目的:分析颈内动脉系统短暂性脑缺血发作(transient ischemic attack,TIA)后再发脑卒中的相关影响因素.方法:回顾性分析 2018 年 1 月—2020 年 6 月收治于厦门大学附属第一医院的 79 例颈内动脉系统TIA患者的资料,并根据是否再发脑卒中分为无脑卒中组(n=48)和脑卒中组(n=31).对比两组患者的一般资料、临床资料及颈动脉内膜中层厚度(carotid intima-media thickness,CIMT),采用多因素logistic回归模型对颈内动脉系统TIA患者再发脑卒中的影响因素进行分析.结果:脑卒中组高血压、既往脑梗死病史比例高于无脑卒中组,差异有统计学意义(P<0.05);两组其余一般资料对比,差异无统计学意义(P>0.05).脑卒中组首次发作距就诊时间、症状持续时间长于无脑卒中组,CIMT大于无脑卒中组,差异有统计学意义(P<0.05);两组甘油三酯(triacylglycerols,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、总胆固醇(total cholesterol,TC)及高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)对比,差异无统计学意义(P>0.05).多因素logistic回归分析结果显示,既往脑梗死病史、首次发作距就诊时间、症状持续时间及CIMT是颈内动脉系统TIA后再发脑卒中的危险因素(P<0.05).结论:颈内动脉系统TIA后再发脑卒中的风险较高,既往脑梗死病史、首次发作距就诊时间、症状持续时间及CIMT是颈内动脉系统TIA后再发脑卒中的影响因素,同时还需注意高血压在风险评估时的重要性.

Objective:To investigate the predictive value of intraoperative transcranial electrical stimulation motor evoked potential (TES-MEP) monitoring for the patient′s muscle strength post craniocerebral surgery.Methods:A retrospective analysis was conducted on 59 patients with craniocerebral surgery who underwent intraoperative TES-MEP monitoring from January 2019 to December 2020 in the Department of Neurosurgery, Changzhou Second People′s Hospital Affiliated to Nanjing Medical University. Changes of intraoperative TES-MEP amplitude and muscle strength before and 1 month after surgery were documented. According to the changes of muscle strength, the patients were divided into muscle strength decreased group and muscle strength non-decreased group. Univariate analysis and binary logistic regression analysis were used to explore the influencing factors of muscle strength changes at 1 month after craniocerebral surgery.Results:The results of univariate analysis showed that the proportion of intraoperative TES-MEP amplitudes with an irreversible decrease of >50% in the muscle strength decreased group (5/8) at 1 month after surgery was higher than that of the postoperative muscle strength non-decreased group (1/50) ( P<0.001). The preoperative Glasgow coma score in the group with decreased muscle strength at 1 month after operation was lower than that in the group without postoperative muscle strength decrease ( P<0.001). Binary logistic regression analysis revealed that the intraoperative TES-MEP amplitude decrease was an independent influencing factor for muscle strength changes 1 month post surgery ( OR: 51.77, 95% CI: 4.07-658.96, P=0.002). The irreversible reduction greater than 50% in the TES-MEP amplitude predicted a decrease in muscle strength 1 month after surgery. The results of receiver operating characteristic curve analysis showed that the area under the curve for diagnosing the changes in muscle strength at 1 month after surgery was 0.803, the sensitivity was 0.625, and the specificity was 0.980. The positive predictive value was 83.3% and the negative predictive value was 94.3%. Conclusions:The change of 50% in intraoperative TES-MEP amplitude as an alarm criterion has a good predictive value for postoperative limb function changes in neurosurgical patients. The irreversible decrease greater than 50% in the TES-MEP amplitude can predict a lower muscle strength 1 month after surgery than before surgery.

