周围神经病华山医院神经内科.pptxVIP

周围神经病华山医院神经内科卢家红第1页，共20页。概述组成（颅神经、脊神经）神经元结构第2页，共20页。神经干神经束神经纤维神经外膜神经束膜神经内膜第3页，共20页。周围神经的变性Wallerian degeneration，瓦勒变性，沃勒变性 dying back neuropathy，逆行死亡性神经病axonal degeneration，轴突变性segmental demyelination，节段性脱髓鞘第4页，共20页。神经病（neuropathy）、神经炎（neuritis）、神经痛（neuralgia）周围神经病分类：病程突出症状临床常用分类（部位）对称性多发性神经病单神经病或多数性单神经病第5页，共20页。多发性神经病（炎）polyneuropathy病因感染代谢及内分泌障碍营养障碍药物及毒物感染后结缔组织病遗传癌性及不明原因第6页，共20页。共同临床表现感觉、运动、植物神经多同时受累多为四肢远端对称性第7页，共20页。格林巴利综合征Guillain Barre syndrome Guillain-Barre syndrome is a disorder in which the bodys immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances the weakness and abnormal sensations spread to the arms and upper body. When severe, the patient is almost totally paralyzed. In these cases the disorder is life threatening-potentially interfering with breathing. Such a patient is often put on a respirator to assist with breathing. Most patients, however, recover from even the most severe cases of Guillain-Barre syndrome, although some continue to have a certain degree of weakness. 第8页，共20页。病因 感染后自身免疫病病理 神经根、周围神经 脊神经、颅神经 节段性脱髓鞘、轴索变性第9页，共20页。临床表现年龄（可发生于任何年龄，儿童、老年人）性别（无明显差异）前驱感染首发症状（下肢无力、四肢远端麻木）运动（无力、反射↓、病理征-）感觉（较运动障碍轻）颅神经（Ⅶ、Ⅸ、Ⅹ、Ⅲ、Ⅵ、Ⅻ、Ⅴ）植物神经（心率、血压、皮肤营养、括约肌）病程第10页，共20页。实验室检查电生理 神经传导速度减慢脑脊液 蛋白细胞分离第11页，共20页。诊断、鉴别诊断急性脊髓炎重症肌无力脊髓灰质炎周期性麻痹治疗静脉丙球、血浆交换激素呼吸机第12页，共20页。面神经炎Bell palsy第13页，共20页。病因（茎乳孔）临床表现Facial nerve paralysis: SignsFacial asymmetry Eyebrow droop Loss of forehead d nasolabial folds Drooping of corner of mouth Uncontrolled tearing Inability to close eye Lips cannot be held tightly together: Difficulty keeping food in mouth Facial muscle atrophy （Late）第14页，共20页。鉴别诊断格林巴利糖尿病性腮腺病变等后颅窝病变治疗第15页，共20页。三叉神经痛trigeminal neuralgia病因 原发性 继发性临床特征（原发性）部位疼痛特点触发点无明显阳性体征第16页，共20页。鉴别诊断牙痛舌咽神经痛继发性治疗药物射频阻滞手术第17页，共20页。坐骨神经痛sciaticaL4-S2第18页，共20页。病因（原发性、继发性） 继发性根性 腰椎间盘突出、椎管狭窄、蛛网膜炎、椎管内肿瘤干性 骶髂关节、髋关节、盆腔、注射第19页，共20页。临床表现腰背痛（根性）沿路疼痛（干性明显）咳嗽、排便加剧脊柱侧弯Lasegue