《周围神经病》 .ppt
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1、 周周 围围 神神 经经 病病 Peripheral NeuropathyPeripheral neuropathy is a large group of diseases:Damage of nerves outside of the spinal cord and brain.Dysfunction of these nerves.Caused by any of risk factorsAnatomyandfunctionofperipheralnervebasictounderstandneuropathyAnatomy cranial nerve olfactory nerve o
2、lfactory nerve optic nerveoptic nerve oculomotor nerveoculomotor nerve trochlear nervetrochlear nerve trigeminal nervetrigeminal nerve abducent nerve facial abducent nerve facial nervenerve vestibulocochlear nerve vestibulocochlear nerve glossopharyngeal nerve glossopharyngeal nerve vagus nerve vagu
3、s nerve accessory nerve accessory nerve hypoglossal nerve hypoglossal nerveSpinalnervesHistologyElectrophysiologyUnmyelinated nerve fiberUnmyelinated nerve fiberMyelinated nerve fiberMyelinated nerve fiberFunctionsMotor nerveMotor nerveMotor nerveMotor nerveSensory nerveSensory nerveSensory nerveSen
4、sory nerveAutonomic nerveAutonomic nerveAutonomic nerveAutonomic nervereflexreflexreflexreflexStep 1:ClinicalfeaturesofneuropathieshistoryandexaminationofpatientisthecluestodiagnosisofneuropathyMuscle weaknessWeaknessinthearmsorlegsWeaknessinthearmsorlegs:difficultywalking,difficultywalking,running,
5、climbstairs,Stumblingortiringeasily.running,climbstairs,Stumblingortiringeasily.Difficultieswithcarryingaloadofgroceries,Difficultieswithcarryingaloadofgroceries,openingjars,turningdoorknobs,orcombinghair.openingjars,turningdoorknobs,orcombinghair.Cranialnerveparalysis:Cranialnerveparalysis:ophthalm
6、oplegia,ophthalmoplegia,facialweakness,dysarthria,facialweakness,dysarthria,RespiratoryinsufficientRespiratoryinsufficientMuscleatrophy.Muscleatrophy.Reflexlost.Reflexlost.tips:tips:Lower motor Lower motor neurogenic neurogenic damagedamageAnatomic Anatomic distributiondistributionSymmetricSymmetric
7、 proximal proximal distal distalAsymmetricAsymmetricsingle nerve single nerve multiple nervemultiple nerveplexus plexus nerve rootnerve rootSensory abnormalitiesParesthesias Paresthesias Spontaneous sensations,Spontaneous sensations,numbness,tingling,pins and needles,prickling,numbness,tingling,pins
8、 and needles,prickling,burning,cold,pinching,sharp deep stabs,and burning,cold,pinching,sharp deep stabs,and electric shocks or buzzing.electric shocks or buzzing.Dysesthesias Dysesthesias Unpleasant abnormal sensations Unpleasant abnormal sensations brought on by touching or other stimuli.brought o
9、n by touching or other stimuli.Anesthesia Anesthesia a lack of sensation,leading to a lack of sensation,leading to injuries,cuts and burns due to the lack of injuries,cuts and burns due to the lack of normal warning sensations.a lack of sensation normal warning sensations.a lack of sensation of posi
10、tion,which leads to uncoordinated and of position,which leads to uncoordinated and unsteady walking.unsteady walking.tips:tips:l lHearing patientHearing patient s s descriptiondescriptionl lAnatomic Anatomic distributiondistributionSymmetricSymmetric “Glove and StockingGlove and Stocking”distributio
11、ndistributionAsymmetricAsymmetric single nerve single nerve multiple nervemultiple nerve plexus plexus nerve root nerve rootAutonomic Nerve Damage blurred visionblurred vision decreased ability to sweat(anhidrosis)decreased ability to sweat(anhidrosis)decreased ability to regulate body temperaturede
12、creased ability to regulate body temperature disturbances of bladder functiondisturbances of bladder function orthostatic hypotensionorthostatic hypotension ConstipationConstipation diarrhea,nausea after meals,abdominal bloatingdiarrhea,nausea after meals,abdominal bloating sexual dysfunction(impote
