奥卡西平(oxcarbazepine,OXC)是临床常用抗癫痫药物.奥卡西平在肝脏中快速代谢为活性代谢产物10-羟基-卡马西平(monohydroxy-carbazepine,MHD)[1],MHD通过阻断神经元电压依赖性钠通道,从而稳定过度兴奋的神经细胞膜,抑制神经元异常放电,减少神经冲动的突触传递,达到对大脑皮质运动高选择性的抑制作用.奥卡西平常见的不良反应为嗜睡、呕吐、心动过速、激越、低血压、低钠血症、昏迷和癫痫发作[2].奥卡西平急性过量的病例,目前为止国外共报道5例[3-7];国内仅1例儿童急性过量的报道[8].此文报道1例成人短时间内急性过量使用奥卡西平的诊疗经过,为临床工作提供参考.

To investigate the feasibility and time window of early detection of Wallerian degeneration in the corticospinal tract after middle cerebral artery infarction, 23 patients were assessed using magnetic resonance diffusion tensor imaging at 3.0T within 14 days after the infarction. The fractional anisotropy values of the affected corticospinal tract began to decrease at 3 days after onset and decreased in all cases at 7 days. The diffusion coefficient remained unchanged. Experimental findings indicate that diffusion tensor imaging can detect the changes associated with Wallerian degeneration of the corticospinal tract as early as 3 days after cerebral infarction.

脑栓塞是常见的卒中类型(约占10%～20%),碘油相关性脑栓塞(lipiodol brain embolism,LBE)却非常罕见.绝大多数LBE为经导管肝动脉化疗栓塞(hepatic transcatheter arterial chemoembolization,TACE)治疗肝癌过程中或延后发生.TACE治疗病史、关联性临床表现及特征性神经影像学表现对本病的诊断有重要意义[1,2].本文报道新近诊断的1例LBE病例并结合目前已有病例报道对该病进行详细阐述.

Objective To investigate the effect of curcumin on alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and kainate (KA) receptor-mediated calcium influx in cultured rat hippocampal neurons. Methods The hippocampal neurons from SD rat embryos (17 days old) were cultured for 9 days, and fluorescent calcium chelator and confocal microscopy calcium imaging were used to observe the changes in intracellular free calcium in the neurons following stimulation with 100 μmol/L KA. The effect of curcumin pretreatment at different concentrations (10, 30, 50, 100, 200 and 300 μmol/L) for 30 min on 100 μmol/L KA-induced intracellular calcium changes in the neurons were evaluated, and the effect of 15 μmol/L curcumin on intracellular calcium in the neurons stimulated with 10, 30, 50, 100, 200 and 300 μmol/L KA were also assessed. Cobalt staining was used to examine the expression of calcium permeable AMPA/KA channel in the hippocampal neurons treated with 30 and 100 μmol/L KA. Results Curcumin pretreatment at different concentrations for 30 min significantly relieved the elevation of flee calcium concentration induced by 100 or 30 μmol/L KA (P<0.05), and the effect was especially obvious with 15 μmol/L KA curcumin. Both 30 and 100 μmol/L KA increased the ratio of cobalt staining-positive hippocampal neurons, and curcumin pretreatment at 15 μmol/L, but not at 5 or 30 μmol/L, significantly reduced the ratio of the positive neurons (P<0.05). Conclusion Curcumin at appropriate concentrations can modulate calcium influx mediated by AMPA and KA in cultured rat hippocampal neurons, which might be one of the anti-epileptic mechanisms of curcumin

Objective To explore the incidence,the features of behavioral neurology and the influencing factors of cognitive function recovery in patients at 12 weeks after subcortical small vessel infarction(SSVI).Methods Sixty patients with first attack of SSVI,whose course of disease was 2 weeks,were selected by using the prospective cohort study,and 52 elderly person were selected as the control group.Cognitive function scores were performed by using mini-mental state examination(MMSE) and Loewenstein occupational therapy cognitive assessment(LOTCA)(including LOTCA total score,orientation,visual-spatial ability,and executive function) were performed 2 and 12 weeks after SSVI.The neurological impairment and activities of daily living were evaluated.All factors influencing cognitive function recovery were analyzed.The differences of daily living ability in patients with full recovery of not of cognitive function were compared.Results ①A total of 44 patients had cognitive impairment within two weeks after SSVI.The scores of MMSE,orientation,visual-spatial ability,executive function and LOTCA total score were improved 12 weeks after SSVI,as compared with those at two weeks after SSVI,the recovery rates were 36.8%(14/38),87.5%(14/16),33.3%(4/12),26.1%(12/46),30.2%(13/44),respectively.②Multivariate Logistic regression analysis showed that the male sex(OR 3.49;95% CI 1.18-7.81) was related to the MMSE scores 12 weeks after SSVI;the education level(junior high school or above,OR 2.53,95% CI 1.23-6.87) and white matter lesions(OR 0.23,95% CI 0.07-0.79) were associated with the scores of executive function.③There were no statistically significant differences in NIHSS scores 12 weeks after SSVI compared with those two weeks after SSVI(P0.05),and the MBI scores increased significantly(P0.05).Only executive function and LOTCA total score between the recovered and non-recovered patients in MBI scores had significant differences in all types of cognitive function 12 weeks after SSVI(P0.05).Conclusions All types of cognitive impairment improved significantly 12 weeks after SSVI.However,most patients still had certain type of cognitive impairment.The recovery of executive function may contribute to the improvement of daily living ability.

