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1、医学知识双语浏览：头痛医学知识双语浏览：头痛下面学习啦我为大家带来医学知识双语浏览：头痛，欢迎大家学习!Headache(cephalalgia)isacommonsymptom,oftenassociatedwithdisability,butrarelylifethreatening.Headachesmaybeaprimarydisorder(migraine,cluster,ortensionheadache)orasecondarysymptomofsuchdisordersasacutesystemicorintracranialinfection,intracranialtumo
2、r,headinjuries,severehypertension,cerebralhypoxia,andmanydiseasesoftheeyes,nose,throat,teeth,ears,andcervicalvertebrae.Sometimesnocauseisfound.头痛是一种常见症状，经常与功能障碍有关，但很少危及生命。头痛可能是一种原发性疾病(如偏头痛，丛集性头痛或紧张型头痛)，可以能是某些疾病的继发症状，如急性全身性感染或颅内感染、颅内肿瘤、头外伤、严重的高血压、脑缺氧、及眼、耳、鼻、喉、口腔牙齿和颈椎等多种疾病，有时找不到任何病因。Headachesmayresult
3、fromstimulationof,tractionof,orpressureonanyofthepain-sensitivestructuresofthehead:alltissuescoveringthecranium;the5th,9th,and10thcranialnerves;theuppercervicalnerves;thelargeintracranialvenoussinuses;thelargearteriesatthebaseofthebrain;thelargeduralarteries;andtheduramaterattheskullbase.Dilationorc
4、ontractionofbloodvesselwallsstimulatesnerveendings,causingheadache.Thecauseofmostheadachesisextracranialratherthanintracranial.Stroke,vascularabnormalities,andvenousthrombosesareuncommoncausesofheadache.对头部任何疼痛敏感构造的刺激、牵引或压迫都能引起头痛，这些构造包括覆盖头颅的所有组织;第5、9、10颅神经;上部颈神经;颅内大静脉窦;颅底大动脉;硬脑膜大动脉以及颅底硬脑膜。血管壁的扩张或收缩刺
5、激神经末梢，引起头痛。大多数头痛的病由于颅外性而非颅内性。因脑卒中、血管畸形与静脉血栓构成引起的头痛并不常见。DiagnosisThefrequency,duration,location,andseverityoftheheadache;thefactorsthatmakeitbetterorworse;associatedsymptomsandsigns,suchasfever,stiffneck,nausea,andvomiting;andspecialstudieshelpidentifythecauseofheadache.诊断诊断内容包括：头痛的发生频率、持续时间、部位、严重程度;
6、改善或加剧头痛的因素;相关症状与体征(如发热、颈项强直、恶心与呕吐);及辅助头痛病因检查的特殊检查。Secondaryheadachesmayhavespecificcharacteristics.Anacutewhole-cranial,severeheadacheassociatedwithfever,photophobia,andstiffneckindicatesaninfectiousprocess,suchasmeningitis,untilprovedotherwise.Subarachnoidhemorrhagealsocausesacuteheadachewithsympto
7、msandsignsofmeningealirritation.Space-occupyinglesionsoftencausesubacute,progressiveheadache.New-onsetheadacheinanadult40yralwaysrequiresthoroughevaluation.Withspace-occupyinglesions,thefollowingmayoccur:headacheonawakeningoratnight,fluctuationofheadachewithposturalchanges,andnauseaandvomiting.Addit
8、ionalneurologiccomplaints,suchasseizure,confusion,weakness,orsensorychanges,mayoccurlateandareominous.一些继发性头痛具有某些特定特征。急性、剧烈的满头痛伴发热、畏光和颈项强直，提示感染，如脑膜炎，应寻找证据加以排除。蛛网膜下腔出血也能引起急性头痛，常伴有脑膜刺激的症状与体征。占位性病变经常引起亚急性、渐进性头痛。40岁以后新发病的头痛始终需要彻底的评估。.颅内占位性病变引起的头痛可出现下列情况：睡醒时或夜间头痛，体位改变引起头痛变化，恶心和呕吐。其他神经性疾病主诉，如惊厥发作、精神错乱、无力或
9、感觉异常变化等，出现较迟，为恶性症状。Tensionheadachetendstobechronicorcontinuousandcommonlyoriginatesintheoccipitalorbifrontalregion,thenspreadsovertheentirehead.Itisusuallydescribedasapressuresensationoraviselikeconstrictionoftheskull.Febrileillnesses,arterialhypertension,andmigraineusuallycausethrobbingpainthatcano
