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Diagnosis and Treatment of Carotid Artery Stenosis 颈动脉狭窄的诊断与治疗
Pub Date : 2017-08-10 DOI: 10.15406/JNSK.2017.07.00238
B. Radić
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引用次数: 0
How do we Handle Traumatic Pediatric Carotid Artery Dissection 如何处理外伤性儿童颈动脉夹层
Pub Date : 2017-08-06 DOI: 10.15406/jnsk.2017.07.00239
D. B. Hazer, Övünç Erdem Çorapçi, Gökmen Reyhani
Head and neck trauma in pediatric population differs from adult cases due to the immature cranio-cervical stability resulting from the weak neck musculature and large head to neck proportion. These cases also have drawn attention due to concomitant severe damage to the regional vascular structures such as carotid artery [1,2]. In some cases, especially with skull base fractures and cervical vertebral column trauma; carotid artery dissections at the cervical segment can occur [3,4]. The goal of our study is to draw attention to the radiodiagnostics and management of the traumatic pediatric cervical carotid artery dissection with the aid of a case of traumatic cervical carotid artery dissection (CAD).
儿童头颈外伤不同于成人,因为颈部肌肉组织薄弱,头颈比例大,颅颈稳定性不成熟。这些病例也因其对颈动脉等局部血管结构的严重损伤而引起关注[1,2]。在某些情况下,特别是颅底骨折和颈椎外伤;颈动脉剥离可发生在颈段[3,4]。本研究的目的是通过一例外伤性颈动脉夹层(CAD),引起人们对外伤性儿童颈动脉夹层的放射诊断和治疗的关注。
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引用次数: 0
Ventriculoperitoneal Shunt Disconnection Associated with Loss of Consciousness in a Child Patient: A Case Report and Review of Intra-Abdominal Complications of Vp Shunts 脑室-腹膜分流管断开与意识丧失相关的儿童患者:一例Vp分流管腹腔内并发症的报告和回顾
Pub Date : 2017-08-04 DOI: 10.15406/JNSK.2017.07.00237
Kaveh Haddadi, H. Qazvini, M. Sahebi
Case report: An 8-year-old boy with a right VP shunt was referred to our center because of progressive loss of consciousness in the morning. A CT scan of the head established moderate hydrocephalus. A shunt series presented a disconnection of the distal tube of the shunt as the distal part was free in the abdominal cavity. The patient experienced a complete shunt revision. The abdominal incision was revived and the tube removed from the abdominal cavity gently. The patient was discharged 72 h later.
病例报告:一名8岁的右副静脉分流的男孩,因为在早上逐渐失去意识而被转介到我中心。头部CT扫描确定中度脑积水。分流器系列显示分流器的远端管断开,因为远端部分在腹腔内是自由的。患者经历了一次完全的分流翻修。恢复腹部切口,轻轻将管从腹腔取出。患者72 h后出院。
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引用次数: 1
Instruments of Active Search and Assessment of Memory Complaint. A Systematic Review 记忆抱怨的主动搜索和评估工具。系统回顾
Pub Date : 2017-07-25 DOI: 10.15406/JNSK.2017.07.00236
E. Ribeiro, M. Terassi, E. S. Rossetti, F. Vale
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引用次数: 0
An Intracranial Tumor Appeared Two Months after the Operation of Bladder Cancer: Metastatic or Primary? 膀胱癌术后两个月出现颅内肿瘤:转移性还是原发性?
