Diagnostic and prognostic implications of non-high-density lipoprotein cholesterol and homocysteine levels for cognitive impairment in thalamic infarction

BACKGROUND Patients with thalamic infarction experience abnormal blockages of multinuc-leated vessels,affecting the body and thereby the thalamus.Most patients with thalamic infarction have an adverse prognosis,which seriously affects their safety.Therefore,it is essential to analyze the independent risk factors that influence the prognosis of patients with thalamic infarction and develop corresponding preventive measures.AIM To explore the effect of non-high-density lipoprotein cholesterol(non-HDL-C)and Homocysteine(Hcy)levels in cognitive impairment in thalamic infarction.METHODS From March 2019 to March 2022,80 patients with thalamic infarction were divided into a group with cognitive impairment[Montreal Cognitive Assessment(MoCA)score<26;35 patients]and a group with normal cognitive function(MoCA score of 26-30;45 patients)according to the MoCA score.In addition,50 healthy people in the same period were selected as the control group.A correlation between the non-HDL-C and Hcy levels and the MoCA score and receiver operating characteristic curve was observed,and the serum non-HDL-C and Hcy levels were analyzed for the diagnosis of cognitive impairment in patients with thalamic infarction.According to the Modified Rankin Scale(MRS)score,80 patients with thalamic infarction were divided into a good prognosis group(MRS score≤2)and a poor prognosis group(MRS score>2).RESULTS The non-HDL-C and Hcy levels were significantly higher in the group with cognitive impairment than in the group with normal cognitive function(P<0.05).There was no significant difference in the non-HDL-C level between the control group and the group with normal cognitive function(P>0.05).The MoCA scores of the group with cognitive impairment were significantly lower than those of the group with normal cognitive function and the control group(P<0.05).There was a significant difference between the control group and the group with normal cognitive function(P<0.05).The non-HDL-C and Hcy levels were correlated with the MoCA score(P<0.05),cognitive impairment[areas under the curve(AUC)=0.709,95%confidence interval(95%CI):0.599-0.816],the non-HDL-C level,and could predict cognitive impairment in patients with thalamic infarction(AUC=0.738,95%CI:0.618-0.859).Hcy combined with non-HDL-C levels can predict cognitive impairment in patients with thalamic infarction(AUC=0.769,95%CI:0.721-0.895).RESULTS There were 50 patients in the good prognosis group and 30 patients in the poor prognosis group.Compared with the good prognosis group,in the poor prognosis group,the National Institutes of Health Stroke Scale(NIHSS)score,non-HDL-C level,Hcy level,large-area cerebral infarction,atrial fibrillation,and activated partial prothrombin time were statistically significant(P<0.05).The non-HDL-C level,the Hcy level,the NIHSS score,extensive cerebral serum,and atrial fibrillation may all be independent risk factors for poor prognosis in patients with thalamic infarction(P<0.05).CONCLUSION Non-HDL-C and Hcy levels are positively correlated with cognitive impairment in patients with thalamic infarction.Non-HDL-C and Hcy levels can be used in the diagnosis of cognitive impairment in patients with thalamic infarction,and the combined detection effect is better.The main factors affecting the prognosis of patients with thalamic infarction are the non-HDL-C level,the Hcy level,the NIHSS score,large-area cerebral infarction,and atrial fibrillation.Clinically,corresponding preventive measures can be formulated based on the above factors to prevent poor prognosis and reduce mortality.

