西氏内科学中英文对照翻译(部分)

西氏内科学中英文对照翻译(部分)

来源：医学全在线更新：2009-11-2 医学英语论坛

Part XXV - NEUROLOGY

第八分册——神经系统疾病

Section - Evaluation of the Patient

病人评估

Chapter 438 - APPROACH TO THE PATIENT

第438章——诊疗途径

Robert C. Griggs

The symptoms of nervous system diseases are a part of everyday experience for most normal people. Slips of the tongue, headaches, backache and other pains, dizziness, light-headedness, numbness, muscle twitches, jerks, cramps, and tremors all occur in totally healthy persons. Mood swings with feelings of elation and depression, paranoia, and displays of temper are equally a part of the behavior of completely normal people. The rapid increase in information about neurologic diseases coupled with the intense interest of people in all walks of life in medical matters has focused public attention on both common and rare neurologic conditions.

神经系统症状是大多数正常人每天都能体验到的一些情况。像口误(slips of the tongue)、头痛、背痛和其他疼痛、头晕、肌肉抽搐或抽动、痉挛性震颤等，都是完全健康者也可能发生的。情感波动时的喜气洋洋或郁郁寡欢、妄想、发怒等，也是完全正常者可能出现的。神经系统疾病认识的迅速提高，以及医疗活动与各界人士的密切关系，使得常见和罕见情况都能引起公众的关注。

Most older people are concerned that they or their spouse have or are developing Alzheimer's disease or stroke or both. The almost ubiquitous tremor of the elderly prompts concern about Parkinson's disease. Many younger patients are concerned about multiple sclerosis or brain tumor, and few normal people lack one or more symptoms suggesting the diagnosis of a serious neurologic disease. For most of these and other common diagnoses, imaging and other tests are typically normal when symptoms first appear and should not be obtained to reassure the patient or

physician. Moreover, the widespread availability of neurodiagnostic imaging and electrophysiologic, biochemical, and genetic testing has detected "abnormalities" in many young and most elderly persons. In evaluating a patient's symptoms, it is imperative that a clinical diagnosis be reached without reference to a neurodiagnostic laboratory finding. Patients with disorders such as headache, anxiety, or depression usually do not have abnormal laboratory studies. Abnormalities that are noted on various neurodiagnostic studies are often incidental findings whose treatment may be justified and necessary but will not improve the patient's symptoms. Abnormalities detected incidentally that do not have signs or symptoms may, as for disorders such as hypertension, require aggressive evaluation and treatment, but in general, the adage that it is difficult to improve the asymptomatic patient should be kept in mind. Thus, in elderly patients, few imaging or electrophysiologic studies are interpreted as "normal" but in the absence of specific complaints consistent with the findings, treatment and even further evaluation should reflect an estimate of the specificity and sensitivity of the test, as well as the likelihood that the patient will require and benefit from treatment. It is a good rule-of-thumb that one should never obtain (or refer to the result of) a neurodiagnostic procedure without a specific diagnosis or at least a differential diagnosis in mind.

很多老人都在关心自己或其配偶是否已有或正在发生Alzheimer病(早老性痴呆)和中风；面老人几乎都有的震颤，则会带来Parkinson病的忧虑。很多年龄较轻的病人关心自己是否有多发性硬化和脑肿熘，而且正常人几乎都可能有一两种提示严重神经系统疾病的症状。像这些和其他常见病变症状初见时，影像检查和其他试验往往都是正常的．但病人和医生却不能以此自慰，掉以轻心。另一方面，神经诊断性影像、生化、电生理和遗传检查，又能从很多年轻和大多数老人中发现“异常改变”。在对病人症状进行评估时，重要的是不能依托神经诊断性实验室检查结果来建立临床诊断。像头痛、声虑及抑郁之类病变。实验室检查一般并无异常。而由各种神经诊断性检查发现的异常，往往是伴随性的，对此进行治疗可能是正确和必要的。但却不能使病人症状获得改善。没有症状或体征而偶然检测到的异常，像高血压之类病变时，可能需要积极追查和冶疗，但是很难使无症状病人得到改善的一般性规律，是应该记取的。因此对老年病人来说，没有什么影像或电生理检查可以评估为“正常”，但是如果没有与此“异常发现”相应的特异症状，则治疗甚至进一步检查也只是对检查的敏感性和特异性进行评估，以及病人需要和受惠于治疗的可能性。在没有特异诊断至少是鉴别诊断方面的考虑时，不要轻动神经诊断检查(或参照其检查结果)，是一条很好的经验。

It is important to allow the patient to describe any symptoms in his or her own words. Direct questions are often necessary to fully characterize the patient's problem, but suggested terms or descriptors for symptoms are frequently grasped by the patient unfamiliar with medical terminology and then parroted to subsequent interviewers. The patient's terms should always be used when recording symptoms. Terms such as lameness, weakness, numbness, heaviness, cramps, and tiredness may each mean pain, weakness, or alteration of sensation to some patients.

让病人用自己的语言叙述症状是很重要的。为充分了解病人谈到的情况，常须直接提出—些问题，但是不熟悉医学术语的病人，往往把这些提示性术语或描述词记在心里，下次就诊时照样搬用。记录症状一定要用病人自己的语言。像走路发拐、虚弱、麻木、发沉、痉挛、