神经病学课件 周围神经病变
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trigeminal roots • Vascular decompression
Idiopathic facial paralysis
• idiopathic facial paralysis is also called facial neuritis or Bell palsy, which is peripheral facial paralysis due to the non special inflammation of facial nerve.
• Mutiple mononeuropathy: more than one peripheral nerve are involved
• Polyneuropathy: symmetrical weakness of limbs and areflexia, symmetric loss of sensory, autonomic dysfunction in the affected area
– Not include the optic nerves and olfactory bulbs
– Composed of Cranial nerves (10 pairs) and Spinal nerves (31 pairs)
• Myelinated fibers: coated with the membrane of one Schwann cell every 250 to 1000μm in concentric way, forming the insulated myelin (a multilayer sheath). Each segment is called node of Ranvier, permitting the conduction of the nerve impulse saltatory and therefore rapidly
salivation.
Treatment
• Prednisone: 40-60mg/day • Medication of vitamin B12 and vitamin B1 • Antiviral therapy • Protection of the eye during sleep • Physical therapy • Surgery
Peripheral neuropathy
运动、感觉传导通路
• 浅感觉和粗触觉传导通路：皮肤粘膜感受器→后根脊神经节→ 后角换神经元→脊髓灰、白质前联合交叉→对侧脊髓丘脑束 （前、侧）→脊髓丘系→丘脑外侧核换元（腹后--脊丘系，腹 内--三叉丘系）→丘脑皮质束→中央后回。头面部浅感受器→ 三叉神经半月神经节→三叉神经脊束核换元→交叉（桥脑下部） →三叉丘系→丘脑、大脑。
• The first pathological change of cranial nerve is the edema of nerve and demyelination, in serious condition axonal degeneration occurs.
Scheme of facial nerve
Impairment of taste. – Nerve to the stapedius muscle— hyperacusis or distortion of
sound in the ipsilateral ear(paralysis of the stapedius muscle) – Above geniculate ganglia—reduction of lacrimation and
Clinical manifestation
• The disorder affects men and women more or less equally and occurs at all ages and all times of the year.
• The onset is acute • Pain behind the ear may precede the paralysis by a day
Neuropathy: Secondary degeneration due to neuron necrosis
Clinical symptoms
• Impairment of motor function
– LMN paralysis – Stimulus symptoms: fasciculation
– Injury of the myelin causes the destruction of node of Ranvier leading the slow down of nerve conducting velocity
• Unmyelinated fibers: bundles of fibers is capsulated by a single Schwann cell.
or two. • Symptoms according the lesion position
– Stylomastoid foramen—paralysis of muscles of facial expression – Junction of the chorda tympani fibers to geniculate ganglia–
Etiological factor and ology
• Usually idiopathic. Some may be due to the compression of tortuous blood vessel.
Clinical manifestation
• Women: men=3:2. Much higher in elderly; • Paroxysmal in nature • Unilateral and limited to one or two divisions
Diagnosis and differential diagnosis
According to the location and nature of the pain , trigger point and without positive signs of nerve system examinations. • Symptomatic trigeminal neuralgia; • Dental neuralgia;
Etiology and Pathology
• The cause is still unclear. Maybe is related with virus infection, especially herpes zoster. Compression from the osseous facial canal after the edema formation also participates pathologic process.
Treatment
• Anticonvulsant drugs
– Carbamazepine (often the first choice drug ) – Phenitoin – Valproic acid – Gabapentin
• Baelofen • Vitamin B12 and Vitamin B1 • Pimozide • Nerve blocking therapy • Stereotactically controlled thermocoagulation of the
• Sensory impairment
– anaesthesia, paraesthesia and pain
• Autonomic dysfunction: Anhidrosis and orthostatic hypotension
Clinical patterns
• Mononeuropathy: weakness and sensory loss in the territory of a single peripheral nerve
– No sheath– slow propagation of electric flow of nerve impulse.
Etiology
Connective tissue diseases: lupus erythometosis
Trauma/entrapment
Intoxication: pesticide Nutrition deficiency / metabolic disturbance
degeneration or demyelination – Distinguish muscle disease from neuropathy
Idiopathic Trigeminal Neuralgia
• Trigeminal neuralgia is a disease characterized with transient and recurrent severe pain within the distribution of trigeminal nerve.
