30例急性血吸虫病的脑电图分析

本文报道了30例急性血吸虫病的脑电图(EEG）资料分析。其中25例异常(占83．3％),主要表现为a波慢化、不规则或基本节律消失。25例中22例(占88％)的慢波以低。中波幅不规则θ波为主,分布以双侧中央区为多,额、枕区次之。EEG异常者,与病情严重程度相关,病情严重者EEG异常程度相对高。12例经治疗后,11例EEG有所改善。     

脑电图与早产儿脑损害的相关性研究

脑电图（Electroencephalography EEG）是观察早产儿（premature infants）脑损害的敏感方法。急性和慢性EEG的改变与早产儿以后的神经和认知功能异常有相关性,应用神经生理学的方法诊断早产儿脑损害,早期持续在ICU病房的EEG监测和在以后阶段的EEG检查相结合是比较理想的手段。     

抽动障碍临床特点与脑电图关系的研究进展

抽动障碍(Tic disorder,TD)是一种儿童期发病且主要侵犯神经系统的疾病。临床工作中发现部分患儿脑电图(electroencephalogram,EEG)明显异常,提示患儿脑功能障碍与疾病严重程度有关;TD患儿治疗后EEG变化特点也对临床医生选择何种治疗方式有指导意义。     

CO中毒继发癫痫的脑电图和经颅多普勒改变的关系研究

目的:探讨一氧化碳(Carbon monoxide,CO)中毒继发癫痫的经颅多普勒(Transcranial Doppler,TCD)和脑电图(Electroencephalogram,EEG)特征的关系。方法:对我院自2011年6月至2015年5月收治的145例CO中毒患者的临床资料和EEG、TCD特征进行检查,并分析其与继发癫痫的相关性。结果:145例CO中毒患者中,EEG结果显示正常患者93例(64.13%);异常患者52例(35.86%)。TCD正常患者90例(62.07%),异常55例(37.93%)。主要表现为颈内动脉系统血流动力学的改变,大脑前动脉流速与病情严重程度成正相关,TCD血流速度增加或减慢不对称,脑血流速度升高比率显著高于脑血流速度减低比率。无论在睡眠期还是清醒期EEG异常患者全导阵发性3.0~4.0Hz的棘慢波均存在放电。患者出现EEG、TCD异常与年龄、癫痫家族史、发热温度、持续时间、继发癫痫类型以及24h内发作次数有关。继发癫痫39例,占EEG异常患儿的75.00%,占TCD异常患儿的72.73%。继发癫痫患者中,15例额区放电日后发生发生癫痫14例(93.33%),19例枕区放电16例(84.21%)发生癫痫,13例Rolandic区放电8例(61.54%)发生癫痫,5例广泛性棘慢波者继发癫痫的有1例(20%)。结论:EEG、TCD检查异常的CO中毒患者中具有较高的继发癫痫的发病率,中枕区和额区阵发性异常放电者更容易继发癫痫。     

脑血吸虫与脑肺吸虫病的MRI 诊断与鉴别诊断

目的:探讨总结脑血吸虫病与脑肺吸虫病MRI影像特点,更好的指导临床早期诊断。方法:回顾分析10例脑血吸虫及9例脑肺吸虫的MRI影像特点,总结分析其影像征象及价值。结果:脑血吸虫和肺吸虫病临床表现类似,均以颅内压增高和癫痫为主要变现。MRI扫描脑血吸虫病呈多发结节信号,周围大片水肿,增强均匀或不均匀强化;肺吸虫呈斑片样及囊样信号,周围大片水肿,增强扫描环状及斑絮样强化。结论:脑血吸虫与脑肺吸虫病临床表现类似,但MRI有特定的影像特点,可以用来进行诊断。     

49例儿童暴发性心肌炎的临床特点与预后

目的:探讨儿童暴发性心肌炎的临床特点及与预后的关系。方法:回顾性分析患者病史、ECG、UCG、CMR、血清学检查资料及随访结果,得出影响预后的相关危险因素。结果:共收治49例暴发性心肌炎患者,平均年龄8.89±3.63岁。死亡9例(18.37%),平均存活时间4天,无晚期死亡。以心外表现为首发症状者占83.67%。初诊时血清CK-MB及c Tn I异常检出率分别为51.11%和81.39%,两者同时增高占47.50%。49例患者在疾病初期均存在明显的心电图异常,其中室性心律失常的发生率在恢复组与死亡组间存在明显差异(P=0.020)。恢复组与死亡组LVEF/LVFS降低的发生率分别为62.5%和100%(P=0.157),恢复组LVEF恢复正常平均时间10.22天。恢复组中10例患者在急性期行CMR检查,其中9例符合路易斯湖。所有患者均使用大剂量激素及丙种球蛋白治疗。8例患者安装临时心脏起搏器,4例接受ECOM治疗。恢复组平均随访19.28月,100%临床痊愈。多因素生存分析,最终与死亡有关的危险因素为年龄≤6岁(RR40.215,95%CI(1.285-1258.369))。结论:暴发性心肌炎起病急骤,以心外症状为首发者多见,经及时诊断、治疗的患者有望完全康复。所有患者均存在不同程度心电图异常。多因素生存分析发现年龄≤6岁为死亡的危险因素。     

