神经病学(英文)1.symptomatologyofneurologicaldisea

Neurology,DepartmentofNeurology,The2ndaffiliatedhospital,HarbinMedicalUniversity,Chapter1.Introduction,神经病学(Neurology),TheObjectsofNeurology:CNS、PNSandmusculardisordersThecontentsofstudy:EtiologyandPathogenesisPathologyClinicalfeaturesDiagnosisandDifferentialdiagnosis,TreatmentandPreventionPrognosis,Nervoussystem,Centralnervoussystem:brainspinalcordPeripheralnervoussystem:cranialnervesspinalnerves,Nervoussystem,Neurologyisapartofneuroscience,including:Neuroanatomy,Neurophysiology,Neurobiochemistry,Neuropathology,Neurogenetics,Neuroimmunology,Neuroepidemiology,Neuroiconography神经影像学,Neurophamacology,Neuropsychology,ExperimentalNeurology,Neurobiology,MolecularBiology,Catalogueoftheneurologicaldiseases,VasculardiseasesInfectiousdiseasesTumorsTraumaticdiseases,Catalogueoftheneurologicaldiseases,Autoimmunediseases(someofthemaredemyelinativediseases脱髓鞘疾病)HereditaryandmetabolicdisordersCongenitaldysplasia先天性发育障碍IntoxicationNutritionaldisturbances,SymptomsofNervousSystemcoulddividedtofourclasses:,Deficitsymptomsdeficitsorlossonthenormalfunctions(hemiparalysis,aphasia)Irritativesymptomsexcessiveexcitementsthatnervousstructuresappearedwhentheywerestimulated(seizures,radicalpain),SymptomsofNervousSystemcoulddividedtofourclasses:,LiberatedsymptomsWhenthehighercenterswereimpaired,thefunctionofthelowercenterthatnormallycontrolledbytheformerwasliberated(pyramidalsigns锥体束征).,SymptomsofNervousSystemcoulddividedtofourclasses:,ShockSymptomsCNS急性局部严重病变，引起与之功能相关的远隔部位神经功能短暂缺失Brainshock:cerebralhemorrhageSpinalshock:intheacutestageoftotalcordtransverse,thereisaflaccidparalysiswithlossoftendonandotherreflexes,accompaniedbysensorylossbelowthelevelofthelesionandbyurinaryandfecalretention.,Supplementedexaminneurologicaldiseases,1.LumbarpunctureandCSFanalysis:Appearance,Pressure,DynamicsRoutineexamBiochemicalexaminationsCSF-IgGindex,OBCytologicexamSpecificantibodies(MBP,AChR),Supplementedexam,2.Imagingstudies:plainX-raysoftheskullandthespine,myelographyCT,MRI(magneticresonanceimaging),MRADSA(digitalsubtractionangiography),Supplementedexam,3.Electrophysiologicstudies:EEG(electroencephalography)EMG(electromyography)NCV(nerveconductionvelocity)VEP(visualevokedpotentials)BAEP(brianstemauditoryevokedpotentials)SEP(somatosensoryevokedpotentials)4.Transcranialdoppler(TCD),Supplementedexam,Radioisotopeexaminations(放射性同位素)SPECT(singlephotoncomputedtomography)PET(positronemissiontomography)Immunologicandvirologicdetections(免疫学及病毒学检测)：suchasMBP、AChRandcysticercusantibodies,(HSV)PCRBiopsy:muscles,nervesandbrain,Chapter2.SymptomatologyoftheNeurologicalDiseases,Section1.DisordersofConsciousness,DisturbancesoftheLevelofConsciousness,Consciousnessisawarenessoftheinternalorexternalworld.