神经病学总论2016七年制英文.pptx

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1、会计学1神神经经病病学学总论总论(znln)2016七年制英文七年制英文第一页，共107页。Chapter 1 IntroductionWorking protocolWorking protocoln nSimilar Similar to to internal internal medicine.medicine.First First take take the the medical medical history,history,then then do do physical physical exam,exam,and and then then do do some some

2、 medical medical exams.exams.So So we we get get the the correct correct diagnosis diagnosis and and begin to treat the patient.begin to treat the patient.Some differences to Internal MedicineSome differences to Internal Medicinen nNeed Need to to master master the the thorough thorough and and syst

3、emic systemic examination examination skills skills of of the the nervous system,nervous system,n nFocus on the localization diagnosis and etiological diagnosis of the disease.Focus on the localization diagnosis and etiological diagnosis of the disease.n nSelectively Selectively choose choose some s

4、ome medical medical examinations examinations from from so so many many available available today,today,such such as lumbar puncture(LP),CT,CTA,MRI,MRA,DSA,ECT,EEG,EMG,etc.as lumbar puncture(LP),CT,CTA,MRI,MRA,DSA,ECT,EEG,EMG,etc.第2页/共107页第二页，共107页。第一章第一章 绪绪 论论工作思维方法工作思维方法工作思维方法工作思维方法 与内科大体与内科大体与内科大

5、体与内科大体(dt)(dt)(dt)(dt)相同，通过病史、体格检查、辅助检查，相同，通过病史、体格检查、辅助检查，相同，通过病史、体格检查、辅助检查，相同，通过病史、体格检查、辅助检查，来进行诊断、治疗和预防。与内科不同之处在于：来进行诊断、治疗和预防。与内科不同之处在于：来进行诊断、治疗和预防。与内科不同之处在于：来进行诊断、治疗和预防。与内科不同之处在于：1 1 1 1、需要掌握神经系统检查方法。、需要掌握神经系统检查方法。、需要掌握神经系统检查方法。、需要掌握神经系统检查方法。2 2 2 2、强调疾病的定位诊断与定性诊断。、强调疾病的定位诊断与定性诊断。、强调疾病的定位诊断与定性诊断。

6、、强调疾病的定位诊断与定性诊断。3 3 3 3、辅助检查发展的很快，有腰穿、辅助检查发展的很快，有腰穿、辅助检查发展的很快，有腰穿、辅助检查发展的很快，有腰穿、CTCTCTCT、MRIMRIMRIMRI、PETPETPETPET（正电子发射（正电子发射（正电子发射（正电子发射断层扫描）、断层扫描）、断层扫描）、断层扫描）、DSADSADSADSA（脑血管造影）等，要有针对性地选择。（脑血管造影）等，要有针对性地选择。（脑血管造影）等，要有针对性地选择。（脑血管造影）等，要有针对性地选择。4 4 4 4治疗原则：治愈（脑炎、脑膜炎、治疗原则：治愈（脑炎、脑膜炎、治疗原则：治愈（脑炎、脑膜炎、治疗

7、原则：治愈（脑炎、脑膜炎、GBSGBSGBSGBS）、缓解（）、缓解（）、缓解（）、缓解（EPI,PD,MSEPI,PD,MSEPI,PD,MSEPI,PD,MS）、）、）、）、对症对症对症对症(AD,OPCA,PMD,ALS)(AD,OPCA,PMD,ALS)(AD,OPCA,PMD,ALS)(AD,OPCA,PMD,ALS)第3页/共107页第三页，共107页。CT-Computerized Tomography Chapter 1 Introductionn nImportance of Neurology第4页/共107页第四页，共107页。CTA-Computerized Tomog

8、raphy Angiography第5页/共107页第五页，共107页。MRI-Magnetic Resonance Imaging第6页/共107页第六页，共107页。MRA-Magnetic Resonance Angiography第7页/共107页第七页，共107页。DSA-Digital Substration AngiographyDSA-Digital Substration Angiography 第8页/共107页第八页，共107页。ECT Emission Computerized Tomography:ECT Emission Computerized Tomograph

9、y:n nPET(Positron Emission Tomography)PET(Positron Emission Tomography)n nSPECT(Single Photon Emission CT)SPECT(Single Photon Emission CT)第9页/共107页第九页，共107页。Neurophysiolgy:n nEEG-Electroencephlographyn nEMG-Electromyographyn nMEG-Magnetoencephlographyn nCEP-Cerebral Evoked Potentials第10页/共107页第十页，共1

10、07页。第一章第一章 绪绪 论论神经系统疾病的种类感染、血管病、肿瘤、外伤、免疫、变性、遗传(ychun)、中毒、先天、营养代谢、等。第11页/共107页第十一页，共107页。第一章第一章 绪绪 论论神经症状的分类缺损症状（脑血管病）刺激(cj)症状（肿瘤、腰凸）释放症状（锥体束征、强笑强哭）休克症状（脑休克、脊髓休克）第12页/共107页第十二页，共107页。第一章第一章 绪绪 论论神经病学的特点及重要性神经病学的特点及重要性神经病学的特点及重要性神经病学的特点及重要性大脑是人体的大脑是人体的大脑是人体的大脑是人体的“司令部司令部司令部司令部”，支配和调节全身各系统的功能。中枢神经一旦发，支

11、配和调节全身各系统的功能。中枢神经一旦发，支配和调节全身各系统的功能。中枢神经一旦发，支配和调节全身各系统的功能。中枢神经一旦发生损害难于治疗，原因是中枢神经元不能再生。生损害难于治疗，原因是中枢神经元不能再生。生损害难于治疗，原因是中枢神经元不能再生。生损害难于治疗，原因是中枢神经元不能再生。神经解剖神经解剖神经解剖神经解剖(jipu)(jipu)(jipu)(jipu)复杂、难学、难懂，但是它非常有条理、逻辑性强，只要复杂、难学、难懂，但是它非常有条理、逻辑性强，只要复杂、难学、难懂，但是它非常有条理、逻辑性强，只要复杂、难学、难懂，但是它非常有条理、逻辑性强，只要入门，有兴趣，就不难。入

12、门，有兴趣，就不难。入门，有兴趣，就不难。入门，有兴趣，就不难。神经病学大有前途，随着社会的发展，寿命的延长，发病率明显增加，脑血神经病学大有前途，随着社会的发展，寿命的延长，发病率明显增加，脑血神经病学大有前途，随着社会的发展，寿命的延长，发病率明显增加，脑血神经病学大有前途，随着社会的发展，寿命的延长，发病率明显增加，脑血管病已成为三大死亡疾病之一，我们将来无论干那一科都用得上神经科管病已成为三大死亡疾病之一，我们将来无论干那一科都用得上神经科管病已成为三大死亡疾病之一，我们将来无论干那一科都用得上神经科管病已成为三大死亡疾病之一，我们将来无论干那一科都用得上神经科的知识。的知识。的知识。

13、的知识。第13页/共107页第十三页，共107页。Chapter 1 IntroductionArrangementLectures:n nGeneral information:8 hours(Cranial nerves,motor system,sensory system,reflex system,localization.)n nIndividual information:20 hrs(CVD,spinal diseases,Epilepsy,muscular disease)Internship:2 times,8 hours第14页/共107页第十四页，共107页。Chapt

14、er 2 FUNDAMENTAL NEUROANATOMY FUNDAMENTAL NEUROANATOMY AND LOCALIZATIONAND LOCALIZATION 第15页/共107页第十五页，共107页。Section 1 Cranial nerves Do Do you you remember remember what what are are the the 12 12 pairs pairs of of cranial cranial nerves?nerves?，Olfactory nerve第16页/共107页第十六页，共107页。TemporalnasalOpti

