糖尿病周围神经病与认知障碍作为糖尿病的神经系统并发症常共存于糖尿病个体中,严重影响患者的生活质量.二者分别表现为糖尿病的周围和中枢神经系统病变,传统观点认为二者为独立的疾病.目前越来越多的证据表明,二者存在显著的相关性,病理生理机制有许多共同之处,且存在许多共同的生物学标志物.现对糖尿病患者发生周围神经及认知损伤的临床表现及电生理表现、病理生理机制、病理变化、生物学标志物进行综述,以进一步阐述二者之间的相互联系.

高血压是脑小血管病(CSVD)最重要的危险因素之一,血压的调控在CSVD的发生、进展和预后中起着重要作用.血压变异性(BPV)反映的是血压在一定时间内波动的程度,异常的血压波动与高血压所致的靶器官损害具有紧密关联.因此,BPV也与CSVD的发生发展密切相关,是独立于平均血压之外的CSVD的危险因素.不同类型的BPV指标对CSVD的影响存在差异,目前潜在的作用机制尚不完全清楚,有待进一步研究深入探索相关机制,以期通过降低BPV来预防CSVD的发生,达到早期防治的目的.

目的:探讨轻度认知功能障碍(mild cognitive impairment,MCI)患者的胰岛素抵抗(insulin resistance,IR)程度与认知水平、海马-内嗅皮层体积变化的关系.方法:417例研究对象根据Petersen的MCI诊断标准分别纳入MCI组或正常认知组,MCI患者再据胰岛素敏感指数(insulin sensitivity index,ISI)纳入相对胰岛素抵抗组(MCI-rIR组)或相对无抵抗组(MCI-rnIR组),简易智力状态检查表(mini-mental state examination,MMSE)、临床记忆量表(clinical memory scale,CMS)进行认知评分,MRI测量海马-内嗅皮层体积,分析MCI患者IR程度与认知评分、海马-内嗅皮层体积的关系.结果:同正常认知组比较,MCI患者胰岛素抵抗程度更重,并存在病理性海马-内嗅皮层体积萎缩,萎缩同认知功能相关;MCI患者中,MCI-rIR组较MCI-rnIR组的海马-内嗅皮层体积萎缩更严重,总认知评分及多项认知功能更差,除外糖尿病患者后亦然;多元回归分析显示,MCI患者海马-内嗅皮层体积同胰岛素抵抗程度呈正相关,同年龄、空腹血糖、收缩压呈负相关.结论:MCI患者存在病理性海马、内嗅皮层萎缩,该萎缩能同相应的认知损伤相印证,且二者与胰岛素抵抗有关联.

人体脑卒中后免疫系统会发生一系列变化,外周血中白细胞介素-6、降钙素原以及其他炎症因子水平在短时间内迅速上升.随着时间的推移,免疫系统功能逐渐丧失,包括淋巴细胞、单核细胞等在内的一些炎症相关因子数量均可出现不同程度的下降,导致机体抗炎能力减弱,使患者发生感染相关并发症的概率增加.这些炎症相关因子数量的变化规律不同,可通过监测其异常改变,在脑卒中早期有效地预测脑卒中相关性肺炎的发生.

目的 通过线性法测量皮质下缺血性血管病(SIVD)患者脑萎缩,分析其与认知功能损害的相关性.方法 共纳入SIVD组50例,健康对照组50例.所有入组对象均完成一般情况评定、MoCA量表评估认知功能、头颅MRI检查,线性法进行脑萎缩测量.结果 SIVD组代表脑室系统横径的测量值及脑沟测量值,除桥池宽度外,均较对照组显著增大(P＜0.05).SIVD组的脑萎缩测量相对值除脑干指数外,均显著高于对照组(P＜0.05).SIVD组双侧侧脑室两额角间最宽距离、双侧侧脑室额角两侧尾状核头间最小距离、第三脑室宽度、双侧侧脑室腰部外侧壁最小距离与MoCA评分呈显著负相关(P＜0.05).SIVD组脑萎缩测量相对值中的额角指数、尾状核指数、哈氏值、第三脑室宽度与视空间能力、计算力、延迟记忆和定向力均呈负相关(P＜0.05).结论 SIVD患者存在明显的皮质和皮质下萎缩,并与认知功能损害相关.哈氏值、额角指数、尾状核指数、第三脑室宽度可作为SIVD患者脑萎缩的预测指标,提示执行功能/视空间及计算力、记忆力的损害.

