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IIH患者在CSF压力正常后横窦持续狭窄

世界核心医学期刊文摘(神经病学分册) 2006年第2期 47-48页

作者： Bono F. Giliberto C. Mastrandrea C. A.Quattrone 陈海 clinica neurologica Policlinico MaterDomini Via T. Campanella 88100 Catanzaro Italy.Dr

Background: Bilateral transverse sinus (TS) stenosis has been found in more than 90%of patients with idiopathic intracranial hypertension (I I H). Objective: To evaluate whether TS stenosis changed after normalization of CSF pressure in patients with I I H during medical treatment. Methods: Fourteen consecutive patients with I I H with bilateral TS stenosis on cerebral MR venography (MRV) during the medical treatment were studied. Patients were followed for over a 6-year period. During the follow-up, patients underwent repeated lumbar punctures (LPs ) and cerebral MRV. MRV was always performed before each LP. Results: TS stenosi s persisted in all the patients during the follow-up. In 9 of 14 (64%) patient s with IIH, CSF pressure normalized during medical treatment. Conclusions: Trans verse sinus (TS) stenoses, as revealed by MR venography, persist in patients wit h idiopathic intracranial hypertension after normalization of CSF pressure, sugg esting the lack of a direct relationship between the caliber of TS and CSF press ure.

关键词：横窦压力正常 IIH CSF 患者

比较不同MR静脉成像术在检测原发性颅内高压横窦狭窄中的作用

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世界核心医学期刊文摘(神经病学分册) 2006年第1期 17-18页

作者： Fera F. Bono F. Messina D. A. Quattrone 张慧 clinica neurologica Policlinico Mater Domini Via T. Campanella 88100 Catanzaro Italy Dr.

Cerebral venous outflow abnormalities, as transverse sinuses (TSs) stenosis,may underlie a picture of idiopathic intracranial hypertension (IIH). To identify the best non-invasive MR venography (MRV) technique for exploring the disturbance of flow of TSs in IIH patients, we compared three dimensional phase contrast (3D-PC) MRV images, acquired with different velocity encodings (15 and 40 cm/s) with two-dimensional time-of-flight (2D-TOF) MR images in 6 subjects with IIH and 12 age-matched normal controls. In both groups, we also measured flow velocity in TSs by using single slice 2D-CINE PC acquisitions. In all subjects with IIH, 3D-PC showed marked flow disturbance in the mid-lateral portion of both TSs when velocity encoding (VENC) was set to 15 cm/s while only a slightly irregular flow in TSs was detected when VENC was set to 40cm/s or when 2D-TOF was used. By contrast, 3D-PC (VENC 15 and 40) and 2D-TOF techniques were comparable in detecting TS signal flow in normal controls. Measures of flow velocity, by using 2D-CINE PC, revealed a three-fold increase of velocity at the level of the flow disturbance in IIH patients compared to normal controls (p < 0.0001), suggesting a marked stenosis of mid-lateral portion of TSs in these patients. Setting the VENC to 15 cm/s on 3D-PC MRV may represent the best technical approach for visualizing disturbances of flow in TSs in subjects with symptoms suggestive of IIH.

关键词：颅内高压 IIH MR 横窦血流障碍原发性

Secondary prevention of ischaemic stroke

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World Journal of Neurology 2013年第4期3卷 97-114页

作者： Irene Volonghi Alessandro Padovani Elisabetta Del Zotto Alessia Giossi Paolo Costa Andrea Morotti Loris Poli Alessandro Pezzini Dipartimento di Scienze Cliniche e Sperimentali Clinica Neurologica Università degli Studi di Brescia U.O. di Recupero e Rieducazione Funzionale IRCCS Fondazione Don Gnocchi U.O. Neurologia Istituto Clinico Sant’Anna

In spite of a documented reduction in incidence in highincome countries over the last decades, stroke is still a leading cause of death and disability worldwide. With the ageing of the population stroke-related economic burden is expected to increase, because of residual disability and its complications, such as cognitive impairment, high risk of falls and fractures, depression and epilepsy. Furthermore, because of the substantial rate of early and long-term vascular recurrences after the first event, secondary prevention after cerebral ischaemia is a crucial issue. This is even more important after minor stroke and transient ischaemic attack(TIA), in order to reduce the risk of potentially more severe and disabling events. To accomplish this aim, acute long-term medical and surgical treatments as well aslifestyle modifications are strongly recommended. However, apart from the well-established indications to thrombolysis, studies in acute phase after a first stroke or TIA are scarce and evidence is lacking. More trials are available for long-term secondary prevention with different classes of drugs, including antithrombotic medications for ischaemic events of arterial and cardiac origin, especially related to atrial fibrillation(antiplatelets and anticoagulants, respectively), lipid lowering agents(mainly statins), blood pressure lowering drugs, surgical and endovascular revascularization procedures.

