#46
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Óâàæàåìûå êîëëåãè, ñïàñèáî çà èíòåðåñíóþ äèñêóññèþ!
Äàâàéòå ïîäîæäåì äî ïåðâîé ÌÐÒ, ê ñîæàëåíèþ çà íåé íàäî ñúåçäèòü çà 80 êì. ×òî êàñàåòñÿ êëèíèêè, òî â íåé áûëî êîå-÷òî íåòèïè÷íîå äëÿ îáû÷íîãî èøåìè÷åñêîãî èíñóëüòà: ïëåãèÿ â ðóêå áûëà ñ ñàìîãî íà÷àëà, à àôàçèÿ è ïàðåç â íîãå òåêëè âîëíîîáðàçíî -- òî èñ÷åçàëè, òî ïîÿâëÿëèñü, ó ëå÷àùåãî âðà÷à áûëî äàæå ïîäîçðåíèå, ÷òî ýòî èñòåðèÿ, à íå èíñóëüò. ñ óâàæåíèåì, À. Îõîòèí |
#47
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Èç ïîñòà 37:
◦Occasionally venous thrombosis may be mistaken for a psychiatric disorder (neurosis, hysteria, depression) |
#48
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 äàííîì ñëó÷àå ðå÷ü èäåò îá ýíöåôàëîìàëÿöèè íà ôîíå òÿæåëîé æåëåçîäåôèöèòíîé àíåìèè ïî àíàëîãèè ñ ìèåëîìàëÿöèåé, ðàçâèâàþùåéñÿ ïðè ôóíèêóëÿðíîì ìèåëîçå.
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#49
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Íåéðîàíåìè÷åñêèé ñèíäðîì, ïðè êîòîðîì ìîæåò íàáëþäàòüñÿ ïîðàæåíèå ãîëîâíîãî ìîçãà, èçâåñòåí äàâíî, (ßðîø À.À.1985 ã.). Äèàãíîç ýíöåôàëîìèåëîç íà ôîíå àíåìè÷åñêîãî ñèíäðîìà ïîçâîëÿåò îïðåäåëèòü ñîîòâåòñòâóþùóþ ëå÷åáíóþ òàêòèêó â êîíêðåòíîì ñëó÷àå
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#50
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Ññûëêó, ïîæàëóéñòà, äàéòå.
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#51
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#52
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"....Âñå áîëåå ïîâûøàåòñÿ ðîëü îòå÷åñòâåííîé íåâðîëîãèè â ìèðîâîé íåâðîëîãè÷åñêîé íàóêå, ðàñøèðÿåòñÿ ìåæäóíàðîäíîå ñîòðóäíè÷åñòâî â ýòîé îáëàñòè. Îäíèì èç ãëàâíûõ óñëîâèé óñïåõà ñîâåòñêîé íåâðîëîãèè ÿâëÿåòñÿ åå âîîðóæåííîñòü íàó÷íîé ìåòîäîëîãèåé, îñíîâàííîé íà òåîðåòè÷åñêèõ ïîëîæåíèÿõ äèàëåêòè÷åñêîãî è èñòîðè÷åñêîãî ìàòåðèàëèçìà....."
Ñ íåêîòîðûìè ïîñòóëàòàìè, îñîáåííî êàñàþøèìèñÿ ðîëè äèàìàòà è èñòìàòà, ñîãëàñèòüñÿ, ïîæàëóé, ñëîæíîâàòî..... |
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#53
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Çà÷åì ñòó÷àòüñÿ â îòêðûòóþ äâåðü?
