除联合MIOL植入手术的年龄相关性白内障患者78例78眼。根据植入MIOL的不同分为A、B、C组,各26例26眼。A组植... 目的:比较不同多焦点人工晶状体(MIOL)植入治疗白内障术后患者的视觉质量。方法:选取2016-02/2017-06于本院行白内障超声乳化摘除联合MIOL植入手术的年龄相关性白内障患者78例78眼。根据植入MIOL的不同分为A、B、C组,各26例26眼。A组植入区域折射型MIOL SBL-3,B组植入阶梯渐进衍射型MIOL SN6AD1,C组植入全光学面衍射型MIOL Tecnis ZMB00。比较三组患者术后3mo的视力恢复情况、对比敏感度、离焦曲线、对比度视力以及视觉质量满意度。结果:三组患者术后不良反应发生情况比较,差异无统计学意义(P>0.05);三组患者裸眼中视力、裸眼近视力、矫正远视力下的中视力、矫正远视力下的近视力的比较,差异均有统计学意义(P<0.05),且A、B组均显著优于C组(P<0.05)。三组患者术后在明光、明光眩光下4种空间频率(3、6、12、18c/d)以及暗光、暗光眩光下3种空间频率(3、6、12c/d)的对比敏感度比较,差异均有统计学意义(P<0.05),且A组患者均显著优于B、C组患者(P<0.05)。三组患者术后离焦曲线表明A、B组患者在-1.5、-2.0、-2.5D处视力高于C组患者(P<0.05)。三组患者术后对比度为20%、9%的对比度视力比较,差异均有统计学意义(P<0.05),且A组显著优于B、C组患者(P<0.05)。三组患者术后视觉质量满意度比较,差异有统计学意义(P<0.05),且A组显著优于B、C组(P<0.05)。结论:区域折射型MIOL SBL-3不仅可提供较理想的远、近、中视力,还可提供更佳的对比敏感度及对比度视力,从而提高了患者对视觉质量的满意度。 展开更多
关键词 区域折射多焦点人工晶状体 阶梯渐进衍射型多焦点人工晶状体 全光学面衍射型多焦点人工晶状体 视觉质量
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皮质下动脉硬化性脑病血压及心率变异性分析 被引量:5
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作者 陈春富 贾海燕 +2 位作者 任旭东 郭述苏 陈同慧 《中国病理生理杂志》 CAS CSCD 北大核心 1998年第3期296-299,共4页
目的和方法:采用动态检测技术观察31例皮质下动脉硬化性脑病和对照组31例健康人血压和心率的变异性。结果:患者均存在动态血压异常,其中平均收缩压、平均舒张压超过正常值者27例(87%),夜间基底血压异常升高22例(71... 目的和方法:采用动态检测技术观察31例皮质下动脉硬化性脑病和对照组31例健康人血压和心率的变异性。结果:患者均存在动态血压异常,其中平均收缩压、平均舒张压超过正常值者27例(87%),夜间基底血压异常升高22例(71%),血压异常波动20例(64%),昼夜节律逆转4例(13%)。患者心率变异时域指标24小时内全部正常心动周期的标准差、24小时内5分钟节段平均正常心动周期的标准差、在一定时间内相邻两正常心动周期差值大于50毫秒的个数所占的百分比均明显低于对照组,收缩压与心率无显著相关性。结论:提示血压波动及持续的夜间升压现象在该病中起着一定作用。 展开更多
关键词 多病灶性进行性白质脑病 血压 心率变异性 SAE 皮质下动脉硬化性脑病
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糖皮质激素治疗海洛因海绵状白质脑病的临床对照研究 被引量:13
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作者 周亮 陆兵勋 +3 位作者 尹恝 罗一峰 王群 刘晓加 《第一军医大学学报》 CSCD 北大核心 2003年第2期172-174,共3页
