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Proton magnetic resonance spectroscopy of the brain in dementia. 脑质子磁共振波谱在痴呆中的应用。
Pub Date : 1999-01-01 DOI: 10.1007/s100729970008
N De Stefano, M Mortilla, A Federico

Proton magnetic resonance spectroscopy (MRS) allows accurate and noninvasive biochemical assay of living tissues. In vivo measurements provided by MRS have greatly enhanced our understanding of the pathophysiology of dementia. Increases in choline and myo-inositol (markers of membrane turnover) have been demonstrated in several studies on patients with Alzheimer's disease (AD), suggesting the presence of a significant cellular membrane (and glial) pathology in this disorder. Large decreases in brain N-acetylaspartate (NAA) (a marker of neuroaxonal integrity) are commonly seen in AD as well as in other forms of dementia in cerebral gray and white matter, indicating the presence of significant axonal damage. Since greater NAA decreases have been demonstrated in brains of patients with clinically more severe disease, NAA could provide an index relevant to patients' clinical status. Brain metabolic changes can be independent of abnormalities detected by conventional magnetic resonance imaging (MRI), since proton MRS may show a normal metabolic pattern in patients with mild neurological impairment and severe MRI abnormalities. However, quantitative measurements of regional brain volumes can be useful in the diagnosis of dementia. Thus, proton MRS, alone or combined with new quantitative magnetic resonance techniques, can provide sensitive indices able to monitor disease progresson or effects of drug therapy.

质子磁共振波谱(MRS)允许准确和无创的生物化学分析的活组织。MRS提供的体内测量大大增强了我们对痴呆病理生理学的理解。在阿尔茨海默病(AD)患者的几项研究中已经证实胆碱和肌醇(膜转换的标志物)的增加,表明这种疾病中存在显著的细胞膜(和神经胶质)病理。脑n -乙酰天冬氨酸(NAA)(神经轴突完整性的标志)的大量减少在阿尔茨海默病以及其他形式的脑灰质和白质痴呆中常见,表明存在显著的轴突损伤。由于临床上疾病更严重的患者大脑中NAA的下降幅度更大,因此NAA可以提供与患者临床状态相关的指标。脑代谢变化可以独立于传统磁共振成像(MRI)检测到的异常,因为质子MRS可能在轻度神经损伤和严重MRI异常的患者中显示正常的代谢模式。然而,区域脑容量的定量测量在痴呆症的诊断中是有用的。因此,质子MRS单独或结合新的定量磁共振技术,可以提供能够监测疾病进展或药物治疗效果的敏感指标。
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引用次数: 10
Magnetization transfer imaging to monitor the evolution of multiple sclerosis. 磁化转移成像监测多发性硬化症的进展。
Pub Date : 1999-01-01 DOI: 10.1007/s100729970003
M Filippi

Magnetization transfer imaging (MTI) is a magnetic resonance imaging (MRI) technique that is now used in multiple sclerosis (MS) studies, and is thought to have a higher pathological specificity than conventional T2-weighted imaging. This review outlines the major contributions given by MTI for the understanding of MS evolution.MTI studies of individual MS lesions confirm the pathological heterogeneity of T2-weighted MRI abnormalities and the potential role of unenhanced T1-weighted hypointensities as specific markers of localized severe white matter disruption. Correlative cross-sectional and longitudinal studies using MIT and gadolinium (Gd)-enhanced MRI reveal that MTI findings may vary in lesions with different patterns of enhancement, and that MTI abnormalities are closely related to the onset and recovery of blood-brain barrier disruption in new MS plaques. MTI lesion load (LL) is highly correlated with T2-weighted MRI lesion load, but it has a limited reliability as a measure of MS lesion burden. On the other hand, measures obtained from MT scans using whole-brain histogram analysis are highly correlated with the extent of MS abnormalities on conventional MRI scans, and predict patients' clinical disability well, since they are sensitive to both macro- and microscopic MS lesion burden in the whole brain and in specific regions. These data suggest that (a) MTI is sensitive to different stages of lesion pathology and pathological evolution in MS patients; and (b) MT histogram analysis can provide a more global assessment of MS lesion burden, since it encompasses both macro- and microscopic MS pathology.

