1. 杂
● 三个引起呼吸肌麻痹得疾病诊断要点
格林巴利综合征,急性脊髓炎,重症肌无力。余略。 ● 吟诗样语言见于小脑蚓部受损或多发性硬化MS ● ☆☆基于脑脊液得脑膜炎得鉴别
一种以中枢神经系统白质炎性脱髓鞘为主要病理特点得自身免疫病。多在成年早期发病,女性多于男性,大多数患者表现为反复发作得神经功能障碍,多次缓解复发,病情每况愈下。
A chronic disease that affects the central nervous system 、 It is probably an autoimmune disease, which the body incorrectly directs antibodies and white blood cells against proteins in the myelin sheath in white matter, causing inflammation and injury to the sheath and ultimately to the nerves that it surrounds 、
视力障碍(最常见、首发症状。急起单眼视力下降,常伴眼球疼痛),2肢体无力(不对称瘫痪最常
见),3感觉异常,4共济失调(Charcot 三主征:眼球震颤,意向性震颤,吟诗样语言),5自主神经功能障碍,6
精神症状,认知功能障碍,7发作性症状,8可伴其她多种自身免疫性疾病。 ● 脑脊液IgG 指数
反映IgG 鞘内合成得定量检测指标,多发性硬化患者得阳性率70~75%。上限值就是0、7,超过则提示IgG 鞘内合成增加。
◆偏头痛
一组反复发作得头痛疾病,呈一侧或搏动性疼痛,常伴恶心与呕吐,少数典型病例发作前有视觉、感觉与运动障碍灯先兆,可有家族史。偏头痛得发作与理化、精神、体内激素等多种因素有关。
Migraine is a benign recurring throbbing headache, recurring neurologic dysfunction, or both、Nausea, Vomiting, Diarrhea, Sweating, Cold hands, Sensitivity to light, Sensitivity to sound, Scalp tenderness, Pale color, Pulsing temple, Pressure pain、
●☆☆偏头痛得典型临床表现
①反复发作得搏动性头痛,多呈单侧分布,疼痛中度或重度;②常伴恶心呕吐;③日常活动会加重
头痛;④可有畏光、畏声。
●偏头痛得用药:
预防:首选β受体阻滞剂(普萘洛尔),SNRIs(阿米替林),抗惊厥药,钙通道阻断剂
轻度发作:地西泮,阿司匹林,对乙酰基氨基酚
严重发作:麦角碱类,曲普坦类
●☆☆阿尔茨海默病Alzheimer disease, AD
发病机制:脑内β淀粉样蛋白异常沉积
病理特点:大体:弥漫性脑萎缩,脑回变窄,脑沟变宽;镜下:老年斑,神经元纤维缠结,神经元减少。
诊断标准:有症状标准(如器质性精神障碍,全面性智能性损害)、严重标准、病程标准、排除标准。具体见P334
药物:①胆碱酯酶抑制剂ACheE-I(多奈哌齐、利斯得明等),②NMDA受体拮抗剂(美金刚)
◆Wilson脑病Wilson’s disease (肝豆状核变性hepatolenticular degeneration)
A neurodegenerative disease of copper metabolism、 Tremor may be present in one hand or leg and gradually progress to involve all four limbs、 Generalized, impaired muscle tone and sustained muscle contractions that produce abnormal postures, twisting, and repetitive movements (dystonia); and slowness of movements (bradykinesia)、Other symptoms include rigidity, spasticity, seizures and excessive salivation、
●晕厥Syncope
弥漫性脑部短暂性缺血、缺氧所致,站立或坐位时发作,常有意识丧失、跌倒,部分患者可出现肢体得强直或阵挛clonus,可伴有面色苍白、大汗等。
transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery due to global cerebral hypoperfusion that most often results from hypotension。
◆遗忘amnesia:
①顺行性遗忘;②逆行性遗忘;③选择性遗忘;④分离性遗忘;⑤界限性遗忘,大多属心因性
2、基础
◆症状分类
1.缺失(破坏)症状(Destruction)
2.释放症状(Release)
3.刺激症状(Irritation)
4.休克症状(Shock)
◆大脑分叶:Frontal lobe,Temporal lobe ,Parietal lobe,Occipital lobe
●☆☆十二对脑神经cranial nerves得英文名
I-Olfactory, II-optic, III-oculomotor, IV-trochlear, V-trigeminal, VI-abducent,
VII-facial, VIII-vestibulocochlear, IX-glossopharyngeal, X-vagus, XI-accessory,
XII-hypoglossal
●12对脑神经连接脑得部位(用于理解损伤得定位)
I-端脑,II-间脑,III、IV-中脑,V-脑桥,VI、VII、VIII桥延沟,IX、X、XI、XII-延髓
●☆☆除支配面下部肌得面神经核(即面神经核下半)与舌下神经核只接受单侧(对侧)皮质核束
支配外,其她脑神经运动核均接受双侧皮质核束得纤维
●黄斑回避
视野检查时,在偏盲与全盲视野内,中心注视区功能保留得现象。该现象见于视放射中后部或视觉皮质区得损害或病变。如右侧枕叶视中枢损伤,双眼左侧视野同向性偏盲,黄斑回避。
●控制眼球运动得颅神经
III-oculomotor nerve,IV-trochlear nerve,VI-abducent nerve
●☆☆动眼神经支配得肌肉,动眼神经麻痹oculomotor nerve palsy得临床表现与常见病因
肌肉:上睑提肌levator palpebrae superioris muscle,上直肌superior rectus,内直肌medial