脑皮质下小血管梗死(subcortical small vessel infarction,SSVI),除导致运动、感觉功能受损外,还可由于额叶-皮质下回路、颞叶-边缘系统回路的受损而出现认知功能的损害.这些认知功能的损害多表现为执行功能损害、失语、记忆力减退等,可隐袭起病,也可渐进发展,最终发展为重度认知功能损害或痴呆.关于SSVI的研究目前多局限于运动功能的损害与康复方面.国外较少的文献已证实卒中后3个月不同认知功能损害程度的发生率及其对神经功能的影响,但目前尚无脑皮质下梗死早期(2周内)认知功能损害的报道.本研究目的在于阐明SSVI早期认知功能损害的发生率及其特点.

Wilson病,亦称肝豆状核变性,是少数可治性、常染色体隐性遗传铜代谢障碍性疾病[1],exon8是突变热区之一,首发症状多样,常累及肝、脑、肾、骨骼等,易延误诊治.在我们近200例患者资料中,仅1例表现为肝占位而行手术探查,现报告如下.

1924年Bleuler提出脑血管病变后患者常伴有行为和心理功能障碍.1977年,Folstein等首次报道抑郁是脑卒中后常见的伴随症状,称脑卒中后抑郁(post-stroke depression,PSD),其发生率为30%～40%.PSD与情感性精神障碍抑郁症的临床表现基本相似,但在哈密尔顿抑郁(HAMD)量表的各项目中,更集中表现在焦虑/躯体化、睡眠障碍、迟滞和绝望感等四个方面,是一种较严重的脑卒中后的并发症,极易被临床神经科医生所忽视或误诊,严重影响脑卒中后患者的认知、语言功能和家庭、社会能力的恢复以及生命质量的改善,也会延长住院时间,甚至增加脑血管病患者的死亡率.因此, 对PSD患者进行系统的抗抑郁治疗已成为目前脑卒中神经康复治疗方面的一个热点.

1924年B1euler提出脑血管病变后患者常伴有行为和心理功能障碍.1977年,Folstein等首次报道抑郁是脑卒中后常见的伴随症状,称为脑卒中后抑郁(post-stroke depressi on,PSD),其发生率为30%～40%.PSD与情感性精神障碍抑郁症的临床表现基本相似,但在HAMD量表的各项目中,更集中表现在躯体化症状如焦虑、睡眠障碍、迟滞和绝望感等四个方面,是一种较严重的脑卒中后的并发症,但易被临床神经科医生所忽视或误诊,严重影响脑卒中后患者的认知、言语功能和家庭、社会能力的恢复以及生命质量的改善,也会导致住院时间延长,甚至增加脑血管病患者的死亡率.因此,对PSD患者进行系统的抗抑郁治疗已成为目前脑卒中神经康复治疗方面的一个热点.

目的了解脑卒中患者的认知功能损伤情况以及比较LOTCA与MMSE量表评定的效能.方法采用MMSE、LOTCA量表评定93例脑卒中后患者认知功能.结果脑卒中后患者MMSE量表评定显示左、右侧脑损伤在地点定向、近事记忆力、语言理解、句子书写、图形描绘等分项中存在差异(P<0.01).LOTCA量表评定显示右侧大脑半球损伤组在定向力、知觉功能、模仿模拟能力等分项评分明显高于左侧大脑半球损伤组(P<0.01),左侧大脑半球损伤组在视觉空间觉、视运动组织及LOTCA量表评定等评分显著高于右侧大脑半球损伤组,左、右侧大脑半球损伤组在意念运动性失用、物体失认、注意力障碍等方面具有显著性差异(P<0.01).结论脑卒中患者中左、右侧大脑半球损伤后的各种认知功能障碍表现不一,LOTCA量表评定较MMSE量表评定更适合于脑行为功能研究.