目的 总结4例神经梅毒患者的临床特点,了解神经梅毒的发病机制、实验室检测及诊断标准.方法 回顾性分析2018年8月至2019年12月青岛市市立医院神经内科收治的4例神经梅毒患者的临床特征及实验室检查,并进行文献复习.结果 4例神经梅毒患者中,男性2例,女性2例,年龄45～64岁.3例患者为麻痹性痴呆,1例为脊膜脊髓型神经梅毒.4例患者血清及脑脊液梅毒螺旋体明胶凝集试验阳性,4例患者血清甲苯胺红不加热血清试验阳性,3例患者脑脊液甲苯胺红不加热血清试验阳性.3例患者脑脊液白细胞计数和蛋白含量均升高,1例患者仅脑脊液蛋白含量升高.4例患者糖化血红蛋白均高于5.7％.3例患者颅脑MRI可见异常改变,主要表现为脑萎缩,双侧半卵圆中心多发缺血灶,1例可见新发脑梗死灶,1例显示双侧额叶、左侧岛叶、左侧颞叶异常信号;1例颅脑MRI未见异常改变,但脊髓内(颈5/6)可见异常信号,增强扫描病灶无强化.经青霉素治疗,1例完全恢复,另3例症状有好转.结论 神经梅毒临床表现复杂多样,早期识别、早期诊断尤为重要.合并高糖化血红蛋白的梅毒患者更易转化为神经梅毒,因此要注意梅毒患者的血糖控制.

目的 报道1例以周围神经系统异常为首发症状的成人伯基特淋巴瘤(Burkitt lymphoma,BL)病例报道,并结合国内外文献总结该病的临床特点,提高对该病的认识.方法 回顾性分析山东省青岛市市立医院收治的1例以周围神经系统异常为首发症状的成人BL患者的临床表现、神经系统查体、腰椎穿刺等实验室检查、治疗转归并复习文献.结果 成人BL发病率低,进展快,预后差.累及神经系统者少见,其中以中枢神经受累相对多,而周围神经病变包括自主神经受累则非常罕见.BL化疗过程中易出现溶瘤综合征和嗜血综合征,应注意预防.结论 以周围神经系统异常为首发症状的成人BL临床罕见,易发生误诊,根据其临床特点和病理检查结果 可明确诊断.

目的 探讨颅内动脉瘤破裂出血的危险因素.方法 回顾性分析2015年10月至2016年12月在青岛市市立医院东院住院的104例颅内动脉瘤患者的临床资料,根据动脉瘤是否破裂分为破裂组(33例)和未破裂组(71例).比较两组患者的临床资料和动脉瘤特征,对危险因素进行单因素和多因素logistic回归分析.结果 单因素统计结果显示破裂组患者的平均年龄较低,差异有显著性(P<0.01).破裂组中有高血压病史的患者比例(69.7%)高于未破裂组(47.9%),差异有显著性(P<0.05),有心脏病病史的患者比例(15.2%)低于未破裂组(35.2%),差异有显著性(P<0.05).Logistic回归分析示50~59岁、高血压、前交通动脉瘤与动脉瘤破裂显著相关(P<0.05).结论 50~59岁、高血压、前交通动脉瘤是颅内动脉瘤破裂出血的独立危险因素.

患者男,54岁,因右眼发作性黑矇2天于2016年11月8日入住本院.右眼发作性从上至下拉幕或从外向内的缩小,至右眼全部视野黑矇,每次发作1分钟左右,频繁时每5分钟发作1次;既往高血压病史,脑梗死史,曾于2016年9月5日行脑动脉造影检查,发现左侧大脑中动脉闭塞,右侧眼动脉起始部斑块形成.查体示:T 36.5℃,P 78次/分,R 19次/分,BP 120/75mmHg,神清语利,双侧瞳孔等大等圆,直径2.5mm,对光反射灵敏,双眼球运动充分,双侧鼻唇沟等称,伸舌居中,四肢肌力、肌张力正常,腱反射(++),双侧Babinski征(-),脑膜刺激征阴性.美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分0分.

Objective To discuss clinical and neuroimaging changes of posterior reversible encephalopathy syndrome. Method Analyze the clinical data of 21 pateints with PRES. Result Clinical manifestation is headache, epilepsy, visual disorder, consciousness and mental changes. Risk factors:13 cases with eclampsia and preeclampsia; 5 cases with hypertensive encephalopathy; 2 cases with uremia; 1 case with postoperation of pulmonary arteriovenous fistula. Brain MRI shows vasogenic edema especially in the posterior white matter of the brain.It's not uncommon of the variant which frontal lobe, basal nuclei, pons or cerebellum are affected. Besides vasogenic edema, it may accompany with ischemic and hemorrhagic lesions. Conclusion The causes of PRES are variant. Brain MRI shows vasogenic edema especially in the posterior white matter of the brain, prognosis is relatively well if it can be identified and treated early.

Objective To summarize the relation between infection and acute cerebral infarction and the nature of carotid plaques. Methods In this study, 258 patients with acute cerebral infarction who were admitted to our hospital between Oc-tober 2010 and December 2012 were assigned to the observation group, and other 149 patients without acute cerebral in-farction in our hospital in the same period were assigned to the control group randomly. The infection rate, infection loca-tion, and the nature of carotid plaques were recorded. Results The study showed that in risk factors for stroke, smoking ac-counted for 23.26%, hypertension for 1.16%, hyperlipidemia for 11.24%, coronary heart disease for 13.57%, diabetes for 29.07%and transient ischemic for 6.20%, and there was no statistically significant difference between the two groups (P>0.05). Conclusion Recent infection has become an important risk factor for acute cerebral infarction and carotid atherosclerotic plaques.