目的 探讨中老年癫痫患者脑小血管病(cerebral small vessel disease,CSVD)总负荷以及单个CSVD影像标志物与认知功能的关系.方法 回顾性连续纳入首都医科大学附属北京天坛医院神经内科2019年1月-2021年12月住院的50岁及以上中老年癫痫患者.收集患者的一般临床资料、脑电图、影像学信息和MoCA分值.判读此次住院前1周或住院期间首次头颅MRI中的CSVD影像标志物,包括腔隙、白质高信号、微出血和血管周围间隙扩大,并计算CSVD总负荷评分.采用简单及多重线性回归模型分析中老年癫痫患者CSVD总负荷评分以及单个CSVD影像标志物与MoCA评分的关系.结果 共纳入54例患者,平均年龄63.6±8.7岁,男性35例(64.8％).校正了混杂因素的多重线性回归显示CSVD总负荷评分与MoCA评分呈负相关(β?-1.713,95％CI?-3.388～-0.038,P=0.045).单独分析单个CSVD影像标志物,在对相同混杂因素进行校正后,只有针对白质高信号的Fazekas评分与MoCA评分呈负相关(β?-1.457,95％CI?-2.599～-0.315,P=0.014).结论 合并高CSVD负荷的中老年癫痫患者认知功能较差,脑血管病理与中老年癫痫患者认知功能障碍之间的关系值得被进一步研究.

目的 探讨睡眠相关过度运动癫痫(sleep-related hypermotor epilepsy,SHE)患者神经心理损害的相关危险因素.方法 纳入2015年5月-2019年5月在首都医科大学附属北京天坛医院癫痫中心及天坛-丰台医疗联盟癫痫中心诊治的68例SHE患者,将患者分为神经心理损害组(31例)和无神经心理损害组(37例),收集临床资料进行分析,采用多因素Logistic回归分析,寻找影响SHE患者神经心理损害的相关危险因素.结果 基线分析结果显示,神经心理损害组患者起病年龄较低,发作频率较高,存在发作间期癫痫样放电(Interictal epileptiform discharges,IEDs)睡眠期占优和潜在脑部疾患的患者比例较高,差异具有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,IEDs睡眠期占优(OR=17.315,95％CI3.304～90.746,P=0.001)、较高的发作频率(OR=7.493,95％CI 1.416～39.665,P=0.018)是SHE患者神经心理损害的危险因素(P＜0.05);起病年龄高(OR=0.862,95％CI 0.777～0.957,P=0.005)是SHE患者神经心理损害的保护因素(P＜0.05).结论 IEDs睡眠期占优、起病年龄低、较高的发作频率是SHE患者神经心理损害的危险因素,对其及早的识别,对改善患者的生活质量有较大临床意义.

1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People’s Republic of China; 3Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, People’s Republic of China; 4Department of Neurology, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing, People’s Republic of China; 5Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 6Beijing Neurosurgical Institute, Capital Medical University, Beijing, People’s Republic of China; 7Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China

Objective To investigate clinical characteristics and diagnostic value of scalp video electroencephalography (VEEG) for sleep⁃related hypermotor epilepsy (SHE). Methods Total 32 patients with SHE from May 2014 to January 2020 were collected, and their general clinical data, clinical semiology, interictal electroencephalography (EEG) and onset patterns of ictal EEG were analyzed. Results Ten patients (31.25%) showed abnormal signs on MRI. Patients were categorized according to their semiology patterns (SPs). One patient (3.13%) was classified as SP1 (elementary motor signs), 18 patients (56.25%) as SP2 (unnatural hypermotor movements), 6 patients (18.75%) as SP3 (integrated hypermotor movements), and 7 patients (21.88%) as SP4 (gestural behaviors with high emotional content). The positive finding in interictal and ictal EEG were seen in 81.25% (26/32) and 71.88% (23/32) of patients. EEG onset occured earlier than clinical seizure in 23 patients (71.88%). Among these 23 patients whose scalp EEG started earlier than clinical seizure, 14 patients (43.75%) had focal discharge, 8 patients (25%) had regional discharge, one patient (3.13%) had bilateral/extensive discharge. Among initial scalp EEG patterns with focal and regional discharge, low⁃voltage fast activity was the most common. In addition, 11 patients (34.38%) had EEG epileptiform discharges at the same brain region during the interictal and ictal EEG recording, which were constantly confined to 1 or 2 to 3 adjacent electrodes. Conclusions The rate of positive finding in imaging in patients with SHE is low. However, the symptomatic manifestations are specific. High ⁃ quality VEEG recording and interpretation play an important role in the diagnosis and management of SHE patients. Ictal EEG can provide the necessary lateralization and localization information for preoperative evaluation. DOI:10.3969/j.issn.1672⁃6731.2020.11.008