13、nce)sexual dysfunction(impotence)thinning of the skin,with easy bruisability and thinning of the skin,with easy bruisability and poor healing.poor healing.Step 2:Laboratory findingsnerve conductionnerve conduction study can confirm study can confirm neuropathy and distinguish between neuropathy and
14、distinguish between damage to axons or the myelin sheath.damage to axons or the myelin sheath.electromyographyelectromyography differentiates myogenic differentiates myogenic(muscle tissue)from neurogenic(nerve(muscle tissue)from neurogenic(nerve tissue)causes of weakness and can tissue)causes of we
15、akness and can confirm abnormal neuromuscular confirm abnormal neuromuscular junctions.junctions.nerve biopsynerve biopsy is needed only when other is needed only when other tests are inconclusive.tests are inconclusive.Step3:causes Disease炎症性炎症性炎症性炎症性/免疫介导型神经病免疫介导型神经病免疫介导型神经病免疫介导型神经病中毒性神经病中毒性神经病中毒性
16、神经病中毒性神经病维生素缺乏维生素缺乏维生素缺乏维生素缺乏遗传性神经病遗传性神经病遗传性神经病遗传性神经病神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤异常球蛋白血征相关的神经病异常球蛋白血征相关的神经病异常球蛋白血征相关的神经病异常球蛋白血征相关的神经病感染相关的神经病感染相关的神经病感染相关的神经病感染相关的神经病系统性疾病系统性疾病系统性疾病系统性疾病外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤神经病伴肿瘤肿瘤的远隔效应肿瘤的远隔效应肿瘤直接浸润肿瘤直接浸润异常球蛋白血征相关的异常球蛋白血征相关的异常球蛋白血征相关
17、的异常球蛋白血征相关的神经病神经病神经病神经病感染相关的神经病感染相关的神经病感染相关的神经病感染相关的神经病 HIVHIV 麻风麻风 Lyme Lyme 病病 带状疱疹带状疱疹系统性疾病系统性疾病系统性疾病系统性疾病糖尿病神经病糖尿病神经病 甲状腺功能低下甲状腺功能低下肾脏、肺、肝脏衰竭肾脏、肺、肝脏衰竭危重病神经病危重病神经病器官移植相关神经病器官移植相关神经病外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压外伤切割、挤压、嵌压Pathomechanism WalleriandegenerationWalleriandegeneration axonaldegeneration
18、axonaldegeneration neuronaldegenerationneuronaldegeneration segmentaldemyelinationsegmentaldemyelination onion-bulbformationonion-bulbformation InterstitialneuropathyInterstitialneuropathy VasculiticneuropathyVasculiticneuropathy周围神经病的临床病理分类周围神经病的临床病理分类对称性广泛性多神经病对称性广泛性多神经病对称性广泛性多神经病对称性广泛性多神经病l l四肢远端
19、对称性感觉四肢远端对称性感觉四肢远端对称性感觉四肢远端对称性感觉运动障碍和皮肤植物运动障碍和皮肤植物运动障碍和皮肤植物运动障碍和皮肤植物神经功能异常。神经功能异常。神经功能异常。神经功能异常。l l电生理检查:广泛神电生理检查:广泛神电生理检查:广泛神电生理检查:广泛神经传导异常和失神经经传导异常和失神经经传导异常和失神经经传导异常和失神经电位。电位。电位。电位。l l常见病因:中毒,代常见病因:中毒,代常见病因:中毒,代常见病因:中毒,代谢,遗传,免疫,结谢,遗传,免疫,结谢,遗传,免疫,结谢,遗传,免疫,结缔组织病等缔组织病等缔组织病等缔组织病等单神经病单神经病单神经病单神经病/多发单神经
20、病多发单神经病多发单神经病多发单神经病l l单个神经支配区域感觉单个神经支配区域感觉单个神经支配区域感觉单个神经支配区域感觉异常,局部肌肉无力萎异常,局部肌肉无力萎异常,局部肌肉无力萎异常,局部肌肉无力萎缩,非对称性。缩,非对称性。缩,非对称性。缩,非对称性。l l电生理检查:单神经电生理检查:单神经电生理检查:单神经电生理检查:单神经l l常见原因:外伤,血管常见原因:外伤,血管常见原因:外伤,血管常见原因:外伤,血管病,感染,肿瘤浸润,病,感染,肿瘤浸润,病,感染,肿瘤浸润,病,感染,肿瘤浸润,结缔组织病,甲低,等结缔组织病,甲低,等结缔组织病,甲低,等结缔组织病,甲低,等吉兰吉兰巴雷综合
21、征巴雷综合征Guillain-BarresyndromeGuillain-Barresyndromel l18591859年年 LandryLandry s Acending paralysis s Acending paralysis l l18921892年年 acute febrile polyneuroritis acute febrile polyneuroritis l l19181918年年 acute infective polineuritis acute infective polineuritis l l19161916年年 Guillain-Barre-Strohl G
22、uillain-Barre-Strohl syndrome syndrome Pathologic changes of AIDPPathologic changes of AIDPMechanismAntecedenteventsforGBS InfectionsInfections virusesviruses E-B virus E-B virus Cytomegalovirus Cytomegalovirus HIV HIV Infuenza virus Infuenza virus Coxsackie viruses Coxsackie viruses Herpes simplex
23、Herpes simplex Hepatitis Hepatitis A A and and C C virusesviruses Others OthersBacterial infectionBacterial infection Campylobacter jejuniCampylobacter jejuni Mycoplasma Mycoplasma pneumoniacpneumoniac Escherichia coli Escherichia coli Others Others ParasticParastic Mararia Mararia Toxoplasmosis Tox
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