The diameters of the optic nerves in 54 patients with high intracranial pressure(ICP)were checked and measured with B type ultrasonic tomography and the relationship between thewidth of optic nerve and the optic papiliedema was studied. The results showed that the average diameter (6. 324-0.53)mm of the optic nerves in patients with high ICP was wider than that(3.61 ~:0.29 )mm in health subjects (P(0.01). The rate of increasing width of optic nerve (87.00%)was higher than that (67.00~)of papilledema (P(0.05). In addition,in 19 patients with ICP between 1.97 and 2.50 kPa, the rate of increasing width of optic nerve (79. 00~)was higher than that (42.00%)of papilledema (P (0. 05). These results indicated that measuring the diameter of optic nerve might be more practical than observing tile presence of papilledema in diagnosing high ICP,especially in early stage. （Chin J Ocul Fundus Dis,1996,12: 86-87）
ObjectiveTo evaluate the application of stereotactic electrode implantation on precise epileptogenic zone localization. MethodRetrospectively studied 140 patients with drug-resist epilepsy from March 2012 to June 2015, who undergone a procedure of intracranial stereotactic electrode for localized epileptogenic zone. ResultsIn 140 patients who underwent the ROSA navigated implantation of intracranial electrode, 109 are unilateral implantation, 31 are bilateral; 3 patients experienced an intracranial hematoma caused by the implantation. Preserved time of electrodes, on average, 8.4days (range 2~35 days); Obseved clinical seizures, on average, 10.8 times per pt (range 0~98 times); There were no cerebrospinal fluid leak, intracranial hematoma, electrodes fracture or patient death, except 2 pt's scalp infection (1.43%, scalp infection rate); 131 pts' seizure onset area was precisely localized; 71 pts underwent SEEG-guide resections and were followed up for more than 6 months. In the group of 71 resection pts, 56 pts were reached Engel I class, 2 were Engel Ⅱ, 3 was Engel Ⅲ and 10 were Engel IV class. ConclusionTo intractable epilepsy, when non-invasive assessments can't find the epileptogenic foci, intracranial electrode implantation combined with long-term VEEG is an effective method to localize the epileptogenic foci, especially the ROSA navigated stereotactic electrode implantation, which is a micro-invasive, short-time, less-complication, safe-guaranteed, and precise technique.
ObjectiveTo analyze the clinical characteristics of acquired immune deficiency syndrome (AIDS) complicated with intracranial infection and to explore the nursing countermeasures. MethodsWe retrospectively analyzed the clinical features, laboratory examination indexes, and nursing methods of 12 AIDS patients complicated with intracranial infection between January and December 2010. ResultsIn the 12 patients, 8 were male, 4 were female; 11 were married and 1 was unmarried. The first symptom of headache occurred in 8 patients, and feverin 4 patients. Detection of HIV-1P24 antigen in all the 12 patients with HIV was positive for nucleic acid analysis. After treatment and symptomatic care, 3 cases were cured, 3 quit the treatment voluntarily, 2 improved patients were transferred to a higher-level hospital, 3 patients were readmitted to our hospital after improvement of the situation, and 1 patient died. ConclusionThe most common symptom of AIDS was neural disease. The diagnosis should be based on clinical manifestations, and the epidemiological data should be used as reference. At the same time, attention should be paid to the admission assessment and good occupation protection, health education promotion, improvement of patients' quality of life, and reduction of the incidence of complications and mortality rate.
ObjectiveTo summarize the experience of microsurgery in primary hospital for the posterior communicating artery aneurysms (PCOAan). MethodsThe clinical data of 48 patients with PCOAan who underwent microsurgery from January 2008 to December 2012 were retrospectively analyzed. ResultsAll the necks of aneurysms of 48 cases were successfully clipped, Acording to the Glasgow outcome score (GOS), the early curative effects were good in 36 cases (75.0%, GOS 4-5) poor in 10 cases (20.8%, GOS 2-3) and death in 3 cases (2.1%, GOS 1). After the operation was carried out, the operation time was shorten, aneurysm intraoperative rupture rate was lower, postoperative complications were lower, and the average medical expense was reduced; the difference was significant in 24 cases before and after the operation (P<0.05). ConclusionMicrosurgery for PCOAan is an effective method which should be popularized in primary hospitals.