10、ccurinanypartofthehead.紧张型头痛往往表现为慢性或持续性，通常始于枕部或双额部，然后扩散到整个头部，常被病人描绘为受压感或颅紧箍感。发热性疾病、动脉性高血压以及偏头痛通常引起搏动性头痛，可出如今头部任何部位。UsefultestsincludeCBC,STS,serumchemistryprofile,ESR,CSFexamination,and,forspecificsymptoms,oculartests(acuity,visualfields,refraction,intraocularpressure)orsinusx-rays.Ifthecauseofrecen
11、t,persistent,recurrent,orincreasingheadacheremainsindoubt,MRIand/orCTisappropriate,especiallyifabnormalneurologicsignsarepresent.有用的检查包括血常规、梅毒血清试验、血生化分析、血沉与脑脊液检查，如有特殊症状，应进行视觉检查(视敏度、视野、屈光、眼内压)或鼻窦X线检查。如对近期发生的持续、反复、或程度加重的头痛，无法查明其原因的，就应作MRI和/或CT检查，十分是出现异常神经体征时。TreatmentManyheadachesareofshortdurationand
12、requirenotreatmentotherthanmildanalgesics(eg,aspirin,acetaminophen)andrest.治疗很多头痛都是短期的，除服用一些轻镇痛剂(如阿司匹林或扑热息痛)及休息外，无需其他治疗。Treatmentofprimaryheadachesisdiscussedunderthespecificdisorders,below.Alternativeapproaches,suchasbiofeedback,acupuncture,dietarymanipulations,andsomelessconventionalmodes,havebeen
13、advocatedforthesedisorders.Noneofthesetreatmentshasshownclear-cutbenefitsinrigorousstudies.However,totheextentthatanalternativetreatmentposeslittlerisk,itmaybetried,withtheideathateffectiveheadachemanagementismultidimensional.原发性头痛的治疗将在下文讨论。有人主张采用不同的治疗措施，如生物反应、针灸、饮食调控及某些较少使用的治疗方式。这些治疗措施都未能在严格的检验中证实其
14、明确的疗效。不过，既然这些另类治疗措施几乎没什么风险，试一下倒也不妨，由于有效的头痛治疗本来也是多种多样的。Treatmentofsecondaryheadachesdependsontreatmentoftheunderlyingdisorder.Formeningitis,promptantibiotictherapyiscritical.Subsequently,symptomscanberelievedwithanalgesics,includingacetaminophen,NSAIDs,oropioidnarcotics.Certaindisordersrequiremorespe
15、cifictreatment;eg,temporalarteritisistreatedwithcorticosteroids,andheadacheduetobenignintracranialhypertensionistreatedwithacetazolamideordiureticsandweightloss.Subduralhematomasorbraintumorsmaybetreatedsurgically.继发性头痛的治疗取决于潜在疾病的治疗。对脑膜炎而言，即时的抗生素治疗至关重要。以后，镇痛剂，包括扑热息痛、非类固醇抗炎药或阿片类麻醉剂，都可用于缓解头痛症状。有些疾病则需要
16、更专门的治疗。如，颞动脉炎需用肾上腺皮质激素治疗，由良性颅内压增高引导的头痛则可用乙酰唑胺或利尿剂，并配合减轻体重。硬膜下血肿或脑肿瘤则需进行外科手术。Stressmanagementtaughtbyapsychologistoftenreducestheincidenceofheadaches.However,mostpatientsarehelpedbyanunderstandingphysicianwhoacceptsthepainasreal,seesthepatientregularly,andencouragesdiscussionofemotionaldifficulties,w
17、hethertheyarethecauseortheresultofchronicheadaches.Thephysiciancanreassurethepatientthatnoorganiclesionispresentandrecommendenvironmentalreadjustmentsandtheremovalofirritantsandstresses.Forparticularlydifficultproblems,ateamcomposedofaphysician,psychotherapist,andphysiotherapistismosteffectiveinmana
18、gingchronicheadache.心理医生的减压疗法经常能够减少头痛的发病率。不过，大多数病人还是要由懂行的医生来治疗，定期随访，鼓励讨论一些情感问题，不管这些习慢性头痛能否由这些因素引起或是头痛导致这些问题，医生的这些措施对病人都是有帮助的。医生能够安慰病人，告诉他并不存在器质性病变，并量出一些环境适应方面的建议及消除刺激与压力方法。对一些十分难处理的病情，则应交给由临床医生、心理治疗医生和理疗师组成的医疗小组来处理，他们在治疗慢性头痛方面是最为有效的。Nightsweatsaredrenchingsweatsthatrequireachangeofbedding.盗汗为淋透性出汗，需
