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Pathophysiology of Brain Somatic Interactions in Aneurysmal Subarachnoid Hemorrhage - Review and Update 动脉瘤性蛛网膜下腔出血中脑-体相互作用的病理生理学综述与最新进展
Pub Date : 2015-09-28 DOI: 10.4172/2168-975X.1000183
B. Lo, H. Fukuda
This commentary summarizes and updates current evidence regarding pathophysiologic mechanisms of brain somatic interactions in aneurysmal subarachnoid hemorrhage. It discusses primary and secondary injurious processes after aneurysmal rupture. It reviews current state of knowledge of multi-organ involvement in this disease condition, including brain-cardiopulmonary, neuroendocrine and renal manifestations. Emerging evidence is also summarized regarding brain-gastrointestinal, immune and hematologic systems.
这篇评论总结和更新了目前关于动脉瘤性蛛网膜下腔出血中脑躯体相互作用的病理生理机制的证据。讨论了动脉瘤破裂后的原发性和继发性损伤过程。它回顾了目前对该病多器官累及的认识,包括脑-心肺、神经内分泌和肾脏表现。还总结了有关脑-胃肠、免疫和血液系统的新证据。
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引用次数: 1
Bleeding from an Aneurysm is not Arrested Immediately: Based on Findings on CT Angiography at an Acute Stage in Patients with Aneurysmal Subarachnoid Hemorrhage 动脉瘤出血不能立即停止:基于急性期动脉瘤性蛛网膜下腔出血患者的CT血管造影结果
Pub Date : 2015-09-28 DOI: 10.4172/2168-975X.1000182
H. Kasuya
There is an increasing number of articles of extravasation of contrast material from a ruptured aneurysm in patients with subarachnoid hemorrhage (SAH) during CT angiography (CTA) [1-16]. Most of authors regard this phenomenon as rerupture of aneurysm, probably because they believe that bleeding from a ruptured aneurysm is arrested immediately when the intracranial pressure is increased to the level of the systolic blood pressure [17]. In our observation, all patients with active bleeding were severe grade of SAH and all CTA in patients with active bleeding were obtained within 2 hours after symptoms of SAH [15]. We could observe re-rupture from an aneurysm by the extravasation of contrast material from the aneurysm on intra-arterial angiography in patients with marked changes in vital and neurological signs. We have encountered many patients with extravasation of contrast material during CTA without marked neurological deterioration, which may reflect the inclusion of patients with continuous bleeding, as seen with other systematic injuries. It is time to recognize that extravasation from an aneurysm on CTA does not always mean re-rupture and that bleeding from an aneurysm is not arrested immediately [8]. We should take this in mind and it might be advisable to wait at least a few hours after the onset of symptoms for invasive examinations, treatments, and even transfer to a stroke center in severe grade SAH patients [15].