磁化转移成像(MTI)是一种磁共振成像(MRI)技术,目前用于多发性硬化症(MS)的研究,被认为比传统的t2加权成像具有更高的病理特异性。这篇综述概述了MTI对理解MS进化的主要贡献。单个MS病变的MTI研究证实了t2加权MRI异常的病理异质性,以及未增强的t1加权低信号作为局部严重白质破坏的特异性标志物的潜在作用。利用MIT和钆增强MRI进行的相关横断面和纵向研究显示,不同增强模式的病变中MTI的表现可能不同,MTI异常与新发MS斑块血脑屏障破坏的发生和恢复密切相关。MTI病变负荷(LL)与t2加权MRI病变负荷高度相关,但作为MS病变负荷指标的可靠性有限。另一方面,使用全脑直方图分析从MT扫描中获得的测量值与常规MRI扫描中MS异常的程度高度相关,并且可以很好地预测患者的临床残疾,因为它们对全脑和特定区域的宏观和微观MS病变负担都很敏感。这些数据表明(a) MTI对MS患者不同阶段病变病理及病理演变敏感;(b) MT直方图分析可以提供更全面的MS病变负担评估,因为它包括宏观和微观MS病理。
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引用次数: 10
XXXI National Congress of the Italian Neurological Society. Verona, October 2-6, 1999. Abstracts. 意大利神经学会第三十一届全国代表大会。维罗纳,1999年10月2日至6日。摘要。
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引用次数: 0
Diffusion-weighted imaging in multiple sclerosis. 多发性硬化的弥散加权成像。
Pub Date : 1999-01-01 DOI: 10.1007/s100729970005
M Cercignani, G Iannucci, M Filippi

Diffusion-weighted imaging (DWI) provides a unique form of magnetic resonance (MR) contrast that enables the diffusional motion of water molecules to be quantitatively measured. As a consequence, DWI provides information about the orientation, size and geometry of brain structures. Cellular structures in the central nervous system restrict water molecular motion, and the apparent diffusion coefficient (ADC) is reduced compared to diffusion in bulk water. Pathological processes that modify tissue integrity, thus removing some of the "restricting" barriers, can result in increased ADC. Preliminary studies in multiple sclerosis (MS) using DWI showed that the ADC is higher in macroscopic lesions than in the normal appearing white matter (NAWM). The ADC is also dependent on the direction in which diffusion is measured, thus making comparison of ADC values meaningless without taking into account the measurement direction. One measurement of diffusion that is independent of the orientation of structures is provided by measuring the ADC in three orthogonal directions, and then averaging the results to form the mean diffusivity, D. We obtained DW scans from 35 patients with relapsing-remitting MS and 24 healthy volunteers. D was measured inside T2-visible lesions and regions located in different areas of the NAWM. D histograms from a large portion of the brain were created. MS lesions had a significantly higher D than NAWM. T1-hypointense lesions had the highest diffusion values, consistent with more severe tissue disruption. D was higher in the NAWM from patients than in the white matter from healthy controls. We also found significant differences between D histogram-derived measures from patients and controls, confirming the presence of diffuse damage in the brain of patients with MS.