Pub Date : 2017-07-19 DOI: 10.15406/jnsk.2017.07.00235
Congyan Wu, Yao-dong Zhao
It is common for an intracranial mass to occur after another malignancy, which is usually metastasis. There are also reports that intracranial tumors have appeared years after another carcinoma had been previously treated with radiotherapy or chemotherapy. In the latter case, the intracranial tumor is usually attributed to metastasis or a secondary primary malignancy. There are also some hereditary or familial syndromes that present with multiple tumors, e.g., Li Fraumeni, Lynch, and Turcot syndrome. For these syndromes, the proband cancer generally occurs in children and young adults with a definitive familial aggregation. However, we found no previous reports of the appearance of a primary glioma only 2 months after a bladder cancer carcinectomy in an old patient without a typical family history. Here, we report the case of a 59-year-old female who complained of a constant headache for one week at the time of admission. Only 2 months before, she had undergone a bladder cancer carcinectomy. Upon admission, a cranial MRI scan revealed right temporal lobe lesions, and the post-operative pathological diagnosis was anaplastic astrocytoma. Cases such as these are easily misdiagnosed, and the opportunity for surgical treatment can be lost. Moreover, the appearance of two concurrent cancers or the occurrence of one after another within a very short interval in different body parts has rarely been reported. Therefore, this case may provide neurosurgeons with knowledge of an uncommon clinical experience that could reduce misdiagnosis and mistreatment.
颅内肿块在另一恶性肿瘤后发生是很常见的,通常是转移。也有报道称,颅内肿瘤是在另一种癌症接受放疗或化疗多年后出现的。在后一种情况下,颅内肿瘤通常归因于转移或继发原发恶性肿瘤。也有一些遗传性或家族性综合征出现多发性肿瘤,如Li Fraumeni综合征、Lynch综合征和Turcot综合征。对于这些综合征,先证者癌症通常发生在儿童和年轻人中,具有明确的家族聚集性。然而,我们没有发现在没有典型家族史的老年患者膀胱癌切除术后仅2个月出现原发性胶质瘤的既往报道。在此,我们报告一位59岁的女性,在入院时抱怨持续头痛一周。就在两个月前,她刚刚接受了膀胱癌切除术。入院时,颅脑MRI扫描显示右侧颞叶病变,术后病理诊断为间变性星形细胞瘤。这样的病例很容易误诊,并可能失去手术治疗的机会。此外,两种癌症同时出现或在很短的时间间隔内在不同身体部位相继发生的情况很少有报道。因此,这个病例可以为神经外科医生提供一个不常见的临床经验,可以减少误诊和虐待。
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引用次数: 0
Opium Overdose: “A Black Sheep in Acute Stroke Management” 鸦片过量:“急性中风治疗中的败类”
Pub Date : 2017-07-13 DOI: 10.15406/JNSK.2017.07.00234
S. Mansoor, Shoab Saadat, Salman Assad, Abhishak, S. Qadir, W. Malik, R. Shoaib, Khwaja Junaid Mustafa
Submit Manuscript | http://medcraveonline.com unconsciousness while he was having his breakfast. A stroke code was announced and neurology was consulted. In his medical history he was Diabetic type 2 for 25 years and hypertensive for 20 years. He was taking oral hypoglycemics (Metformin, Gliclazide) and antihypertensives (Zestril) with adequate compliance. In his personal history he was also an oral opium addict for last 40 years. On examination he was a thin old gentleman not oriented in time, place and person. His Glasgow Comma Scale (GCS) for conscious status was E2M5V1=8/15. Vital signs were a blood pressure of 160/90mmHg, heart rate was 90/minute, and temperature of 98.6 Fahrenheit. Neurological exam revealed central gaze, doll’s eye and corneal reflexes were intact. Pupils were 2mm in size which were sluggish to direct and indirect light and nystagmus was not observed. Facial sensation to pain was intact assessed by grimace with a preserved facial symmetry. His tongue was central without any fasciculation. Uvula was central and gag reflex was present. Motor exam showed normal bulk and tone. Power in his limbs to painful stimulus was 3/5 in both upper limbs and 2/5 in both lower limbs approximately. Deep tendon reflexes were 2+ in upper limbs and 1+ in both lower limbs with bilateral flexor plantar responses. Sensory examination to pain was grossly adequate in all limbs. Neck was supple with no signs of meningeal irritation. Systemic examination was normal with no heart murmurs, abnormal breath sounds or visceromegaly. Laboratory workup is shown in Table 1. Computed tomography (CT-scan) of the brain acquired 1 hour 30 minutes into his symptoms showed mild cortical atrophy, normal sized ventricles and no intracranial bleed. He was being considered for intravenous thrombolysis for possibility of posterior circulation ischemic stroke. Other differential included opium overdose due to his chronic addiction. He was given 0.4mg of intravenous naloxone to which he responded within 1 minute and regained his consciousness. GCS improved to 15/15. Stroke code was called off. He was admitted for 24 hours during which he had restlessness and irritability. He was discharged after 2 days in stable condition with regular follow-ups in psychiatry and medicine clinics for long term rehabilitation for his chronic addiction.