Intracerebral hemorrhage is the most important type of hemorrhagic stroke,and its mortality and disability rate are the highest among all types of stroke.Secondary hematoma enlargement is an independent risk factor for early neurological deterioration and poor outcome in patients with intracerebral hemorrhage.This article reviews the predictive factors and possible mechanisms of hematoma enlargement in patients with intracerebral hemorrhage from the aspects of clinical features,laboratory examination,and imaging examination.

Cognitive impairment and dementia are increasingly considered to be a continuum of overlapping neurological syndrome in the elderly with cerebrovascular disease and neurodegenerative disease.The association between cerebral microbleeds and cognitive impairment have attracted more and more attention.This article reviews the relationship between spatial distribution of cerebal microbleeds and cognitive impairment.

Objective To investigate the clinical and imaging features of carotid steal syndrome( CSS),as well as collateral circulation establishment,compensation methods,and outcomes of different treatment modalities,and to provide a basis for the diagnosis and treatment of CSS.Methods A total of 11 patients with CSS who were hospitalized from January to May,2016,were enrolled. Carotid color Doppler ultrasound,head CT angiography,magnetic resonance angiography,or digital subtraction angiography was performed for all patients to make a definite diagnosis of CSS and evaluate the compensation of collateral circulation. Of all 11 CSS patients,4 underwent carotid endarterectomy( CEA),5 underwent carotid artery stenting( CAS),and 2 patients with carotid artery occlusion underwent conservative pharmacotherapy. All the patients were followed up after 3 and 6 months and 1 year of treatment,and ischemic cerebrovascular events and the modified Rankin Scale( mRS) score were evaluated.Results Of all 11 CSS patients,7 had lesions in the unilateral internal carotid artery and 4 had lesions in the bilateral internal carotid arteries; 7 had a clinical manifestation of transient ischemic attack,3 had watershed infarction,and 1 had lacunar infarction; 7 patients had posterior circulation ischemia and 4 had anterior circulation ischemia. According collateral circulation establishment on DSA,all 11 patients had primary collateral circulation and 4 also had secondary collateral circulation. According to the ASITN score,most patients had a grade of 3-4. During the follow-up after treatment,two patients who underwent CAS experienced stroke-like symptoms in different periods after discharge,and four patients who underwent CEA did not experience stroke. The patients who underwent CAS or CEA had varying degrees of improvement in the mRS score at 3 and 6 months and 1 year after surgery.Conclusions Patients with severe carotid stenosis tend to develop CSS,with well established collateral circulation,mainly primary and secondary collateral circulation,and posterior circulation ischemia is a common clinical feature of CSS. CEA and CAS can improve carotid stenosis and thus may be used for the treatment of CSS.

Perivascular space(PVS) can exist in all populations,but its size and number increase with age.At present,PVS is mainly known through magnetic resonance imaging(MRI) method.In some situation,PVS will expand,which is called enlarged PVS(EPVS).EPVS often coexists with lacunar infarction(LI),leukoarai(LA) and other cerebrovascular disease on MRI,and it is especially difficult to identify with LI,resulting that LI and LA cover the brain tissue damage caused by EPVS which is deemed as benign alteration.However,there is growing evidence showing that EPVS is associated with cognitive dysfunction and cerebrovascular disease such as cerebral hemorrhage,LI and atherosclerotic cerebral infarction,which is a type of small brain vascular disease.