15、c N.chiasmOptic tractOptic radiationLateralGeniculatebodyVisual cortexLesion sites and clinicalSection 1 Cranial nerves ，Optic nerve Anatomy and pathwayAnatomy and pathway R Retina(rods,cones)ganglion cellsoptic etina(rods,cones)ganglion cellsoptic nerveoptic chiasm(nasal half fibers nerveoptic chia

16、sm(nasal half fibers cross,temporal half fibers cross,temporal half fibers uncross)optic tractlateral geniculate uncross)optic tractlateral geniculate bodyposterior limb of the internal bodyposterior limb of the internal capsuleoptic radiationoccipital capsuleoptic radiationoccipital(calcarine)corte

17、x(visual center)(calcarine)cortex(visual center)第17页/共107页第十七页，共107页。Section 1 Cranial nerves ，Optic nerveOptic nerveClinical Findings:Clinical Findings:Vision and Visual Field Defects(Visual loss)Vision and Visual Field Defects(Visual loss)a.a.Optic Optic nervenerve:total total blindness blindness(

18、visual(visual loss)loss)of of the the ipsilateral eye.ipsilateral eye.b.b.Optic Optic chiasmchiasm(such(such as as pituitary pituitary tumor)tumor):bitemporal bitemporal hemianopsia.hemianopsia.c.c.Perichiasmal Perichiasmal areaarea(such(such as as calcified calcified ICA):ICA):ipsilateral ipsilater

19、al nasal hemianopsia.nasal hemianopsia.d.d.Optic Optic tracttract:contralateral contralateral total total homonymous homonymous hemianopsia.hemianopsia.*.*.Optic Optic radiationradiation:plete complete lesionlesion can can cause cause contralateral contralateral total total homonymous homonymous hem

20、ianopia.hemianopia.f.f.lower lower portionportion cause cause contralateral contralateral sup.sup.quadrantanopsia;quadrantanopsia;g.g.upper upper portionportion cause cause contralateral inf.quadrantanopsia;contralateral inf.quadrantanopsia;h.h.Occipital Occipital lobelobe:often often produces produ

21、ces contralateral contralateral homonymous homonymous hemianopia with macular sparing.hemianopia with macular sparing.8TemporalnasalOptic N.chiasmOptic tractOptic radiationLat.eralGeniculatebodyVisual cortexLesion sites and clinical第18页/共107页第十八页，共107页。Section 1 Cranial nerves ，Optic nerve“macular s

22、paring”“macular sparing”:n n the the visual visual field field in in the the central central portion portion of of the the hemianopia hemianopia side side is is preserved preserved and and the the light light reflex reflex in in the the same same side side still still exists.exists.Macular Macular s

23、paring sparing is is a a characteristic characteristic of central hemianopsia.of central hemianopsia.第19页/共107页第十九页，共107页。Section 1 Cranial nerves ，Optic nerveOptic disk changes(with ophthalmoscope)Optic disk changes(with ophthalmoscope)PapilledemaPapilledemaBleeding of retina Bleeding of retina Fun

24、dus change of blood hypertentionFundus change of blood hypertentionOptic atrophyOptic atrophy第20页/共107页第二十页，共107页。Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N)(Oculomotor N,Trochlear N,Abducens N)Anatomy and PhysiologyAnatomy and Physiology group of nuclei(midbrain):group of nuclei

25、(midbrain):muscle function muscle function levator palpebrae m.open the eye levator palpebrae m.open the eye superior rectus m.move the eye upward superior rectus m.move the eye upward medial rectus m.move the eye medially medial rectus m.move the eye medially inferior rectus m.move the eye downward

26、 inferior rectus m.move the eye downward inferior oblique m.move the eye upward inferior oblique m.move the eye upward and outward and outward sphincter m.of iris(sphincter m.of iris(虹膜虹膜(hngm)constrict the pupil(hngm)constrict the pupil ciliary muscle thicken the lens ciliary muscle thicken the len