投稿| http://medcraveonline.com他在吃早饭的时候昏迷不醒。宣布了中风代码,并咨询了神经病学。病史中2型糖尿病25年,高血压20年。他正在服用口服降糖药(二甲双胍、格列齐特)和抗高血压药(Zestril),并给予足够的依从性。在他的个人历史中,他在过去的40年里也是一个口服鸦片瘾君子。经检查,他是一个瘦弱的老绅士,不知道时间、地点和人物。他的格拉斯哥逗号评分(GCS)为E2M5V1=8/15。生命体征为血压160/90mmHg,心率90/分钟,体温98.6华氏度。神经系统检查显示中央凝视、娃娃眼和角膜反射完好无损。瞳孔大小为2mm,对直接和间接光线反应迟钝,未见眼球震颤。面部对疼痛的感觉是完整的,通过鬼脸来评估,保持面部对称性。他的舌头在中央,没有任何缠绕。小舌位于中央,有呕吐反射。运动检查显示体积和张力正常。他的四肢对疼痛刺激的反应强度上肢约为3/5下肢约为2/5。上肢深腱反射2+,双下肢深腱反射1+,双侧足底屈肌反应。所有四肢的感觉检查都非常充分。颈部柔软,无脑膜刺激迹象。全身检查正常,无心脏杂音、呼吸音异常或内脏肿大。实验室检查结果见表1。在他出现症状1小时30分钟后进行的脑部计算机断层扫描(ct)显示轻度皮质萎缩,脑室大小正常,无颅内出血。他正在考虑静脉溶栓治疗后循环缺血性中风的可能性。其他差异包括慢性成瘾导致的鸦片过量。患者静脉注射纳洛酮0.4mg, 1分钟内起反应,恢复意识。GCS提高到15/15。笔划代码取消了。他住院24小时,期间他坐立不安、易怒。患者于2天后出院,病情稳定,并定期在精神病学和医学诊所随访,对其慢性成瘾进行长期康复。
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引用次数: 0
A Rare Case of Cavernous Sinus Syndrome in a Patient with TuberculousMeningitis 结核性脑膜炎并发海绵窦综合征1例
Pub Date : 2017-07-05 DOI: 10.15406/jnsk.2017.07.00232
N. Arifin, K. A. Latif, Joyce Pauline Jospeh
The incident of Tuberculosis (TB) in Malaysia is estimated 81.4 per 100,000 population [1]. In 2011, the number of extra pulmonary TB reported was 2888 cases [1]. Reported cases of extra pulmonary TB in Malaysia noted to be increasing in trend over the years based on statistic from 2005 to 2011 [1]. Although the prevalence of TB meningitis is low, it has high mortality and morbidity if inadequately treated. Presentation of TB meningitis varies from chronic headache, neurological abnormalities to behavioural changes. As TB is endemic in Malaysia, TB meningitis is one of differentials in patient who presents with signs and symptoms of CSF infection. CSF in TB meningitis have the characteristic finding of elevated CSF protein with low CSF sugar. CSF direct smear for acid fast bacilli may not yield any findings. As CSF Mycobacterium Tuberculosis (MTB) has sensitivity of 40 to 60 percent [2] and newer method namely CSF for TB PCR has sensitivity of 44.5 percent and specificity of 92.0 percent [1], the definitive diagnosis of TB meningitis could prove to be challenging at times. The diagnosis of TB meningitis highly relies on high index of suspicion based on presentation and clinical findings, aided with characteristic of CSF findings and radio imaging [3]. Treatment needed to be commenced early despite pending CSF culture in order to reduce mortality and morbidity. We report a rare case of TB meningitis presenting with bilateral cavernous sinus syndrome.