在CT血管造影(CTA)中,越来越多的蛛网膜下腔出血(SAH)患者动脉瘤破裂后造影剂外渗[1-16]。大多数作者认为这种现象为动脉瘤再破裂,可能是因为他们认为当颅内压升高到收缩压[17]时,破裂的动脉瘤出血立即停止。在我们的观察中,所有出现活动性出血的患者均为重度SAH,所有出现活动性出血的患者的CTA均在SAH出现症状后2小时内获得。在生命体征和神经体征有明显改变的患者,我们可以通过动脉瘤造影剂外渗来观察动脉瘤再破裂。我们遇到许多患者在CTA期间有造影剂外渗,但没有明显的神经系统恶化,这可能反映了包括持续出血的患者,正如其他系统性损伤所见。是时候认识到,CTA显示的动脉瘤外渗并不总是意味着再破裂,动脉瘤出血也不能立即停止。我们应该牢记这一点,对于严重SAH患者b[15],建议在症状出现后至少等待几个小时进行有创检查、治疗,甚至转移到卒中中心。
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引用次数: 0
Superficial Siderosis Following Posterior Fossa Exploration 后颅窝探查后的浅表面性铁沉着
Pub Date : 2015-09-28 DOI: 10.4172/2168-975X.1000184
James Gauci, R. Grech, J. Aquilina
A 70 year old lady presented with symptoms and signs suggesting lesions in the vestibulocochlear nerve, the cerebellum and brainstem. Features on magnetic resonance imaging of the brain led to the diagnosis of superficial siderosis. This condition is a very rare neurodegenerative disorder characterised by deposition of haemosiderin in several areas of the nervous system. This occurs a result of recurrent bleeding in the subarachnoid space. Various sources of chronic bleeding have been implicated, including dural defects, neoplasms or arterio-venous malformations. Whilst presenting symptoms depend on the site of haemosiderin deposition, there is a predilection for the eight cranial nerve, the cerebellum and brainstem. The investigation of choice is magnetic resonance imaging of the brain, and linear hypointensity is pathognomonic. Early identification of this condition will obviate the need for further, extensive investigation of the patient’s symptoms. It will also enable the physician to search for an underlying, potentially treatable cause. Our patient gave a history of posterior fossa exploration half a century prior to her current presentation, suggesting the presence of a dural defect as the cause of this disorder.
一位70岁的女士表现出的症状和体征表明病变在前庭耳蜗神经,小脑和脑干。脑磁共振成像特征导致浅表性铁沉着症的诊断。这种情况是一种非常罕见的神经退行性疾病,其特征是在神经系统的几个区域沉积了血黄素。这是由于蛛网膜下腔反复出血的结果。各种来源的慢性出血已牵连,包括硬脑膜缺损,肿瘤或动静脉畸形。虽然表现出的症状取决于血黄素沉积的部位,但主要发生在颅八神经、小脑和脑干。选择的研究是脑磁共振成像,线性低密度是典型的。这种情况的早期识别将避免对患者症状进行进一步广泛调查的需要。它还将使医生能够寻找潜在的、可能治疗的原因。我们的患者在目前的病例出现前半个世纪曾有后颅窝探查史,提示出现硬脑膜缺损是导致这种疾病的原因。
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引用次数: 2
Nosology Lesions of the White Matter of the Brain in Newborns and Young Children 新生儿和幼儿脑白质的分类学病变
Pub Date : 2015-09-28 DOI: 10.4172/2168-975X.1000185
V. Vlasyuk
Important problem of children's neurology is development of a nosology of lesions of the white matter of the brain at newborn children. It is primarily about such diverse lesions as Periventricular Leukomalacia (PVL), Diffuse Leukomalacia (DFL), Subcortical Leukomalacia (SL), Telentsefalic Gliosis (TG; synonyms: Perinatal Telentsefalic Leukoencephalopathy), Periventricular Hemorrhagic Infarction (PHI) and Multicystic Leukomalacia. All lesions have their own characteristics in the etiology, pathogenesis and clinic, which are not sufficiently developed [1].
儿童神经学的重要问题是新生儿脑白质病变分类学的发展。主要涉及脑室周围白质软化症(PVL)、弥漫性白质软化症(DFL)、皮层下白质软化症(SL)、神经胶质瘤(TG;同义词:围产期远端性脑白质病,脑室周围出血性梗死(PHI)和多囊性白质软化。所有病变在病因、发病机制和临床上都有各自的特点,目前对这些特点的研究还不够充分。
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引用次数: 0
Survival after Total vs. Partial Removal of Low Grade Gliomas 低级别胶质瘤完全切除与部分切除后的生存率
Pub Date : 2015-09-28 DOI: 10.4172/2168-975X.1000186
Nikolaos Sakellaridis, George Bourzinos
We have collected a series of 102 operated oligodendrogliomas [2]. Our results confirm that total tumor vs. partial tumor or biopsy removal offered a statistically significant extended survival postoperatively. This survival advantage was lost when we measured survival after first symptoms of the disease: For statistical analysis life table analysis and logrank test have been performed. The results for total vs. partial tumor removal were 0,3049 after first symptoms and 0,0250 postoperatively. The second but not the first result is statistically significant.