Objective To find out the composite risk factors associated with early neurological deterioration (END) in acute ischemic stroke,to reveal the mechanism of END,and to provide the data base for the early prediction and prevention.Methods Five hundred and fifty-eight patients with cerebral infarction admitted to our hospital from October 2009 to December 2012,were screened.Among them,107 patients met the diagnostic criteria of END in acute ischemic stroke,451 patients met the diagnostic standard of early acute ischemic stroke without END.Neurological function scale and other variables included 58 related factors of 9 categories were selected.Association rule mining methods were used to analyze relations between END in acute ischemic stroke and risk factors sets.Results The results of association rule mining discovered that there were 2 individual risk factors,3 double-factor combinations,7 triple-factor combinations and 15 four-factor combinations related with END in the early stage of acute ischemic stroke;the more the composite factors,the higher the probability of neurological deterioration;the composite factors were mostly the combination of variables of different categories,involving neurological function scale scores,infection condition,dysphagia,personal life history (smoking and drinking),infarction location,age,and levels of electrolyte,C reactive protein,and homocysteine.Besides some independent risk factors which had been reported in the literatures,the results of this study found that heart rate and time interval from onset to hospitalization also related with END in early acute ischemic stroke.Conclusion END in acute ischemic stroke may be attributed to the combination effect of variable factors;all risk factors should be considered and a variety of targeted measures should be taken to prevent and treat the patients with END in early acute ischemic stroke.

目的：研究急性缺血性卒中早期神经功能恶化与感染及颈动脉斑块性质的关系。方法急性缺血性卒中患者558例,将其中107例早期神经功能恶化患者作为研究组,451例早期神经功能无恶化患者作为对照组,记录两组患者的感染率、不稳定斑块发生率、C反应蛋白(CRP)水平、美国国立卫生院神经功能缺损评分(NIHSS)情况。结果研究组CRP水平、NIHSS评分及感染率、不稳定斑块发生率均明显高于对照组(P<0.05)。结论急性缺血性卒中早期神经功能发生恶化是由患者的感染程度、NIHSS评分情况、颈动脉不稳定斑块情况以及CRP水平等各种相关因素共同影响产生的结果。

目的：探讨脑静脉血栓形成的有效诊治方法。方法根据临床表现及颅脑影像学检查诊断脑静脉血栓形成患者17例，3例采用低分子肝素皮下注射溶栓，14例持续静脉泵入普通肝素，据APTT值调整普通肝素剂量，常规使用2～3周。肝素静脉泵入不能阻止病情进展者采取介入溶栓，肝素及介入溶栓后给予华法令口服抗凝治疗。结果17例肝素治疗2～3周，14例脑静脉窦血栓再通，2例足量普通肝素静脉泵入效果不佳采取介入溶栓再通，1例合并血液病治疗效果不佳。随访半年，12例预后好，生活自理；3例留有残疾，不能行走及言语；1例死亡；1例失访。结论颅脑MRI联合MRV是诊断脑静脉血栓的可靠手段，应用肝素抗凝治疗脑静脉血栓安全有效。

脑微出血(cerebral microbleed,CMB)的概念在二十世纪九十年代中期首次提出,是由于小血管红细胞渗漏导致的含铁血黄素在脑内的沉积所致[1],常规MRI是检测不到的,而且由于通常无相关临床症状和特征,因此以往无法在患者中检出.

<正>椎基底动脉扩张延长症(Vertebrobasilar dolichoecta-sia,VBD)是一种相对少见且病因不清的椎基底动脉壁受累的疾病,表现为椎基底动脉显著延长、扩张、扭曲或成角,当脑组织受压及血流动力学改变,则出现复杂的临床表现,易发生漏诊及误诊。由于VBD的诊断主要依靠影像学诊断,本研究结合病例讨论其影像学诊断特征。1临床资料患者,男性,72岁,因阵发性右侧面部疼痛伴头晕半月余,于2010年12月1日入院。患者半月前无明显诱因出现右侧面部发作性刺痛,持续时间短暂,数秒钟即缓解,每日发作5～6次,无明确"扳机"现象,同时伴有头晕、运动性幻觉

目的 探讨颈动脉粥样硬化斑块的稳定性与纤维蛋白原的关系.方法 对脑梗死患者应用颈部彩色多普勒超声检测颈部血管斑块形成情况,并同期检测患者血浆纤维蛋白原浓度.结果 有斑块组患者纤维蛋白原水平高于无斑块组.不稳定斑块组高于稳定斑块组(P<0.05);随着纤维蛋白原水平增高,不稳定斑块的发生率也随之增高(P<0.01).结论 血浆纤维蛋白原水平和颈动脉粥样硬化斑块的发生及其稳定性有着密切联系.

病人,男,35岁.因言语不清、行走不稳2月入院.既往吸毒史10年,吸毒量约为0.5 g/d,以锡箔烫吸为主,戒毒1月后出现上述症状.神经系统查体:神志清,计算力、记忆力及理解力均下降,构音障碍,吟诗样语言,脑神经检查未见明显异常,四肢肌张力略降低,肌力5级,腱反射(+),病理反射未引出,宽基底步态,双侧指鼻、跟膝胫试验笨拙,昂伯征(+).

对脑梗死患者应用颈部彩色多普勒超声检测颈部血管斑块形成情况,并同期检测患者血浆纤维蛋白原和尿酸水平。结果不稳定斑块组患者的纤维蛋白原和尿酸水平显著高于无斑块组和稳定斑块组(P<0.05,<0.01)。并且随着纤维蛋白原水平和尿酸水平升高,颈动脉不稳定斑块的发生率升高。认为颈动脉斑块的发生及其稳定性与血浆纤维蛋白原和尿酸水平有着密切的关系。