抗癫痫治疗中注意改善微循环

癫痫是一种常见的神经症状,表现为突然发生的短暂脑功能异常,意识障碍,肢体抽动.由于病因复杂,发病机理至今尚未完全阐明,国内外尚无特效的治愈药物.我们在治疗癫痫病的临床实践中,发现部分病人的癫痫发作与其微循环之间,有相当密切的关系,引起了我们的思索,因而作了些初步探讨.现将有关情况报告如下:1 抽样检查1.1 检查季节:均为1990年4～8月.排除气候因素对微循环检查结果的影响.1.2 检查方法:甲皱微循环加权积分法.1.3 检查资料:抽样检查癫痫病人16例.其中:男9例;女7例.年龄最大53岁.最小5岁.检查结果:微循环正常者5例,占31%;异常者11例,占69%(其中:中度异常8例,占50%,轻度异常3例,占19%).     

外伤性急性弥漫性脑肿胀的临床分析

目的:探讨外伤性急性弥漫性脑肿胀的诊断与治疗.方法:回顾性分析颅脑创伤后脑肿胀患者52例的临床资料.结果:52例中完全恢复16例,生活基本自理者11例,重残6例,植物生存3例,死亡16例.入院格拉斯哥昏迷评分(GCS)计分3～5分(瞳孔均散大)27例,预后良好9例,预后不良18例;GOS计分6～8分18例,预后良好12例,预后不良6例;GCS计分9～12分7例,预后良好5例,预后不良2例.结论:急性弥漫性脑肿胀的死亡率高,预后差,应积极综合治疗.     

阻塞性睡眠呼吸暂停的脑影像研究：来自静息态脑电和功能磁共振的证据

阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)是一种常见的临床睡眠障碍,表现为上呼吸道在睡眠时反复阻塞,并导致睡眠片段化、间歇性低血氧等症状。本文回顾了针对OSA患者的静息态脑成像研究,包括静息态脑电(electroencephalography, EEG)和静息态功能磁共振成像(functional magnetic resonance imaging, fMRI)。在静息态EEG中,OSA主要表现为前额叶和中央区域δ波和θ波增加;而在静息态fMRI研究中,OSA患者在默认网络(default-mode network, DMN)、中央执行网络(central executive network, CEN)和突显网络(salience network, SN)等大尺度脑网络水平上存在改变。综合来自静息态EEG和静息态fMRI的研究,大量证据都共同指出OSA患者前额叶区域的活动异常,并且其异常活动强度与OSA严重程度相关,表明前额叶是OSA患者大脑功能受损的一个关键脑区。最后,本文从治疗效果、多模态数据采集、以及相关共病等方面对OSA未来研究方向进行了展望。     

18例新生儿李斯特菌病的母婴临床分析

本文旨在通过探讨新生儿李斯特菌病的临床特点、治疗及预后,明确母体危险因素,为新生儿产单核细胞李斯特菌(下称李斯特菌)感染的临床诊断和治疗提供依据。回顾性分析2011年5月-2018年4月西北妇女儿童医院新生儿科诊治的18例李斯特菌感染新生儿及其母亲的发病情况、临床表现、实验室指标、影像学检查、治疗及预后,发现18例产妇中15例有临床症状,以发热及不规则腹痛最为常见;患儿中13例有临床症状,多数表现为呼吸窘迫和发热;89%患儿发生血流感染(61%为化脓性脑膜炎、28%为肺炎);影像学检查提示,存活患儿中56%有神经系统后遗症,50%可能有先天性心脏病。14例在明确李斯特菌感染后调整抗生素治疗,所有产妇经治疗均预后良好;患儿除1例放弃治疗、3例要求出院外,其余14例均痊愈或好转出院。新生儿李斯特菌感染是一种严重的感染性疾病,因此对有发热、腹痛及早产症状的孕妇,应警惕李斯特菌感染,尽早进行病原学检测和目标性治疗,以改善预后。     

Neurophysiological indices of CNS plasticity in the course of treatment of head trauma in adolescents

Using the methods of quantitative EEG analysis and cognitive evoked potentials, we investigated delayed consequences of head trauma (HT) after nootropic therapy with cerebrolysin. The study was performed in 30 12-to 19-year-old adolescents who had had severe HT with brain contusion one to five years prior to the study and manifested asthenic symptoms. During the study, they underwent treatment with 30 daily intramuscular injections of cerebrolysin at a dose of 0.1 ml/kg body weight. A positive effect on the functional state of the brain was found in 77% of patients. It was expressed as the appearance of the occipital α rhythm in the EEGs, an increase in the EEG spectral power, normalization of frequency parameters of the α rhythm, a decrease in the power spectrum of the low-frequency θ and δ EEG activity, and shortening of the P300 peak latency. These changes were associated with an improvement of the general clinical state and the psychometric indices of attention and memory in the patients.     

