英语神经外科病例及英汉神经外科词汇

英语神经外科病例及英汉神经外科词汇Case4:PosteriorfossasubduralhematomainneonateThisnewbornfemalewasbornatagestationalageof40weeks,weighing3780,toagravida2para1mother.Forcepswereappliedtothefetalheadforfailuretoprogress.Apgarscoreswere6and9.withinthe1stdayoflife,thebabywasobservedtobelistlessandlethargicandtohaveapoorsuck.Theanteriorfontanellewastense.Seizuresdeveloped.Endotrachealintubationandventilationwererequiredforbradycardiaandapneicepisodes.Thehemogramwasnormal.Alumbarpuncturewasperformedtoruleoutcentralnervoussystemsepsis,andbloodycerebrospinalfluidwasobtained.CTwasthenperformed,andalargePFSDHwasobservedinadditiontomoderateventriculomegaly.Aneurosurgicalconsultationwasobtained.Theneonatewasquadriplegiconaventilator,makingonlytheoccasionalrespiratoryeffort.Theneonatewastakenurgentlytosurgery,andaposteriorfossacraniectomywasperformed.Theclotcouldberemovedfromtheposteriorfossasubduralspace.Thebleedingsiteswereidentifiedandsuccessfullycoagulated.Theinfantdidnotrequireanexternalventriculardrainnordidshegoontodevelopprogressivehydrocephalus.Shebegantobreathereadilyaftertheposteriorfossadecompressionandclotevacuationn.Shewasweanedfromtheventilatorwithin4days.SubsequentCTshowedminimalleftcerebellarparenchymainvolvementwithcalcificationandvolumeloss.Theventriculomegalyhadresolvedcompletely.At4yearsofaged,thecildwalkedandtalkednormally.Arightesotropiaremainedthathadpersistedsincesurgery.新生儿后颅窝硬膜下血肿一位妊娠两次生育一胎的母亲，在怀孕四十周后生下了一个重3780克的女婴，在胎头娩出不顺利时应用了产钳，Apgar评分为6和9。在生后的第一天，她吮吸较差并且嗜睡，精神萎靡，前囟门张力较高，抓握反射存在，由于心率过缓窒息，不得不应用气管插管通气，血象正常。为了除外小儿中枢系统脓毒症，进行了腰穿检查，可见血性脑脊液，行头CT检查显示患儿后颅窝硬膜下血肿，并且有轻微的脑室扩大，请神经外科会诊。患儿四肢瘫，并且应用呼吸机辅助呼吸。患儿被快速送到神经外科，实行后颅窝开颅手术，血块被从后颅窝硬膜下清除，出血点被找出并且确切止血。患儿没有放置外引流，也未检出进展性脑水肿。在后颅窝血肿清除，压迫解除后，她恢复呼吸。四天后她脱离了呼吸机。复查CT可见左侧小脑实质小片钙化，体积缩小。脑室回复正常。小孩四岁时，可以正常走路说话，但在外科手术后就出现的内斜视仍然存在。Case5AstrocytomaoffrontallobeThepatientwasa48-year-oldmalewhopresentedwithcomplaintsofincreasinglysevereheadaches.Workupatanotherhospitalrevealedalucentleftfrontallesion.ThebiopsydiagnosiswasgradeⅢastrocytoma.Hewasreferredtoourhopsitalafterexternalradiationtherapywasdelivered.Neurologicalexamrevealedmildbradykinesia,butwasotherwiseunremarkable.Hewasadmittedandunderwentaleftfrontallobectomy,withgrosstotaltumorresection.Onemonthlaterheunderwentstereotacticimplantationofbrachytherapycatheters.Hereceived6000radstothemarginofthetumorcavity.Subsequentscansrevealedprogressivelyworseningenhancement,edema,andshiftaroundthetumorcavity.Reoperationwasundertakenwithresectionofallgrosslyabnormaltissue.Pathologicanalysisrevealedradiationnecrosisandtumor.Thepatientisalive5yearslater,withnoevidenceofdiseaseprogression.