2014年 · 第94卷第47期

The incidence of stroke in China increases by 8.7% every year, which is higher than the world average on a global scale, showing the characteristics of high incidence, high disability, high mortality and high recurrence rate. Stroke changes the lives of patients and brings a heavy burden to their families and society. Given that more than 76% of strokes are the first episode, effective preventive measures are the best way to reduce the burden of stroke^[1]。 Cerebral atherosclerosis, which can be divided into intracranial atherosclerosis and extracranial atherosclerosis, is an important cause of stroke worldwide^[2]Especially in Chinese and Asian populations. In China, 33% to 50% of strokes and transient ischemic attacks have symptomatic cerebral atherosclerotic intracranial artery stenosis^[3,4]。 The screening of cerebral atherosclerosis is helpful for its early diagnosis, thus improving the early warning and prevention and treatment level of cerebral atherosclerotic stroke^[5]To provide effective preventive measures for the first stroke attack, thereby reducing the incidence and disability rate of stroke in China.

This specification includes the definition, screening (strategies and methods), diagnostic basis and diagnostic principles of cerebral atherosclerosis.

This specification includes the definition, screening (strategies and methods), evaluation basis and evaluation principles of cerebral atherosclerosis.

A 54-year-old male was admitted for "repeated dyspnea for 2 years, limb weakness for 1 1/2 years, aggravated for 1 month." The patient began to experience breathing difficulty during mild activity in April 2011, which could be relieved after rest and was not paid attention to. In October, there was ptosis of both eyelids, accompanied by weakness of the right hand and neck, fatigue and light morning and heavy evening. Mediastinal tumor revealed by PET-CT in December. In March 2012, he was diagnosed with "myasthenia gravis" in the First Affiliated Hospital of Sun Yat-sen University. On April 12th, we underwent "sternal split mediastinal mass resection + pericardial repair + wedge resection of right upper lung". Pathology showed mixed B2/B3 thymoma, invading lung and mediastinum. Postoperative myasthenia crisis, three-line cytopenia (bone marrow cytology examination showed decreased bone marrow hyperplasia, decreased erythroid proportion, biopsy showed low bone marrow hyperplasia, and scattered distribution of granulocyte cells in partial maturity stage was seen), which improved after treatment. In August and September, the patients underwent radiotherapy 27 times in our hospital and Guangzhou Military Region General Hospital, and chemotherapy once in November. At the beginning of March, 2013, he began to have repeated cough and sputum. On April 12th, he developed dysphagia and dyspnea. On April 17th, he underwent tracheal intubation ventilator-assisted breathing. The patient had persistent high fever, chest radiograph showed "double lung infection", sputum culture showed Acinetobacter baumannii infection, and gradually developed septic shock and decreased blood pressure. Norepinephrine was given to maintain at about 70~90/50 mmHg (1 mmHg =0.133 kPa). Blood routine showed that the lowest white blood cell was 2.33×10⁹/L, red blood cells 2.39×10¹²/L, hemoglobin 73 G/L, platelets 44×10⁹/L. Cefoperazone, sulbactam sodium, linezolid, imipenem, cilastatin sodium, piperacillin, tazobactam combined with vancomycin, voriconazole and other anti-infections were given successively, and recombinant human granulocyte colony-stimulating factor and recombinant human thrombopoietin were infused every other day to increase blood cells. The patient was emotionally anxious and could not sleep at all for 21 consecutive days and 24 hours. The use of alprazolam and dexmedetomidine to induce sleep was ineffective. Enteral nutrition suspension (TPF) was given 2 000~2 500 ml nasogastric feeding daily, but the patient was losing weight day by day. On May 13th, he was transferred to this district. After admission, his body temperature fluctuated between 37 and 39 ℃, and his heart rate fluctuated between 100 and 130 beats/min. He continued ventilator-assisted ventilation, and was given norepinephrine 20 mg +5% glucose 50 ml intravenously at a rate of 5 ml/h to maintain the blood pressure fluctuation at 100-130/55-70 mmHg. Loss of weight, coarse breathing sounds in both lungs, a small amount of dry rales and phlegm sounds can be heard in the right lower lung, and no dry and wet rales can be heard in the left lower lung. Heart rate: 108 beats/min, homogeneous rhythm, strong heart sounds, no pathological murmur. Neurological specialist examination: clear consciousness, mental stress, anxiety state, no abnormalities in advanced nerve activity, no drooping of both eyelids, good movement of both eyeballs in all directions, no diplopia, symmetric nasolabial folds on both sides, inability to speak, no choking and dysphagia during drinking water, and extending the tongue in the center. The muscles of the whole body were atrophied uniformly, the muscle tone of the limbs was normal, the muscle strength was grade V, and the fatigue test was positive. No abnormalities were found in the whole body deep and superficial sensory examination; The bilateral limb tendon reflexes were symmetrical and did not elicit pathological reflexes; Negative for meningeal irritation.

