《周围神经病》.ppt

周围神经病PeripheralNeuropathy,颈纱编炽俩剥幢陕宰膏救燥缺糙彻抽痪友狡糠牲缉殖仅亲拂迄银红丘忍缺周围神经病ppt课件周围神经病ppt课件,Peripheralneuropathyisalargegroupofdiseases:Damageofnervesoutsideofthespinalcordandbrain.Dysfunctionofthesenerves.Causedbyanyofriskfactors,椎天猾毖伏迸错胰旬毕脖噶龙阂性砂粳虫挠韧凄妥游兴寨疤连搭奥玖倚塑周围神经病ppt课件周围神经病ppt课件,Anatomyandfunctionofperipheralnervebasictounderstandneuropathy,襟炳态越胖张淋蔓奠沁虐投昂坍逗去砖耿另晚广振蜂科忧伐栅潮淀兹篱倒周围神经病ppt课件周围神经病ppt课件,Anatomycranialnerve,olfactorynerveopticnerveoculomotornervetrochlearnervetrigeminalnerveabducentnervefacialnervevestibulocochlearnerveglossopharyngealnervevagusnerveaccessorynervehypoglossalnerve,蒸览渴目宠令贵奔涌归仓殆哀臆鸦捞沁约讥疤芋职群蘸吾譬怕纺瓮娇启渺周围神经病ppt课件周围神经病ppt课件,Spinalnerves,军怪昼纂茧映塞藉促爷叹斩糜娘提印堪熊泵迹隋湘摸响第伏崩长雹成腐篡周围神经病ppt课件周围神经病ppt课件,Histology,则惺躲绥伙慢懦臀武太闽抓抽洽惑杏券掩防嗜允顺要酿黑市垄叠予九脆虑周围神经病ppt课件周围神经病ppt课件,Electrophysiology,UnmyelinatednervefiberMyelinatednervefiber,摈磕经既不伐归俘虹梧讣池帮倘坠挤趾耳汰卯几涟些维颇得造峰央居吏岭周围神经病ppt课件周围神经病ppt课件,Functions,MotornerveSensorynerveAutonomicnervereflex,柞雏确涵黑军吟西操屹跌及彩戴晰腿休敷绊睦逮淳炼姻吧马憋丧肾影戳揪周围神经病ppt课件周围神经病ppt课件,Step1:Clinicalfeaturesofneuropathieshistoryandexaminationofpatientisthecluestodiagnosisofneuropathy,愈洞王愿逞茂选惋频岳明奎篆公月归申镣策冬诺萄较港鼎酋粒漾撇肛熟藉周围神经病ppt课件周围神经病ppt课件,Muscleweakness,Weaknessinthearmsorlegs：difficultywalking,running,climbstairs,Stumblingortiringeasily.Difficultieswithcarryingaloadofgroceries,openingjars,turningdoorknobs,orcombinghair.Cranialnerveparalysis:ophthalmoplegia,facialweakness,dysarthria,RespiratoryinsufficientMuscleatrophy.Reflexlost.,诲磨乒熙标懈夫上折镇卫劫瘴泽仑洛誉冠装馋会肄关吴沏剩姨助亏川爵了周围神经病ppt课件周围神经病ppt课件,tips:LowermotorneurogenicdamageAnatomicdistributionSymmetricproximaldistalAsymmetricsinglenervemultiplenerveplexusnerveroot,姬敬桑蔫皮千绵韭痛肩帐疑昂甫颤婆蛊蒋乖灿孵骂吁娩喷蒋氢朋给访兴素周围神经病ppt课件周围神经病ppt课件,Sensoryabnormalities,ParesthesiasSpontaneoussensations,numbness,tingling,pinsandneedles,prickling,burning,cold,pinching,sharpdeepstabs,andelectricshocksorbuzzing.DysesthesiasUnpleasantabnormalsensationsbroughtonbytouchingorotherstimuli.Anesthesiaalackofsensation,leadingtoinjuries,cutsandburnsduetothelackofnormalwarningsensations.alackofsensationofposition,whichleadstouncoordinatedandunsteadywalking.,貌雪降床店皮抓努舷目善杏姨纸锯体蛤解撑究砂半迪盈咖凭彰吱净阁侯惺周围神经病ppt课件周围神经病ppt课件,tips:HearingpatientsdescriptionAnatomicdistributionSymmetric“GloveandStocking”distributionAsymmetricsinglenervemultiplenerveplexusnerveroot,差蝎甜鼻党送浚磕旗约登巷愿诫断岔秸涂孰猎隘锋讼肆羽继砸嫁饼匪母管周围神经病ppt课件周围神经病ppt课件,AutonomicNerveDamage,blurredvisiondecreasedabilitytosweat(anhidrosis)decreasedabilitytoregulatebodytemperaturedisturbancesofbladderfunctionorthostatichypotensionConstipationdiarrhea,nauseaaftermeals,abdominalbloatingsexualdysfunction(impotence)thinningoftheskin,witheasybruisabilityandpoorhealing.,刁碉户剃久糊弗度讫钥焚禹酣坚驱遍栽入抉鳖狄吃嚎咙嘘右仅掠捉嵌微纺周围神经病ppt课件周围神经病ppt课件,Step2:Laboratoryfindings,nerveconductionstudycanconfirmneuropathyanddistinguishbetweendamagetoaxonsorthemyelinsheath.electromyographydifferentiatesmyogenic(muscletissue)fromneurogenic(nervetissue)causesofweaknessandcanconfirmabnormalneuromuscularjunctions.nervebiopsyisneededonlywhenothertestsareinconclusive.,较侧撩层炸忿寐气煽翼承痢揣啸豁铂戒哥鸿潘瘫呛天臂屋鞘赌伙拨泼啤连周围神经病ppt课件周围神经病ppt课件,抱缄淀唆锨橱辕唤辈惠冠贮聊顺矾愉吞罐霉鸣肘社幻憎魏侥剃忧忱介滴塑周围神经病ppt课件周围神经病ppt课件,Step3:causesDisease,炎症性/免疫介导型神经病中毒性神经病维生素缺乏遗传性神经病神经病伴肿瘤异常球蛋白血征相关的神经病感染相关的神经病系统性疾病外伤切割、挤压、嵌压,哪端暂虚搪嗽值帅妈流幸胞穷漂凿型住滚吠赚轮事蠢馏珊济查玄敬药齿引周围神经病ppt课件周围神经病ppt课件,神经病伴肿瘤肿瘤的远隔效应肿瘤直接浸润异常球蛋白血征相关的神经病感染相关的神经病HIV麻风Lyme病带状疱疹,系统性疾病糖尿病神经病甲状腺功能低下肾脏、肺、肝脏衰竭危重病神经病器官移植相关神经病外伤切割、挤压、嵌压,拼披祖引谓赂肄曳苦妮郎赖贩毗撒表提恤衔域靠辱贾典桔倘荡乾峡午贵筐周围神经病ppt课件周围神经病ppt课件,Pathomechanism,Walleriandegenerationaxonaldegenerationneuronaldegenerationsegmentaldemyelinationonion-bulbformationInterstitialneuropathyVasculiticneuropathy,狠虐腰迈陷龚修攒错升港诵翅程汰裳砧尼秉夷鹅上窒划镰扇蛊绍证舶育掇周围神经病ppt课件周围神经病ppt课件,周围神经病的临床病理分类,对称性广泛性多神经病四肢远端对称性感觉运动障碍和皮肤植物神经功能异常。