目的评价糖皮质激素对海洛因海绵状白质脑病的疗效.方法随机将20名患者分为对照组和治疗组.对照组给予维生素B族药及辅酶Q10治疗,1个月后带药出院;治疗组在上述用药的基础上加用地塞米松20 mg/d,连用10 d后渐减量.对比治疗前、治疗后1... 目的评价糖皮质激素对海洛因海绵状白质脑病的疗效.方法随机将20名患者分为对照组和治疗组.对照组给予维生素B族药及辅酶Q10治疗,1个月后带药出院;治疗组在上述用药的基础上加用地塞米松20 mg/d,连用10 d后渐减量.对比治疗前、治疗后1个月、半年及1年两组患者的症状改善情况.结果两组患者治疗前、后对比无显著差异(P>0.05).各组内对比结果显示,治疗后均较治疗前好转(P<0.05).结论糖皮质激素治疗海洛因海绵状白质脑病无显著疗效,病后1~6个月内恢复较快,而6个月后症状恢复较慢. 展开更多
关键词 糖皮质激素 治疗 海洛因海绵状白质脑病 中枢神经系统疾病
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血清叶酸水平与脑白质高信号严重程度及伴发脑微出血的相关性 被引量:5
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作者 钟根龙 陈智才 +4 位作者 张睿婷 刘畅 周颖 严慎强 楼敏 《浙江大学学报(医学版)》 CAS CSCD 北大核心 2017年第4期390-396,共7页
目的:研究血清叶酸水平与脑白质高信号严重程度以及伴发脑微出血的相关性。方法:回顾性分析2011年7月至2016月2月在浙江大学医学院附属第二医院神经内科连续收集的脑白质高信号患者的临床资料。根据血清叶酸水平,将患者分为高叶酸组(≥1... 目的:研究血清叶酸水平与脑白质高信号严重程度以及伴发脑微出血的相关性。方法:回顾性分析2011年7月至2016月2月在浙江大学医学院附属第二医院神经内科连续收集的脑白质高信号患者的临床资料。根据血清叶酸水平,将患者分为高叶酸组(≥15.68 nmol/L)、低叶酸组(6.8~<15.68 nmol/L)和叶酸缺乏组(<6.8 nmol/L)。在T2-Flair序列上使用Fazekas评分方法,将患者分为轻度脑白质高信号组(0~3分)和重度脑白质高信号组(4~6分);在磁敏感加权成像(SWI)序列上评估脑微出血。二元logistic回归分析血清叶酸水平与脑白质高信号严重程度、脑白质高信号伴脑微出血的相关性。结果:共有228例脑白质高信号患者纳入分析,其中重度脑白质高信号患者149例(65.35%),高叶酸组、低叶酸组和叶酸缺乏组的重度脑白质高信号患者比例分别为52.88%、73.33%和89.47%。二元logistic回归分析显示,叶酸水平与重度脑白质高信号相关,低叶酸(OR=2.109,95%CI:1.112~4.001,P<0.05)和叶酸缺乏的患者(OR=6.383,95%CI:1.168~34.866,P<0.05)更容易出现重度脑白质高信号。脑白质高信号伴脑微出血组的叶酸水平低于不伴脑微出血组(13.42 nmol/L与16.51 nmol/L,P<0.01),但二元logistic回归分析提示叶酸水平与脑微出血无独立相关性(P>0.05)。结论:血清叶酸水平低与重度脑白质高信号相关,但与脑微出血无独立相关性。 展开更多
关键词 脑白质病 进行性多灶性 脑出血/病理生理学 叶酸 半胱氨酸
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缺血性脑白质病额顶叶白质的扩散峰度表现 被引量:6
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作者 叶德湫 陈向荣 +3 位作者 黄永础 许淑惠 连涛 蔡建忠 《中国医学影像学杂志》 CSCD 北大核心 2016年第7期481-485,共5页