Ipsilateral versus bilateral limb-training in promoting the proliferation and differentiation of endogenous neural stem cells following cerebral infarction in rats

We investigated the effects of ipsilateral versus bilateral limb-training on promotion of endogenous neural stem cells in the peripheral infarct zone and the corresponding cerebral region in the unaffected hemisphere of rats with cerebral infarction. Middle cerebral artery occlusion was induced in Wistar rats. The rat forelimb on the unaffected side was either wrapped up with tape to force the use of the paretic forelimb in rats or not braked to allow bilateral forelimbs to participate in training. Daily training consisted of mesh drum training, balance beam training, and stick rolling training for a total of 40 minutes, once per day. Control rats received no training. At 14 days after functional training, rats receiving bilateral limb-training exhibited milder neurological impairment than that in the ipsilateral limb-training group or the control group. The number of nestin/glial fibrillary acidic protein-positive and nestin/microtubule-associated protein 2-positive cells in the peripheral infarct zone and in the corresponding cerebral region in the unaffected hemisphere was significantly higher in rats receiving bilateral limb-training than in rats receiving ipsilateral limb-training. These data suggest that bilateral limb-training can promote the proliferation and differentiation of endogenous neural stem cells in the bilateral hemispheres after cerebral infarction and accelerate the recovery of neurologic function. In addition, bilateral limb-training produces better therapeutic effects than ipsilateral limb-training.

Hemichorea due to ipsilateral thalamic infarction: A case report

BACKGROUND Hemichorea usually results from vascular lesions of the basal ganglia.Most often,the lesion is contralateral to the affected limb but rarely,it may be ipsilateral.The pathophysiology of ipsilateral hemichorea is still poorly understood.We review the literature on hemichorea due to ipsilateral cerebral infarction and explore possible mechanisms for its occurrence.CASE SUMMARY A 72-year-old woman presented with complaints of involuntary movements of the muscles of the left side of the face and mild weakness of the right limbs.Her symptoms had started suddenly 1 d earlier.After admission to the hospital,the involuntary movements spread to involve the left limbs also.Magnetic resonance imaging revealed a left thalamic infarction.The patient’s hemichorea subsided after treatment with haloperidol(2 mg per time,3 times/d)for 3 d;the hemiparesis resolved with rehabilitation physiotherapy.She is presently symptom free and on treatment for prevention of secondary stroke.We review the literature on the occurrence of ipsilateral hemichorea following thalamic infarction and discuss the possible pathomechanisms of this unusual presentation.CONCLUSION Ipsilateral hemichorea following a thalamic stroke is rare but it can be explained by structure of the extrapyramidal system.The thalamus is a relay station that exerts a bilateral control of motor function.

Bilateral Blunt Internal Carotid Artery Occlusions Associated with Multiple Trauma: A Case Report

In multiple trauma, blunt carotid artery injuries (BCAIs) have occasionally been reported. However, bilateral blunt carotid artery occlusions (Grade 4 BCAIs) associated with multiple trauma are rare, and delays in diagnosis and treatment result in a lethal outcome. Here, we report our experience with bilateral carotid artery occlusions. A 76-year-old female suffered multiple traumas in a motor vehicle accident. On arrival at our hospital, she presented in a coma, with left mydriasis and unreactive pupils. Computed tomography (CT) showed bifrontal intracranial epidural hematoma and fractures of the facial bone and anterior skull base, and osteoplastic craniotomy was urgently undertaken for the epidural hematoma. However, the comatose state and unreactive pupils persisted during the post-operative course. Serial head CT findings showed progressive bilateral ischemic changes, and radiological examinations revealed bilateral internal carotid artery occlusions. We speculated that bilateral Grade 4 BCAIs had induced progressive cerebral infarctions. The patient partially responded to anticoagulation therapy with heparin infusion, but died of multiple organ failure on day 15. When bilateral progressive ischemic changes are observed in a patient with severe traumatic brain injury, bilateral Grade 4 BCAIs should be considered in the differential diagnosis. CT angiography as part of whole-body CT at admission may be effective for preventing delays in diagnosis and treatment of bilateral Grade 4 BCAIs.