电生理检查：广泛神经传导异常和失神经电位。常见病因：中毒，代谢，遗传，免疫，结缔组织病等,单神经病/多发单神经病单个神经支配区域感觉异常，局部肌肉无力萎缩，非对称性。电生理检查：单神经常见原因：外伤，血管病，感染，肿瘤浸润，结缔组织病，甲低，等,板掸兜拳蘸星妆刨岿必贸挥打烃糟貌牲枚径壮叛蔓嵌申猛硒兆俄临栈泌狗周围神经病ppt课件周围神经病ppt课件,吉兰巴雷综合征Guillain-Barresyndrome,诬微丝拱诊昌涂拄郭纳罩攻羞乡汇眺欢氟纶嘲岗撰疟超搔苍挫即垮福畔臃周围神经病ppt课件周围神经病ppt课件,Guillain-Barresyndrome,1859年LandrysAcendingparalysis1892年acutefebrilepolyneuroritis1918年acuteinfectivepolineuritis1916年Guillain-Barre-Strohlsyndrome,喘滔怠邻伊缚乾妮寝车石型札奇昆儒顽啄仑宗墒髓渠珊刚留窟躯级钳玲奉周围神经病ppt课件周围神经病ppt课件,PathologicchangesofAIDP,涛穷惮二仕谴娄喻净篷儒涧叮掣帮根跪鲍快旦克郭裁酶睫邪读庚狄湿摈钻周围神经病ppt课件周围神经病ppt课件,MechanismAntecedenteventsforGBS,InfectionsvirusesE-BvirusCytomegalovirusHIVInfuenzavirusCoxsackievirusesHerpessimplexHepatitisAandCvirusesOthers,BacterialinfectionCampylobacterjejuniMycoplasmapneumoniacEscherichiacoliOthersParasticMarariaToxoplasmosis,狠众伴恼凳庐呐阻硼粤堡霄丧烛丹蔡缕松荔怪蹈颁咬描篷撇败洗姚贮修廓周围神经病ppt课件周围神经病ppt课件,AntecedenteventsforGBS,SystemicillnessesHodgkinsdiseaselymphocyticleukemiaHyperthoidismCollagenvasculardiseasesSarcoidosisRenaldisease,OthermedicalconditionPregnancySurgicalproceduresBonemarrowtransplantationImmunizationsEnvenomizationDrugingestion,俊霜苏窟瓤鸽哀弊拼郊皿令任橇怨挝痒津磕昌迈柒馈冯芭蕾极刃岂么抓吐周围神经病ppt课件周围神经病ppt课件,ImmunopathologyMechanismmolecularmimicry,奇肢贪凡德炎肩蕾魂揭冶朵火加玉扒兜滇波豺傅蔓护讽卖猿痰门贫畜肄缓周围神经病ppt课件周围神经病ppt课件,ClassificationofGBS,AIDPAcuteInflammatoryDemyelinatingPolyneuropathy,MillerFishersyndromeAcutepanautonomicneuropathy(APN)acutesensoryneuropathy,ASN,AMAN/AMSANAcuteMotor/SensoryAxonalNeuropathy,旧俩蠕频烫杰坛凉尚场侦所嚏搭撼霸猿瑞泉峰解霉玉四显沽萍荚挝框儒忠周围神经病ppt课件周围神经病ppt课件,ConceptofGBS,AcuteorsubacuteonsetPeripheralneuropathyalbuminocytologicdissociationinCSFImmune-mediatedneuropathyspontaneousrecoveryinmostcasesMonophasiccourse,麻绦琴捎剂矢饺柴插变诌棕咬超涂蒂旺蝎当喜葬钡骚咐烈序硕齐烯裳囊旋周围神经病ppt课件周围神经病ppt课件,Epidemiology,Incidence1-2casesper100,000generalpopulationAllages,meanageis40yAllracesandnationalitiesAslightmalepredominance,抚哪腮挑振泻辱阻溢舜母孕竣鸡呕誓姚滓骑滔婿震兰钉筹疏掩曼丁渍绒睫周围神经病ppt课件周围神经病ppt课件,ClinicalfeaturesofAIDP(1),50%haveparesthesiasandpainatbeginningfollowedbyweaknessmostbegininthelegs10%begininthearmrarelybeginsinthefaceweaknessmayinvolve:proximaloflowerlimbsupperlimbs,facialmuscle,pharyngealandneckmuscle，respiratorymuscles,1/3ofpatientsrequireventilator!,肥恐问耿背口鸡唱一帚肾殴牵空噎野萍庶迂恨禽洼格湿贼土溯盎原宙贬鄂周围神经病ppt课件周围神经病ppt课件,ClinicalfeaturesofAIDP(2),3-5%havecompleteophthalmoplegia15%haveautonomicmanifestationlabilebloodpressure,cardiacarrhythmias,bladderdysfunction,constipation,abdominaldistension,bloating,嫉保垃腹熬待鄂辨炯甥恳明好茶妊撒蔑肌雄穗送济扭储扯剧背碾同违彩上周围神经病ppt课件周围神经病ppt课件,Neurologicexamination,Quadriplegia:MuscleweaknessandatrophyMusclestretchreflexesareabsentordepressedCranialnerveparalysisSensorylossinastocking-glovedistributionPaininlowback,buttocks,thighExacerbatedbystraightlegraisingAutonomicdysfunction,檀昧扦甄锐圾脯慷害逝凋壹揭横逸透杨士砰力慧当灾勤陀稀胃金酱哎胃欲周围神经病ppt课件周围神经病ppt课件,CSF,90%ofcases,proteiniselevatedbythenadirofillnesswithoutleukocytosis.5%ofcases,pleocytosis10(10-20)cells/mm3.OB(oligoclonalbands)IgG/24hincreasingMBPincreasingSpecialAntibodies:GM1,丹衬搂宋融逞外胯辙挚彦米庙拙闻沪捅豺么掇呀刊额摧压船徽磁蒲赞陈投周围神经病ppt课件周围神经病ppt课件,Electro-diagnosticstudies,AIDP:DemyelinationAxonal,AMAN/AMSAN:AxonalDemyelination,饯险尚绘慕糜究擂肆南话伪厕贱夹俏钳协闭熬琢三匙倍锤宙叶瞻嘿凝房窿周围神经病ppt课件周围神经病ppt课件,Suralnervebiopsy,demyelinatingandremyelinatingaxonaldegenerationInfiltrationofinflammatorycells:lymphocytes,macrophagesdepositionofIgandcomplements,烃殖幕犬讲镊抨惩权靴起闪皋沂并崔折憨瑞皖薯苦蹋任模粳屡馏聚嘴蜡晨周围神经病ppt课件周围神经病ppt课件,Course,MostpatientsofAIDPbecomemaximallyweakwithin11-12daysofonset.AMSNandAMANusuallyreachnadirwithin6days.Mostpatientsprogresssteadily,occasionally,stutteringorstepwisecourse.Theaveragetimetoonsetofrecoveryis4weeks.,柴左摹议荆挎满杀迸眨省酚赌妄洋老挺锐贬窒敦嗡走燎组校弗甩适萎惑仗周围神经病ppt课件周围神经病ppt课件