Objective To analyze the risk factors and early prognosis factors of cerebral venous sinus thrombosis (CVST). Methods 68 patients with CVST were analyzed retrospectively. The patients were divided into early favorable prognosis group and early unfavorable prognosis group according to modified Rankin Scale (mRS). The clinical data and prognosis were analyzed by univariate analysis and multivariate logistic regression analysis. Results and Conclusion On discharge, there were 37(54.4%) cases and 31(45.6%) cases in the early favorable prognosis group and the early unfavorable prognosis group respectively. Univariate analysis showed that 8 factors, including pregnancy-associated factors, central nervous system infection, hyperhomocysteinemia, ocular symptoms, disturbance of consciousness, limb paralysis,secondary cerebral infarction and ventricular compression/midline shift/encephaledema were associated with the early prognosis.Multivariate logistic regression analysis showed that pregnancy-associated factors, central nervous system infection, hyperhomocysteinemia,disturbance of consciousness and ventricular compression/midline shift/encephaledema were the independent factors.

Objective To explore the etiology of headache after aneurismal subarachnoid hemorrhage (SAH) and find clinical features of various kinds of headache.Methods All of the 107 patients with SAH and intracranial aneurysm diagnosed upon CT scan and angiographic demonstration within 24 hours after onset were evaluated by numeric rating scales (NRS) 1,2,3,5,7,10 and 14 days after SAH. Patients suffered from moderate-severe headache were examined by cranial CT scan and transcranial Doppler (TCD) to find the reason, and their diversities were analyzed.Results 86.9% (93/107) patients with SAH suffered from moderate-severe headache. 9.7% (9/93) of them were caused by rebleeding of untreated aneurysm and the pain always occurred abruptly, always followed by conscious disturbance/new neurological signs. CT scan found hydrocephalus in 16.1% (15/93) patients with headache, they could aggravated with time but sometimes released spontaneously; TCD found intracranial vasospasm in 12.9% (12/93) of patients, their clinical features were no more than other 61.3% (57/93) patients with negative results, but patient's condition could exacerbate caused by later brain ischemia or even infarction.Conclusion Majority of SAH patients suffer from headache.

Objective To analyze the clinical characteristics of cerebral venous sinus thrombosis(CVST)and evaluate the diagnosis and treatment.Methods All the medical records,including age,mode of onset,clinical manifestations,findings of neuro-imaging and prognosis were analyzed.retrospectively in 53 cases with CVST from August 2003 to May 2008 in Beijing Tian Hospital.Results Of the 53 cases(22 men,31 women),aged from 15 to 52(mean 34.92±9.69)years.Acute or sub-acme onset accounted mostly.The principal clinical characteristics were headache and vomit,weak sight,diplopia,focal deficit,conscious disturbance and seizures.The neuro-imaging findings of CVST were venous sinus occlusion and local infarction,sometimes accompanied by capillary hemorrhage or haematoma.The major treatment involve dehydration,anticoagulation,and thrombolysis or stent implanted.After the treatment,12 cases recovered completely,37 improved,2 invalided,and 2 cases discharged for herniation of brain.Conclusion Improvement in awareness of CVST and prompt MRI in combination with MRV examination is the key to accurate diagnosis and timely therapy.The treatment of CVST should be based on anticoagulatin,and acompanyed.by thrombolysis or stent implanted in cerebral venous sinus on the baisis of effect.

OBJECTIVE: Functional deterioration of the nerves following cerebral hemorrhage is associated with cerebral hemorrhage-induced brain edema and involves multiple pathways of nerve injuries, now recognized as a complex pathophysiological process involving the interactions between multiple factors. Elucidation of the mechanisms of nervous system injury after cerebral hemorrhage may provide theoretical basis for implementing effective rehabilitative interventions for cerebral hemorrhage.DATA SOURCES: A computer-based search in the Medline database for related articles published between January 1991 and December 2003 was conducted using the combinations of the searching words of "emorrhagic stroke, cerebral hemorrhage, brain edema, and nervous system injury", with the language of the articles limited to English. A search in Wanfang database was also conducted using the key words of "cerebral hemorrhage, brain edema, nervous system injury" (in Chinese) for related Chinese articles published between January 2004 and January 2005.STUDY SELECTION: Total 85 original articles were selected after elimination of the irrelevant ones. Inclusion criteria: reports of animal experiments and clinical trials on cerebral hemorrhage following brain edema and mechanisms of nervous system injury were selected, particularly those focusing on brain edema after cerebral hemorrhage.DATA EXTRACTION: Of the 85 articles, 22 were found closely related to the subject concerned and 18 were indirectly relevant. Nine were excluded for duplicated reports, so that 31 articles were finally selected for analysis.DATA SYNTHESIS: Analysis of the literature suggested that secondary edema around the hematoma and nervous system injury were important indicators for poor prognosis of patients with cerebral hemorrhage. Multiple factors participated in the process of secondary brain edema and nerve injuries,such as the hydrostatic pressure during formation of the hematoma and clot retraction, activation of blood coagulation cascade, generation of thrombin,erythrocytolysis and the toxicity of hemoglobin, the activation of the complement system, space-occupying effects, rupture of the blood-brain barrier,secondary ischemia around the hematoma, inflammatory reaction of the neurons around hematoma and cell apoptosis.CONCLUSION: Effective protective interventions for brain edema after cerebral hemorrhage and complex pathophysiological changes may attenuate nervous system injuries following cerebral hemorrhage and improve the prognosis of functional recovery.