ObjectiveTo summarize the clinical features of an adult patient with occult cerebral alveolar echinococcosis with liver and lung infection. MethodsA Tibetan male patient in his middle age from the epidemic area of echinococcosis infection was diagnosed to have liver, lung and cerebral alveolar echinococcosis infection in Ganzi People's Hospital. He had the resection surgery, and the pathological result confirmed the primary diagnosis. We searched the literatures from January 1985 to December 2015 for occult cerebral alveolar echinococcosis and reviewed all the full texts in China Journal Full-text Database. Seventeen articles were qualified and 42 patients were reported. Combining with the relevant English literature using Medline, we analyzed the epidemic, pathophysiological and clinical manifestations of cerebral alveolar echinococcosis infection and explored the methods of prevention and treatment. ResultsAccording to the results of literature analysis, cerebral alveolar echinococcosis appeared often secondary to infection of other organs. Nervous system symptom concealed or progressed slowly; imaging and pathological tests were important for diagnosis. Resection surgery was the essential method of cure. ConclusionAlveolar echinococcosis can affect multiple organs. In patients without neurological symptoms, if other organs are found to be infected, it is important to screen patients with intracranial involvement. Because this kind of patients with intracranial lesions with hydatid are often secondary to other organ infection, active treatment in early phase is necessary in order to avoid further expansion of lesions and metastasis.
ObjectiveTo investigate the efficacy of stellate ganglion block (SGB) on postoperative palpebral edema in patients undergoing intracranial aneurysm surgery. MethodsSixty patients who were scheduled to undergo intracranial aneurysm surgery between September 2012 and Novermber 2014 were recruited, and were assigned into 2 groups randomly with 30 in each:SGB group and control group. Patients in SGB group were administered SGB by injecting 0.3% ropivacaine on the operative side under the ultrasound guidance after surgery completed, while patients in the control group received injection of saline on the operative side under the ultrasound guidance. Incidence of postoperative palpebral edema at hour 24, 48, and 72 after surgery were measured. Numerical rating scale (NRS) was used to detect the severity of uncomfortable symptoms for palpebral swelling during rest state. The severity of palpebral edema was evaluated with continuous rating scale (0-5, 0 indicated normal palpebral, and higher score indicated more serious palpebral edema). Complications related with SGB were recorded. ResultsThe overall incidence of palpebral edema at hour 24 after surgery in SGB group was lower than that in the control group (P<0.05). There was no statistically significant difference in the overall incidence of palpebral edema at hour 48 and 72 after surgery between the two groups (P>0.05). The palpebral edema rating scores of the SGB group at hour 24 after surgery were lower than those of the control group (P<0.01).The incidence of palpebral edema which was scored 3 or more at hour 24 and 48 after surgery in SGB group was lower than that in the control group (P<0.05). No statistically significant difference was found in the incidence of palpebral edema which was scored 3 or more at hour 72 after surgery between the two groups (P>0.05). No complication related with SGB was found. ConclusionSGB can safely reduce the incidence of postoperative palpebral edema in patients undergoing intracranial aneurysm surgery, and reduce the severity of palpebral edema.
ObjectiveTo investigate the value of head boneless CT angiography (CTA) for surface shaded display (SSD) (hereinafter referred to as the SSD-CTA technology) and volume computed tomographic digital subtraction angiography (VCTDSA) in diagnosing intracranial aneurysms. MethodsWe collected the clinical data of 35 patients diagnosed to have intracranial aneurysm by VCTDSA between April 2013 and November 2014 from the First Affiliated Hospital of Chongqing Medical University. The original data were imported into the CT workstation of the First People's Hospital of Chengdu. Then, SSD-CTA technology was performed for bone reconstruction. We compared the results of these two technologies. In addition, we selected another 27 patients diagnosed with intracranial aneurysm by SSDCTA and DSA examination at the same time between June 2012 and November 2014 in the First People's Hospital of Chengdu for comparison. ResultsThe quality score of SSD-CTA reconstructed image was lower than that of VCTDSA, but the diagnosis of the two technologies for intracranial aneurysm was not statistically different (P>0.05). Compared with DSA, the sensitivity and specificity of the diagnosis for intracranial aneurysms by SSD-CTA were both 100%. ConclusionSSD-CTA is valuable in diagnosing intracranial aneurysms.