Bilateral cerebral infarction in diabetic ketoacidosis and bilateral internal carotid artery occlusion:A case report and review of literature

BACKGROUND Diabetic ketoacidosis(DKA)is a serious complication of type 1 diabetes mellitus(T1DM).Very rarely does DKA lead to cerebral edema,and it is even rarer for it to result in cerebral infarction.Bilateral internal carotid artery occlusion(BICAO)is also rare and can cause fatal stroke.Moreover,case reports about acute cerebral infarction throughout both internal carotid arteries with simultaneous BICAO are very scarce.In this study,we present a patient with BICAO,T1DM,hypertension,and hyperlipidemia,who had a catastrophic bilateral cerebral infarction after a DKA episode.We briefly introduce BICAO and the mechanisms by which DKA results in cerebral infarction.CASE SUMMARY A 41-year-old woman presented with ischemic stroke that took place 3 mo prior over the left corona radiata,bilateral frontal lobe,and parietal lobe with right hemiplegia and Broca’s aphasia.She had a history of hypertension for 5 years,hyperlipidemia for 4 years,hyperthyroidism for 3 years,and T1DM for 31 years.The first brain magnetic resonance imaging not only revealed the aforementioned ischemic lesions but also bilateral internal carotid artery occlusion.She was admitted to our ward for rehabilitation due to prior stroke sequalae.DKA took place on hospital day 2.On hospital day 6,she had a new massive infarction over the bilateral anterior cerebral artery and middle cerebral artery territory.After weeks of aggressive treatment,she remained in a coma and on mechanical ventilation due to respiratory failure.After discussion with her family,compassionate extubation was performed on hospital day 29 and she died.CONCLUSION DKA can lead to cerebral infarction due to several mechanisms.In people with existing BICAO and several stroke risk factors such as hypertension, T1DM,hyperlipidemia, DKA has the potential to cause more serious ischemic strokes.

非高密度脂蛋白胆固醇、同型半胱氨酸水平与丘脑梗死患者认知障碍及预后的相关性

目的探讨非高密度脂蛋白胆固醇(non-HDL-C)、同型半胱氨酸(Hcy)水平与丘脑梗死患者认知障碍及预后的相关性。方法选择2017年3月至2021年3月濮阳市人民医院收治的丘脑梗死患者80例为研究对象。根据蒙特利尔认知评估(MoCA)量表得分将患者分为认知障碍组(MoCA评分<26分,n=35)和认知正常组(MoCA评分26~30分,n=45);另选择同期健康体检者50例作为对照组。采用全自动生物化学分析仪检测所有受试者血清中总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、Hcy水平,并计算non-HDL-C水平。采用Perason相关分析non-HDL-C、Hcy水平与MoCA评分的相关性,受试者操作特征曲线分析non-HDL-C、Hcy水平诊断丘脑梗死患者认知障碍的效能。根据改良Rankin量表(mRS)评分将丘脑梗死患者分为预后良好组(mRS评分≤2分,n=50)和预后不良组(mRS评分3~6分,n=50),采用多因素logistic回归分析丘脑梗死患者预后不良的独立危险因素。结果认知障碍组患者血清non-HDL-C、Hcy水平显著高于认知正常组和对照组(P<0.05);对照组与认知正常组受试者血清non-HDL-C、Hcy水平比较差异无统计学意义(P>0.05)。丘脑梗死患者non-HDL-C、Hcy水平与MoCA评分均呈负相关(P<0.05)。Hcy水平诊断认知障碍的曲线下面积(AUC)为0.709,敏感度为0.724,特异度为0.630;non-HDL-C水平诊断认知障碍的AUC为0.738,敏感度为0.701,特异度为0.870;Hcy联合non-HDL-C诊断认知障碍的AUC为0.769,敏感度为0.758,特异度为0.889。Hcy联合non-HDL-C诊断认知障碍的效能优于non-HDL-C、Hcy单独诊断。心房颤动及non-HDL-C、Hcy水平和NIHSS评分升高是丘脑梗死患者预后不良的独立危险因素(P<0.05)。结论non-HDL-C、Hcy水平均与丘脑梗死患者认知障碍呈正相关,non-HDL-C、Hcy水平可用于诊断丘脑梗死患者认知障碍,且联合检测诊断效果更优。心房颤动及non-HDL-C、Hcy水平和NIHSS评分升高是丘脑梗死患者预后不良的独立危险因素。