马来西亚的结核病发病率估计为每10万人81.4例[1]。2011年新增肺结核报告2888例[1]。根据2005年至2011年的统计数据,马来西亚报告的额外肺结核病例呈逐年增加趋势[1]。虽然结核性脑膜炎的患病率很低,但如果治疗不当,死亡率和发病率很高。结核性脑膜炎的表现从慢性头痛、神经异常到行为改变不等。由于结核病在马来西亚流行,结核性脑膜炎是表现出脑脊液感染体征和症状的患者的区别之一。结核性脑膜炎的脑脊液有脑脊液蛋白升高和脑脊液糖降低的特征性表现。脑脊液直接涂片检测抗酸杆菌可能无任何结果。由于脑脊液结核分枝杆菌(MTB)的敏感性为40%至60%[2],而较新的方法即CSF for TB PCR的敏感性为44.5%,特异性为92.0%[1],因此结核性脑膜炎的明确诊断有时可能具有挑战性。结核性脑膜炎的诊断高度依赖于基于临床表现和临床表现的高怀疑指数,辅以脑脊液表现和放射影像学特征[3]。尽管脑脊液培养尚未完成,但仍需尽早开始治疗,以降低死亡率和发病率。我们报告一例罕见的结核性脑膜炎,表现为双侧海绵窦综合征。
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引用次数: 0
Laser Interstitial Thermal Therapy for Radiation Necrosis / Adverse Inflammatory Responses to SRS - Case Report and Literature Review 激光间质热治疗放射性坏死/ SRS不良炎症反应-病例报告及文献复习
Pub Date : 2017-07-05 DOI: 10.15406/jnsk.2017.07.00233
Vadim Tsvankin, E. Howell, P. Fecci
Brain metastases are the most common type of intracranial tumor [1-4], and confer a dismal prognosis; despite aggressive secondary and even tertiary resections, stereotactic radiosurgery, high-dose external beam radiotherapy, and multi-mechanistic chemotherapy delivered at toxic doses, median survival ranges from 2 to 25 months [5]. The morbidity of intracranial tumors is substantial, and arises not only from neurological deficits associated with direct brain compression or invasion, but also secondary to systemic and local treatment modalities. In particular, radiation necrosis, a common sequelae of stereotactic radiosurgery (SRS), results in difficult-to-control mass effect and perilesional edema, severely limiting a patient’s ability to function and reducing quality of life [6-8]. Truly, “radiation necrosis” is a misnomer, as the process is more accurately an adverse inflammatory response post-stereotactic radiotherapy (AIRS). The mainstay of treatment is high-dose corticosteroids, which themselves generate a litany of poorly-tolerated symptoms, including hyperglycemia, elevated infection risk, impaired wound healing, osteopenia and suppressed adrenal function [9]. Alternative strategies such as therapeutic anticoagulation, bevacizumab [10], hyperbaric oxygen [11], and even resection [7] have been attempted with limited success, and AIRS remains a substantial therapeutic challenge.