ObjectiveTo explore the nursing method to avoid rupture of intracranial aneurysm during induction of anesthesia. MethodWe retrospectively analyzed the nursing method for 428 patients with aneurysm during the induction of anesthesia between October 2012 and October 2013. According to the causes of rupture of intracranial aneurysm (anxiety, tension, excitement, sudden elevation of blood pressure, physical labor), we adopted nursing methods to avoid those causes, and implemented targeted nursing methods during induction of anesthesia. ResultsNo intracranial aneurysm rupture occurred in these 428 aneurysm patients during induction of anesthesia. Two patients' absolute value of systolic blood pressure was below 80 mm Hg (1 mm Hg=0.133 kPa) during induction of anesthesia, and the vital signs of other patients kept normal. The number of intraoperative rupture cases was 3. When discharged from hospital, there were 385 patients with good prognosis, 39 patients with bad prognosis, and 4 death cases. ConclusionsTargeted nursing method based on patients' particular situation during induction of anesthesia can effectively control patients' emotion, stabilize fluctuations in hemodynamic indexes, decrease the incidence of aneurysm rupture, improve surgery treatment effect of intracranial aneurysm clipping, decrease complications, and improve patients' prognosis.
ObjectiveTo systematically review the safety and validity of the treatment of intracranial atherosclerosis diseases (ICAD) by using Wingspan stents, and to provide the reference for clinical practice and research. MethodsDatabases such as the PubMed, The Cochrane Library, EMbase, Cochrane Central Register of Controlled Trials, CBM, CNKI and VIP were searched for studies concerning the safety and validity of the treatment of intracranial atherosclerosis diseases (ICAD) by using Wingspan stents from January 1st, 2005 to January 10th, 2014. Randomized controlled trials (RCTs), non-randomized controlled trials, case-control studies, cohort studies and case series were all included. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data. Then, meta-analysis was performed by using the R software. ResultsA total of 34 studies (2 RCTs, 22 cohort studies, and 10 case-control studies) involving 2 511 patients were included. The results of meta-analysis showed that:operation success rates was 96.75% (95%CI 95.82% to 97.48%), 30 day rates of the end point events was 8.75% (95%CI 7.61% to 10.04%), 1 year rates of the end point events was 13% (95%CI 11.47% to 14.70%), total mortality was 2.98% (95%CI 2.16% to 4.10%), incidence of in-stent restenosis was 21.76% (95%CI 18.27% to 25.71%), the ratio of the patients with symptomatic restenosis and total patients was 6.50% (95%CI 4.89% to 8.60%), and the ratio of the patients with symptomatic restenosis and total patients with restenosis was 26.06% (95%CI 19.94% to 33.29%). ConclusionCurrent evidence shows that treatment of ICAD by using Wingspan stents is effective and safe. However, this conclusion should be approved by further higher quality RCTs.
ObjectiveTo observe the neuro-ophthalmological features of intracranial aneurysm. Methods169 patients with intracranial aneurysm were retrospectively studied. 45 patients, including 18 men and 27 women, had neuro-ophthalmological symptoms or signs. Their average age was (56.21±16.11) years and 32 (71.11%)patients' age was more than 50 years. The onset time ranged from 30 minutes to 20 years. 20 (44.44%) patients' onset time was among 24 hours. CT, CT angiography, MRI, MRI angiography and cerebral digital subtraction angiography were performed alone or combined in all 45 patients. Visual acuity, pupil reflex and eye movement were examined. Clinical data including general condition, initial symptoms, neuro-ophthalmological changes, imaging data and treatment effects were recorded. Results26.63% of the 169 patients had neuro-ophthalmological symptoms or signs. There were 6 patients (13.33%) with neuro-ophthalmological changes as their first manifestation and 39 patients (86.67%) with neurologic changes as first manifestation. Neuro-ophthalmological symptoms included vision loss (10 patients, 22.22%), diplopia (4 patients, 8.89%) and ocular pain (2 patients, 4.44%). The most common neuro-ophthalmological sign was pupil abnormality which was found in 31 patients (68.89%). The second most common sign was eye movement disorder (16 patients, 35.56%).The other signs included ptosis (8 patients, 17.78%), nystagmus (2 patients, 4.44%), exophthalmos (1 patient, 2.22%) and disappeared corneal reflection (1 patient, 2.22%). Imaging examination indicated that intracranial hemorrhage happened in 29 patients (64.44%). The most common neuro-ophthalmological features were pupil abnormality, eye movement disorder and vision loss in both patients with or without intracranial hemorrhage. The incidence of pupil abnormality was higher in patients with intracranial hemorrhage than that without intracranial hemorrhage, the difference was statistically significant(χ2=7.321, P=0.007). Pupil abnormality and vision loss were common in patients with internal carotid artery aneurysm, and eye movement disorder was common in patients with internal carotid artery aneurysm and posterior communicating aneurysms. ConclusionsPatients with intracranial aneurysm have different neuro-ophthalmological features. The most common features are pupil abnormality, eye movement disorder and vision loss.