意识(awareness)指大脑的觉醒(arousal)程度，是机体对自身和周围环境的感知和理解功能，并通过语言、躯体运动和行为表达出来；是CNS对内、外环境刺激应答反应的能力。该能力减退或消失就意味着不同程度的意识障碍(disordersofconsciousness)。,意识(consciousness)-Concept,Consciousnessdescribesthatsetsofneuralprocessesthatallowanindividualtoperceive,comprehend,andactupontheinternalandexternalenvironments.Itisusuallyenvisionedintwoparts:arousalandawareness.,Arousaldescribesthedegreetowhichtheindividualappearstobeabletointeractwiththeseenvironments;thecontrastbetweenwakingandsleepingisacommonexampleoftwodifferentstatesofarousal.,Arousalrequirestheinterplayofboththereticularformationandthecerebralhemispheres.Thereticularcomponentsnecessaryforarousalresideinthemidbrainanddiencephalon;thepontinereticularformationisnotnecessaryforarousal.,Awarenessreflectsthedepthandcontentofthearousedstate.Awarenessisdependentonarousal,sinceonewhocannotbearousedappearstolackawareness.Awarenessdoesnotimplyanyspecificityforthemodalityofstimulation.Thisstimulationmaybeexternal(e.g.,auditory)orinternal(e.g.,thirst).,Attentiondependsonawarenessandimpliestheabilitytorespondtoparticulartypesofstimuli(modality-specific).,Stuporreferstoaconditioninwhichthepatientislessalertthanusual,butcanbestimulatedintoresponding.,Obtundation(意识模糊)describesapatientwhoappearstobeasleepmuchofthetimewhennotbeingstimulated.Thiseyes-closedstateisnotelectroencephalographicsleep,however.,Stuporous/obtundedpatientswillrespondtonoxiousstimulibyattemptingtodeflectoravoidthestimulus.,PatientwithComalieswitheyesclosedanddoesnotmakeanattempttoavoidnoxiousstimuli.Suchapersonmaydisplayvariousformsofreflexposturing,butdoesnotactivelytrytoavoidthestimulus.,Vegetativestate,inwhichtheeyesopenandclose,thepatientmayappeartotrackobjectsabouttheroom,andmaychewandswallowfoodplacedinthemouth.,However,thevegetativepatientdoesnotrespondtoauditorystimuli,anddoesnotappeartosensepain,hunger,orotherstimuli.Thisisastateinwhichthereisarousalbutnoawareness.,Deliriumisdefinedasadisturbanceofconsciousnessthatisaccompaniedbyachangeincognitionthatcannotbebetteraccountedforbyapreexistingorevolvingdementia.,Thedisturbancedevelopsoverashortperiodoftime,usuallyhoursordays,andtendstofluctuateduringthecourseoftheday.,Thereisevidencefromthehistory,physicalexamination,orlaboratoryteststhatthedeliriumisadirectphysiologicalconsequenceofageneralmedicalcondition,substanceintoxicationorwithdrawal,useofamedication,ortoxinexposure,oracombinationofthesefactors.,DisordersofConsciousness,Anatomicalbasisofalertingsystem(维持意识清醒的重要结构):脑干上行性网状激活系统(ascendingreticularactivatingsystem)广泛的大脑皮质神经元的完整性(Cerebralcortexandtheafferentpathways)(中枢整合机构)Themaintenanceofconsciousnessrequiresafinebalanceofactivitybetweenthecerebralcortexandthereticularsystem.,Disordersofconsciousness-Clinicalclassification,意识障碍：指意识水平下降嗜睡(somnolent):患者处于睡眠状态，唤醒后定向力基本完整，但注意力不集中，记忆稍差，如不继续对答，又进入睡眠。Theearlystageofconsciousnessdisorder,itisoftenafeatureofraisedintracranialpressure.,Disordersofconsciousness-Clinicalclassification,昏睡状态(stupor)：处于较深睡眠状态，较重的疼痛或言语刺激方可唤醒，作简单模糊的回答，旋即熟睡。Thepatientcanberousedonlybrieflybypainstimulationorloudspeech.,Disordersofconsciousness-Clinicalclassification昏迷(coma):thepatientisunresponsiveandunarousable)意识丧失，对言语刺激无应答反应，可分为浅、中、深昏迷。,Disordersofconsciousness-Clinicalclassification,Disordersofconsciousnessaffectingthecontentsofconsciousness意识模糊(confusion)或朦胧状态(twilightstate)意识轻度障碍，表现意识范围缩小，常有定向力障碍，突出表现是错觉，幻觉较少见，情感反应与错觉相关，可见于癔症。,Disordersofconsciousness-Clinicalclassification,Disordersofconsciousnessaffectingthecontentofconsciousness谵妄状态(deliriumstate)定向力(orientation)、自知力障碍，注意力涣散(attention)，不能与外界正常接触。常有hallucinations、delusions，以错视为主，形象生动逼真，可有恐惧、外逃或伤人行为。Acute:fever,intoxicationsuchasAtropineChronic:chronicalcoholism,Disordersofconsciousness-Clinicalclassification,特殊类型意识障碍-醒状昏迷(comavigil)1.去皮层综合征(decorticate)无意识睁眼闭眼，光、角膜反射(cornealreflex)存在，对外界刺激无反应，去皮层强直状态(decorticaterigidity)，病理征(+)上行网状激活系统未受损，保持觉醒-睡眠周期，无意识咀嚼和吞咽缺氧性脑病、大脑皮质广泛损害CVD及外伤等,Disordersofconsciousness-Clinicalclassification,2.无动性缄默症(akineticmutism)：对外界刺激无意识反应，四肢不能动，不语。无目的睁眼或眼球运动，睡眠-醒觉周期可保留。伴自主神经功能紊乱，体温高、心跳或呼吸节律不规则、多汗、尿便潴留或失禁，无锥体束征。脑干上部或丘脑网状激活系统及前额叶-边缘系统损害。,Disordersofconsciousness-Clinicalclassification,Differentialdiagnosis(1)意志缺乏症清醒状态，但不讲话，无自主活动。对刺激无反应、无欲望，严重淡漠状态。双侧额叶病变。,闭锁综合征(locked-insyndrome),脑桥基底部病变，皮质核束tumorsincerebellum,brainstem,andthefourthventricle;increasedintracranialpressure;auditoryneuroma;epilepsyetal.系统性眩晕的鉴别,Vertigo-Clinicalfeaturesandclassification,2.Non-systemicvertigoetiology：causedbyothersomaticdiseases,forinstanceeyediseases,anemia,hematonosis,heartfailure,infection,intoxicationandneurasthenia(神经功能失调),andsoon.features：是头晕眼花或轻度站立不稳，无眩晕感，seldomaccompanyingnausea、vomiting，nonystagmus.,Vertigo-Clinicalfeaturesandclassification,耳聋(deafness)Conductivedeafness(传音性耳聋)外耳道和中耳病变，如外耳道异物或耵聍、骨膜穿孔和中耳炎等。Perceptivedeafness(感音性耳聋)内耳、听神经、蜗神经核核上听觉通路病变所致Mixedhearingloss传导性及神经性耳聋同时存在,AuditoryDisorders-Clinicalfeatures,耳鸣(tinnitus)Concept:无外界声音刺激，患者却主观听到持续性声响。Lesions:是由听感受器及其传导径路病理性刺激所致的主观性耳鸣。,AuditoryDisorders-Clinicalfeatures,听觉过敏(acoustichyperesthesia,hyperacusis)Concept声音呈病理性增强，即患者感觉到的声音较真正听到的强。