Clinical and Imaging Characteristics of Cerebral Schistosomiasis

In recent years, there has been a trend for increased incidence of cerebral schistosomiasis. It is often misdiagnosed because of the diversity of clinical symptoms. We wished to explore clinical characteristics and imaging findings in cerebral schistosomiasis. We retrospectively analyzed clinical data, laboratory tests, CT, and MRI results in 11 patients with cerebral schistosomiasis. All patients had chronic cerebral schistosomiasis (five with epilepsy type, five with brain tumor type, and one patient with stroke type). All patients with brain tumor type were misdiagnosed as having gliomas. There were typical findings on CT and MRI. In conclusion, clinical manifestations of cerebral schistosomiasis are variable, and the rate of misdiagnosis is high. For more precise diagnosis, a combination of laboratory and imaging data is required.     

多发性抽动症的脑电图观察

目的:进一步探究脑电图对多发性抽动症患儿的辅助诊断价值。方法:本文对45例多发性抽动症患儿进行脑电图描记录,选择理想信号段进行分析。结果发现24例异常,异常率为53.3%。其中中度异常6例,占25%,脑波表现为在高幅δ、θ波长程阵发的背景上偶发尖波;轻度异常18例,占75%,表现背景脑波频率变慢,出现高幅δ、θ波及活动,伴短程出现;正常21例,较同年龄组的脑电图调节差,波形杂乱。结论:脑电图反映脑功能活动,通过计算机分析方法可提供更多信息,并且脑电图操作方便,无痛无创,易于被儿童接受,在多发性抽动症早期临床诊断中具有较高的应用价值。     

Changes in the functional parameters of the brain structures under the influence of enkephalin-like tetrapeptidamide

In complex neurophysiological and cytobiochemical study single injections of tetrapeptide amide (TPA) caused a short-term analgetic effect which manifested itself in the absence of motor reactions and EEG changes of cortical and subcortical brain structures after painful stimulation of extremities. This effect was accompanied by changes of some indices of transmitter (monoamine oxidase) and protein metabolism in the cerebral hemispheres at cellular and subcellular levels. In 30-40 min after a TPA injection, EEG suppression and absence of EPs to light flashes were observed in cortical and subcortical structures. Simultaneously motor disorders developed. The observed EEG changes had an undulatory character: on the second day EEGs were restored and on the third day--suppressed once again. This period of TPA action was accompanied by varied changes of the investigated types of metabolism. The question of the necessity of systemic approach to the study of TPA action is discussed, as such an approach allows to reveal complex neurophysiological and fine biochemical relations in the reactions of brain structures and in animal behaviour.     

Post-radiation effect on the interhemispheric asymmetry in EEG and thermography characteristics

Complex analysis of EEG and thermographic parameters carried out in 10 healthy subjects and 34 patients, Chernobyl clean-up participants revealed a correlation between EEG and brain temperature changes in the baseline state and during mental arithmetic. During cognitive activity the maximal increase in the average EEG coherence and temperature shifts in healthy subjects were observed in the left frontotemporal and right parietotemporal areas. In patients changes in both parameters under study were most pronounced, the interhemispheric relations were impaired. The visual analysis revealed "flat" and "hypersynchronous" EEG types in patients. The dominant pathologic activity in the betal range indicative of mediobasal and oral brainstem lesions was characteristic of the flat EEG. This type of activity was observed in 60% of patients. In these cases, a general decrease in EEG coherence and temperature was most pronounced in the left hemisphere. The hypersynchronou EEG type (40% patients) was characterized by paroxysmal activity in the theta and alpha ranges suggesting diencephalic brain lesions. In these cases, EEG coherence and temperature were more variable; changes in the right hemisphere were significant, be it increase or decrease. Our complex approach to investigation of brain activity in different aspects seems to be promising in estimation of the brain functional state both in healthy persons and patients in remote terms after exposure to radiation. The specific hemispheric temperature changes revealed in Chernobyl patients especially during cognitive activity can be the sequels of postradiation disorders of vascular neuro-circulation. The EEG findings suggest subcortical disorders at different levels (diencephalic or brainstem) and functional failure of the right or left hemispheres in remote terms after exposure to radiation.     