Tumor-related
Hereditary diseases
Inflammation
cryptogenic
NEUROPATHY
Wallerian degeneration: the nerve degenerates from the point of axonal damage outwards
Segmental demyelination: Focal degeneration of the myelin sheath with sparing of the axon
Axonal degeneration: the axon degenerates from the distalmost site to the proximal site (both axon and myelin)
(mandibular and maxillary branches are more involved) of trigeminal nerve territory • Intensity to make patients grimace or tic • Presence of initiating or trigger point • Lack of demonstrable sensory or motor deficit.
神经病学的诊断原则
病史
临床表 ↗
现阐述
→
↘
神经系
统检查
根据生理解 剖知识解释 症状和体征
病变综合征 → 的定位
定位诊断
+ → 发病和病程进展模式
+ 辅助检查
1
2
3
4
(定位诊断)
(定性诊断)
各 种 类 型 感 觉 障 碍 分 布 图
锥 体 束 不 同 病 损 的 瘫 痪 分 布
The peripheral nervous system (PNS) includes all neural structures lying outside the pial membrane of the spinal cord and brain stem.
Auxiliary examination
• NCV and EMG are helpful to the diagnosis of the peripheral nerve disease.
– Discover the preclinical nerve impairment – Find out whether the disease is caused by the axon
• 深感觉和精细触觉传导通路：关节、肌腱感受器→后根脊神经 节→同侧脊髓后束（薄束、楔束）→延髓 楔束核（楔状结节）、 薄束核（棒状体）换元→延髓交叉→内侧丘系→丘脑腹后外侧 核换元→丘脑皮质束→中央后回。
• 随意运动传导通路：中央前回大锥体细胞→ 皮质脊髓束→内囊 后支前2/3→大脑脚中部3/5→→延髓锥体交叉→皮质脊髓侧束 2/3→→→前角细胞 →前根→脊神经→神经丛、神经干→横纹 肌。
Idiopathic facial paralysis
• idiopathic facial paralysis is also called facial neuritis or Bell palsy, which is peripheral facial paralysis due to the non special inflammation of facial nerve.
• Mutiple mononeuropathy: more than one peripheral nerve are involved
• Polyneuropathy: symmetrical weakness of limbs and areflexia, symmetric loss of sensory, autonomic dysfunction in the affected area
– Not include the optic nerves and olfactory bulbs
– Composed of Cranial nerves (10 pairs) and Spinal nerves (31 pairs)
• Myelinated fibers: coated with the membrane of one Schwann cell every 250 to 1000μm in concentric way, forming the insulated myelin (a multilayer sheath). Each segment is called node of Ranvier, permitting the conduction of the nerve impulse saltatory and therefore rapidly
salivation.
Treatment
• Prednisone: 40-60mg/day • Medication of vitamin B12 and vitamin B1 • Antiviral therapy • Protection of the eye during sleep • Physical therapy • Surgery
Peripheral neuropathy
运动、感觉传导通路
• 浅感觉和粗触觉传导通路：皮肤粘膜感受器→后根脊神经节→ 后角换神经元→脊髓灰、白质前联合交叉→对侧脊髓丘脑束 （前、侧）→脊髓丘系→丘脑外侧核换元（腹后--脊丘系，腹 内--三叉丘系）→丘脑皮质束→中央后回。头面部浅感受器→ 三叉神经半月神经节→三叉神经脊束核换元→交叉（桥脑下部） →三叉丘系→丘脑、大脑。
• The first pathological change of cranial nerve is the edema of nerve and demyelination, in serious condition axonal degeneration occurs.
Scheme of facial nerve
Impairment of taste. – Nerve to the stapedius muscle— hyperacusis or distortion of
sound in the ipsilateral ear(paralysis of the stapedius muscle) – Above geniculate ganglia—reduction of lacrimation and
Clinical manifestation
• The disorder affects men and women more or less equally and occurs at all ages and all times of the year.