Objective To study the distribution of pathogenic bacterium and its sensitivity to antibiotic in severe cerebral vascular disease patients with nosocomial pneumonia.Methods Retrospective studies were done in 42 cases of severe cerebral vascular disease patients in neurological intensive care unit (NICU). Secretion from lower respiratory tract was cultivated and done medicine sensitive test at 3 d、4 d、5 d、9 d、16 d after hospitalized,then the etiologic data of nosocomial pneumonia were analyzed.Results Among 42 cases,15 pathogenic microorganisms and 163 strains were cultivated, the fisrt 4 strains were Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella and Enterobacter cloacae. The results of medicine sensitive test indicated that Gram-negative bacteria was sensitive to Imipenem,and Gram-positive bacteria was sensitive to Vancomycin.Conclusions The main pathogen of nosocomial pneumonia in severe cerebral vascular disease patients may be Staphylococcus aureus,Pseudomonas aeruginosa. Staphylococcus aureus was sensitive to Vancomycin,so Vancomycin can be act as the first choice drug to deal Gram-positive bacteria. Pseudomonas aeruginosa is relatively sensitive to Amikacin and Ciprofloxacin,while Imipenem is the second, but drug fast is to cephalosporins. So the first two antibiotics can be as the experience drugs to deal Pseudomonas aeruginosa.

0.05).However,There were significantly positive correlation between MMP-9 level and abnormal volume on mean transit time map(r=0.371,P=0.026),time to peak map(r=0.379,P=0.023),cerebral blood flow map(r=0.447,P=0.006) and great vessel occlution(r=0.416,P=0.004) on magnetic resonance.Conclusions The serum MMP-9 level of acute cerebral infarction are significantly positively correlated with the change of magnetic resonance,but there are no correlation between MMP-2 and MMP-13 levels and the change of magnetic resonance.It suggests that the MMP-9 may be involved in the pathology of acute cerebral ischemia.

Objective To explore the characteristics and mechanisms of dysphagia in patients with dorsola-teral medullary syndrome ( DMS). Methods Twelve DMS patients were evaluated clinically and submitted to videofluoroscopic study in order to investigate clinical manifestations and the pathophysiological changes in swallowing. Swallowing function was recorded at discharge and during a three-month follow-up period. Results All patients had difficulties in swallowing and drinking, presenting coughing and throat clearing, and needed nasogastric feeding at admission. Insufficient soft palate elevation was observed in seven patients, who had no other oral phase dysfunction. The pharyngeal phase was injured in all patients. Decreased larynx elevation and invalid swallowing were observed in 10 patients. Delayed pharyngeal swallowing was seen in 8 patients. Under videofluoroscopy, 9 patients showed significantly decreased larynx elevation. Ten patients opened the cricopharyngeal muscles insufficiently, while two could not open at all. Larynx penetration was seen in all patients. Eleven patients were able to return to oral feeding, after 36 days on average (range 13 - 50 d). The patients with a disease history of 3 or more years could not return to oral feeding. Conclusion DMS patients are characterized by decreased larynx elevation and reduced compliance of the cricopharyngeal muscles. Early therapy may provide patients with a good prognosis.

Objective To explore the relationship between lesion sites of stroke and swallowing function. Methods Ischemic stroke patients consecutively admitted into the stroke unit were screened in this study. The new and previous lesion sites of stroke, dysphagia and aspiration under videofluoroscopy (VF) were recorded and their relation was analyzed. Results 211 patients were included and 169 patients had completed the MRI and VF examination. 159 patients had dysphagia and 94 had aspiration under VF. 72 patients (9 missing) were found disorder in oral phase and 150 in pharyngeal phase. There was no significantly difference in dysphagia under VF and in aspiration among different lesion sites (P>0.05). Patients with stroke in medulla tended to happen aspiration (P=0.056). Stroke sites above the tentorium of cerebellum (P=0.028) or above medulla (P=0.005) may cause disorder in oral phase. Conclusion The stroke injury in brain cortex, white matter, brainstem and cerebellum or hemisphere could lead to dysphagia and aspiration. The injury of medulla may cause aspiration. Lesion of brain hemisphere or above the medulla could result disorder in oral phase of swallowing.

ObjectiveTo compare the prognosis of patiens with acute(within 72 hours) subarachnoid hemorrhage (SAH) within or without the clinical standardized pathway(CSP).Methods123 acute SAH cases were collected before CSP established meanwhile another 146 cases after CSP established from 2005 to 2009 in neurological intensive care unit of our hospital. Information such as age, gender, Hunt-Hess and CT-Fisher grade, timing and result of digital subtraction arteriography, treating time of aneurysm, and Modified Rankin Scale(MRS) at different time were recorded. Rehaemorrhagia, complications, mortality, prognosis and average stay were compared between two groups.ResultsThere was a significant difference between two groups in rehaemorrhagia, vasospasm，hydrocephaly, mortality, prognosis and average stay.ConclusionCSP is helpful to improve the prognosis of aneurysm subarachnoid hemorrhage.

ObjectiveTo investigate the effects of transcranial magnetic stimulation(TMS)on motor function after acute cerebral infarction.Methods60 patients who suffered acute cerebral infarction were assigned to experiment group and control group(30 cases each group). Both groups received rehabilitation theropy. Meanwhile,experiment group received TMS. Fugl-Meyer Assessment(FMA), National Institute of Health Scale of Stroke(NIHSS), Barthel Index(BI) were used to measure the outcome.ResultsThe scores of FMA and BI increased significantly(P<0.05) while that of NIHSS decreased significantly(P<0.05) in both groups after treatment. However, these scores in experiment group improved more compared with those of control group(P<0.05).ConclusionTMS is helpful to improve the motor function, ability of daily living and neurological function.