椎动脉起始部支架置入术对首发颞叶或丘脑梗死患者认知功能的影响

目的探讨椎动脉起始部(VAO)支架置入术对首发颞叶梗死或丘脑梗死患者认知功能的影响。方法选取65例首发颞叶或丘脑梗死患者作为研究对象,均经颅脑磁共振成像(MRI)检查确诊颞叶内侧或丘脑单一部位新发梗死,且经头颈计算机断层血管造影(CTA)检查明确重度狭窄的VAO为梗死责任血管。将35例接受VAO支架置入术治疗的患者纳入支架组,将30例接受药物保守治疗的患者纳入对照组,比较2组患者治疗前、治疗后14 d、治疗后3个月时蒙特利尔认知评估量表(MoCA)、韦氏成人智力量表-数字广度测验(WAIS-DS)、Fuld物体记忆测验量表(FOM)评分。结果治疗前,2组患者各量表评分比较,差异无统计学意义(P>0.05);治疗后14 d、治疗后3个月时,支架组的MoCA总分和视空间与执行功能、延迟回忆、语言维度评分均高于对照组,差异有统计学意义(P<0.05);支架组治疗后3个月时的FOM评分高于对照组,差异有统计学意义(P<0.05)。结论VAO支架置入术可显著改善颞叶梗死、丘脑梗死患者的认知功能。

Mechanisms of secondary damage to the thalamic nucleus and substantia nigra in an adult hypertensive rat model following middle cerebral artery occlusion

BACKGROUND： Following ischemia, apoptosis is observed at the ipsilateral ventropostenor thalamic nucleus and substantia nigra, which are distant from, but connected to, the ischemic cerebral cortex, in animals with normotension. However, secondary brain damage in hypertension has not been clearly investigated. OBJECTIVE： The present study determined whether neuronal apoptosis is associated with neuronal loss in the ipsilateral ventroposterior thalamic nucleus and substantia nigra following cortical ischemia in adult hypertensive rats. Results should provide options for determining a time window for anti-apoptotic therapy. DESIGN, TIME AND SETTING： All experimental procedures in this randomized, controlled trial were conducted at the Neurological Laboratory of the First Affiliated Hospital of Sun Yat-sen University of China between October 2006 and July 2008. MATERIALS： Monoclonal primary antibodies specific to mouse anti-rat microtubule-associated protein 2 and glial fibrillary acidic protein were respectively purchased from Sigma Chemical, USA and BD Pharmingen, USA. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling （TUNEL） detection kits were purchased from Roche Applied Science, Switzerland and Upstate, USA, respectively. METHODS： A total of 64 male, Sprague Dawiey rats, aged 60-90 days, were equally and randomly divided into middle cerebral artery occlusion and sham surgery groups. Renovascular hypertension was established in both groups by renal artery occlusion. Right distal middle cerebral artery occlusion was performed by electrocoagulation in the middle cerebral artery occlusion group. MAIN OUTCOME MEASURES： Microtubule-associated protein 2 and glial fibrillary acidic protein were detected by immunohistochemistry, and apoptotic cells were observed by TUNEL assay. The stainings were separately detected in the ipsilateral ventroposterior thalamic nucleus and substantia nigra. RESULTS： During the 4 weeks following distal middle cerebral artery occlusion in renovascular hypertensive rats, microtubule-associated protein 2 expression gradually, but significantly, decreased （P 〈 0.05）. Expression of glial fibrillary acidic protein increased significantly in the ipsilateral ventroposterior thalamic nucleus and substantia nigra （P 〈 0.05） and reached a peak at 4 weeks. In addition, number of apoptotic cells was significantly increased in both areas compared with the sham controls （P 〈 0.05）, with a peak at 2 weeks. CONCLUSION： Results suggested that neuronal loss in the ipsilateral ventroposterior thalamic nucleus and substantia nigra following distal middle cerebral artery occlusion in hypertensive rats could be a secondary event resulting from apoptosis. The temporal apoptosis profile provides options for determining a time window for anti-apoptotic therapy at 2 weeks after stroke.

