Objective To analyze the clinical characteristics of non-exercise symptoms in patients with vascular pakinsonism（VP）.Methods Clinical data of 66 elderly VP patients admitted to Department of Neurology of Shunyi District Hospital from January 2013 to December 2021 were retrospectively collected.They were divided into acute/subacute onset VP group（27 cases） and occult onset VP group（39 cases） according to our inclusion and exclusion criteria.Their clinical characteristics of non-motor symptoms were analyzed.Results There were no significant differences in proportions of hypertension, diabetes, hyperlipidemia and coronary heart disease between the 2 groups, but ratios of history of cerebrovascular disease（66.67% vs 23.08%,P=0.000） and ischemic cerebrovascular disease（48.15% vs 12.82%,P=0.032） were obviously larger in the acute/subacute onset group than the occult onset VP group.In terms of motor symptoms, the former group had larger proportions of unilateral bias and dysarthria, but lower proportions of abnormal gait, freezing, orthostatic hypotension and olfactory dysfunction when compared with the latter group（P＜0.05）.Conclusion Occult onset is more common in VP patients.According to the different clinical symptoms and onset forms, more attention should be paid to non-motor symptoms while to motor symptoms at the same time in these patients.

目的 探讨老年动脉瘤性蛛网膜下腔出血(aSAH)患者认知损害的特点及相关危险因素.方法 入选2012年12月至2017年12月期间顺义区医院和首都医科大学附属北京天坛医院收治的老年aSAH患者共106例作为aSAH组,收集同期在神经内科门诊就诊的正常患者120例作为对照组.aSAH组患者分别于入院,出院,出院后3、6及12个月时进行神经心理学量表测定,对照组患者就诊时行神经心理学量表测评.应用北京版简明精神状态检查(MMSE)量表进行认知功能评估,同时应用修订版长谷川智能量表和痴呆简易筛选量表进行校正.采用SPSS 17.0软件进行数据处理.依据数据类型,组间比较分别采用t检验或χ2检验.采用多因素logistic回归分析筛选独立危险因素.结果 aSAH组与对照组的MMSE量表评分差异具有统计学意义[(23.51±1.20)vs(27.01±3.72)分,P<0.05].aSAH患者出院3个月时的认知损害发生率最高,执行能力、言语理解及表达力、言语命名能力、言语复述、注意力及计算力和短程记忆力亚项得分最低.多因素logistic回归分析结果显示,动脉瘤的干预方式(OR=1.667,95％CI 0.567～6.468;P=0.027)、H分级(OR=1.126,95％CI 0.518～2.755;P=0.002)和Fish分级(OR=1.297,95％CI 0.477～1.982;P=0.028)与认知损害显著相关.结论 aSAH后的认知损害多在发病后3个月内较明显,主要表现在言语、执行能力、注意力、计算力及短程记忆力方面,临床上应重视Fish分级和H分级的评估,早期识别认知损害的高危人群并进行早期干预可改善预后.

目的 探讨急性脑梗死溶栓后出现脑缺血再灌注损伤与炎症反应、糖化清蛋白(GA)水平之间的关系以及异丙酚的保护效果分析.方法 选择2015年3月至2018年1月收治的150例急性脑梗死患者,按随机数字表法分为观察组(50例)和对照组(100例)2组,均给予拟行数字减影选择性脑动脉内溶栓术,对照组患者给予瑞芬太尼静脉注射麻醉,观察组患者给予瑞芬太尼和异丙酚注射麻醉,比较2组患者术后再灌注损伤发生情况以及简易智力状态检查量表(MMSE)评分情况,观察2组患者内皮素(ET)、丙二醛(MDA)以及S100B水平变化.再将对照组患者根据是否出现脑缺血再灌注损伤,将其分为损伤组和非损伤组2组,比较2组患者麻醉前后的炎症因子、血糖、糖化蛋红蛋白(HbA1c)以及GA水平.结果 观察组患者术后发生脑缺血再灌注损伤明显低于对照组,且MMSE评分明显高于对照组(P<0.05),与麻醉前相比,2组患者麻醉后ET、MDA、S100B水平均明显升高,而对照组患者上述指标升高更为显著(P<0.05).与麻醉前相比,损伤组和非损伤组2组患者麻醉白细胞介素(IL)-6、IL-8、IL-10、肿瘤坏死因子(TNF)-α、血糖、HbA1c以及GA水平均明显升高,而损伤组患者升高更为显著(P<0.05).结论 急性脑梗死溶栓后出现脑缺血再灌注损伤与炎症反应、GA水平关系密切,溶栓治疗过程中给予异丙酚可以较好地改善脑组织缺血缺氧状态,减少缺血再灌注损伤,保护脑组织.

