Objective Application of auditory brainstem response (ABR) in the study on the relationship of neonates with hypoxic-ischemic encephalopathy (HIE) and the children with hearing loss and auxiliary determine the prognosis of encephalopathy. Methods We prospectively selected neonates diagnosed as HIE in the department of neonatology of the Chengdu Women and Children Central Hospital from January, 2006 to June, 2008. Neonatal ABR was tested and the prognosis of neonates were observed through 3-year followed up in order to analyze the relationship between HIE severity and the severity of hearing handicap and the relationship between the severity of hearing handicap and prognosis. Statistical analysis was performed using SPSS 18.0. χ2 test was used to compare the rate between groups. Results 40 cases involving 80 ears were included, of which 33 cases accomplished the 3-year follow-up for prognosis. The results showed that, 86.3% HIE neonates had hearing handicap (mainly mild hearing loss, 40.0%). Medium-severe HIE groups had more serious hearing handicap than Mild HIE group with a statistical significance (continuity correction χ2=7.383, P=0.007). ABR results showed that, mild HIE is mainly manifested as I wave PL prolonged or poorly differentiated, accounting for 78.1%; medium - severe HIE are mainly manifested as III and V wave PL prolonged central segment abnormalities, accounting for 95.8%; the hearing threshold no more than 60 dB group had better prognosis than the hearing threshold more than 60 dB group prognosis (Fisher exact probability P=0.001). Conclusion ABR reflects that HIE severity and was positively related to the severity of hearing handicap. The more serious hearing loss in neonates is, the worse prognosis the neonates have. ABR can be used to assist the assessment of the prognosis of neonatal HIE.
目的:探讨高血压脑干出血的显微外科治疗的手术指征、手术技巧、效果和预后。方法: 回顾性分析21例高血压脑干出血患者的临床资料、手术方式、治疗效果及随访资料。结果:21例患者均于显微镜下清除血肿,无手术死亡,术中运用神经电生理监测。11例患者术后神经功能障碍得到改善,5例症状加重持续昏迷。5例术后死亡,术后随访6～18个月,9例生活基本能够自理,7例长期卧床。结论: 采用显微外科技术治疗高血压脑干出血,效果良好。
目的:探讨神经电生理监测对脑干手术的指导意义，总结实施体会和改进方向。方法:回顾分析了既往2年内，在电生理监测下完成手术的48例脑干肿瘤病例资料。在总结手术疗效的同时，就影像资料对临床判断的指导作用，手术指征的把握，电生理指标的选择和意义等进行了讨论。结果:运用听觉脑干诱发电位、体感诱发电位、运动诱发电位等手段，为手术提供了强有力的支持。48例患者中，27例全切，15例大部切除，6例部分切除；术后无1例昏迷，一例因脑室炎死亡；神经机能较术前相仿或改善者31例，症候加重或出现新的废损17例（治疗随访，12例明显恢复，达到术前神经机能水平）。结论:在手术入路日趋成熟的今天，多参数神经电生理监测对于提高手术疗效、减少功能废损，具有重要意义。它为术中选择切入的安全区或探知神经通路的完整性提供了有力支撑，但对于特定神经机能评判仍存在不确定性，需要进一步研究
【摘要】 目的 探讨脑干海绵状血管瘤患者临床表现及影响预后的相关因素。 方法 回顾分析2008年9月-2010年9月27例脑干海绵状血管瘤患者临床资料。 结果 20例（74.1%）患者CT显示出血及血肿。急性或突然神经功能废损22例，渐进性功能障碍15例，病情平稳4例。显微手术12例，放射治疗6例，保守观察9例。长期随访25例，2例再次出血，无新发病灶，无患者死亡。手术组患者年龄（Plt;0.05）、术前病情严重程度（Plt;0.05）与术后KPS评分相关。非手术组不良预后评分与患者高龄及再出血有关。 结论 展神经麻痹和面瘫患者功能恢复较差。年龄、术前病情严重程度及手术时机影响患者预后，术中全切病灶对复发和并发症发生起主要作用，如何处理合并发生的静脉畸形有待讨论。立体定向放射治疗明显降低再出血风险，但其适应证尚有争议。【Abstract】 Objective To discuss the clinical manifestations and prognostic factors of brain stem cavernous hemangioma. Methods Based on the literature, the clinical data of 27 patients having brain stem cavernous hemangioma from September 2008 to September 2010 were reviewed and analyzed. Results Twenty patients (74.1%) presented with hemorrhage and hematoma in CT scan. Acute or sudden neurological deterioration occurred to 22 patients, progressive in 15 and stable in 4. Twelve patients underwent surgical removal of the lesion; 6 underwent radiosurgery; and 9 continued with conservative management. Twenty-five patients were followed up. Two patients had rehaemorrhagia. There were no de novo lesions or death. The risk factors indicative of a possible poor postoperative KPS score in the operative group included age (Plt;0.05) and the initial clinical condition (Plt;0.05). In the non-operative group, old age and rehaemorrhagia were obviously related to the poor outcome. Conclusions Patients with abducens and facial palsy have poor functional recovery. Age, the initial clinical condition and timing of operation are the major factors correlated to surgical outcome. The factor that affects recurrence and the occurrence of complications is complete resection during the operation. How to deal with the concomitant venous malformation should be further studied. The indications for stereotactic radiosurgery are still controversial, although it has confered a reduction in the risk of rehaemorrhagia.
【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
ObjectiveTo investigate the effect of distortion product otoacoustic emission (DPOAE) in hearing assessment for children with mumps, by comparing the results of DPOAE and auditory brainstem response (ABR) threshold value examination. MethodsA total of 116 children (232 ears) with mumps and 50 healthy children (100 ears) without mumps received DPOAE and ABR threshold value examination between March 2010 and October 2012. The results of these two examinations were compared in the first place. Then, The passing rate of DPOAE and the normal rate of ABR were compared between the two groups. ResultsThe passing rate in the mumps group was significantly lower than that in the control group[94.83% (220/232), 100.00% (232/232); P<0.05]. The pure tone test of 6 children (12 ears) in the mumps group who did not pass the DPOAE screening test showed that they had slight or moderate hearing loss. The ABR hearing thresholds of all children were normal. No significant difference was detected in Ⅲ wave latency, Ⅰ-Ⅲ and Ⅲ-Ⅴ intervals based on 75 dB nHL (P>0.05). However, there was a significant difference in the latency of I wave, V wave and interval between Ⅰ and Ⅴ between the two groups (P<0.05). The normal rate of ABR was significantly higher than the passing rate of DPOAE in the mumps group (P<0.05). ConclusionThe hearing is normal in all mumps children. However, mumps virus infection can affect the function of the eighth nerve and some auditory nuclei in the brainstem. Although DPOAE can be a useful method for hearing assessment in the mumps children, other hearing tests including ABR should also be considered.