Percheron动脉梗死2例报告及文献复习

目的报告2例Percheron动脉梗死病例,并对86例Percheron动脉梗死病例进行文献回顾,总结该病的临床特点。方法报告西安医学院第一附属医院收治的2例Percheron动脉梗死患者的临床诊治过程和转归。通过查阅国内外文献获得86例Percheron动脉梗死病例数据,对88例患者的临床数据进行统计分析。结果纳入Percheron动脉梗死患者共88例,男41例(46.6%)、女47例(53.4%),年龄为6~93(58.7±18.9)岁。Org 10172急性脑卒中治疗试验分型为小动脉闭塞23例(26.1%)、心源性栓塞22例(25.0%)、其他原因22例(25.0%)、不明原因21例(23.9%)。未行静脉溶栓者80例(90.9%)。急性起病83例(94.3%)。临床表现为意识障碍80例(90.9%)、眼肌麻痹41例(46.6%)、言语障碍(构音障碍或丘脑性失语)37例(42.0%)、肢体运动功能障碍34例(38.6%)、瞳孔异常34例(38.6%)、头晕15例(17.0%)、记忆减退14例(15.9%)、共济失调5例(5.7%)、面神经麻痹3例(3.4%)。梗死部位以单纯丘脑梗死最多(44例,50.0%),其次为丘脑合并中脑梗死(35例,39.8%)。影像学表现为典型中脑“V”字征14例(15.9%)。治疗后病情好转73例(83.0%),死亡11例(12.5%),再发梗死2例(2.3%),病情无变化2例(2.3%)。年龄和梗死部位与预后有关(均P<0.01)。结论Percheron动脉梗死早期症状多变,急性期弥散加权成像提示丘脑和/或中脑可见高信号,可有典型中脑“V”字征。早期Percheron动脉梗死治疗可用静脉溶栓和其他缺血性脑卒中治疗方案,其预后与年龄和梗死部位有关。

延髓“心”形梗死合并急性心肌梗死1例报道

脑梗死和急性心肌梗死均属于缺血性血管疾病,有共同的危险因素,两者可能同时或相继发病。延髓梗死诱发自主神经功能紊乱影响心脏神经,梗死后的应激反应也会导致心肌缺血梗死。本文报道1例双侧延髓内侧梗死合并急性心肌梗死患者的诊治过程,患者在疾病早期MRI检查未显影,数天后复查才呈现“心”形梗死灶,经过抗血小板聚集、调脂治疗仍有肢体偏瘫。本病例强调了脑梗死患者应进行详细的体格检查、辅助检查并全面评估心脏指标,防止误诊、漏诊。