Acute posthypoxic myoclonus after cardiopulmonary resuscitation

ABSTRACT: BACKGROUND: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP) and electroencephalogram (EEG). METHODS: Patients with acute PHM (focal myoclonus or status myoclonus) within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used). Good outcome was defined as good recovery or moderate disability after 6 months. RESULTS: Acute PHM was reported in 79/391 patients (20%). SEPs were available in 51/79 patients and in 27 of them (53%) N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64%) patients fulfilling criteria for a cortical origin. Nine patients (12%) had a good outcome. A broad variety of drugs was used for treatment. CONCLUSIONS: The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.     

THE ELECTROENCEPHALOGRAM IN PEDIATRICS—The Indications for Use and the Limitations

Electroencephalograms normally undergo pronounced serial changes during maturation of the brain.Many physiological and nonphysiological influences may alter the EEG tracing.As regards EEG''s, appraisal of cerebral function is based on comparison with normal standards of frequency, rhythm, wave configuration and amplitude, bilateral synchrony, and response to various physiological stimuli.Various abnormal EEG patterns are fairly constantly related to concomitant clinical disease.A laboratory tool which may be used to supplement clinical data but not to make a clinical diagnosis, the EEG may also sometimes be of value in helping to suggest prognosis and in helping with evaluation of a therapeutic program.     

Circulatory and EEG changes during resuscitation in experiments

In anaesthetized dogs blood pressure (BP), carotid artery flow (CAF), oxygen tension of arterial blood (paO2) and brain surface (bs-pO2), ECG, frequency analyzed EEG were measured and/or recorded. The changes in these parameters were detected before and during ventricular fibrillation with external and direct heart massage as well as after defibrillation. Comparisons were made between the effect of oxygen and room air ventilation. The ratio of successful resuscitation was 88% with direct heart massage and O2 respiration, 76% with external thoracic massage and O2 ventilation, and 68% with external massage combined with room air respiration. The highest BP and CAF could be achieved with direct heart massage. The results suggest that the minimal requirement for success is to achieve a BP of 5 kPa (40 mmHg) and 13 ml/min CAF. In dogs with large and stiff thorax this minimal pressure and flow could not be attained. During effective massage with room air ventilation brain surface pO2 increases moderately, but with O2-respiration it returns to normal. Small or no changes in bs-pO2 indicates unfavourable prognosis. The start bs-pO2 elevation coincides with the reappearance of the first EEG waves, while pO2 increase on the brain surface precedes the normalization of EEG.     

小波能量评价EEG的不同成分对癫痫发作预报的价值

癫痫是一种严重危害人类健康的常见疾病,对癫痫发作进行预报具有重要的重要意义。通过对3例部分性继发全身性发作的癫痫病人在发作最长约30min的8导EEG进行小波分解,将EEG中的棘波、尖波成分与慢波成分分别突出到不同的尺度上,并计算相应尺度上这些成分的能量,考察这些不同成分在发作前的变化趋势。发现在发作前的若干分钟,8导EEG的慢波能量都有显著增大,而与棘波／尖波有关的快波能量基本上没有什么变化趋势,说明EEG慢波成分的增大对部分性继发全身性发作的预报具有重要价值,EEG的“慢波过大”可能是癫痫从发作间状态转变为发作的重要因素。     

视频脑电图和影像学检查对继发性癫痫患儿的诊断价值研究

目的:研究视频脑电图(V-EEG)和影像学检查对继发性癫痫患儿的诊断价值。方法:选取从2014年3月到2017年4月在我院接受诊治的癫痫患儿168例纳入本次研究。分别对所有患儿实施V-EEG和核磁共振成像(MRI)诊断,比较两种方式的诊断价值。结果:168例患儿中,V-EEG监测到154例有异常的脑电信号,其中120例有痫样放电,V-EEG显示痫样放电分布在左侧和右侧导联的比例较双侧导联明显更高(P0.05),MRI检测结果显示,140例患儿有颅内有关结构的病变亦或是发育异常,28例未发现异常。168例患儿中,发作类型为单纯部分型者72例,占比最高,为42.86%;主要病因中,颅内感染的发作类型以全身型为主,占11.31%。脑梗塞的发作类型以单纯部分型为主,占8.33%。颅内软化灶的发作类型以复杂部分型为主,占6.55%。颅内肿瘤的发作类型以单纯部分型为主,占6.55%。MRI定位主要在单侧,其中左侧占38.10%,右侧占29.76%;而经V-EEG监测显示异常放电154例,占91.67%,其中颅内感染和脑梗塞以及颅内肿瘤和颅内软化灶的阳性检出比例最高,分别为24.40%,13.10%,11.90%和10.71%。V-EEG诊断灵敏度和特异度均明显高于MRI(P0.05)。结论:V-EEG较MRI对继发性癫痫患儿的诊断价值更高,能够更加准确地提供诊断结果数据,值得在临床诊治过程中给予推广和应用。