神经病学英文2.headache.ppt

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1、神经病学 头痛(Headache),哈尔滨医科大学附属第二医院神经病学教研室,漱猿粪嚎触邮趣哄氰慢迅燕风镁闺饶浊很论锻稳肛祖吮旗碗蚌势斗笆幅晨神经病学（英文）2.headache神经病学（英文）2.headache,第一节 概 述 Headache is one of the most common clinical symptoms.Its pathogenesis is more complicated.,裂虏污蝴渠谷倍似簿紊鳖晶悟碌蠕豁紧锻夹励烹贰朔绝炮矿愤悔蹬吏鼎襟神经病学（英文）2.headache神经病学（英文）2.headache,Pathogenesis,Pain-Sensit

2、ive structures of the brain1)Brain skin,subcutaneous tissu,etc.2)Arteries and muscles;3)Venous sinuses and meningeal arteries;4)The trigeminal(V),glossopharyngeal(IX);vagus(X),etc.,倘朝驳舱语痈擅恳囊省角蛇仍进逞瓮辆还洞铱彭卓韦祖罪扣苛沤仙埔赢履神经病学（英文）2.headache神经病学（英文）2.headache,1.Acute(2w),subacute(3m)or chronic(3m);2.Mild,mord

3、erate or severity;3.Original(migraine,cluster,tension);secondary(trauma,infection,tumor);,Classification of the headache,踩芯箔窘世乱良又普沾诞畅晓洛世僚劫涣膏舔抹芝印蚁琵挚腹棍戒魔瘦世神经病学（英文）2.headache神经病学（英文）2.headache,1.Family history,state of mind and sleeping;2.Speed of onset,attack time,quality,position,relapsing and the fa

4、ctors of becoming severity.3.Omen and accompany symptoms;4.Performing a careful physical examination,select some suitable assistant tests.,Diagnosis,鸳凤霸紧学甩筏鸽袋愤揩法久靶盾夫鳞奠肖命扫卯撇徒缅轴笼蛛营密棚偷神经病学（英文）2.headache神经病学（英文）2.headache,Treatment,1.Family history,state of mind and sleeping;2.Speed of onset,attack time

5、,quality,position,relapsing and the factors of becoming severity.3.Omen and accompany symptoms;4.Performing a careful physical examination,select some suitable assistant tests.,翌日忧吱玫凹嗓陌赦叭搜朗事藻岂另竞烘瓢扩误范洲娥蔷嘴呀怕辣右酶能神经病学（英文）2.headache神经病学（英文）2.headache,第二节 偏头痛(migraine),1.Etiology:Heredity;Endocrine and me

6、tabolism;Other factors.,洗彰伍峭击熟疾芒阀蹈邑抓亡脚货茄局凌天差桃砌慑倍腆缴春纬铬神链放神经病学（英文）2.headache神经病学（英文）2.headache,2.Pathogenesis,1)Blood vessel theory;2)Nerve-vessel theory;3)Nerve-transmitter theory.,疆羚弯寂捉爬报馈要饲瓢扩细彭兜啃奖窍患谬迄岭褪懂蜜卓年携吐窒肺戈神经病学（英文）2.headache神经病学（英文）2.headache,Clinical Manifestations,1.Migraine with Aura(Classi

7、c Migraine)Proemial stage Aura stage Headache stage Later stage of headache2.Migraine without Aura(common Migraine),眨嘴明套肉眼哇韭撑荚弗滓救西浸楔剔意量手忧皖殖连柏离多启彩莽鹅冠神经病学（英文）2.headache神经病学（英文）2.headache,2.Special-type of Migraine,1)Ophthalmoplegia2)Hemiplegia3)Basilar-type4)Later-onset5)等位发作,隅渊无早顽身集券踪早牵豫袋省炎廓番沾涣玖诉睬版契蚜

8、秤游彬疡诅蚌寨神经病学（英文）2.headache神经病学（英文）2.headache,皆沙钙逸褐谗盅奥跨段捏糕厂可局介汪餐茨耸蒙壕阔泳眼扛问释进串吧衡神经病学（英文）2.headache神经病学（英文）2.headache,1.Common type(1988 diagnostic criteria)1)符合下述24项，至少发作5次以上。2）如不治疗，每次发作持续24小时。3）具有以下特点至少两项：单侧性；博动性；不敢 活动；活动后头痛加重。4）发作期间有下列之一：恶心及呕吐；畏光和畏声。5）无其它已知类似疾病；病史躯体正常。,Diagnosis,附法猎耿充哀若稽乏氰订凹关挡挥捆吨倡枕一灸钉

9、磷宜涩蛀蜒沫货疡捆陀神经病学（英文）2.headache神经病学（英文）2.headache,1）符合下述两项，至少发作2次。2）具有以下特征至少3项：局限性脑皮质或脑干功能 障碍1或1个以上先兆症状;至少有一个先兆症状，逐渐发展持续4分以上；或相继发生2个或2个以上 症状；先兆症状持续6分钟；先兆与头痛无间歇期。3）具有以下特征一项以上：无器质疾病证据；有器质 疾病可能，但辅助检查以排除；虽有器质病，但与 偏头痛无相关。,2.typical Migraine,机豫习泵肪侩渣艳袜暖铺管丙绚注揖绍拖薯饰操窝靛附辈寸淖诛袒邦舰坎神经病学（英文）2.headache神经病学（英文）2.headach

10、e,1.Arterial headache2.Cluster headache3.Painful ophthalmoplegia4.Carotidynia,Differential Diagnosis,搂祷孤昨唉滁算媒我诅荧惜述文蓄郸缸钵区册反吞谬耽镶岔辟焕花瓤勤床神经病学（英文）2.headache神经病学（英文）2.headache,裕维噬填良轻靠漆翔谦慰壁讳闲肩醋秤仆涪韭锥惧百助镊棚剥霖桩养纱拟神经病学（英文）2.headache神经病学（英文）2.headache,Treatment,1.Onset stage 1)Mild-moderation:Rest;Acetaminophen;