关键词： Stroke Transient ischaemic attack Secondary prevention Antiplatelets Anticoagulants Medical stroke treatment Carotid stenosis

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偏头痛病史与自发性颈动脉夹层的发病风险

世界核心医学期刊文摘（神经病学分册） 2005年第11期1卷 12-13页

作者： Pezzini A. Granella F. Grassi M. 高中宝 clinica neurologica Universit'a degli Studi di Brescia P.le Spedali Civili 1 25100 Brescia Italy

The pathophysiology of spontaneous cervical artery dissection (sCAD) is largely unknown. An association with migraine has been suggested, but not definitively proven. In the setting of a hospital-based prospective case-control study we assessed personal and family history of migraine in 72 patients with sCAD, 72 patients with cerebral infarct unrelated to a CAD (non-CAD) and 72 control subjects. Personal history of migraine was significantly associated to sCAD compared to non-CAD (59.7%vs. 30.6%; OR 3.14; 95%CI 1.41-7.01) and controls (18.1%; OR 7.41; 95%CI 3.11-17.64). As opposed to migraine with aura, migraine without aura was significantly more frequent among sCAD than among non-CAD (56.9%vs. 25.0%; OR 3.91; 95%CI 1.71-8.90) and controls (12.5%; OR 9.84; 95%CI 3.85-25.16). Similar results were observed when the frequencies of family history of migraine were compared. These findings are consistent with the hypothesis that migraine may represent a predisposing condition for sCAD.

关键词：偏头痛病颈动脉夹层偏头痛患者发病风险病理生理试验结果病例对照研究

动脉性高血压是自发性颈动脉夹层的危险因素:一项病例对照研究

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世界核心医学期刊文摘(神经病学分册) 2006年第4期 50-51页

作者： Pezzini A. Caso V. Zanferrari C. 刘凯 clinica neurologica Università degli Studi di Brescia P. le Spedali Civili 1 25100 Brescia Italy.Dr

Because of the presumed non-atherosclerotic pathogenesis, the potential link between spontaneous cervical artery dissection (sCAD) and common risk factors for atherosclerosis has never been investigated systematically. Therefore, this prospective, multicentre, case-control study compared the frequency of tobacco use, hypertension, diabetes mellitus, and hypercholesterolaemia among a group of consecutive patients with sCAD (n = 153), a group of patients with ischaemic stroke, not related to CAD (non-CAD), and a group of controls. As opposed to the other variables, a trend towards a significant association was seen when the prevalence of hypertension was compared among patients with sCAD and controls (26.8% v 17.0% ; odds ratio (OR) 1.79; 95% confidence interval (CI), 0.98 to 3.27; p = 0.058). Hypertension was also significantly associated with the subgroup of patients with sCAD and cerebral infarction (OR, 1.94; 95% CI, 1.01 to 3.70; p = 0.045), particularly when involving the vertebral arteries (OR, 2.69; 95% CI, 1.20 to 6.04; p = 0.017). These findings might help define the spectrum of pathogenic conditions predisposing to sCAD and provide information to help investigate the combined effect of such susceptibility factors in future studies.

关键词：高血压危险因素 CA 危险隐患颈动脉夹层病例对照

一过性完全性遗忘症是否为健忘性轻度认知缺损的危险因素?

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世界核心医学期刊文摘（神经病学分册） 2005年第2期1卷 29-30页

作者： Borroni B. Agosti C. Brambilla C. A. Padovani 江山 Dipto. Scienze Mediche e Chirurgiche Clinica Neurologica Univer sita degli Studi di Brescia Piazza Spedali Civili 1 25100 Brescia Italy

Transient Global Amnesia (TGA) is a common condition of unknown aetiology char acterised by the abrupt onset of severe anterograde amnesia, which lasts less th an 24 hours. Some authors have suggested that subclinical impairment of memory f unctions may persist for much longer, but neuropsychological assessment lasting years after TGA attack has not been performed so far. The aim of this study was to evaluate long term cognitive functions in patients with a previous TGA episo de. Fifty five patients underwent a standardised neuropsychological assessment after at least one year from the TGA attack, and were compared with 80 age mat ched controls. TGA patients showed worse performances on tests evaluating verbal and nonverbal long term memory and attention, with comparable global cognitive functions. By applying current criteria for amnestic Mild Cognitive Impairment (MCI a) on TGA subjects, a group consisting of 18/55 (32.7%) MCI a subjects w as identified. There was no association between the presence of MCI a and demog raphic variables, vascular risk factors, years since the TGA episode, or ApoE ge notype. This study demonstrates that TGA appears to be a relatively benign syndr ome although objective memory deficits ffulilling MCI a criteria persist over t ime, as detected by multidimensional neuropsychological tasks performed at long term follow up.