扩散加权成像(DWI)提供了一种独特的磁共振(MR)对比形式,可以定量测量水分子的扩散运动。因此,DWI提供了有关大脑结构的方向、大小和几何形状的信息。中枢神经系统的细胞结构限制了水分子的运动,表观扩散系数(ADC)比在散装水中的扩散要低。病理过程改变组织完整性,从而消除一些“限制性”屏障,可导致ADC增加。多发性硬化症(MS)的DWI初步研究显示,ADC在宏观病变中高于正常白质(NAWM)。ADC还依赖于测量扩散的方向,因此如果不考虑测量方向,ADC值的比较就没有意义。通过在三个正交方向上测量ADC,提供了一种独立于结构方向的扩散测量,然后将结果取平均值,形成平均扩散率d。我们获得了35名复发缓解型MS患者和24名健康志愿者的DW扫描。D在t2可见病变和位于NAWM不同区域的区域内测量。绘制了大脑大部分的D直方图。MS病变的D值明显高于NAWM。t1 -低信号病变弥散值最高,与更严重的组织破坏一致。患者NAWM中的D含量高于健康对照组的白质。我们还发现来自患者和对照组的D直方图衍生测量之间存在显著差异,证实了MS患者大脑中弥漫性损伤的存在。
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引用次数: 15
Long-term effects of boxing and judo-choking techniques on brain function. 拳击和柔道窒息技术对脑功能的长期影响。
Pub Date : 1998-12-01 DOI: 10.1007/BF02341784
G Rodriguez, P Vitali, F Nobili

Regional cerebral blood flow (rCBF) was measured by 133-xenon inhalation in 24 amateur and 20 professional boxers, and in 10 judoka. Results were compared with those from age- and sex-matched healthy controls. Eighteen boxers (9 amateurs and 9 professionals) and all judoka also underwent electroencephalography (EEG). Mean rCBF values did not differ between either amateur boxers orjudoka and controls, whereas in professional boxers rCBF was significantly (p<.001) reduced in the whole brain, especially in the frontocentral regions. Healthy subjects, judoka, and amateur boxers showed a similar distribution of global CBF (gCBF, the mean of 32 probes) values, although 12.5% of amateurs had a significantly lower gCBF than controls. Among professional boxers, 25% showed a significantly low gCBF value; in the remaining 75%, gCBF was below the mean value of controls but did not reach statistical significance. Regional hypoperfusion, mainly in the frontocentral regions of both sides, was found in 35% of professional and in 29% of amateur boxers. A correlation between gCBF values and number of official matches was not found in boxers. EEG was normal in all judoka and amateur boxers, but it was abnormal in 3 professionals. This study shows the relevance of the neurophysiological assessment of athletes engaged in violent sports which can cause brain impairment. In fact, while professional boxers may show brain functional impairment in comparison to normal subjects, judoka do not. The lack of correlation between CBF values in boxers and the number of official matches points to the difficulty of taking into account variables, such as the number and the severity of matches during training.

采用133-氙吸入法测定了24名业余拳击手和20名职业拳击手以及10名柔道运动员的局部脑血流(rCBF)。结果与年龄和性别匹配的健康对照进行了比较。18名拳击手(9名业余运动员和9名职业运动员)和所有柔道运动员也接受了脑电图检查。平均rCBF值在业余拳击手或柔道运动员和对照组之间没有差异,而在职业拳击手中rCBF显著(p
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引用次数: 27
Isolated hypoglossal nerve palsy due to an anomalous vertebral artery course: report of two cases. 椎动脉异常行引起孤立性舌下神经麻痹2例报告。
Pub Date : 1998-12-01 DOI: 10.1007/BF02341786
A Morini, L Rozza, V Manera, M Buganza, E Tranquillini, D Orrico

The authors report two patients with isolated unilateral tongue atrophy. Magnetic resonance imaging (MRI) of the brain stem and angio-MRI demonstrated a dolichovertebral artery with an abnormal course compressing the medulla oblongata at the emergence of the hypoglossal rootlets. The semeiological observation of a sectorial and not uniform distribution of atrophy in the half-affected tongue is discussed in relation to the lesional site.