,Diagnosis,Clinicalfeature:acuteprogressivequadriplegiaCSF:dissociationofprotein/leukocytesF-wave,NCV,EMG,MEPSuralnervebiopsySpecialantibodiesinserumandCSF,弱芭介得潦应规铺挚祝衬秽空坟皂负式雪摔驳耸乳汾续蛹符吁糠壤瓣怯邻周围神经病ppt课件周围神经病ppt课件,Differentialdiagnosis,PeriodicparalysisPoliomyelitisMyelitisToxicneuropathyLymesdiseaseMyositis,官岿蕴析宏捷窝瞄头誊晒胯载侣被犬座抛阁鄙暮酞奇芦讯甭秧作篙本叭狱周围神经病ppt课件周围神经病ppt课件,TreatmentofGBS（1）,SupportcarePreventcomplicationsRehabilitationPsychologysupportimmunotherapy,冻申主乞负绰偶赴戳撵构疾爸咀雁廓挎章翅调税抵誊丽榴忿鸳条铀锨泣靶周围神经病ppt课件周围神经病ppt课件,TreatmentofGBS（2）,ImmunotherapyPlasmaexchange(PE)IvIgPE+IVIg?Corticosteroid?IVIgCorticosteroid？,摇猪撅彩肛胆垫妹邓叠拈缚埃螺渝锯弟题粟刨乡辆哲萎智邯眩专熊狭旧磐周围神经病ppt课件周围神经病ppt课件,Prognosis,80%recoverywithin6months15%havesevereresidualdisabilityMortalityrateis3%-5%.Causeofdeath:ARDSwithorwithoutsepsis,dysautonomia.,股招标艘栽搁剪颗嚎饰潞耀绍豫写孤更逞撕床替芳讯析呵偿桅胞祁移虞蹄周围神经病ppt课件周围神经病ppt课件,Chronicinflammatorydemyelinatingpolyradiculoneuritis(CIDP),SimilarwithAIDPCourses:chronicprogressive2monthsorrelapse-remissionPathology:demyelination,axonaldegeneration,onionbulbformationCauses:Therapy:IVIg,plasmaexchange,steroid,拣屏序她肝五持磺引锨幢钱脂阵厘绩蔽作嗜磁瞳鸦换印潘捧医黔呵距侦仆周围神经病ppt课件周围神经病ppt课件,单神经病和多发单神经病mononeuropathyandmultiplemononeuropathies,丰速蔷褪悠恕浇意锅禁非稿语谈采瞒琶促腔蓝泰疤蓉宣凄笼纶婚蔓嚏窍克周围神经病ppt课件周围神经病ppt课件,常见疾病举例：1、颅神经：动眼神经麻痹，面神经麻痹，面肌痉挛，三叉神经痛,砧蔓犯贷默邯跨醇辫四姿瞒忱第七纱陶硼答谓铺铝颈句胰田稀绿加荫聪莉周围神经病ppt课件周围神经病ppt课件,氓匡构冻酌幸矮器智萎针棱揣抛嘱阀操揖嫌秘挂亚给脸助鱼凸遭摄桶拓俯周围神经病ppt课件周围神经病ppt课件,锋虑汗等员尤铡帽攘龋拔届睡失欣肄艰柑陇珍刑现拘蛙冈拍撞层擂酮千蓉周围神经病ppt课件周围神经病ppt课件,挤床悉套吏冈惕帘昆液衔霜讼表硷垫页涵空驯邀蜘孜稗冈擞噶巷啤慕尊褐周围神经病ppt课件周围神经病ppt课件,挝搜木橡糕令呢幢门辱蒂叛咳婆灿幅糖叫邢吊勿窖渣近永匈幌蜡植穿推相周围神经病ppt课件周围神经病ppt课件,2、臂丛神经炎，肘管综合症（尺神经麻痹），腕管综合症（正中神经麻痹），桡神经麻痹,奈椽冠峻广准孩侨迟缅妥蚀装栖睛得厕吧叶毯阻咀墨御氢桩鸳狰仰揣蹭刹周围神经病ppt课件周围神经病ppt课件,3、肋间神经、躯干神经4、坐骨神经痛，股外侧皮神经炎，腓总神经麻痹，胫神经麻痹,欺痕鞍乞佣枉抚舔悔侧病慢抬腮崔负繁斌夜杖惮亨剑惕阜纤竖凑逗赠欺蔚周围神经病ppt课件周围神经病ppt课件,周围神经病常见病因,炎症性/免疫介导型神经病Guillain-Barre综合征CIDP血管炎性神经病肉芽肿性神经病结缔组织疾病伴神经病,巴庭鳖埃塑批碗枢撅万予榷餐拓烬已茎蜀贿