关键词：完全性神经心理学认知功能顺行性遗忘亚临床持续时间注意能力诊断标准 ApoE 能力缺失

Stroke and depression: A bidirectional link

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World Journal of Meta-Analysis 2014年第3期2卷 49-63页

作者： Elisabetta Del Zotto Paolo Costa Andrea Morotti Loris Poli Valeria de Giuli Alessia Giossi Irene Volonghi Antonio Callea Alessandro Padovani Alessandro Pezzini U.O. di Recupero e Rieducazione Funzionale IRCCS Fondazione Don Gnocchi Dipartimento di Scienze Cliniche e Sperimentali Clinica NeurologicaUniversità degli Studi di Brescia U.O Neurologia Istituto Clinico "S. Anna" Dipartimento Fisiopatologia Medico-Chirurgica e dei Trapianti Sezione di NeuroscienzeUniversità degli Studi di Milano

A number of studies have assessed the influence of depression on the risk of cardiovascular disease. A growing literature indicates a link between depression and cerebrovascular events, although the direction of this association remains unclear. Numerous data have emerged suggesting an association between depressive symptoms and subsequent risk of stroke, thus leading to the hypothesis that a direct causality between depression and stroke exists. Notwithstanding, how depression may act as a risk factor for stroke is still unclear. Depression might be linked to stroke via neuroendocrine and inflammation effects, through correlation with major comorbidities such as hypertensionand diabetes or by intervention of lifestyle behavioral mediators. Finally, antidepressant medications have recently drawn attention for a possible association with increased risk of stroke, although such findings remain uncertain. Depression has been also established as an important consequence after stroke, exerting a significant adverse impact on the course of motor recovery, social functioning and, overall, on quality of life. Post stroke depression occurs in nearly one third of stroke cases, but the exact mechanism leading to depression after stroke is still incompletely understood. In this article, we will review contemporary epidemiologic studies, discuss potential mechanisms and specific aspects of the complex relation between depression and stroke.

关键词： Depression Mood disorders Stroke Poststroke depression Antidepressant medications Cerebrovascular disease

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腔隙性卒中发病率和预后的人群研究

世界核心医学期刊文摘（神经病学分册） 2006年第9期2卷 21-22页

作者： Sacco S. Marini C. Totaro R. A. Carolei 邱伟庆 clinica neurologica Dipartimento di Medicina Interna e SanitàPubblica Universitàdegli Studi di L'AquilaPiazzale Salvatore Tommasi 1 67010 L'Aquila-Coppito Italy Dr

Objective: To evaluate incidence and prognosis of lacunar stroke in a prospective, population-based patient registry. Methods: The authors included first-ever strokes occurring between 1994 and 1998. They assessed incidence, risk factors, mortality, and recurrence in patients with lacunar stroke. Results: The authors identified 491 patients (15.3%) with lacunar stroke (252 men and 239 women) and 2,153 patients (67.3%) with nonlacunar stroke (998 men and 1,155 women). Crude annual incidence rate for a first-ever lacunar stroke was 33.0/100,000 (95%CI 30.2 to 36.0). At the univariate logistic regression analysis among patients with lacunar stroke there was a higher proportion of cigarette smoking and hypercholesterolemia and a lower proportion of chronic atrial fibrillation than in patients with nonlacunar stroke. For lacunar stroke, the 30-day case-fatality rate was 4.3%(95%CI 2.5 to 6.1) and the 1-year case-fatality rate was 13.0%(95%CI 10.0 to 16.0). During the first year of follow-up the average annual stroke recurrence rate was lower in patients with lacunar (2.83%; 95%CI 1.36 to 4.30) than in those with nonlacunar stroke (5.10%; 95%CI 4.17 to 6.03) while from the second year onward, rates were similar in both groups. Conclusion: In the short term, patients with nonlacunar stroke had more vascular events, but in the long term, the risk of death and of stroke recurrence was similar.

关键词：腔隙性卒中年发病率人群研究 logistic回归分析预后卒中患者高胆固醇血症死亡事件

联合血小板淀粉前蛋白比和rCBF单光子发射计算机断层扫描分析对阿尔茨海默病进行临床前诊断

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世界核心医学期刊文摘（神经病学分册） 2006年第3期2卷 9-9页

作者： Borroni B Perani D. Broli M. 江山 clinica neurologica Universitdegli Studi di Brescia Pza Spedali Civili 1 25100 Brescia Italy

Platelet Amyloid Precursor Protein ratio of different abnormal forms and 99mTc-ECD SPECT perfusion analysis were evaluated in Mild Cognitive Impairment (MCI) subjects who progressed to Alzheimer Disease (AD) and in stable MCI. We report that their combined evaluation increases the discriminative power of the analysis in identifying presymptomatic AD. The positive predictive value of these combined markers in identifying progressive MCI was 0.87, and the negative predictive value was 0.90. This observation suggests that the interplay of different markers should be considered for enhancing diagnostic accuracy of pre-clinical AD.

关键词： rCBF 阿尔茨海默病临床前蛋白比认知功能损伤阴性预测值阳性预测值鉴别能力