神经病学英文2.headach课件

1、神经病学（英文）2.headach1神经病学神经病学 头痛头痛 (headache)哈尔滨医科大学附属第二医院哈尔滨医科大学附属第二医院神经病学教研室神经病学教研室神经病学（英文）2.headach2第一节第一节 概概 述述 headache is one of the most common clinical symptoms. its pathogenesis is more complicated. 神经病学（英文）2.headach3 pathogenesisathogenesis pain-sensitive structures of the brain 1) brain skin

2、, subcutaneous tissu,etc. 2) arteries and muscles; 3) venous sinuses and meningeal arteries; 4) the trigeminal(v), glossopharyngeal(ix); vagus(x), etc.神经病学（英文）2.headach4 1. acute(2w) ,subacute(3m) or chronic(3m); 2. mild, morderate or severity; 3. original(migraine, cluster, tension); secondary(trau

3、ma,infection,tumor);classification of the headache神经病学（英文）2.headach5 1. family history, state of mind and sleeping; 2. speed of onset, attack time,quality, position, relapsing and the factors of becoming severity. 3. omen and accompany symptoms; 4. performing a careful physical examination, select s

4、ome suitable assistant tests. diagnosis神经病学（英文）2.headach6treatment1. family history, state of mind and sleeping; 2. speed of onset, attack time,quality, position, relapsing and the factors of becoming severity. 3. omen and accompany symptoms; 4. performing a careful physical examination, select some

5、 suitable assistant tests.神经病学（英文）2.headach7第二节第二节 偏头痛偏头痛 (migraine) 1. etiology : heredity; endocrine and metabolism; other factors.神经病学（英文）2.headach8 2. pathogenesis 1) blood vessel theory; 2) nerve- vessel theory; 3) nerve-transmitter theory.神经病学（英文）2.headach9 clinical manifestations 1. migraine

6、with aura (classic migraine) proemial stage aura stage headache stage later stage of headache 2. migraine without aura (common migraine) 神经病学（英文）2.headach102. special-type of migraine 1) ophthalmoplegia 2) hemiplegia 3) basilar-type 4) later-onset 5) 等位发作神经病学（英文）2.headach11神经病学（英文）2.headach12 1. com

7、mon type (1988 diagnostic criteria) 1) 符合下述符合下述24项，至少发作项，至少发作5次以上。次以上。 2）如不治疗）如不治疗 ，每次发作持续，每次发作持续24小时。小时。 3）具有以下特点至少两项：单侧性；博动性；不敢）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。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。）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。）无其它已知类似疾病；病史躯体正常。diagnosis神经病学（英文）2.headach13 1 1）符合下述两项，

8、至少发作）符合下述两项，至少发作2 2次。次。 2 2）具有以下特征至少）具有以下特征至少3 3项：局限性脑皮质或脑干功能项：局限性脑皮质或脑干功能 障碍障碍1 1或或1 1个以上先兆症状个以上先兆症状; ;至少有一个先兆症状，至少有一个先兆症状， 逐渐发展持续逐渐发展持续4 4分以上；或相继发生分以上；或相继发生2 2个或个或2 2个以上个以上 症状；先兆症状持续症状；先兆症状持续6f. quality: diffuse, band-like, dull headache. position: bilateral occipital, frontal. course: days or yea

9、rs. accompany symptoms: vertigo,insomnia, anxious and depression. part of the patients have daily chronic headache. 神经病学（英文）2.headach21神经病学（英文）2.headach22 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

10、 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神经病学（英文）2.headach23 drugs used in

11、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, ergotamine)treatment神经病学（英文）2.headach

12、24 第四节第四节 低颅压头痛低颅压头痛 （intracranial hypotension headache） intracranial pressure 90mmh2o etiology and pathogenesis： original: csf secret disorder. secondary: csf leaking (lumbar puncture, trauma, operation, meningitis, severe infection, etc. )神经病学（英文）2.headach25clinical manifestations position: occipi

13、tal 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.神经病学（英文）2.headach26diagnosis and differential diagnosis 典型临床表现典型临床表现 ct/mri 腰穿腰穿 与脑、脊髓肿瘤、脑室梗阻、寄生虫感与脑、脊髓肿瘤、脑室梗阻、寄生虫感 染、脑静脉血栓形成、亚急性硬膜下血染