19、换床单。I.Approach.Thefirstpriorityistoexcludenightsweatscausedbyfever.Sweatingassociatedwithfeverisaseparateevaluation.Beforethe20thcentury,nightsweatsimpliedinfectionwithtuberculosis.Now,manyotherailmentsareassociatedwiththissymptom.Nightsweatsareoftenthemarkofaknownconditionsuchasdiabetes(especiallyw
20、ithnocturnalhypoglycemia),cancer,headtrauma,andrheumatologicdisorders.Nightsweatscanalsobeasymptomofanewdisorder.Theinvestigationofapatientreportingnightsweatsrequiresareviewofpastillnessesandnewsymptoms.I.诊断。首先要排除发烧引起的出汗。发烧性出汗应另行诊断。20世纪前，盗汗通常提示有结核菌感染。如今，其他很多不适都与此症状相关。盗汗通常是某已知病症的标志，如糖尿病(十分是伴夜间低血糖者)、
21、癌症、头外伤和各种风湿病。盗汗可以能是新的疾病的一种症状，在给盗汗报告病人进行检查时，需检查既往病史及新的症状。II.History.Nightsweatscanbecharacterizedbydeterminingonset,frequency,exacerbations,andremissionsofsymptoms.Questionpatientsaboutthecurrentstateofknowndisorders.Excessivesweatingisassociatedwithpoornocturnalglycemiccontrol.Flaresofrheumatologicd
22、isorders(rheumatoidarthritis,lupus,juvenilerheumatoidarthritis,andtemporalarteritis)causesweatingtoo.Pregnancytemporarilychangestheintrinsicthermostatinmanywomenwhoperspireexcessively.Patientswhoareimmuno-compromisedareatincreasedriskforinfections,especiallywithatypicalagents.Patientswithahistoryofs
23、ubstanceabuseneedtobeaskedaboutneedleuseandcontaminants.II.病史。盗汗可通过确认发作时间、次数、加剧及症状消退加以确定。询问病人已知疾病。多汗也与夜间血糖控制不良有关。风湿性疾病(如类风湿关节炎、狼疮、幼儿性类风湿性关节炎、颞关节炎等)也导致出汗，妇娠也会暂时的改变很多妇女的体温状况，导致出汗太多。免疫代偿病人感染风险增加，十分是非典型性病原体感染。有药物滥用史病人需询问其针头使用及其他接触状况。A.Reviewofsystems.Othersymptomsthatcanaccompanynightsweatsincludeflushi
24、ng(carcinoidsyndrome,pheochromocytoma),jointpain,sleepapnea,menstrualirregularities,reflux,cough,headache,dysuria,dyspnea,rashes,fatigue,palpitations,andweightandbowelhabitchanges.A.系统检查。伴随盗汗的其他症状包括潮红(类癌综合症、嗜铬细胞瘤)、关节痛、睡眠性呼吸暂停、月经不调、反流、咳嗽、头痛、排尿困难、睡眠困难、皮疹、疲惫、心悸及体重与排便习惯改变。B.Exposurefactors.Inquireaboutr
25、ecentimmunizationsornewmedicinessuchasantidepressants,cholinergics,meperidine,estrogeninhibitors,gonadotropininhibitors,niacin,steroids,stimulants,over-the-counterpreparations,antipyretics,andnaturopathictherapies.Questionpatientsaboutexposuretosexuallytransmitteddiseases(STDs),humanimmuno-deficienc
26、yvirus(HIV),hepatitis,tuberculosis,oroccupationalandtravel-relatedexposures.Alsoaskaboutincreasesingeneralchangesintheambientnighttemperature.B.暴露因素。询问近期免疫及新药使用情况，如抗抑郁剂、胆碱能药、哌替定、雌激素抑制剂、促性腺激素抑制剂、烟酸、类固醇、兴奋剂、非处方制剂、解热剂和自然疗法。询问病人有无接触性传染病(STD)、HIV、肝炎、结核病，有否职业性及旅游相关性接触。也应询问周围夜间体温总体变化增加情况。C.Psychologicalfac
27、tors.Anxiety,nightmares,andpsychoactivepreparationscanprecipitatenightsweatsinhealthyindividuals.C.精神因素。焦虑、噩梦及兴奋剂可导致健康个体盗汗。D.Familyhistory.Patientswhoreportafamilyhistoryofhereditarydisordersandpossiblemalignanciesshouldhaveappropriatescreening.D.家庭史。有遗传疾病及可能的恶性肿瘤家庭史病人应进行适当的筛检。III.Physicalexaminatio