孤立性丘脑梗死后发生认知障碍的影响因素分析

目的研究孤立性丘脑梗死患者应用尼麦角林联合醒脑静治疗后发生认知障碍的相关影响因素。方法回顾性分析2020年1月至2022年12月牡丹江医学院附属红旗医院神经内科收治的120例脑梗死患者的临床资料,患者均接受尼麦角林联合醒脑静治疗,统计认知障碍发生情况,整理及分析其相关资料,以多因素logistic回归分析导致认知障碍发生的相关影响因素。结果孤立性丘脑梗死患者的认知障碍发生率为37.50%,单因素分析结果显示,认知障碍患者中年龄≥60岁、高同型半胱氨酸(Hcy)血症、后循环大血管重度狭窄或闭塞、丘脑内侧部梗死占比均高于非认知障碍患者,差异有统计学意义(P<0.05);认知障碍、非认知障碍患者的性别、高血压、糖尿病、高脂血症、卒中史、高尿酸血症、吸烟及饮酒占比比较,差异无统计学意义(P>0.05)。多因素logistic回归分析显示,后循环大血管重度狭窄或闭塞(β=0.513、OR=1.670、95%CI:1.318~2.117)、高Hcy血症(β=0.679、OR=1.972、95%CI:1.247~3.119)以及丘脑内侧部梗死(β=0.427、OR=1.533、95%CI:1.245~1.887)为孤立性丘脑梗死患者发生认知障碍的主要影响因素(P<0.05)。结论后循环大血管重度狭窄或闭塞、丘脑内侧部梗死、高Hcy血症为导致孤立性丘脑梗死后认知障碍的重要因素,临床治疗过程中,需密切监测各指标变化情况,通过合理用药、饮食调节等方式改善病情。

双侧延髓内侧梗死临床诊治二例并文献复习

双侧延髓内侧梗死(MMI)是一种罕见的后循环卒中类型,发病早期易被误诊为吉兰-巴雷综合征等疾病,总体预后较差。迫切需要对其早期诊断和正确治疗。作者对诊断为双侧MMI的两例患者病历资料进行总结:均急性发作,其中1例患者具有急性吉兰-巴雷综合征样症状(快速进展性四肢瘫痪和发音困难),另1例患者以双侧肢体无力及麻木为主要表现。临床医师根据症状、体征和发病模式(急性发作,特别是在睡眠期间发作或睡眠期间迅速恶化)等特点,结合扩散加权成像,快速做出正确的诊断。由于早期给予强化三联抗血小板聚集药物(阿司匹林+氯吡格雷+替罗非班)治疗,两例患者初期均迅速好转。本研究旨在通过报道其临床表现、神经影像学特征和治疗体会,以为神经内科临床医师早期诊断和有效治疗提供参考。

基于MRI及CT的双侧中线旁丘脑病灶体积错配比在丘脑肿瘤诊断中的价值

目的:探讨基于MRI及CT的双侧中线旁丘脑病灶体积错配比在丘脑肿瘤诊断中的价值。方法:回顾性分析某院2012年3月至2023年5月确诊的37例双侧中线旁丘脑肿瘤患者(肿瘤组)及36例非肿瘤患者(非肿瘤组)的病历资料。由2名观察者在MRI及CT图像上测量两侧病灶的前后径、左右径及上下径并计算其体积,再计算病灶体积较大侧与较小侧的体积错配比。采用组内相关系数(intra-class correlation efficient,ICC)比较2名观察者计算结果的一致性,采用t检验比较2组病灶体积错配比的差异,采用ROC曲线分析MRI及CT图像上双侧中线旁丘脑病灶体积错配比对丘脑肿瘤的诊断效能。采用SPSS 26.0软件进行统计学分析。结果:2名观察者计算的双侧中线旁丘脑病灶的体积错配比一致性好(ICC_(MRI)=0.910,P<0.001;ICC_(CT)=0.929,P<0.001)。肿瘤组病灶体积错配比均较非肿瘤组大,差异有统计学意义(t_(MRI)=2.621,P_(MRI)=0.011;t_(CT)=2.500,PCT=0.015)。ROC曲线分析显示,MRI及CT图像上双侧中线旁丘脑病灶体积错配比诊断肿瘤的AUC分别为0.788、0.749,诊断阈值分别为1.769、1.742,诊断敏感度分别为83.8%、70.3%,诊断特异度分别为77.8%、77.8%,Youden指数分别为61.6%、48.1%。结论:基于MRI及CT的双侧中线旁丘脑病灶体积错配比对丘脑肿瘤的诊断具有一定价值,CT相比MRI诊断效能略低,具有初筛价值。

