| 1 | 循证指南:弥散和灌注MRI在急性缺血性卒中诊断中的作用美国神经病学学会治疗和技术评价委员会的报告显示文摘目的 评价弥散加权成像(diffusion-weighted imaging,DWI)和灌注加权成像(perfusionweighted imaging PWI)在急性缺血性卒中患者诊断中应用的证据.方法 对1966年至2008年1月期间有关DWI和PWI诊断和预后价值的文献进行系统分析.结果和推荐 对于发病12 h内的急性缺血性卒中的诊断,DWI已被确认为有效的评价手段,且其诊断价值应高于非增强CT.为了最准确地诊断急性缺血性卒中,应进行DWI(A级推荐);然而,在疑似急性卒中患者的总体样本中,DWI诊断缺血性卒中的敏感性并不完美.DWI诊断脑出血的准确性不在本指南的范围之内.根据Ⅱ级和Ⅲ级证据,基线DWI体积可预测前循环卒中的基线卒中严重程度(B级推荐),但不能预测椎基底动脉系统卒中的基线卒中严重程度(C级推荐).基线DWI病变体积可预测(最终)梗死体积(B级推荐),并且有可能预测早期和远期临床转归(C级推荐).与DWI相比,基线PWI体积预测基线卒中严重程度的价值较小(C级推荐).尚无足够的证据支持或反对PWI在急性缺血性卒中诊断中的价值(U级推荐). | P.D. Schellinger R.N. Bryan L.R. Caplan J.A. Detre R.R. Edelman C. Jaigobin C.S. Kidwell J.P. Mohr M. Sloan A.G. Sorensen S. Warach 章娟娟(译) 王国颖(译) 汪凯(译) | 2010 | 国际脑血管病杂志2010，18，11： | 38 |
| 8 | 髓质椎动脉压迫显示文摘Background: Intracranial arteries in the subarachnoid space may compress the brain parenchyma and cranial nerves. Most arterial compressive lesions have been attributed to dolichoectasia in the vertebral-basilar system, and prior reports have concentrated on the pressure effects of basilar artery ectasia. Much less is known about vertebral artery compression of the medulla. Objective: To describe a series of patients with vertebral arteries compressing the medulla oblongata. Design: Prospective case studies. Setting: Tertiary care center. Patients: Nine symptomatic patients, 4 men and 5 women, between the ages of 32 and 79 years. Main Outcome Measures: Clinical phenomena, radiographic findings, treatment, and outcomes. Results: We found that compression most commonly occurs at the ventrolateral surface. The clinical features can be transient or permanent and are predominantly motor and cerebellar or vestibular, but a poor correlation exists between the clinical findings and the severity or extent of impingement. The vertebral arteries were angulated, tortuous, or dilated but not necessarily dolichoectatic to cause obvious indentation. Seven patients were treated with antiplatelets and anticoagulants or analgesics, whereas 2 underwent microvascular decompression, resulting in temporary or no relief. One surgical patient developed cranial nerve complications. Among the medically treated patients, none had progression of deficits, and those with single episodes had no recurrence of symptoms. Conclusion: This study is the largest collection, to our knowledge, of patients with medullary vascular compression. Further studies are needed to estimate its frequency, natural course, and preferred management. | Savitz S.I. Ronthal M. Caplan L.R. 郭俊 | 2006 | 世界核心医学期刊文摘(神经病学分册)2006，2，6： | 0 |
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