Lesions常见于面神经麻痹时，因镫骨肌瘫痪使微弱的声波振动即导致内淋巴强烈震荡而引起。,Section5.SyncopeandSeizure,Syncope-Concept,晕厥(syncope)Pathogenesis:Thelossofconsciousnessisduetoreducedsupplyofbloodtothecerebralhemispheresorbrainstem,并因姿势性张力丧失而倒地，但可很快恢复。Etiology:orthostatichypotension,decreasedcardiacoutput,acuteglobalischemia.,Syncope-Classification,反射性晕厥调节血压和心率的反射弧功能障碍，或自主神经疾病所致。包括：血管减压性晕厥(普通晕厥):最常见(vasovagalsyncope)直立性低血压性晕厥(orthostatichypotension)特发性直立性低血压性晕厥(Shy-Drager),Syncope-Classification,Others:carotidsinussyncopemicturitionsyncope(排尿性)swallowsyncope(吞咽性)glossopharyngealneuralgia,coughsyncope,andsoon.,Syncope-Classification,CardiovascularsyncopeArrhythmiacardiacoutflowobstruction(valvediseases,coronaryheartdisease)pulmonarybloodflowobstruction,Syncope-Classification,脑源性晕厥：各种严重脑血管闭塞性疾病引起全脑供血不足transientcerebralischemiahypertensiveencephalopathyaorticarchsyndromebasilarmigrainelesionsinbrainstem:tumors,inflammation,angiosis,injury,medullaryvasomotorcenterdiseases,andsoon.Others:哭泣性晕厥、低血糖性晕厥、严重贫血性晕厥,Syncope-Clinicalfeatures,发作前期(aura)出现短暂而明显的自主神经症状，头晕、苍白、出汗、恶心、恍惚、无力、打哈欠。先兆期持续数秒至数十秒。发作期(spell)患者感觉眼前发黑、站立不稳，出现短暂的意识丧失而倒地。意识丧失数秒至数十秒。神经系统检查无阳性体征。恢复期(recoveryphase)意识转清，仍面色苍白、恶心、出汗、周身无力等，经数分或数十分钟休息可缓解，不遗留任何后遗症。,Seizure-Concept,癎性发作(seizure)Theseizureisatransientdisturbanceofcerebralfunctioncausedbyanabnormalneuronaldischarge。痫性发作的临床表现形式多种多样。Pathogenesis引起脑部结构或代谢异常的各种局限性或广泛性病因，或目前尚不明确的原因均可导致癎性发作。表2-5癎性发作与晕厥的临床特点比较,Section6.Disordersofsomaticsensation,Disordersofsensation-concept,感觉(sensation)是作用于各感受器的各种形式刺激在人脑中的反映。包括：Specialsenses:vision,taste,smellandhearingSomaticsenses,Somaticsenses,Superficialsense(pain,temperature,touch):fromskinandmucosaDeepsense(movement,position,vibration)，frommuscles,muscletendon,periosteum(骨膜)andjointsComplexsense(corticalsensibility:stereognosis(实体觉)、图形觉、two-pointdiscrimination,graphesthesia(皮肤书写觉),location(定位觉),barognosis(重量觉),Disordersofsensation-Anatomy&Physiology,Sensorypathway图2-8共同特点：Threeneurons第二个神经元后发出的纤维交叉到对侧,Disordersofsensation-Anatomy&Physiology,Conductivepathway:Thefibersfromtheneuronsintheposteriorhornsmediatepain,temperatureandtouchcrossthemidlineandtravelinthelateralspinothalamictract。深感觉、精细触觉的纤维自后根神经节发出后，在同侧后索上行至薄束核、楔束核。Differentpathwaysarethebasisofdissociatedsensoryloss(impairmentofpainandtemperaturewithpreservationoftouch).,Disordersofsensation-Anatomy&Physiology,髓内感觉传导束的排列图2-9Spinalthalamictractfromexternaltointernal,laminationofsensorypathwaysrangeinsacral,lumbar,thoracic,cervical(SLTC)Gracilefasciculus,cuneatefasciculusrangeincervical,thoracic,lumbar,sacralfromoutsidetoinside(CTLS)对髓内及髓外脊髓病变鉴别诊断有重要意义,Disordersofsensation-Anatomy&Physiology,节段性感觉支配(segmentaldistribution)(图2-10)皮节(dermatomere)每个感觉根或脊髓节段支配一片皮肤的感觉。