我们收集了102例手术治疗的少突胶质细胞瘤[2]。我们的研究结果证实,全肿瘤与部分肿瘤或活检切除在统计学上显著延长了术后生存期。当我们测量疾病首次出现症状后的生存时,这种生存优势就消失了:为了进行统计分析,我们进行了生命表分析和logrank试验。首次出现症状后肿瘤全部切除和部分切除的结果分别为0,3049例和0,250例。第二个而不是第一个结果在统计上是显著的。
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引用次数: 0
Integrated Diagnostic Approach for Adult Oligodendroglioma and Oligoastrocytoma 成人少突胶质细胞瘤和少星形细胞瘤的综合诊断方法
Pub Date : 2015-09-26 DOI: 10.4172/2168-975X.1000187
J. Schittenhelm
Diffuse gliomas with clear cell morphology are represented in the 2007 WHO classification of brain tumors as oligoastrocytomas and oligodendrogliomas of grades II and III. Although preoperative neuroimaging of these brain tumors are often successful, histopathologic evaluation of neurosurgically removed tumor specimens is still required for a definite diagnosis and subsequent molecular analysis. Such CNS tumors show an extensive variety of histological and cytological appearance making diagnosis in clear cell gliomas somewhat difficult, especially as oligoastrocytomas are often less clearly defined. There is an ongoing debate whether these tumors indeed constitute an entity or whether they represent a mixed bag containing both astrocytomas and oligodendroglioma. Recent advances with molecular data on these tumors have a major impact on neuopathological typing, prognosis and therapy of the patients. This neuro-oncologic review focuses on neuropathological and molecular features of the different types of diffusely infiltrating gliomas. Core features and distinct patterns and variants are also introduced and illustrated. Recent advances in immunohistochemistry and molecular biology have contributed to an improved classification and are discussed. Different methodologies for molecular analysis of 1p/19q codeletion, ATRX loss, MGMT promoter methylation and isocitrate dehydrogenase mutations are presented in detail and their prognostic and predictive implications for therapy are discussed.
2007年WHO将脑肿瘤分类为II级和III级的少星形细胞瘤和少突胶质细胞瘤,具有透明细胞形态的弥漫性胶质瘤。尽管这些脑肿瘤的术前神经影像学检查通常是成功的,但仍然需要对神经外科切除的肿瘤标本进行组织病理学评估,以确定诊断和随后的分子分析。这类中枢神经系统肿瘤表现出广泛多样的组织学和细胞学表现,使得透明细胞胶质瘤的诊断有些困难,尤其是少星形细胞瘤的定义往往不太明确。这些肿瘤是否确实构成一个实体,或者它们是否代表星形细胞瘤和少突胶质细胞瘤的混合物,目前仍存在争议。这些肿瘤分子数据的最新进展对患者的神经病理分型、预后和治疗具有重要影响。这篇神经肿瘤学综述的重点是不同类型弥漫性浸润胶质瘤的神经病理学和分子特征。还介绍和说明了核心特征和不同的模式和变体。免疫组织化学和分子生物学的最新进展有助于改进分类,并进行了讨论。本文详细介绍了1p/19q编码缺失、ATRX缺失、MGMT启动子甲基化和异柠檬酸脱氢酶突变的不同分子分析方法,并讨论了它们对治疗的预后和预测意义。
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引用次数: 1
Can a permanent damaged brain be repairable in the phase of chronic stroke 永久性受损的大脑能否在慢性中风阶段得到修复
Pub Date : 2015-09-04 DOI: 10.4172/2168-975X.S1.003
Zhao LiRu
S and traumatic brain injury (TBI) are leading cause of human death and disability across the globe. Unfortunately, there are very few effective therapies for stroke and TBI patients. Most previous and current experimental treatments have focused on affecting one signaling pathway, regulating an individual membrane protein/channel/receptor (e.g. NMDA receptor) or targeting one type of cell death mechanism (e.g. apoptosis). The failure of many clinical trials that have used these approaches in recent years has generated the consensus that for a