作者报告了两例孤立的单侧舌萎缩患者。脑干磁共振成像(MRI)和血管MRI显示椎动脉异常,在舌下神经根出现处压迫延髓。一个部门的符号学观察和不均匀分布的萎缩在半受影响的舌头讨论了有关的病变部位。
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引用次数: 14
Stroke incidence and survival in three Sicilian municipalities. Sicilian Neuro-Epidemiologic Study (SNES) Group. 西西里三个城市的中风发病率和生存率。西西里神经流行病学研究组。
Pub Date : 1998-12-01 DOI: 10.1007/BF02341781
W A Rocca, A Reggio, G Savettieri, G Salemi, F Patti, F Meneghini, F Grigoletto, L Morgante, R Di Perri

We investigated the incidence of first-ever stroke in three Sicilian municipalities over the years 1984-1987. Case ascertainment involved two approaches: a door-to-door two-phase prevalence survey and a study of death certificates. Only first-ever strokes occurring within the study time interval were included, and diagnoses were based on specified criteria. We found 138 subjects who had experienced a first stroke over 73 488 person-years; the average incidence rate (new cases per 1000 population per year) was 1.9 overall, 1.7 in men, and 2.1 in women. Incidence increased steeply with age and was similar in men and women. Incidence was similar in the three study municipalities. The overall case-fatality rate was 35% at 30 days and 22% at one week. Survival after stroke was similar in men and women but better in younger compared to older stroke patients. Comparisons with previous studies suggest the absence of major geographic variations in stroke incidence within Italy.

我们调查了1984-1987年间西西里三个城市首次中风的发病率。病例确定涉及两种方法:挨家挨户的两阶段患病率调查和死亡证明研究。只有在研究时间间隔内发生的第一次中风被包括在内,诊断基于特定的标准。我们发现138名受试者在73 488人年的时间里经历过首次中风;平均发病率(每年每1000人新增病例)为1.9例,男性1.7例,女性2.1例。发病率随着年龄的增长而急剧增加,在男性和女性中相似。三个研究城市的发病率相似。30天的总病死率为35%,一周的病死率为22%。男性和女性中风后的生存率相似,但年轻中风患者的生存率高于老年中风患者。与以前的研究比较表明,意大利卒中发病率没有主要的地理差异。
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引用次数: 12
Tourettism as clinical presentation of Huntington's disease with onset in childhood. 小儿起病的亨廷顿病的临床表现为抽动症。
Pub Date : 1998-12-01 DOI: 10.1007/BF02341787
L Angelini, V Sgrò, A Erba, S Merello, G Lanzi, N Nardocci

Infantile Huntington's disease (HD) shows a wide clinical heterogeneity. Here we describe the case of a child affected by HD who showed unusual neurological features consistent with tourettism. The absence of family history and persisting normal magnetic resonance imaging (MRI) results long after the onset of symptoms delayed the diagnosis of the disease. An MRI exam performed 26 months after disease onset disclosed bilateral atrophy in the putamen, suggesting HD. The diagnosis was confirmed by genetic analysis. The present report underlines the need to consider HD in childhood cases of unusual and even unfamiliar progressive movement disorders.

婴儿亨廷顿舞蹈病(HD)表现出广泛的临床异质性。在这里,我们描述的情况下,儿童受影响的HD谁表现出不寻常的神经特征与抽动症一致。没有家族史和持续正常的磁共振成像(MRI)结果在症状发作后很长一段时间延迟了疾病的诊断。发病26个月后MRI检查显示双侧壳核萎缩,提示HD。遗传分析证实了诊断。本报告强调有必要考虑儿童不寻常甚至不熟悉的进行性运动障碍的HD病例。
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引用次数: 12
Reduced glutathione in amyotrophic lateral sclerosis: an open, crossover, randomized trial. 减少谷胱甘肽治疗肌萎缩性侧索硬化:一项开放、交叉、随机试验。
Pub Date : 1998-12-01 DOI: 10.1007/BF02341783
A Chiò, A Cucatto, A A Terreni, D Schiffer