丘脑梗死患者的临床特点及预后分析

目的分析丘脑梗死患者的临床特点和预后。方法回顾性分析2016年1月至2022年1月于北京水利医院住院的47例单纯丘脑梗死患者的临床资料,采用头颅磁共振成像+弥散加权成像检查确定丘脑梗死区域,观察不同丘脑梗死区域患者的临床表现特点和预后。结果47例单纯丘脑梗死患者中,前核区梗死4例,外侧核区梗死22例,内侧核区梗死13,后侧核区梗死8例。临床表现以病灶对侧偏瘫、偏身感觉障碍及记忆障碍最常见。外侧核区、前核区、后侧核区梗死患者的临床预后较好,内侧核区梗死患者的预后最差。随访90d时患者的改良Barthel指数量表评分均显著高于入院时(P<0.05)。结论丘脑梗死患者易出现偏瘫、偏身感觉障碍、记忆障碍等临床表现,但总体预后良好。

MRI冠状位丘脑中间块高度在诊断双侧中线旁丘脑肿瘤中的价值

目的 :探讨MRI冠状位丘脑中间块高度显著增大及占位征象对双侧中线旁丘脑肿瘤的诊断价值。方法 :回顾性分析某院2012年1月至2023年1月行头部MRI检查的具有双侧中线旁丘脑病变的72例肿瘤患者的病历资料,其中23例肿瘤患者作为肿瘤组,49例非肿瘤患者作为非肿瘤组。由2名观察者独立评估入组病例的病灶是否具有占位效应,并测量MRI冠状位丘脑中间块高度,取所有患者的丘脑中间块高度的平均值作为标准,大于平均值者判定为丘脑中间块显著增大。比较2组间丘脑中间块高度增大程度及病灶占位效应,并计算丘脑中间块显著增大及占位效应诊断双侧中线旁丘脑肿瘤的敏感度、特异度、阴性预测值及阳性预测值。采用SPSS 26.0软件进行统计学分析。结果:入组患者丘脑中间块平均高度为9.3 mm。2名观察者对丘脑中间块高度是否显著增大(丘脑中间块高度>9.3 mm)及是否具有占位效应的判定结果一致性较好(K_(中间块)=0.862,K_(占位效应)=0.830)。肿瘤组患者丘脑中间块高度显著增大、具有占位效应者均多于非肿瘤组(χ~2=46.813,P<0.001;χ~2=39.600,P<0.001)。丘脑中间块高度显著增大(丘脑中间块高度>9.3 mm)诊断双侧中线旁丘脑肿瘤的敏感度、特异度分别为78.3%和98.0%,阴性预测值、阳性预测值分别为90.6%和94.7%。占位效应诊断双侧中线旁丘脑肿瘤的敏感度、特异度分别为73.9%和95.9%,阴性预测值、阳性预测值分别为88.7%和89.5%。结论:丘脑中间块高度显著增大(丘脑中间块高度>9.3 mm)对诊断双侧中线旁丘脑肿瘤具有一定的价值,诊断效能优于占位效应。MRI冠状位对双侧中线旁丘脑病变具有辅助诊断意义。

Bilateral medial medullary infarction with distal stenosis of hypoplastic vertebral artery

To the Editor:Bilateral medial medullary infarction(MMI)is a rare stroke subtype.[1]usually leads to quadriplegia,sensory disturbance,hypoglossal palsy,bulbar paralysis,etc.[2]We encountered a patient with rapidly progressive tetraparesis and diffusion-weighted imaging(DWI)exhibited a“heart appearance”sign in the bilateral ventral medulla.Computed tomography angiography(CTA)demonstrated that the left vertebral artery(VA)was hypoplastic and there was an atherosclerotic stenosis in the V4 segment.