• The onset is acute • Pain behind the ear may precede the paralysis by a day
Neuropathy: Secondary degeneration due to neuron necrosis
Clinical symptoms
• Impairment of motor function
– LMN paralysis – Stimulus symptoms: fasciculation
– Injury of the myelin causes the destruction of node of Ranvier leading the slow down of nerve conducting velocity
• Unmyelinated fibers: bundles of fibers is capsulated by a single Schwann cell.
or two. • Symptoms according the lesion position
– Stylomastoid foramen—paralysis of muscles of facial expression – Junction of the chorda tympani fibers to geniculate ganglia–
Etiological factor and ology
• Usually idiopathic. Some may be due to the compression of tortuous blood vessel.
Clinical manifestation
• Women: men=3:2. Much higher in elderly; • Paroxysmal in nature • Unilateral and limited to one or two divisions
Diagnosis and differential diagnosis
According to the location and nature of the pain , trigger point and without positive signs of nerve system examinations. • Symptomatic trigeminal neuralgia; • Dental neuralgia;
Etiology and Pathology
• The cause is still unclear. Maybe is related with virus infection, especially herpes zoster. Compression from the osseous facial canal after the edema formation also participates pathologic process.
Treatment
• Anticonvulsant drugs
– Carbamazepine (often the first choice drug ) – Phenitoin – Valproic acid – Gabapentin
• Baelofen • Vitamin B12 and Vitamin B1 • Pimozide • Nerve blocking therapy • Stereotactically controlled thermocoagulation of the
• Sensory impairment
– anaesthesia, paraesthesia and pain
• Autonomic dysfunction: Anhidrosis and orthostatic hypotension
Clinical patterns
• Mononeuropathy: weakness and sensory loss in the territory of a single peripheral nerve
– No sheath– slow propagation of electric flow of nerve impulse.
Etiology
Connective tissue diseases: lupus erythometosis
Trauma/entrapment
Intoxication: pesticide Nutrition deficiency / metabolic disturbance
degeneration or demyelination – Distinguish muscle disease from neuropathy
Idiopathic Trigeminal Neuralgia
• Trigeminal neuralgia is a disease characterized with transient and recurrent severe pain within the distribution of trigeminal nerve.
Tumor-related
Hereditary diseases
Inflammation
cryptogenic
NEUROPATHY
Wallerian degeneration: the nerve degenerates from the point of axonal damage outwards
Segmental demyelination: Focal degeneration of the myelin sheath with sparing of the axon
Axonal degeneration: the axon degenerates from the distalmost site to the proximal site (both axon and myelin)
(mandibular and maxillary branches are more involved) of trigeminal nerve territory • Intensity to make patients grimace or tic • Presence of initiating or trigger point • Lack of demonstrable sensory or motor deficit.
神经病学的诊断原则
病史
临床表 ↗
现阐述
→
↘
神经系
统检查
根据生理解 剖知识解释 症状和体征
病变综合征 → 的定位
定位诊断
+ → 发病和病程进展模式
+ 辅助检查
1
2
3
4
(定位诊断)
(定性诊断)
各 种 类 型 感 觉 障 碍 分 布 图
锥 体 束 不 同 病 损 的 瘫 痪 分 布
The peripheral nervous system (PNS) includes all neural structures lying outside the pial membrane of the spinal cord and brain stem.
Auxiliary examination
• NCV and EMG are helpful to the diagnosis of the peripheral nerve disease.
– Discover the preclinical nerve impairment – Find out whether the disease is caused by the axon
• 深感觉和精细触觉传导通路：关节、肌腱感受器→后根脊神经 节→同侧脊髓后束（薄束、楔束）→延髓 楔束核（楔状结节）、 薄束核（棒状体）换元→延髓交叉→内侧丘系→丘脑腹后外侧 核换元→丘脑皮质束→中央后回。
• 随意运动传导通路：中央前回大锥体细胞→ 皮质脊髓束→内囊 后支前2/3→大脑脚中部3/5→→延髓锥体交叉→皮质脊髓侧束 2/3→→→前角细胞 →前根→脊神经→神经丛、神经干→横纹 肌。