therapy to be effective against complicated CNS disorders such as cerebral ischemia and TBI, it requires overwhelming protective effects on multiple pathways and multiple cell types. So far, there has been no therapy that is truly multifaceted and clinically feasible for acute stroke/TBI patients. One potential therapy, however, stands out for its versatile protective effects on the brain, heart and other organs: Hypothermia therapy. Mild-to-moderate hypothermia has shown remarkable neuroprotective effects (up to 90% infarct reduction) against brain ischemia in animal and human studies. Some of the drawbacks to available cooling techniques of physical means are that they are slow (3 hrs) and not practical, which have hampered clinical applications of hypothermia therapy. Thus, chemical compounds that can be utilized for hypothermia therapy have long been sought after for clinical treatments. Using drug-induced hypothermia, it is expected that even a small drop in body temperature (1-2°C) is beneficial for preventing the detrimental post-injury hyperthermia, delay the evolution of the secondary injury, and thereafter extend the therapeutic window for other interventions. We have developed novel neurotensin derivatives such as ABS201, ABS601, and ABS363 that can pass through the blood-brain barrier to induce “regulated hypothermia”, reducing body and brain temperature by 3-5°C in around 30 min without causing shivering. Systemic studies, blood tests, and autopsy examinations showed no toxic or adverse effects of these compounds. Post-ischemic administration of these compounds markedly attenuates ischemiainduced neuronal cell death, blood-brain barrier damage and improved functional recovery. In a hemorrhagic stroke model of the mouse, ABS201 administration 24 hrs after the onset of stroke still showed significant neuroprotection and functional benefits. Our recent investigation also showed protective effects of drug-induced hypothermia against TBI. These compounds thus provide a novel therapy that takes full advantage of therapeutic hypothermia but with no obvious side effects. It is expected that drug-induced hypothermia can be developed as a new category of global brain protection drugs and help to translate the chemical/pharmacological hypothermic therapy into clinical applications.
S和创伤性脑损伤(TBI)是全球人类死亡和残疾的主要原因。不幸的是,对于中风和脑外伤患者,几乎没有有效的治疗方法。大多数先前和当前的实验性治疗都集中在影响一个信号通路,调节单个膜蛋白/通道/受体(如NMDA受体)或针对一种细胞死亡机制(如凋亡)。近年来使用这些方法的许多临床试验的失败已经产生了一个共识,即对于复杂的中枢神经系统疾病(如脑缺血和TBI)有效的治疗,它需要对多种途径和多种细胞类型具有压倒性的保护作用。到目前为止,对于急性脑卒中/TBI患者,还没有真正的多面性和临床可行的治疗方法。然而,有一种潜在的治疗方法因其对大脑、心脏和其他器官的多种保护作用而脱颖而出:低温疗法。在动物和人类研究中,轻度至中度低温对脑缺血显示出显著的神经保护作用(高达90%的梗死减少)。现有的物理冷却技术的一些缺点是它们速度慢(3小时),不实用,这阻碍了低温疗法的临床应用。因此,可以用于低温治疗的化合物长期以来一直被寻求用于临床治疗。使用药物诱导的低温治疗,预计即使是很小的体温下降(1-2℃)也有利于预防有害的伤后热疗,延缓继发性损伤的发展,从而延长其他干预措施的治疗窗口期。我们已经开发出新的神经紧张素衍生物,如ABS201、ABS601和ABS363,它们可以通过血脑屏障诱导“调节低体温”,在大约30分钟内将身体和大脑温度降低3-5°C,而不会引起颤抖。系统研究、血液检查和尸体解剖检查显示这些化合物没有毒性或副作用。缺血后给予这些化合物可显著减轻缺血引起的神经元细胞死亡、血脑屏障损伤和改善功能恢复。在出血性卒中小鼠模型中,在卒中发生24小时后给予ABS201仍显示出显著的神经保护和功能益处。我们最近的研究也显示了药物性低温对TBI的保护作用。因此,这些化合物提供了一种新的治疗方法,充分利用了治疗性低温,但没有明显的副作用。药物性低温治疗有望成为全球范围内一类新的脑保护药物,并有助于将化学/药物性低温治疗转化为临床应用。