31个皮节。每个皮节均由3个后根重叠支配-三根定律,图2-11。脊髓损伤上界比查体平面高1(1)节段性支配关系有助于定位诊断Anteriorramiofcervical,lumbarandsacralformcervicalplexus,lumbarplexusandsciaticplexus,respectivelyperipheralnerve(体表分布与脊髓的节段性分布不同)图2-12,2-13,Disordersofsensation-Symptoms,抑制症状完全性感觉缺失(completesensoryloss)polyneuropathy分离性感觉障碍(dissociatedsensoryloss)syringomyelia刺激症状感觉过敏(hyperesthesia)感觉倒错(noseresthesia)感觉过度(hyperpathia)感觉异常(paresthesia)疼痛(pain)局部性、放射性、扩散性、牵涉性,DisordersofsensationClinicalfeatures,感觉障碍的临床表现多种多样，病变部位不同其临床表现各异，图2-141.末梢型(terminal)2.周围神经型(peripheralnerves)图6-33.节段型(segmental)单侧节段性完全性感觉障碍(dorsalrootinvolvement)unilateralsegmentaldissociatedsensoryloss(dorsalhorn)Bilateralsymmetricsegmentaldissociatedsensoryloss(anteriorcommissura),DisordersofsensationClinicalfeatures,4.传导束型脊髓半切综合征(Brown-Sequardsyndrome)belowthelesion,thereisanipsilateralpyramidaldeficitanddisturbedappreciationofvibrationandjointpositionsense,withcontralaterallossofpainandtemperaturethatbeginstwoorthreesegmentsbelowthelesion图2-19,DisordersofsensationClinicalfeatures,4.传导束型脊髓横贯性损害(cordsection)Lossofallsensesblowthelesion,withparaplegiaandtetraplegia,andurination/defecationdisorders.Occurinacutemyelitisandcompressivemyelopathy.,DisordersofsensationClinicalfeatures,5.交叉型impairedpainandtemperaturesensationonthesamesideofthefaceasthelesion,andsensorylossontheoppositesideofthebody，accompanyingothersymptomsandsignscausedbyotherimpairment如小脑后下动脉闭塞所致延髓背外侧(Wallenberg综合征)involvethespinaltractoftrigeminalnerve,nucleiandlateralspinalthalamictractthathadcrossedmidlinefromthecontralateralside.,WhatisWallenbergsSyndrome?,Wallenbergssyndromeisaneurologicalconditioncausedbyastrokeinthevertebralorposteriorinferiorcerebellararteryofthebrainstem.Symptomsincludedifficultieswithswallowing,hoarseness,dizziness,nauseaandvomiting,rapidinvoluntarymovementsoftheeyes(nystagmus),Continue,andproblemswithbalanceandgaitcoordination.Someindividualswillexperiencealackofpainandtemperaturesensationononlyonesideoftheface,orapatternofsymptomsonoppositesidesofthebodysuchasparalysisornumbnessintherightsideoftheface,withweakornumblimbsontheleftside.,Continue,Uncontrollablehiccupsmayalsooccur,andsomeindividualswilllosetheirsenseoftasteononesideofthetongue,whilepreservingtastesensationsontheotherside.SomepeoplewithWallenbergssyndromereportthattheworldseemstobetiltedinanunsettlingway,whichmakesitdifficulttokeeptheirbalancewhentheywalk.,DisordersofsensationClinicalfeatures,6.