目的:探讨帕金森综合征的病因、临床特点、头颅CT或MRI的改变.方法:回顾性分析22例帕金森综合征病人的资料进行分析.结果:在所有帕金森综合征中,以血管性帕金森综合征最多见,占81.8%.结论:预防脑血管病是减少血管性帕金森综合征的一个重要的方面.

目的回顾分析17例椎基底动脉延长扩张症(Vertebrobasilar dilichoectasia,VBD)的临床表现及影像学特征,提高对该病诊断的认识。方法对我院2009年9月~2013年9月确诊的17例椎基动脉延长扩张症患者分析其临床表现、影像特点及治疗方法。结果椎基动脉延长扩张症是一种少见的血管异常性疾病。临床表现复杂、多样,主要症状有头晕、肢体麻木、乏力,还可表现为面肌痉挛、三叉神经痛,甚至可表现为视野缺损,主要导致的疾病为脑梗死、脑室或蛛网膜下腔出血、脑干的神经压迫症状及脑积水等,无特异性治疗方法对症治疗为主。结论椎基动脉延长扩张症是一种易复发,致残率、致死率高的疾病,应引起临床工作的重视,采取合理的治疗方法。

Objective:To investigate the etiology,clinical features,imaging charateristics,management and prognosis of hemorrhagic infarction(HI) in acute cerebaral infarction.Methods:Retrospective analysis was performed in 28(male,17;female,11)acute hemorrhagic infarction patients admitted in our hospital between Jan 2009 and Jan 2012.This analysis reviewed regarding the etiology,clinical featutes,CT classification and treatment.Results:Risk factors of HI included massive cerebral infarction,long term diabetes,poorly controlled hypertension and hyperlipidemia.HI patients treatment should be timely review of CT;Based on CT classifaction antiplatelet drugs can be stoped in HI-I,HI-II patients,and this treatment does not lead to disease progression.Conclusion:The pstients with massive cerebral infarction,long term diabetes,poorly controlled hypertension and hyperlipidemia are susceptible to HI.HI patients treatment should be combined with CT clsssification and timely adjustment of the threapy plan.

目的探讨自发性脑叶出血的临床特点、发病机制、诊断治疗与预后。方法分析了2005年至2007年在我院住院经CT证实脑叶出血23例的临床资料。结果发现自发性脑叶出血有以下特点:①脑叶出血发生率仅次于基底节出血。②高血压是常见病因。③意识障碍、肢体瘫痪轻或无。④头疼仍是常见症状。⑤大量出血,病情危重可手术治疗。结论本病诊断不难,尽早CT检查是诊断自发性脑叶出血的重要依据,及时抢救,合理治疗是减少死亡、降低致残的关键。

Objective To explore the diagnostic of TCD,DSA and MRA in Moyamoya disease by retrospectively analyzing the clinical and image.Methods 20 Patients who were diagnosed Moyamoya were investigated.The clinical representation,TCD,DSA and MRA changes were observed.Results MRA in 20 cases and DSA in 9 cases showed stenosis or occlusion at the distal bifurcation of internal carotid arteries and proximal portion of the middle or anterior cerebral artery,companied by the apparently abnormal vascular network like puff of smoke.The collateral circulation and anastomotic vessels were showed more clearly on DSA.TCD in 7 cases showed increased velocity of blood flow.Conclusion MRA are helpful to the diagnosis of Moyamoya disease with the non-invasive and feasible advantage.DSA is better than MRA in showing the details such as smoke-like vessels and collateral circulation.TCD can be a alternative tool for detecting abnormal vessels.DSA must be done if the patients need an operation.