目的探讨缺血性脑白质病的额顶叶脑白质扩散峰度表现,并评价高级别Fazekas的病灶特点。资料与方法回顾性分析经临床确诊为缺血性脑白质病的46例患者的扩散峰度成像(DKI)资料,Fazekas 0~3级,比较其额顶叶正常脑白质及病灶的平均扩散峰... 目的探讨缺血性脑白质病的额顶叶脑白质扩散峰度表现,并评价高级别Fazekas的病灶特点。资料与方法回顾性分析经临床确诊为缺血性脑白质病的46例患者的扩散峰度成像(DKI)资料,Fazekas 0~3级,比较其额顶叶正常脑白质及病灶的平均扩散峰度(MK)、平均扩散系数(MD)、各向异性分数(FA)、峰度各向异性分数(FA_k)、轴向扩散峰度(Ka)、径向扩散峰度(Kr)、轴向扩散系数(Da)、径向扩散系数(Dr)加权值的差异。结果 1病灶加权MD、Ka、Dr与Fazekas分级呈正相关(r=0.795、0.863、0.668,P〈0.05),加权MK、Kr、Da与Fazekas分级呈负相关(r=-0.616、-0.682、-0.807,P〈0.05);2额顶叶正常白质各DKI参数MK、MD、FA、FAk、Ka、Kr、Da、Dr加权值与Fazekas分级无明显相关性(P〉0.05)。3 4个Fazekas分级组的额顶叶正常白质各参数MK、MD、FA、FA_k、Ka、Kr、Da、Dr比较,差异有统计学意义(P〈0.05),其中Fazekas 0级与Fazekas 3级组各参数间差异均有统计学意义(P〈0.05)。4 4个Fazekas分级组的额顶叶病灶MK、MD、FA、FA_k、Ka、Kr、Da、Dr的加权值差异均有统计学意义(P〈0.05)。5 Fazekas 3组额顶叶病灶的加权MK值与FA值、加权Kr与FA值呈正相关(r=0.69、0.72,P〈0.05),加权Kr值与Dr值呈负相关(r=-0.95,P〈0.05)。结论 DKI能早期反映额顶叶正常白质扩散峰度变化的差异,能先于T2液体衰减反转恢复序列敏感地探测出缺血性脑白质病额顶叶白质病变;DKI可以发现缺血性脑白质病额顶叶白质扩散峰度的变化特点。 展开更多
关键词 脑白质病 进行性多灶性 脑缺血 磁共振成像 图像处理 计算机辅助
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脑白质高信号伴认知功能障碍患者胆碱能通路损伤与皮质结构改变的关系研究 被引量:4
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作者 王诗男 王金芳 +3 位作者 石庆丽 李越秀 陈红燕 张玉梅 《中国现代神经疾病杂志》 CAS 北大核心 2020年第10期893-902,共10页
目的探讨脑白质高信号伴不同程度认知损害患者的胆碱能通路损伤与大脑皮质结构改变之间的关系。方法以2016年3月至2018年12月80例脑白质高信号患者为研究对象,根据蒙特利尔认知评价量表(MoCA)和临床痴呆评价量表(CDR)分为脑白质高信号... 目的探讨脑白质高信号伴不同程度认知损害患者的胆碱能通路损伤与大脑皮质结构改变之间的关系。方法以2016年3月至2018年12月80例脑白质高信号患者为研究对象,根据蒙特利尔认知评价量表(MoCA)和临床痴呆评价量表(CDR)分为脑白质高信号不伴认知损害组(WMH-CN组,43例)、脑白质高信号伴非痴呆型血管性认知损害组(WMH-VCIND组,21例)和脑白质高信号伴血管性痴呆组(WMH-VaD组,16例),胆碱能通路高信号量表(CHIPS)评价胆碱能通路中白质损害程度;MRI标记胆碱能通路中34个大脑皮质兴趣区(ROI),测量层厚和体积。Spearman秩相关分析和偏相关分析探讨左侧和右侧大脑半球CHIPS总评分与同侧皮质兴趣区层厚和体积的相关性。结果(1)WMH-CN组、WMH-VCIND组和WMH-VaD组患者全脑(P=0.023)、左侧大脑半球(P=0.039)和右侧大脑半球(P=0.004)CHIPS评分差异有统计学意义,其中,WMH-VCIND组(P=0.002,0.000,0.001)和WMH-VaD组(P=0.000,0.003,0.000)3个脑区CHIPS评分均高于WMH-CN组,WMH-VaD组3个脑区CHIPS评分亦高于WMH-VCIND组(P=0.008,0.013,0.020)。(2)脑白质高信号患者与正常对照者左侧大脑半球皮质兴趣区层厚(P=0.000)和体积(P=0.000)、右侧大脑半球皮质兴趣区层厚(P=0.000)差异均有统计学意义,其中,WMH-CN组、WMH-VCIND组和WMH-VaD组左侧兴趣区层厚(均P=0.000)和体积(均P=0.000)、右侧兴趣区层厚(均P=0.000)均低于正常对照组;WMH-VaD组左侧兴趣区层厚高于WMH-CN组(P=0.000)和WMH-VCIND组(P=0.036),WMH-CN组左侧兴趣区体积高于WMH-VCIND组(P=0.033)、低于WMH-VaD组(P=0.025),WMH-VCIND组(P=0.001)和WMH-VaD组(P=0.000)右侧兴趣区层厚均高于WMH-CN组。