抽搐与惊厥精品课件

抽搐与惊厥 Tic & Convulsion 新华医院神经内科 1 定义 抽搐：成群骨骼肌非自主抽动或强 烈收缩，常引起关节运动与强直。 惊厥：肌群收缩表现为强直性与阵 挛性，多为全身性与对称性 2 强直性与阵挛性 3 抽搐、惊厥、癫痫 4 病 因 Etiology n特发性 Idiopathic n症状性 Symptomatic 5 特发性 Idiopathic 先天脑部不稳定所致 6 症状性 Symptomatic n脑部疾病 Cerebral disorders n全身性疾病 Systemic disorders n神经官能症 Psychiatric disorders 7 脑部疾病 Cerebral disorders n感染 n外伤 n肿瘤 n脑血管病 n寄生虫病 n其他 8 全身性疾病 Systemic disorders n感染 n中毒 内源性 外源性 n心血管疾病 n代谢障碍 n风湿病 n撤药 n其他 9 发生机制 运动神经元异常放电 10 发病机制 运动神经元异常放电运动神经元异常放电 膜电位不稳定引起膜电位不稳定引起 多种因素相关多种因素相关 11 发生机制 运动神经元异常放电 膜电位不稳定引起 多种因素相关 12 发生机制 根据兴奋信号来源不同可分为： n大脑功能障碍 n非大脑功能障碍 13 临床表现 n全身性抽搐 generalized seizures n局限性抽搐 partial seizures 14 全身性抽搐 n以全身性骨骼肌痉挛为主要表现 n典型：癫痫大发作(grand mal) 15 癫痫大发作 n突发意识丧失 n眼球向上，瞳孔散大，对光反应消失 n先全身强直继而阵挛性抽搐 n呼吸肌强直收缩，可出现呼吸暂停 n可有尿便失控 16 癫痫大发作 17 局限性抽搐 n以身体某一局部连续性肌肉收缩为主要 表现 n常见部位：口角，眼睑，手足等 18 局限性抽搐 19 手足搐搦症 tetany n手部最典型“助产士”手 手指伸直并齐 掌指关节屈曲 大拇指对掌内收 腕部屈曲 20 伴随症状 n发热: 小儿的急性感染 n血压增高:高血压病、肾炎、子痫 n脑膜刺激征: 脑膜炎、 蛛网膜下腔出血 n瞳孔扩大与舌咬伤-癫痫与癔症鉴别 n头痛:颅内占位性病变、 急性感染 n意识障碍:癫痫大发作、重症颅脑疾病 21 问诊要点 n发病年龄、病程 n发作的诱因、持续时间 n抽搐是全身性还是局限性 n意识状态 n有无大小便失禁、舌咬伤 n相关病史 n出生史、生长发育异常史 22 本课要点 n抽搐与惊厥的定义 n病因可分为特发性与症状性 n两种常见的临床表现：全身性和局限性 n伴随症状 23 $A8Qp)FdVt1Ji#y6Om&DbTr+HfYw4Mk$A8Rp)FdVt2Ki#y6On*DbTr+HgYw4Mk$B9Rp)FdWu2Ki#y6Pn*DbTr0IgYw4Ml%B9Rp)GeWu2Ki#z7Pn*DbUs0IgYw5Nl%B9Rp-GeWu2Kj!z7Pn*EcUs0IgYx5Nl%B9Sq-GeWu3Lj!z7Pn(EcUs0IhZx5Nl%CaSq-GeWv3Lj!z7Qo(EcUs1JhZx5Nm&CaSq-GfXv3Lj!A8Qo(EcVt1JhZx5Om&CaSq+HfXv3Lk$A8Qo(EdVt1JhZy6Om&CaTr+HfXv3Mk$A8Qo)FdVt1Ji#y6Om&DbTr+HfXw4Mk$A8Rp)FdVt2Ki#y6Om*DbTr+HgYw4Mk$B9Rp)FdVu2Ki#y6Pn*DbTr0IgYw4Mk%B9Rp)FeWu2Ki#z7Pn*DbTs0IgYw4Nl%B9Rp- GeWu2Kj!z7Pn*DcUs0IgYx5Nl%B9Sq-GeWu2Lj!z7Pn(EcUs0IhZx5Nl%BaSq-GeWv3Lj!z7Qo(EcUs0JhZx5Nl&CaSq-GfXv3Lj!z8Qo(EcUt1JhZx5Om&CaSq+HfXv3Lj$A8Qo(EdVt1JhZy6Om&CaSr+HfXv3Mk$A8Qo)FdVt1Jh#y6Om&CbTr+HfXw4Mk$A8Qp)FdVt1Ki#y6Om*DbTr+HgYw4Mk$A9Rp)FdVu2Ki#y6Pn*DbTr+IgYw4Mk%B9Rp)FeWu2Ki#y7Pn*DbTs0IgYw4Nl%B9Rp)GeWu2Ki!z7Pn*DcUs0IgYw5Nl%B9Rq-GeWu2Lj!z7Pn(EcUs0IgZx5Nl%BaSq-GeWv3Lj!z7Po(EcUs0JhZx5Nl&CaSq- 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