Oral anti-hepatitis B virus nucleoside (acid) analogs mainly include nucleoside analogs and nucleotide analogs, the former includes lamivudine, entecavir, telbivudine, etc., and the latter includes adefovir dipivoxil (ADV), tenofovir (TFV), etc. Nucleotide drugs are actively secreted by the renal tubules and excreted from the body after being filtered by the glomeruli, and are easy to accumulate in the proximal renal tubular epithelial cells, thus producing nephrotoxicity^[1,2]。

Anterior cervical decompression surgery is a common surgical method for treating cervical spine diseases. It can effectively treat anterior compression such as intervertebral disc, osteophyte and posterior longitudinal ligament, but various complications may occur after surgery, including dysphagia, abnormal pronunciation, dural rupture, esophageal injury, hematoma formation, vertebral artery hemorrhage, postoperative airway compression, spinal cord injury and bone graft material displacement, among which dysphagia is the most common complication^[1]。 Dysphagia after cervical spine surgery refers to the absence of swallowing discomfort before surgery, but the corresponding symptoms only appear after surgery. The incidence, possible pathogenesis, evaluation methods, prevention and treatment of dysphagia after anterior cervical decompression are reviewed.

The patient, a 74-year-old male, first visited Qingdao Mental Health Center on August 21, 2013 due to nightmares accompanied by violent behavior in dreams for 8 years. Eight years ago, the patient gradually had nightmares at night without obvious triggers, mostly angry or frightened, accompanied by shouting, punching and kicking, etc., sometimes hitting his spouse, and then the patient would wake up, and after waking up, he could recall the dream scene, which would appear 2 to 3 times a month. Once, in a dream, I fought with someone. The patient fell from the bed to the floor. His hands, face and head were injured, and five stitches were stitched at the corner of his mouth. The patient suffered from this, so he went to major general hospitals. Brain CT only showed old cerebral infarction. He had taken traditional Chinese medicine and various drugs to improve cerebrovascular disease (details unknown), but they were ineffective. In the past 2 years, the attacks were more frequent, increasing to 7 to 8 times per month. In order to avoid hurting his spouse and himself, the patient asked his spouse to tie his hands with a cloth belt before going to bed every night, and then switched to a seat belt because he undid the cloth belt by himself in his dream. Three days ago, I unbuckled my seat belt by myself and was woken up by my spouse on my bicycle at home. In order to avoid causing more harm, we consulted our hospital. He has a history of hypertension and gastroptosis for 30 years and a history of coronary heart disease for 20 years. At present, he is treated with valsartan and domperidone, and his condition is under stable control. Personal history: Smoking history for more than 50 years, with an average of 30 cigarettes per day, which has been reduced to 10 cigarettes per day in the past 10 years. He has a history of drinking for more than 50 years, drinking 0.3~0.5 kg of liquor every day, and now he has quit for 7 years. Positive family history denied. CT of the brain showed: cerebral cavity foci, and EEG was normal. Initial diagnosis: sleep disturbance (sleepwalking).