目的 探讨非致残性缺血性脑血管事件患者早期进展(即神经功能缺损加重)的相关危险因素.方法 回顾性连续纳入2016年1月至2019年12月在厦门大学附属第一医院神经内科住院的非致残性缺血性脑血管事件患者,根据发病7 d内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较发病时基线水平是否增加≥2分,分为进展组70例,非进展组254例,收集基线资料、临床及影像学特征并进行分析,采用多因素Logistc回归分析,寻找影响NICE患者早期进展的因素.结果 单因素分析结果显示,进展组糖尿病、责任动脉狭窄或闭塞、急性感染、新发缺血性卒中比例较非进展组高,差异有统计学意义(P<0.05);比较两组间脑室旁白质高信号(periventricular white matter hyperintensity,PWMH)评分、深部脑白质高信号(deep white mat-ter hyperintensities,DWMH)评分、PWMH+DWNH评分,进展组得较高分数(PWMH 2～3分、PWMH+DWNH 3～6分者)比例较非进展组高,差异有统计学意义(P<0.05).多因素Logistic回归分析显示,糖尿病(OR=2.355,95％CI 1.220～4.546,P=0.011)、新发缺血性卒中(OR=2.820,95％CI 1.022～7.781,P=0.045)、急性感染(OR=4.513,95％CI 1.699～11.986,P=0.002)、责任动脉狭窄或闭塞(OR=2.542,95％CI 1.405～4.600,P=0.002)、较高的Fazekas评分[PWMH+DWMH 3～6分(OR=2.061,95％CI 1.119～3.798,P=0.020)、PWMH 2～3分(OR=2.046,95％CI 1.096～3.817,P=0.024)]是NICE患者早期进展的危险因素.结论 糖尿病、新发缺血性卒中、急性感染、责任动脉狭窄或闭塞、较高的Fazekas评分(PWMH+DWMH 3～6分、PWMH 2～3分)等因素可能增加NICE患者早期进展的风险.

肺奴卡菌病是由奴卡菌侵犯肺部引起的亚急性、慢性局限性或播散性化脓性或肉芽肿性疾病,可经血源播散至皮肤或中枢神经系统、肾脏等部位或器官.由于是一种少见病,且临床和影像学表现缺乏特异性,故容易误诊或漏诊而延误治疗或治疗不规范而影响预后.本文报道 1 例肺奴卡菌病伴发脑梗死病例,并复习相关文献,希望有助于提高对奴卡菌病的认识.

目的：探讨探讨甲泼尼龙冲击疗法辅治急性脊髓炎的临床效果，以供参考。方法临床研究对象是我院2014年2月至2015年11月收治的急性脊髓炎患者80例，随机分组。两组均给予常规治疗，地塞米松组以地塞米松辅治，甲泼尼龙组以甲泼尼龙冲击疗法辅治。对比两组患者的疗效，并对两组患者排尿复常时间、肌力改善2级时间、下地行走时间进行评估。结果经过数据统计发现，甲泼尼龙组患者治疗效果明显高于地塞米松组（P＜0．05）。甲泼尼龙组排尿复常时间、肌力改善2级时间、下地行走时间明显短于地塞米松组，组间有显著的统计学差异（P＜0．05）。结论甲泼尼龙冲击疗法辅治急性脊髓炎的临床效果确切，可有效改善患者脊髓神经功能，对患者预后有益，值得推广。