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NEJM：正常压力脑积水脑室-腹腔分流术治疗-病例报道

2017-12-28 xing.T MedSci原创

正常压力脑积水脑室-腹腔分流术
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正常压力脑积水典型表现为尿失禁、步态障碍和痴呆。脑脊液分流术是主要的治疗方法。

患者为一名70岁的妇女，因步态障碍、认知障碍和尿失禁病史2年而到神经内科门诊就诊。

检查发现患者迷你精神状态检查（MMSE）评分为12（范围为0至30，分数越高代表状态越好）以及短的阶梯型、狭长型的非共济失调步态。病人在31秒内走了7.6米。磁共振成像显示脑室的膨胀，Evan’s比率（侧脑前角的宽度[该患者为45mm]与头颅的内径（122mm]）为0.37（正常范围的上限为0.31）（如图A所示）。胼胝体角（图B中白色箭头所示）-该角（白色轮廓）为垂直于前和后连合间直线的冠状面上在后连合（黑色箭头）水平上测量到的侧脑室之间夹角小于90度（参考范围为100到120）。腰椎穿刺显示正常的开放压力，与正常压力脑积水相一致。



正常压力脑积水典型表现为尿失禁、步态障碍和痴呆。脑脊液分流术是主要的治疗方法。

该患者接受了侧脑室腹腔分流术，1个月和6个月后该患者步态明显改善；放置分流装置6个月后，该患者在6秒内走了7.6米。MMSE评分在1个月后增加到20分，尿失禁症状消失，在6个月后增加到28分。

原始出处：

Mahmoud A. AbdelRazek,et al. Ventriculoperitoneal-Shunt Placement for Normal-Pressure Hydrocephalus. N Engl J Med 2017; http://www.nejm.org/doi/full/10.1056/NEJMicm1701226

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    2017-12-29 tongyongming

    #脑积水#

    0

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    2017-12-29 hb2008ye

    #脑室-腹腔分流术#

    0

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    2017-12-29 tastas

    #脑室#

    0

  4. 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    2017-12-28 三生有幸9135

    学习一下谢谢分享

    0

  5. 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    2017-12-28 137****9095

    henhao

    0

  6. 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    2017-12-28 邓启付

    为什么脑脊液压力会形成脑积水?

    0

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beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Dec 28 08:46:39 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273155, encodeId=3ae12e3155fb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Dec 28 08:38:38 CST 2017, time=2017-12-28, status=1, ipAttribution=), 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    2017-12-28 Y—xianghai

    学习了新知识

    0

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beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Dec 28 08:46:39 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273155, encodeId=3ae12e3155fb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Dec 28 08:38:38 CST 2017, time=2017-12-28, status=1, ipAttribution=), 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    2017-12-28 龙胆草

    学习谢谢分享

    0

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beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Dec 28 08:46:39 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273155, encodeId=3ae12e3155fb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Dec 28 08:38:38 CST 2017, time=2017-12-28, status=1, ipAttribution=), 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    2017-12-28 明月清辉

    谢谢分享.学习了

    0

  10. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Dec 28 08:46:39 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273155, encodeId=3ae12e3155fb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Dec 28 08:38:38 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273144, encodeId=6fed2e314479, content=谢谢了.学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30331616752, createdName=txqjm, createdTime=Thu Dec 28 07:49:13 CST 2017, time=2017-12-28, status=1, ipAttribution=)]
    2017-12-28 txqjm

    谢谢了.学习

    0

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