偏身型lesionsinpons,midbrain,thalamusandcapsulainterna,皮质感觉区分布较广，一般病变仅损及部分区域7.单肢型(singlelimb)lesionofthesensorycortex,Section7.Paralysis,Paralysis-anatomyandphysiology,LowermotorneuronAnteriorhorncell,motornucleusofcranialnervesanditsneuralaxis.Thefinaljointpathwaythatacceptstheimpulsefrompyramidaltract,extrapyramidalsystemandcerebellasystem,itistheonlywaythatimpulsewastransferredtomuscles.,Paralysis-anatomyandphysiology,Uppermotorneurons大脑额叶中央前回(anteriorcentralconvolution)运动区第V层的锥体细胞thefibersdescendfromthecortexmakeuppyramidaltract(includecorticospinaltractandcorticonucleartract).MotorPathway(图2-15)特点：经两级神经元传导,Paralysis-Clinicalfeatures&classification,弛缓性瘫痪(flaccidparalysis)下运动神经元瘫痪或周围性瘫痪causedbylowermotorneuronlesions痉挛性瘫痪(spasticparalysis)上运动神经元瘫痪(uppermotorneuronparalysis)因其瘫痪肢体肌张力增高而得名。痉挛性瘫痪和弛缓性瘫痪比较表2-6,Central&PeripheralFacialPalsy,中枢性面瘫(centralfacialnervepalsy)Lesions:impairmentonunilateralcorticonucleartractClinicalfeatures:paralysisoflowerpartoftheface,thelesionisontheoppositeside.图2-16,Central&PeripheralFacialPalsy,周围性面瘫(peripheralfacialnervepalsy)Lesions:facialnerveimpairmentClinicalfeatures:thesmoothingofthefurrowsontheparalyzedside,thecornerofthemouthdroops,thenasolabialfoldissmoothedout皱额、闭目、鼓颊、露齿动作均不能,真性球麻痹(Bulbarpalsy)-假性球麻痹(Pseudobulbarpalsy),Commonappearance:dysarthria,hoarsevoice(声音嘶哑),difficultyinswallowing(饮水发呛),dysphagia,andsoon.,Bulbarpalsy&Pseudobulbarpalsy,DifferentialDiagnosis:真性球麻痹(bulbarpalsy)Lesions:affectingthemotornucleiorthefibersofglossopharyngealnerveandvagusnerve.Features:absenceofpharyngealsensation,depressedgagreflex,awastedandfasciculatingtongue.,Bulbarpalsy,Lesions:affectingthemotornucleiorthefibersofglossopharyngealnerveandvagusnerve.TheFeaturesisabsenceofpharyngealsensation,itdepressedgagreflex,awastedandfasciculatingtongue.,Bulbarpalsy&Pseudobulbarpalsy,假性球麻痹(pseudobulbarpalsy)双侧皮质核束损害。常有强哭、强笑(pathologicemotionality)，下颌反射(jawjerkreflex)、掌颏反射(palmomentalreflex)等,TopicalDiagnosis-FlaccidParalysis,周围神经(peripheralnerves)Onlythosemusclessuppliedwhollyorpartlybytheinvolvedperipheralnervesareweak,theaccompanyingsensorydeficitreflectsthesimilarinnervation.神经丛(nerveplexus)一个肢体的多数周围神经瘫痪、感觉及自主神经功能障碍。,TopicalDiagnosis-FlaccidParalysis,前根(Anteriorroot)flaccidparalysisonsegmentaldistribution.Whentherewereposteriorrootinvolvement,itmayproducesimpairmentofcutaneoussensationinasegmentalpatternandradicularpain.Etiology:usuallyoccurincompressionbyextramedullarytumors,perimyelitisorvertebrachanges.,TopicalDiagnosis-FlaccidParalysis,Anteriorhorncellssegmentalparalysiswithoutsensationdisturbance.,TopicalDiagnosis-SpasticParalysis,上运动神经元不同部位病变引起不同的临床表现图2-171.