The present study set out to define the possible effect of reduced glutathione (GSH), the substrate of glutathione peroxidase (GSH-Px), a free radical inactivating enzyme, in amyotrophic lateral sclerosis (ALS). Thirty-two patients affected by definite ALS seen in our institution between August 1993 and July 1994 were admitted to the study. The effect of GSH was studied in an open, crossover, randomized study. GSH was given at the dose of 600 mg each day intramuscularly for 12 weeks. The patients, taken sequentially, were randomly assigned to two groups. The first group received the drug while the second received only symptomatic therapies for 12 weeks. After a week of washout, the second group received GSH and the first only symptomatic therapies for 12 weeks. The rate of progression of the diseases was compared in the two groups. Clinical evaluation included manual test for muscle strength, Norris scale, bulbar scale, and forced vital capacity (FVC) percent. No significant difference was found in the progression of ALS in the two periods, although a slight slowing of the disease progression rate was found during the period of treatment, probably related to the open design of the study. Our data do not show any significant effect of reduced glutathione in modifying the progression of ALS.

本研究旨在确定还原型谷胱甘肽(GSH)在肌萎缩性侧索硬化症(ALS)中的可能作用,GSH是谷胱甘肽过氧化物酶(GSH- px)的底物,一种自由基灭活酶。1993年8月至1994年7月间在我院就诊的32例明确的ALS患者被纳入研究。在一项开放、交叉、随机研究中研究了谷胱甘肽的作用。GSH以每天600 mg的剂量肌肉注射,持续12周。患者按顺序被随机分为两组。第一组接受药物治疗,第二组只接受对症治疗,疗程12周。洗脱期一周后,第二组接受谷胱甘肽治疗,第一组仅对症治疗12周。比较两组患者的病情进展情况。临床评估包括手工测试肌力、诺里斯量表、球量表和用力肺活量(FVC)百分比。两期ALS的进展无明显差异,但在治疗期间,疾病进展速度略有减缓,可能与研究的开放式设计有关。我们的数据没有显示还原型谷胱甘肽在改善ALS进展方面有任何显著作用。
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引用次数: 34
Natural history of carpal tunnel syndrome according to the neurophysiological classification. 腕管综合征的自然病程及神经生理学分类。
Pub Date : 1998-12-01 DOI: 10.1007/BF02341782
L Padua, R Padua, M Lo Monaco, I Aprile, N Paciello, M Nazzaro, P Tonali

Although many studies on carpal tunnel syndrome (CTS) have been reported, few data on the natural history of CTS are available. Knowledge of the natural course of the disease has significant clinical and therapeutic value. We prospectively followed up 80 cases of untreated CTS. The evaluation was based on self-administered questionnaires and on neurophysiological investigation. According to the neurophysiological classification, cases of CTS were divided into six groups on the basis of impairment severity: negative, minimal, mild, moderate, severe, and extreme. Disease worsening was inversely related to severity of nerve entrapment. On the contrary, improvement was proportionally related to nerve function impairment (except for extreme cases that never improved), and about one-third of mild and moderate cases improved. Most minimally cases remained neurophysiologically unchanged. We hypothesize that in a good percentage of CTS cases, nerve impairment is self-limited. Our data suggest the utility of further studies on the natural course of this common disease.

虽然有许多关于腕管综合征(carpal tunnel syndrome, CTS)的研究报道,但关于其自然史的资料却很少。了解疾病的自然病程具有重要的临床和治疗价值。我们对80例未经治疗的CTS进行前瞻性随访。评估基于自我填写的问卷和神经生理调查。根据神经生理分类,将CTS病例按损害程度分为阴性、轻度、轻度、中度、重度、极端6组。疾病恶化与神经卡压严重程度呈负相关。相反,改善与神经功能损伤成正比(极端病例除外),大约三分之一的轻度和中度病例得到改善。大多数微创病例的神经生理没有变化。我们假设在很大比例的CTS病例中,神经损伤是自限性的。我们的数据表明,对这种常见疾病的自然过程进行进一步研究是有用的。
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引用次数: 32
期刊
Italian journal of neurological sciences
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