Åñëè èñõîäèòü èç îïèñàííûõ êëèíè÷åñêèõ ïðîÿâëåíèé âîëíîîáðàçíîå òå÷åíèå ïðîöåññà, îòñóòñòâèå äàííûõ ïîðàæåíèÿ ñîñóäîâ ïðè ñîíîãðàôèè, ñâèäåòåëüñòâóåò íå â ïîëüçó îñòðûõ èøåìè÷åñêèõ î÷àãîâ, äàííûå ÌÐÒ èñêëþ÷èëè ìåòàñòàçû, ïðè õðîíè÷åñêîé èøåìèè ìîçãà ïî äàííûì ÌÐÒ ìîãóò íàáëþäàòüñÿ ïðèçíàêè ëåéêîàðåîçà, ëàêóíàðíûõ è áîëåå êðóïíûõ èøåìè÷åñêèõ î÷àãîâ, àòðîôè÷åñêèõ êîðêîâûõ ïðîöåññîâ è ïð. îïðåäåëåíèå êëèíè÷åñêîãî äèàãíîçà ïîçâîëÿåò áîëåå îáüåìíî è êîíêðåòíî ïîäîéòè ê ëå÷åíèþ ïàöèåíòà ñ ãëóáîêèì óâàæåíèåì ê Âàì |
#54
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 1985 ãîäó â ÑÑÑÐ ÌÐÒ ïðàêòè÷åñêè íå áûëî è òàêîé äèàãíîç êàê òðîìáîç ñèíóñîâ ïðàêòè÷åñêè íå âåðèôèöèðîâàëñÿ. Ñóäÿ ïî âûïèñêàì òåõ ëåò, èíîãäà äîõîäÿùèõ äî íàñ, ïî÷òè âñå íåïîíÿòíûå íåâðîëîãàì ïðîöåññû â ãîëîâå îáúÿñíÿëèñü "ñëèï÷èâûì àðàõíîèäèòîì", âèäèìî, ïîñëå ïðîâåäåíèÿ ïíåâìîýíöåôàëîãðàôèè. Ñâÿçü àíåìèè è òðîìáîçà ñèíóñîâ áûëà ïîêàçàíà â ïðåäûäóùèõ ñîîáùåíèÿõ. Ñêîðåå âñåãî â 85 ãîäó òðîìáîç ñèíóñîâ è îáçûâàëñÿ ßðîøîì òàèíñòâåííûì è ìíîãîçíà÷èòåëüíûì ñëîâîì "ýíöåôàëîìàëÿöèÿ"
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#55
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Âèäèìî, ïðîâîäèòü äèôôäèàãíîñòèêó ñ ñèíóñòðîìáîçîì íå ñîâñåì öåëåñîîáðàçíî, òàê êàê ïðè ýòîì â îñíîâíîì îòìå÷àåòñÿ èíôåêöèîííûé ñèíäðîì( ïîâûøåíèå òåìïåðàòóðû òåëà, ëåéêîöèòîç è äð.) ìåíèíãåàëüíûé ñèíäðîì, ñèíäðîì âíóòðè÷åðåïíîé ãèïåðòåíçèè, öåðåáðàëüíûé âåíîçíûé çàñòîé, êëèíèêà äîâîëüíî ÿðêàÿ, íåò ñìûñëà ïåðå÷èñëÿòü êëèíèêó ïîðàæåíèÿ êàæäîãî ñèíóñà. èìååò ìåñòî è ñîîòâåòñòâóþùèå ÀÊÒ èëè ÌÐÒ èçìåíåíèÿ, ïðè ýòîì íåíàáëþäàþòñÿ ìíîæåñòâåííûå î÷àãè. Ïî ïîâîäó ñîâðåìåííîñòè äàííîé ññûëêè- òàê àêàäåìèê ÐÀÌÍ ïðîôåññîð ßõíî Í.Í.(2005 ã) îòìå÷àåò, ÷òî äàæå ïðè äåôèöèòå âèò  12 ìîæåò íàáëþäàòüñÿ ðàçâèòèå ýíöåôàëîïàòèè, êîòîðàÿ âûçâàíà ïðåèìóùåñòâåííî ëîêàëüíîé äåìèåëèíèçàöèåé â áåëîì âåùåñòâå ïîëóøàðèé ãîëîâíîãî ìîçãà.
Ñ óâ ê Âàì è Âàøåìó ìíåíèþ |
#56
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Öèòàòà:
Âû íå ñîâñåì âåðíî èçëàãàåòå êëèíèêó ñèíóñ òðîìáîçà íà ôîíå ÆÄÀ - òèïè÷íîå îïèñàíèå (íà àíãëèéñêîì èç îïèñàíèÿ ñëó÷àÿ - âûäåëåíî ìíîé íå ñîîòâåòñòâóåò Âàøåìó îïèñàíèþ): A 55-year-old man with a 2-week history of melena presented with generalized seizures and was admitted to the hospital. His body temperature was 36.5°C and a physical examination revealed left hemiparesis. Laboratory findings revealed the presence of iron deficiency anemia (hemoglobin 8.7 g/dL, hematocrit 29%, serum iron 18 μg/dL, unsaturated iron binding capacity 504 μg/dL, and ferritin 13.3 ng/mL). No data indicated the presence of significant inflammation including the levels of C-reactive protein (1.09 mg/dL), serum protein constituents (albumin 60%, α1-globulin 4%, α2-globulin 13%, β-globulin 14%, γ-globulin 8%), and white blood cell count (4510/mm3). Èç J Stroke Cerebrovasc Dis. 2008 Nov-Dec;17(6):426-8. Cerebral venous thrombosis associated with iron deficiency anemia.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#57
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Öèòàòà:
We describe a young man with cobalamin deficiency presenting with sensorimotor deficits, ataxia, dysarthria, mild cognitive deterioration and altered mood of insidious onset. The MRI brain findings were in keeping with a leucoencephalopathy without evidence of MRI changes in the spinal cord. His response to treatment as well as the marked improvement of the leucoencephalopathy on imaging suggests at least partial reversibility of the neurological deficits. Ir Med J. 2009 Oct;102(9):292-4. A pernicious leucoencephalopathy. --- J Neurol. 2005 Aug;252(8):980-2. Vitamine-B12-deficiency causing isolated and partially reversible leukoencephalopathy. --- J Neurol Sci. 2003 Dec 15;216(1):183-4. Cerebellar ataxia and leukoencephalopathy associated with cobalamin deficiency. ect...