27、s nucleus(midbrain)nucleus(midbrain)superior oblique m.rotates the eye downward superior oblique m.rotates the eye downward and outward and outward nucleus(pons)nucleus(pons)lateral rectus m.rotates the eye outward lateral rectus m.rotates the eye outwardSub-neucleiE-W第21页/共107页第二十一页，共107页。Section 1

28、 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N)(Oculomotor N,Trochlear N,Abducens N)Diagram of eye muscle action第22页/共107页第二十二页，共107页。Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N)(Oculomotor N,Trochlear N,Abducens N)Clinical termsClinical terms:n nIntraocular m.Intraocular m

29、.:refer to sphincter m.of iris(constrict the pupil),ciliary:refer to sphincter m.of iris(constrict the pupil),ciliary muscle(thicken the lens)and dilator m.of iris(dilate the pupil),which are muscle(thicken the lens)and dilator m.of iris(dilate the pupil),which are involuntary musclesinvoluntary mus

30、clesn nExtraocular m.Extraocular m.:refer to levator palpebrae m.,superior rectus m.,medial:refer to levator palpebrae m.,superior rectus m.,medial rectus m.,inferior rectus m.,inferior oblique m.,superior oblique m.,and rectus m.,inferior rectus m.,inferior oblique m.,superior oblique m.,and latera

31、l rectus m.,all are voluntary muscles lateral rectus m.,all are voluntary muscles 第23页/共107页第二十三页，共107页。Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N)(Oculomotor N,Trochlear N,Abducens N)Clinical termsClinical terms:n nDiplopia Diplopia(double(double vision)vision):When When one one

32、 extraocular extraocular muscle muscle paralyzed,paralyzed,the the eye eye can can not not move move toward toward the the direction direction that that this this paralyzed paralyzed muscle muscle works,works,and and the the patient patient see see two two separate separate images images of of the t

33、he same same object object in in visual space when both eyes viewing.visual space when both eyes viewing.n nAccommodation Accommodation reflexreflex:When When both both eyes eyes follow follow an an object object brought brought from from a a distance distance up up close close to to the the face,fa

34、ce,both both eyes eyes converge converge with with constriction constriction of of pupils.pupils.第24页/共107页第二十四页，共107页。Section 1 Cranial nerves ,(Oculomotor N,Trochlear(Oculomotor N,Trochlear N,Abducens N)N,Abducens N)Clinical terms:Clinical terms:Light reflexLight reflexn nRefers Refers toto:Constr

35、iction Constriction of of the the pupil pupil when when light light is is thrown thrown on on the retina.the retina.n nPathway of light reflexPathway of light reflex:lightretina-optic nerve(II)optic chiasm midbrain lightretina-optic nerve(II)optic chiasm midbrain E-W nuclei oculomotor nerve(III)cili

36、ary E-W nuclei oculomotor nerve(III)ciliary ganglionpostganglionicganglionpostganglionic fibersthe sphincter m.of iris.fibersthe sphincter m.of iris.n nDiameter of the pupilDiameter of the pupil:Normally,there is a balance between :Normally,there is a balance between the sphincter m.of iris and the

37、dilator m.of iris,so the the sphincter m.of iris and the dilator m.of iris,so the diameter of the pupil has a constant range from 3 mm to 4 diameter of the pupil has a constant range from 3 mm to 4 mm.Pupil constriction(miosis):2mm,pupil dilatation:mm.Pupil constriction(miosis):5mm5mm 第25页/共107页第二十五

38、页，共107页。Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N)(Oculomotor N,Trochlear N,Abducens N)Clinical terms:Clinical terms:n nHorners signHorners sign:when the:when the cervical cervical sympathetic nervesympathetic nerve or its pathway or its pathway was injured,it can produce was in