脑转移瘤是最常见的颅内肿瘤类型[1-4],预后不佳;尽管进行了积极的二次甚至第三次切除、立体定向放射外科手术、高剂量外束放疗和毒性剂量的多机制化疗,中位生存期为2至25个月[5]。颅内肿瘤的发病率很高,不仅与直接脑压迫或侵犯相关的神经功能缺损有关,而且还继发于全身和局部治疗方式。尤其是放射坏死,立体定向放射手术(SRS)的常见后遗症,导致难以控制的肿块效应和病灶周围水肿,严重限制患者的功能,降低生活质量[6-8]。确实,“放射性坏死”是一个用词不当,因为这个过程更准确地说是立体定向放疗(AIRS)后的不良炎症反应。主要的治疗方法是大剂量皮质类固醇,但其本身会产生一系列难以耐受的症状,包括高血糖、感染风险升高、伤口愈合受损、骨质减少和肾上腺功能抑制[9]。治疗性抗凝、贝伐单抗[10]、高压氧[11]、甚至切除[7]等替代策略已被尝试,但成功率有限,而且AIRS仍然是一个重大的治疗挑战。
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引用次数: 1
An Evidence-based Review on Religiosity in Psychiatry 精神病学宗教性的循证回顾
Pub Date : 2017-06-29 DOI: 10.15406/jnsk.2017.07.00231
R. Bonelli
Objective: Religiosity and/or spirituality (R/S) has a deep impact on human psyche. This review describes the evidence on R/S on mental health. 72.1% if the studies find a positive relationship between R/S and better mental health, 18.6% find mixed (positive and negative) results, and 4.7% reported a negative association. All studies on dementia, suicide and stress-related disorders found a positive association, as well as 79% and 67% of the papers on depression and substance abuse, respectively. There is growing evidence today that R/S is correlated with better mental health in the areas of depression, substance abuse, and suicide; insufficient evidence in neurosis and dementia; poor evidence in bipolar disorder and schizophrenia, and no evidence in many other mental disorders.
目的:宗教信仰和/或灵性(R/S)对人类的心理有深刻的影响。本综述描述了R/S在心理健康方面的证据。72.1%的研究发现R/S与更好的心理健康之间存在正相关关系,18.6%的研究发现混合(积极和消极)结果,4.7%的研究报告存在负相关。所有关于痴呆、自杀和压力相关疾病的研究都发现了正相关,关于抑郁和药物滥用的论文分别为79%和67%。今天有越来越多的证据表明,R/S与抑郁、药物滥用和自杀等方面的心理健康状况改善有关;神经症和痴呆证据不足;双相情感障碍和精神分裂症的证据不足,在许多其他精神障碍中没有证据。
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引用次数: 3
Multiple Sclerosis in a Patient with Psudopseudohypoparathyroidism 假性甲状旁腺功能低下患者多发性硬化症1例
Pub Date : 2017-06-27 DOI: 10.15406/JNSK.2017.07.00229
S. Altas, A. T. Sag, B. Cavdarli, N. Oztekin
A 30-year old woman admitted to the emergency department with a complaint of sudden weakness in her right arm and right leg. She had right hemihypoesthesis and 4/5 (MRC scale) right motor deficit on neurological examination. While there was no pathological sign in the initial brain CT scan, a hypodense area that was interpreted as an infarct was seen in the right posterior periventricular white matter in the control CT scan. Detailed studies were started for the etiology of stroke in a young patient. There was a 40 % stenosis in the left internal carotid artery in CT angiography. Cardiological studies (transthorasic echocardiography, holter test), lipid profile, homocysteine level, procoagulant factors and serological biomarkers of vasculitis were all in normal ranges.
一名30岁妇女因右臂和右腿突然无力而住进急诊科。神经学检查有右半假设和4/5 (MRC评分)右侧运动障碍。虽然在最初的CT扫描中没有病理征象,但在对照CT扫描中,在右侧后脑室周围白质中可见低密度区,被解释为梗死。对一位年轻病人中风的病因进行了详细的研究。CT血管造影显示左侧颈内动脉狭窄40%。心脏学检查(经胸超声心动图、霍尔特试验)、血脂、同型半胱氨酸水平、促凝因子和血管炎血清学生物标志物均在正常范围内。
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引用次数: 0
期刊
Journal of Neurology and Stroke
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