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#58
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Óâ.Âàäèì Âàëåðüåâè÷! Âû ñòàâèòå âîïðîñ î âîçìîæíîñòè ðàçâèòèÿ òðîìáîçà âåí ìîçãà, â òî âðåìÿ êàê Ì. Ì. ñòàâèë âîïðîñ î äèôôäèàãíîñòèêå ñ ñèíóñòðîìáîçîì (ñì. âûøå), à ýòî, êàê ãîâîðÿò â Îäåññå 2 áîëüøèå ðàçíèöû. Ïî-ýòîìó ìû îïèñàëè èìåííî êëàññè÷åñêóþ êëèíèêó ñèíóñòðîìáîçà.
Òåïåðü, ÷òî êàñàåòñÿ òðîìáîçà âåí ìîçãà: ïî-âèäèìîìó, èñõîäÿ èç êëèíè÷åñêîé êàðòèíû è ïðèâåäåííûõ äàííûõ ÌÐÒ Âû èìååòå ââèäó äèôôäèàãíîñòèêó ñ âåíîçíûì èíñóëüòîì, äëÿ ïðîâåäåíèÿ êîòîðîé íåîáõîäèìî ïðîàíàëèçèðîâàòü ñëåäóþùèå äèàãíîñòè÷åñêèå êðèòåðèè-1- æàëîáû, íà ãîëîâíóþ áîëü è ÷óâñòâî òÿæåñòè â ãîëîâå íàðîñòàþùèå â íî÷íîå è óòðåííåå âðåìÿ, 2- áîëåçíåííîñòü òî÷åê âûõîäà âåíîçíûõ ñîñöåâèäíûõ âûïóñêíèêîâ, 3- íà ãë. äíå ðàñøèðåíèå âåí, íàëè÷èå èëè îòñóòñòâèå ÑÏÖÂÑ è ïð. 4- äèàìåòð âåíû Ðîçåíòàëÿ ïî äàííûì ñîíîãðàôèè, 5- íà ÌÐÒ âåíîçíûå èíôàðêòû îïðåäåëÿþòñÿ ïîâûøåííîé ïëîòíîñòüþ êîðòèêàëüíîãî è ñóáêîðòèêàëüíîãî ó÷àñòêîâ ñ èíôèëüòðàöèåé áåëîãî â-âà òðåóãîëüíîé ôîðìû, 6- ïðè íàëè÷èè âîçìîæíîñòè ïðîâåäåíèå ýíöåôàëîàíãèîñöèíòèãðàôè÷åñêèõ èññëåäîâàíèé Ñ óâ ê Âàì |
#59
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Ïðè æåëåçîäåôèöèòíîé àíåìèè áûëè îïèñàíû êàê òðîìáîçû öåðåáðàëüíûõ âåí òàê è òðîìáîçû ñèíóñîâ:
Noninfectious thrombosis of the superior sagittal sinus in a patient with iron deficiency anemia. Stehle G, Buss J, Heene DL. Stroke. 1991 Mar;22(3):414. Cerebral sinus thrombosis in patients with severe iron deficiency anaemia due to myoma uteri. Aoki N, Sakai T. Acta Neurochir (Wien). 1989;97(3-4):131-4. Cerebral venous sinus thrombosis associated with iron deficiency: two case reports. Kinoshita Y, Taniura S, Shishido H, Nojima T, Kamitani H, Watanebe T. Neurol Med Chir (Tokyo). 2006 Dec;46(12):589-93.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#60
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Äà, òàêàÿ ïàòîëîãèÿ èìååò ìåñòî â ìåäèöèíå, â òîæå âðåìÿ ðå÷ü èäåò î êîíêðåòíîì êëèíè÷åñêîì ñëó÷àå, è êîíêðåòíûõ êëèíèêî-ïàðàêëèíè÷åñêèõ êðèòåðèÿõ, ïðè íàëè÷èè êîòîðûõ òîãäà ëèøü ìîæíî ãîâîðèòü î òðîìáîçå âåí ìîçãà èëè ñèíóñ òðîìáîçå.
Âàæíî â òàêèõ ñëó÷àÿõ íå âûïëåñíóòü ðåáåíêà, Ñ óâ. ê Âàì |