(3)相关分析仅WMH-VCIND组患者左侧大脑半球CHIPS评分与同侧皮质兴趣区层厚呈正相关(r=0.439,P=0.047)。结论脑白质高信号伴认知功能障碍患者随着认知功能障碍的加重,左侧大脑半球胆碱能通路中34个大脑皮质兴趣区体积和层厚均有一定程度的下降,且皮质结构改变与左侧大脑半球胆碱能通路损害程度呈正相关,但上述结构改变在右侧大脑半球并不明显。 展开更多
关键词 脑白质病 进行性多灶性 认知障碍 胆碱 神经纤维 大脑皮质 磁共振成像
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艾滋病伴发进行性多灶性白质脑病1例报道并文献复习 被引量:5
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作者 刘正琴 徐大飞 +3 位作者 殷剑 李墨 秦巧玲 陈海波 《中国神经免疫学和神经病学杂志》 CAS 2011年第4期261-263,268,共4页
目的提高临床对艾滋病伴发的进行性多灶性白质脑病(PML)的认识,以提高其临床诊出率。方法分析1例临床诊断为艾滋病所致的PML患者的临床表现、体格检查及影像学资料。结果患者神经系统表现为认知功能减退、失用、失读等高级皮层功能障碍... 目的提高临床对艾滋病伴发的进行性多灶性白质脑病(PML)的认识,以提高其临床诊出率。方法分析1例临床诊断为艾滋病所致的PML患者的临床表现、体格检查及影像学资料。结果患者神经系统表现为认知功能减退、失用、失读等高级皮层功能障碍,右侧偏瘫及双侧深感觉减退。脑脊液检查示蛋白升高,余未见明显异常。头部MRI检查示左侧额叶、顶叶、颞叶及右侧颞枕交界处多发T2高信号影,无占位效应,且病灶无强化。结论艾滋病伴发的PML临床表现多种多样,多表现为高级皮层功能减退,对年轻、亚急性起病的患者应警惕此病的可能,以免误诊漏诊。 展开更多
关键词 获得性免疫缺陷综合征 脑白质病 进行性多灶性 磁共振成像 诊断
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偏头痛脑白质病变与卵圆孔未闭相关性研究进展 被引量:8
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作者 张强 罗国刚 《中国现代神经疾病杂志》 CAS 2014年第9期828-831,共4页
偏头痛是一种临床常见的原发性头痛,严重危害人类健康和患者生活质量。近年研究表明,偏头痛患者脑白质病变发生率高于正常人群,并独立于其他脑血管病危险因素。而卵圆孔未闭在偏头痛尤其是先兆性偏头痛患者中的发生率较高,二者关系密切... 偏头痛是一种临床常见的原发性头痛,严重危害人类健康和患者生活质量。近年研究表明,偏头痛患者脑白质病变发生率高于正常人群,并独立于其他脑血管病危险因素。而卵圆孔未闭在偏头痛尤其是先兆性偏头痛患者中的发生率较高,二者关系密切,但是否存在因果关系尚存争议。卵圆孔未闭可引起反常栓塞,其在偏头痛发病机制中的作用尚不十分清楚。伴或不伴卵圆孔未闭的偏头痛患者脑白质病变是否存在差异,值得研究。 展开更多
关键词 偏头痛 脑白质病 进行性多灶性 卵圆孔 未闭 综述
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艾滋病合并进行性多灶性脑白质病的影像学表现及鉴别诊断 被引量:8
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作者 黄华 陆普选 《中国医学影像技术》 CSCD 北大核心 2009年第7期1316-1318,共3页
本文着重对艾滋病合并进行性多灶性脑白质病的影像表现,包括其在CT及MRI上的特点以及与其相似疾病的鉴别诊断进行综述。
关键词 获得性免疫缺陷综合征 进行性多灶性脑白质病 诊断显像
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