周围神经病华山医院神经内科.ppt
周围神经病,华山医院神经内科卢家红,概述,组成（颅神经、脊神经）神经元结构,神经干神经束神经纤维神经外膜神经束膜神经内膜,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,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,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,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,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.,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,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（、）植物神经（心率、血压、皮肤营养、括约肌）病程,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,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,面神经炎Bell palsy,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）,鉴别诊断格林巴利糖尿病性腮腺病变等后颅窝病变治疗,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,鉴别诊断牙痛舌咽神经痛继发性治疗药物射频阻滞手术,坐骨神经痛sciatica,L4-S2,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,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 sign（干性明显）体征,