Objective To investigate the association between mild cognitive impairment( MCI) and white matter damage in different brain regions using diffusion tensor imaging( DTI). Methods A total of 56 patients who were hospitalized in our hospital from July2015 to February 2016 were enrolled and divided into MCI group( 34 patients) and normal cognitive function group( 22 patients).Their general status was examined and neuropsychological scales were also used for evaluation. DTI was used to measure the fractional anisotropy( FA) values of white matter fibers in different brain regions. Results Compared with the normal cognitive function group,the MCI group had significant reductions in the FA values of the white matter in the right frontal lobe( 0. 335 ± 0. 068),the left temporal lobe( 0. 391 ± 0. 032),and the genu of corpus callosum( 0. 658 ± 0. 053)( P < 0. 05). A canonical correlation analysis was performed for the FA values above and cognitive domains in the Mini-Mental State Examination scale and the Montreal Cognitive Assessment scale; the results showed that the FA value of the white matter in the right frontal lobe was positively correlated with attention and calculation( P < 0. 05) and the FA values of the white matter in the left temporal lobe and the genu of corpus callosum were positively correlated with memory( P < 0. 05). Conclusions The impairment of attention and calculation in patients with MCI may be associated with white matter damage in the right frontal lobe,and white matter damage in the left temporal lobe and the genu of corpus callosum may cause early-stage memory disorder. DTI may be a new method for ultra-early identification and diagnosis of MCI.

随着我国医学教育与国际合作的深入,到华留学的医学留学生不断增多,越来越多的医学院校开始开设MBBS课程。如何结合自身特点,构建适合外国留学生的教学模式是目前亟待解决的问题。通过分析昆明医科大学目前外国留学生的特点、神经病学教学模式及主要面临的问题,结合自身带教体会,从师资培养、教学方法、教学评估等方面探讨如何提高留学生神经病学教学效果和质量,为留学生的神经病学教学实践提供参考。

Cryptogenic stroke refers to ischemic stroke that can not be defined by routine examination at present. Studies have show n that patent foramen ovale may be a common cause of cryptogenic stroke, and its possible mechanism is the paradoxical embolism. With the development of imaging technology , more and more studies have show n that patent foramen ovale is closely associated w ith cryptogenic stroke. This article review s cryptogenic stroke in patients w ith patent foramen ovale.

Objective To study the correlation between blood glucose variability and TOAST type of patients with acute ischemic stroke and provide new evidence which can improve the prognosis of ischemic stroke.Methods One hundred and forty-three hospitalized patients with acute ischemic stroke from August 2013 to August 2014 were included.All patients were estimated the general state of

Objective To study the relationship between mild cognitive impairment and insulin resistance(IR) in Parkinson’s disease(PD-MCI),and to provide a new way to diagnose and treat PD-MCI in the early stage. Methods 94 patients with Parkinson’s disease in our hospital were included from August 2013 to February2015. All the patients were divided into insulin resistance group(43 cases) and non-insulin resistance group(51cases) by homeostasis model assessment. Insulin sensitivity index,Montreal Cognitive Assessment(Mo CA) and Self-rating Depression Scale(SDS) were used to estimate the severity of IR, patients’ cognitive function and depression degree,respectively. Results The incidence of PD-MCI in IR group(61.5%) was significantly higher than that in non-IR group(29.6%). There was 72.2% of patients with PD-MCI suffered IR and the rate was much higher than that of patients with non PD-MCI(29.3%). The incidence of PD-MCI in mild IR group(55.2%)was significantly lower than that in severe IR group(81.5%). Compared with the non-IR group, the score of Mo CA in IR group was much lower, and the score of SDS was higher, especially in severe IR group. Logistic analysis showed that IR was one of the independent risk factor for PD-MCI.Conclusion IR may be the risk factor for PD-MCI. The improvement of the degree of IR may help to decrease the development of cognitive impairment and depression.

The treatment of ischemic stroke of thecommon concerns of neurologists. In recent year,with the development and improvement of imaging tech-nology,microsurgery,endovascular,neurosurgery and basic research of neurosurgery,the diagnosis technology of cerebrovascular diseases progresses rapidly and the surgrical treatment of ischemic cerebrovascular disease has made great progress. This article reviews the advances in research on carotid endarterectomy and as-cular intervention.