我国双侧延髓内侧梗死139例临床分析

目的探讨我国双侧延髓内侧梗死(bilateral medial medullary infarction,BMMI)患者的临床特点、影像学表现、治疗及转归情况,以期提高临床医生对BMMI的认识。方法回顾性分析1991—2022年国内期刊公开报道的BMMI病例的临床表现、影像学结果、诊治经过及预后情况。结果本文共纳入72篇文献,139例BMMI患者被纳入分析,其年龄范围为24~94岁,男女比例约为3∶1。最常见的临床症状为不同程度的肢体乏力[96%(133/139)]。影像学结果显示患者延髓病灶主要呈“Y”型、“心”型等改变。71%(78/110)患者存在椎基底动脉粥样硬化改变。只有3例患者进行了溶栓治疗。25%(31/124)患者无明显好转,5%(6/124)患者死亡。BMMI早期误诊率达12%(17/139),最易被误诊为吉兰-巴雷综合征。结论BMMI临床表现多样,易被误诊、漏诊,且预后差,头颅MRI有助于早期诊断。临床医师应提高对BMMI的认识,促使患者得到及时诊治,积极处理并发症,改善患者预后。

急性丘脑梗死病人中医证型与IL-6、hs-CRP、Lp-PLA 2水平及颈动脉硬化的关系探讨

目的从辅助检查角度分析急性丘脑梗死病人中医证型,了解其与血浆脂蛋白磷脂酶A 2(Lp-PLA 2)、白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平、颈动脉硬化程度及性质的关系。方法对103例病人进行实验室血液指标检测及颈动脉彩超检查,同时进行中医辨证分型,分析中医证型与IL-6、hs-CRP、Lp-PLA 2水平及颈动脉硬化程度的关系。结果急性丘脑梗死病人Lp-PLA 2、IL-6、hs-CRP水平明显高于对照组,风证、痰证和瘀证三型Lp-PLA 2、IL-6、hs-CRP水平明显高于其他证型,病例组内膜增厚及斑块检出率、不稳定斑块出现率、中重度狭窄病人明显高于对照组。瘀证内膜增厚及斑块检出率最高,其次为火证、风证及瘀证。病人不稳定斑块出现率风证出现率最高,其次为火证、痰证和瘀证,风证不稳定斑块出现率较痰证、瘀证和火证差异有统计学意义。结论丘脑梗死急性期病人颈动脉内膜中层厚度增厚、斑块形成与痰证和瘀证明显相关;风证、火证、痰证、瘀证等实证为急性丘脑梗死发病的关键因素,其中与风证的关系尤其密切。IL-6、hs-CRP、Lp-PLA 2水平的异常可能为急性丘脑梗死病人风火相煽、痰瘀并见等病理要素的理化基础之一。

表现为认知功能障碍、吞咽困难的直窦部硬脑膜动静脉瘘1例报告

硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)是一种发病率较低的颅内血管畸形,该病临床表现多样缺乏特异性,以认知功能障碍、吞咽困难起病,且瘘口位于直窦的患者更加罕见。本文对1例瘘口位于直窦的DAVF进行报道,经颅内DAVF介入栓塞术后临床症状明显好转,3个月后随访无明显不适。通过该病例进一步探讨DAVF的发病机制及临床表现,旨在提高临床医生对本病的认识,以便及时作出诊断,降低漏诊率。

双侧肢体电刺激对脑卒中大鼠早期功能恢复的影响

目的:脑功能系统内和系统间的重组,可能是脑卒中后功能恢复的基本原因,研究脑梗死大鼠在不同电刺激治疗后的功能恢复情况,证实双侧与患侧电刺激的差异性。方法:用线栓法制成脑梗死模型,在梗死后大鼠肢体进行不同电刺激,用运用走横木测试方法进行测试,观察不同时期的大鼠功能恢复情况。结果:患侧刺激组和双侧刺激组的功能恢复较无刺激组的运动功能恢复明显(F=15.083,44.083,60.473,P<0.05)。双侧刺激组的运动功能恢复较患侧刺激组的功能恢复明显(P<0.05)。结论:双侧肢体电刺激使脑卒中后早期功能恢复增强。这为临床脑梗死患者的康复提供了方便而实用的治疗方法。