皮质(cortex)：局限破坏性病损(destructivelesion)mayproduceafocalmotordeficitinvolving,forexample,asinglelimbparalysisoncontralateralside,weaknessmayberestrictedtothecontralateralarmandthelowerpartofthecontralateralface.Amoreextensivelesionwillproducehemiparalysis.,TopicalDiagnosis-SpasticParalysis,刺激性病变(irritativelesion)对侧躯体相对应部位出现局限性阵发性抽搐，如杰克逊(Jackson)癫癎。,TopicalDiagnosis-SpasticParalysis,2.皮质下白质(放射冠区,coronaradiata)放射冠皮质与内囊间的投射纤维形成，此区的运动神经纤维越近皮质越分散。局灶性病损可引起类似皮质病损的对侧单瘫；病损部位较深或较大范围时可能导致对侧偏瘫，多为不均等性，如上肢瘫痪重于下肢。,TopicalDiagnosis-SpasticParalysis,3.内囊(internalcapsule)：thedescendingfibersarecloselypacked图2-18出现“三偏”征(three-hemisigns)contralateraluniformhemiparalysis,includescentralfacialnervepalsyandhypoglossalnervepalsyhemihypoesthesiaoncontralateralsidehomonymoushemianopiaoncontralateralside偏瘫步态(hemiplegicgait),TopicalDiagnosis-SpasticParalysis,4.脑干(Brainstem)Clinicalfeatures:交叉性瘫痪(crossedhemiplegia)Thelesioninthebrainstemleadstoadisturbanceofcranialnervesontheipsilateralsideandacontralateralhemiplegia.Thecranialnervesareaffectedduetothelowermotorneuronlesions.Theweaknessonthecontralateralsideofthebodyisduetotheuppermotorneuronlesions,thecranialnervesbelowthelesionarealsoimpairedinthepatternofuppermotorneuronlesion.,TopicalDiagnosis-SpasticParalysis,4.脑干(Brainstem)如Weber综合征Millard-Gubler综合征Fovil1e综合征脑干病变，病变累及该平面脑神经运动核及尚未交叉的皮质脊髓束或/和皮质核束。,TopicalDiagnosis-Spasticparalysis,5.脊髓(spinalcord)(1)脊髓半切损害(Brown-Sequardsyndrome)表现为病变同侧损伤水平以下痉挛性瘫痪(腱反射亢进、病理征、踝阵挛)及深感觉障碍病变对侧损伤水平以下痛温觉障碍，病损同节段的征象常不明显(图2-19),TopicalDiagnosis-Spasticparalysis,(2)transverselesion受损平面以下两侧肢体瘫痪、完全性感觉障碍及括约肌功能障碍。Lesionabovecervicalenlargementresultsinuppermotorneuronparalysisofthefourlimbs.Lesionofcervicalenlargementresultsinflaccidparalysisonbothupperlimbsandspasticparalysisonthelowerones.Lesionofthoraciccordresultsinspasticparaplegiaonbothlowerlimbs.Lesionoflumbarenlargementresultsinflaccidparalysisonbothlowerlimbs.,Section8.InvoluntaryMovement,Involuntarymovement-Concept,不自主运动(involuntarymovements)患者在意识清醒状态下，出现不能自行控制的骨骼肌不正常运动，表现形式多样。一般睡眠时停止，情绪激动时增强。Itassociateswiththelesionsofbasalganglia.纹状体组成及病变综合征图2-20,Involuntarymovement-Clinicalsymptoms,1.静止性震颤(statictremor)是主动肌与拮抗肌交替收缩引起的一种节律性颤动(Arhythmicrepetitiveabnormalmovementconsequentonalternatingcontractionofopposingmusclegroups)常伴有肌强直(rigidity)，或称强直性肌张力增高呈铅管样强直(lead-piperigidity)或齿轮样强直(cogwheelrigidity),Involuntarymovement-Clinicalsymptoms,2.舞蹈症(chorea)denotesbrief,jerky,abruptmovementthatflitaroundthebodyinrandom,irregularandirrelevantfashion.是肢体及头面部迅速、不规则、无节律、粗大的不能随意控制的动作。表现为转颈、耸肩、手指间断性屈伸(挤牛奶样抓握)、摆手和伸臂等舞蹈样动作，伴肢体张力低，可有扮