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引用次数: 37
Novel strategy to improve stroke therapy 改进脑卒中治疗的新策略
Pub Date : 2015-09-04 DOI: 10.4172/2168-975X.S1.001
S. Ansar
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引用次数: 0
The Effect of Multi-Disciplinary Psycho-Education for Hospitalized Schizophrenia Patients: The Key Factors for Re-Hospitalization 精神分裂症住院患者多学科心理教育的效果:再次住院的关键因素
Pub Date : 2015-08-31 DOI: 10.4172/2168-975X.1000181
T. Tsuneoka, K. Hori, Atsuko Inamoto, Satoru Sugisawa, Tomohiro Ikeda, A. Iwanami
Object: We discovered the relationship between any experience and discharge, readmitted. Psycho-education effect schizophrenia patients to discharge. Cognitive function is most important factor about re-admission. Backgrounds: Today, in Japanese psychiatric hospital, more and more patients are taking an early discharge. This trend has caused a major concern in the psychiatric hospitals because more number patients are being re-hospitalized within a few months after their first discharge. Methods: We have conducted an experiment in which we offered multi-disciplinary psycho-education to 160 schizophrenia patients. The experiment was conducted in the time span of nearly three years (Dec. 2009-Jul. 2013), with all the patients’ agreement. The patients showed significant improvement in all of the following when compared with prior to the psycho-education: GAF, SAI-J, DAI-10, and objective SCORS-J. Comparing the 137 patients who were able to discharge with 23 patients who were not. And we comparing the 22 patients who re-admitted within one year and the 77 who were not. Results: Comparing discharge or not, there was no significant difference in the amount of CP. However, there was a great improvement in PANSS, BPRS, GAF, SAI-J, and both objective and subjective SCORS-J. Comparing re-admitted or not, PANSS, BPRS and most of other indicators showed any noticeable difference, objective SCORS-J showed a trend that non-readmitted patients had higher scores. Conclusions: This research suggests the potential of psycho-education’s function for schizophrenia patients as a preventive measure of re-hospitalization, and the significance of cognitive function as a critical factor.
目的:了解任何经历与出院、再入院的关系。心理教育对精神分裂症患者出院的影响。认知功能是影响再入院的最重要因素。背景:今天,在日本精神病院,越来越多的病人提前出院。这一趋势引起了精神病院的重大关注,因为越来越多的病人在首次出院后的几个月内再次住院。方法:对160例精神分裂症患者进行多学科心理教育实验。本实验历时近三年(2009年12月- 7月)。2013年),并得到了所有患者的同意。与心理教育前相比,患者在GAF、SAI-J、DAI-10和客观score - j方面均有显著改善。比较137名能够出院的患者和23名不能出院的患者。我们比较了22个在一年内再次入院的病人和77个没有再次入院的病人。结果:与是否出院比较,两组CP量无明显差异,但PANSS、BPRS、GAF、SAI-J及客观、主观评分- j均有较大改善。再入院患者与非再入院患者相比,PANSS、BPRS等大部分指标差异均无统计学意义,客观score - j评分有非再入院患者得分较高的趋势。结论:本研究提示精神分裂症患者心理教育作为预防再住院措施的潜力,以及认知功能作为关键因素的意义。
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引用次数: 2
A Case of Retrocollis and Ophthalmoplegia Due to Progressive SupranuclearPalsy (PSP) 进行性核上性麻痹(PSP)致后碰撞和眼麻痹1例
Pub Date : 2015-08-26 DOI: 10.4172/2168-975X.1000i103
Aiesha Ahmed
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引用次数: 0
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Brain disorders & therapy
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