Objective To assess the values of neuropathy symptom score/neuropathy disability score(NSS/NDS),Michigan neuropathy screening instrument(MNSI),and Toronto clinical scoring system(TCSS)in the diagnosis of diabetic peripheral neuropathy(DPN). Methods The 188T2DM patients were examined by electromyography,NSS/NDS,MNSI,and TCSS.Using the result of the nerve conduction velocity(NCV)examination as golden criteria and its diagnostic sensitivity and specificity for further diagnostic assess by the ROC curve were analyzed to assess the accuracy and diagnostic efficacy of these methods for DPN. Results When MNSI≥2.5and TCSS≥5,there was a moderate correlation with NVC(P<0.01).The consistency of MNSI and TCSS with NVC was higher than with NSS/NDS(Kappawere 0.524,0.547,and 0.534respectively).In comparing the diagnosis of MNSI≥2.5with TCSS≥5and TCSS≥6respectively,there was no significant difference in the results.The area under the ROC curve of NSS/NDS,MNSI,and TCSS were(0.579±0.027),(0.794±0.034),and(0.814± 0.032)respectively.The accuracy of diagnosis of MNSI and TCSS was moderate,however,that of NSS/ NDS was lower. Conclusion MNSI and TCSS have a relatively higher consistency with the NCV examination and higher accuracy than NSS/NDS.When MNSI≥2.5and TCSS≥5,the value of diagnosis of DPN is better,and the two parameters have an equal value,but MNSI is relatively simple to operate and need a short time to finish.

目的:Willis环在人群中的结构变异率较高,Willis环结构变异可引起脑血管缺血性改变,并使血管在血流冲击作用下局部扩张形成动脉瘤。回顾近年来对Willis环结构变异的研究行归纳综述。

Objective To explore the relationship between the white matter lessions(WML) and mild cognitive impairment(MCI).Methods Seventy-one WML patients were divided into mild group(27 cases),moderate group(21 cases) and severe group(23 cases) according to the head MRI examination,and 39 cases of no WML were control group.All the subjects were evaluated with the neuropsychological scale.The prevalence rate of MCI in each group was compared,and the relationship between WML and MCI was analyzed.Results The prevalence rate of MCI in WMI mild,moderate and severe groups were significantly higher than that in control group(all P 0.01).The scores of the mini-mental state examination(MMSE) and Montreal cognitive assessment scale(MoCA) in moderate and severe groups were significantly lower than those in the mild group and control groups(all P 0.01).The scores of MoCA individual cognitive components decreased significantly except the function of abstraction as the lesions grade of WML increased(all P 0.05).The multiple linear correlation analysis showed that degree of WML and scores of MMSE,MoCA and each cognitive domain scores except the function of abstraction were negatively correlated(r =-0.252--0.782,all P 0.01).Conclusion WML can lead to MCI.The effect of WML on cognitive dysfunction is related to its lesions grade.

回顾和归纳近年来对于基底动脉弯曲的研究资料和文献,对基底动脉弯曲的流行病学,基底动脉弯曲的形成及发展,影响因素,诊断,以及基底动脉弯曲对椎基底动脉系统供血的影响,机械压迫造成脑干,脑组织受损所导致的临床症状做一综述。

目的 观察评价云南省急救中心昆明医学院第二附属医院120急救站脑卒中患者的急救医疗服务(emergency medical services,EMS)流程现状.方法 记录院前EMS启动、EMS反应、EMS现场救治和EMS转运四个阶段过程.结果.71.84%的患者在发病后3 h内到达医院.63.11%的急救车行驶时间在15 min之内.91.26%的EMS现场时间在15 min之内.53.40%的EMS转运时间在15 min之内,95.44%的EMS存在延误(主要原因为堵车).提前通知医疗机构接诊的患者为62.14%.66.02%的患者及家属不了解任何脑卒中症状.结论.EMS可以明显缩短脑卒中患者入院时间.加强EMS人员和医疗机构的沟通和配合,可以完善脑卒中EMS.公众普遍缺乏脑卒中方面的知识,对大众进行脑卒中方面的健康教育势在必行.