额叶星形细胞瘤一男性患者，48岁，自诉进行性剧烈头痛数日，在某医院检查示有左额叶高亮度损害，活组织检查诊断为三级星形细胞瘤，在外院应用放疗后，被送入我院。神经系统检查，表明有轻微的运动过缓，但并不明显。入院后行肿瘤全切及左额叶切除术。一个月后，他接受了立体定向导管穿刺移植治疗，在肿瘤腔的边缘吸收6000拉德进行照射，随后CT扫描显示有进行性的瘤腔扩大，周围水肿，并伴有瘤腔移位，再次手术全切了异常组织，病理分析回报，这些异常组织包括放疗后的坏死组织和肿瘤细胞。患者出院后5年，随访无明显的疾病进行性发展的迹象。Case6GlioblastomamultiformeoffrontallobeAhealthy9-year-oldwomanpresentedwitha3-monthhistoryofdysphasia.Computedtomographydemonstratedaringenhancinglesionintherightfrontallobe.Shewasnotimmunosuppessedoronsteroids.TherimwasT2hypointenseandT1hyperintense.Therewasasmallamountofsurroundingedema.Brainabscesswasconsideredinthedifferentialdiagnosis,butatumorwasbelievedmorelikely,because:⑴therewaseaneccentricareaofcapsularthickening,⑵edemawasminimal,and⑶theclinicalcaursewaslong.Atoperation,glioblastomamultiformewasencountered.SubstanceswithunpairedelectronsexhibitanunusualcombinationofincreasedT1signalanddecreasedT2signaltermedparamagnetism.Methemoglobin,melanin,andgadoliniumarefamiliarparamagneticsubstances.Inanabscesscapsule,paramagneticchangesoccurbecausemacrophagesreleasefree-radicalsthatcontainunpairedelectorns.Althoughuncommon,cliniciansshouldbeawarethatparamagneticrimsignalmayalsobeobservedinmetastasis,primarybraintumors,granulomasliketuberculosis,andinlargedemyelinatingplaques.额叶多形胶母细胞瘤一6岁女孩有3个月的言语困难病史，CT检查显示在右侧额叶有一环形增强的损害，她没有免疫抑制也没有应用过类固醇，此损害的边缘在MRIT2像为低信号，T1像为高信号，周围有轻微水肿，此病灶可能为肿瘤，但应除外脑脓肿，考虑肿瘤是因为（1）有囊性增厚的反常区域（2）水肿轻微（3）临床病程长手术时，看到了多形胶母细胞瘤。带有不成对电子的物质常有T1高信号，T2低信号相结合的特殊表现，这也叫顺磁性。正铁血红蛋白，黑色素，钆是常见的顺磁性的物质。在脓肿囊内，常会有顺磁性的表现，因为巨噬细胞释放放射物质中就包括不成对电子。虽然这不常见，但临床医生们应该意识到，顺磁性的环形信号，可以在转移瘤，脑原发肿瘤，结核性肉芽肿和大的脱髓鞘斑块中出现。Case7:glioblastomamultiformelocatednearmotorcortexHistoryPatientA.Lisa23-year-oldrighthandedmanfromHebeiwhoworksasapainterandhashadnocturnalseizuresforapproximatelytwoyears.InJanuarytheseizuresincreaseinfrequencyandbegantooccurduringtheday.Theyareassociatedwithturningoftheheadandshoulderstotherightpriortogeneralization.Thepatientisconfusedandfatiguedafterwards,butdoesnothaveaneurologicdeficit.AscanwasdoneinFebruaryandthisdemonstratesanareaofnonenhancementintheposteriorportionofthesuperiorfrontalconvolution,withasmallcontrastenhancingareainthecenterofthelesion.Thelatterapproximately3mm,theformermeasuresapproximately3.5cm.Thescanwasrepeatedrecentlyanditappearedthatthelesionhadgrownslightly.Stereotacticbiopsywasrecommended.ThepatientinfactwasscheduledforabiopsyinHebeibuttheydecidedtoseekanotheropinion.ThepatientispresentlyonDilan