39、jured,it can produce Horners sign.The affected side Horners sign.The affected side shows:miosis,narrowed palpebral shows:miosis,narrowed palpebral fissure,enophthalmos,absence of fissure,enophthalmos,absence of s w e a t i n g o f t h e f a c e.s w e a t i n g o f t h e f a c e.第26页/共107页第二十六页，共107页

40、。Section 1 Cranial nerves ,(Oculomotor N,Trochlear(Oculomotor N,Trochlear N,Abducens N)N,Abducens N)Clinical types of ophthalmoplegiaClinical types of ophthalmoplegia(1)(1)Peripheral Peripheral ophthalmoplegiaophthalmoplegia:caused caused by by lesion lesion of of oculomotor oculomotor nerves nerves

41、 themselves.themselves.Paralysis Paralysis of of CN CN IIIIII:Ptosis Ptosis or or dropping dropping of of the the upper upper eyelid,eyelid,external external(divergent)(divergent)squint squint(strabismus),(strabismus),eye eye difficult difficult to to move move upward,upward,downward,downward,inward

42、,inward,diplopia(double diplopia(double vision),vision),dilatation dilatation of of the the pupil,pupil,loss of light and accommodation reflexes(see next slide).loss of light and accommodation reflexes(see next slide).Paralysis Paralysis of of CN CN IVIV:Paralysis Paralysis of of superior superior o

43、blique oblique muscle muscle cause cause diplopia diplopia on on looking looking downward,downward,so so the the patient patient has has difficulty difficulty in in descending stairsdescending stairsParalysis Paralysis of of CN CN VIVI:Internal Internal(convergent)(convergent)strabismus,strabismus,t

44、he the eye eye cannot cannot move outward,diplopiamove outward,diplopia第27页/共107页第二十七页，共107页。male，81yrs，complete paralysis of left CN III 第28页/共107页第二十八页，共107页。Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N)(Oculomotor N,Trochlear N,Abducens N)Clinical types of ophthalmoplegiaClinica

45、l types of ophthalmoplegia(2)(2)Nuclear ophthalmoplegiaNuclear ophthalmoplegiaLocation Location of of the the lesionlesion:Nucleus Nucleus of of III(midbrain),III(midbrain),IV(midbrain)IV(midbrain)or or VI(pons)VI(pons)CharacteristicsCharacteristics:besides besides oculomotor oculomotor nucleus,nucl

46、eus,often often involves involves the the nearby nearby structure structure esp.the pyramidal tractesp.the pyramidal tractClinical Clinical manifestationmanifestation:crossed crossed hemiplegia,hemiplegia,such as Weber syndrome such as Weber syndrome Weber syndrome 第29页/共107页第二十九页，共107页。Section 1 Cr

47、anial nerves ,(Oculomotor N,Trochlear(Oculomotor N,Trochlear N,Abducens N)N,Abducens N)Clinical types of ophthalmoplegiaClinical types of ophthalmoplegia(3)(3)Supranuclear ophthalmoplegiaSupranuclear ophthalmoplegiaLocation Location of of the the lesionlesion:conjugate conjugate gaze gaze center cen

48、ter(post.post.portion portion of of mid.mid.frontal frontal gyrus,gyrus,area area 8),8),which which moves moves both both eyes eyes simultaneously simultaneously and and horizontally horizontally to to the the opposite side.opposite side.Clinical Clinical manifestationmanifestation:paralysis paralys

49、is of of the the conjugate conjugate gaze gaze to to the the opposite opposite side.side.Destructive Destructive lesions lesions(eg.(eg.CH)CH)produce produce conjugate conjugate deviation deviation of of the the eyes eyes to to the the side side of of the the lesion,lesion,irritative irritative lesi

50、ons lesions(eg.(eg.tumor)tumor)produce produce conjugate conjugate deviation deviation of of the the eyes to the opposite side of the lesion.eyes to the opposite side of the lesion.第30页/共107页第三十页，共107页。Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N)(Oculomotor N,Trochlear N,Abducens