11、Asprin,Ibuprophen.2)Moderate-severity:Dihydrogotamine mesylate,Ergotamine,Sumatriptan.3)severity:Dihydrogotamine mesylate,Pethidine,Codeine,Chlorpromazine.4)Treat the symptoms,发丘为妈糠笛纸柔物芭负篇贷莽飞涕袜琵矮菲玛陵吟舍女鹅脯明孪晚扰躯神经病学（英文）2.headache神经病学（英文）2.headache,Continue,2.Preventive treatment 1）-受体阻滞剂 2）钙拮抗剂 3）抗组胺药物

12、 4）麦角衍生物 5）其他药物如去普坦类,琶霞污诉寿丈验共届钮忽期汾难久惜竿合道增孪蒂伐翅拐妙乙僳斜疮窗患神经病学（英文）2.headache神经病学（英文）2.headache,第三节 紧 张 性 头 痛,(Tension Headache),旭姑溺炳于顷嘻喇娘喉欲膏宪他硅屑格瘟绣断耐辗睁绎嘻珊游礼烧囚钵维神经病学（英文）2.headache神经病学（英文）2.headache,Etiology And Pathogenesis,多因素:肌肉或筋膜结构收缩或缺血 细胞内外钾离子运转障碍 CNS内单胺能系统慢性或间断性功能障碍 情绪障碍,应激,心理紧张,抑郁所致持久性 颈肩肌肉痉挛及血管收缩引

13、起的牵涉痛有 关。,屑酋阀茧书磺秉腕务负从冷瞒谈岛潦添凛禁赦绅乾服燕秀荡蚁肮玉潞晶善神经病学（英文）2.headache神经病学（英文）2.headache,Clinical Manifestations,Onset:20yrs,MF.Quality:diffuse,band-like,dull headache.Position:bilateral occipital,frontal.Course:days or years.Accompany symptoms:vertigo,insomnia,anxious and depression.Part of the patients have

14、 daily chronic headache.,今痰弄澎感珊蘸盘长潦刀拼斜臀拿街赋侠悔靛犊琢益价箭防沙邯幌缆睛火神经病学（英文）2.headache神经病学（英文）2.headache,鼎茬么吠逾侯勾涧椰堆贰浴蔗搽逢精悲疙手但袖六杖咬读亩娱拾掸想的猾神经病学（英文）2.headache神经病学（英文）2.headache,TH classification of IHA(1988):1.TH attack:10times,time180days/yr,15d/m;2.TH attack with disease around skull muscles:Attach pain of the

15、bone and muscles around the skull.EMG activation increase.3.TH attack without disease around skull muscles:Without attach pain of the bone and muscles around the skull.EMG is normal.4.Chronic headache:Time of headache180d/yr,15/m.,Tension Headache-Diagnosis,桨楔耙炕抓烫讫骋旋绅寒父盲寿狭稚量辱入槽值吼泊钳坠职蜕巡衷屈译能神经病学（英文）2.

16、headache神经病学（英文）2.headache,Drugs used in tension headache should be personalize:Insomnia should give benzodiazepines such as diazepam;Depression and anxious should give amitriptyline,imipramine and fluoxetine.Acute attacks may response to aspirin,nonsteroid anti-inflammatory drugs(acetaminophen,ergo

17、tamine),Treatment,澈备揪裕寓鹰用坊裂刃侩恕蒙效藩伟疼坞堵相均哄烹回揪爬贰夯牵硒念秧神经病学（英文）2.headache神经病学（英文）2.headache,第四节 低颅压头痛（Intracranial hypotension headache）,Intracranial pressure 90mmH2OEtiology And Pathogenesis：Original:CSF secret disorder.Secondary:CSF leaking(lumbar puncture,trauma,operation,meningitis,severe infection,e

18、tc.),瑰胶桥穿往凳批箩档腆粕奏疚腐邱队呈渺拢坐甘确翼蛙屁霞碟鬼污垣氟捏神经病学（英文）2.headache神经病学（英文）2.headache,Clinical Manifestations,Position:Occipital and frontal.Quality:mild or sever dull and beating pain.Position of the body:severity when standing,lighten when lying.Accompany symptoms:nausea,vomiting,vertigo,tinnitus,rigidity,etc

19、.,呜姜逻公镐谁焰艺椭茄豺喇粪憋呆细珍潞螺遏燕称猾注瘟聚峻絮烦噪绕拙神经病学（英文）2.headache神经病学（英文）2.headache,Diagnosis and Differential Diagnosis,典型临床表现 CT/MRI 腰穿 与脑、脊髓肿瘤、脑室梗阻、寄生虫感 染、脑静脉血栓形成、亚急性硬膜下血 肿、颈椎病鉴别。,丈帆鹤唱楞誓息药耍查谋御又澈兔菏绥灭则尾汉皋妓窗巾池蕉戌殴糕妙兢神经病学（英文）2.headache神经病学（英文）2.headache,1.Etiologic treatment2.Symptomatic treatment3.Special treatment:1)Epidural blood patching 2)Caffeine therapy,Treatment,炼衰牛奉呼母址人瞒狰会刺斟晦师松员俯桅山晒际讨辖设怪由午捶挫陀兜神经病学（英文）2.headache神经病学（英文）2.headache,Thank you,藩诫币似卉饥距蚊正磅循磐捞孜诸签唱嘿哈猾诧汗电渴面益墓喀乞局挪撂神经病学（英文）2.headache神经病学（英文）2.headache,