28、n.Thephysicalexaminationshouldaddressthepertinentpositivesnotedinthepatientsmedicalhistory.Notethepatientsweightandtemperature.Examinationofthehead,eyes,ears,nose,andthroat(HEENT)shouldfocusoncommontypesofinfection:sinusitis,pharyngitis,andotitis.Athoroughexaminationoflymphnodesishelpfultoidentifyin
29、fectionorlymphaticabnormalities.Thecardiopulmonaryexaminationcanalsosignalinfection,valvulardisease,andstimulantuse.Patientsshouldbeexaminedforabscesses,skinulcers,septicjoints,phlebitis,andosteomyelitis.III.身体检查。身体检查应针对病人医疗史中的相关阳性记录。注意病人体重体温。头、眼、耳、鼻及喉检查的重点是普通类型的感染：鼻窦炎、喉炎和耳炎。淋逢迎彻底检查有助于确认感染及淋巴病变。心肺检查
30、可以提示感染、辨膜疾病及兴奋剂使用情况。应检查病人能否有脓肿、皮肤溃疡、关节脓肿、静膜炎和骨髓炎。IV.TestingIV.检验。A.Clinicallaboratorytesting.Forpatientswithaknowncondition,testingforexacerbationsisappropriate:erythrocytesedimentationrate(infection,osteomyelitis,andtemporalarteritis),C-reactiveprotein(rheumatologicdisorders),andhemoglobinAiC(diabe
31、tesmellitus).Dependingonthepatientssymptomsorexposures,otherappropriatetestscanincludepurifiedproteinderivativeskintestfortuberculosis,freeT4leveltoruleoutthyrotoxicosis,completebloodcountwithdifferential(infection),andfollicle-stimulatinghormonetoinvestigatethepossibilityofmenopause.Specialtestsmay
32、berequiredofpatientswithtravel-relatedorSTDexposures.A.临床实验室检查。对有已知病症病人，应检测病症能否加剧：血沉(感染、骨髓炎和颞关节炎)、C反响蛋白(风湿性疾病)和血红蛋白AIC(糖尿病)。根据病人症状及暴露情况决定能否进行其他检查，包括结合病纯蛋白衍生物皮肤测试、排除甲状腺机能亢进的游离T4水平检验、全血计数及分类(感染)、促卵泡激素检查停经可能性。有旅游相关及STD接触病人可能需要进行特种检验。B.Imaging.Chestx-raystudiesareusefulintheevaluationofnightsweatsinpati
33、entswithasmokinghistory,industrialexposure,oracough.Thesepatientsneedtobescreenedforoccultmalignancy.Computedtomographyscansaregenerallynotappropriateunlessothersignsorsymptomsdictatefurtherevaluation.B.影像检查。胸部X线检查对评估有下列情况病人的盗汗很有用：吸烟史、工业性接触或咳嗽。这些病人需要进行潜在恶性肿瘤筛检。CT扫描通常并不适宜，除非其他症状或体征提示要作进一步检查。V.Diagnos
34、ticassessment.Nightsweatingasasingleentityisnotworrisome.V.诊断评估。盗汗作为单一征状并不令人担忧。Explorethelikelihoodofexacerbationofknownconditionsortheonsetofanewdiseaseprocess.Thehistoryisthemosthelpfulpartofthepatientencounter.Anewmedication,withperspirationasasideeffect,istheculprit.Patientsmayneedcessationofthe
35、medicationaswellasawashoutperiod.Nightsweatsmightbeanearlysymptomofadevelopingillnesssowatchfulwaitingisuseful.Patientsneedtobeinstructedtowatchforweightchanges,fevers,andsleepandmoodchanges.Patientscancompleteasymptomdiary,whichisveryhelpfultotheclinicianindeterminingtheneedforadditionalevaluation.
36、Considerillnessesthattendtobepresentinthepatientsagegroup.Screeningforcommonmalignanciesthroughmammograms,papsmears,andfecaloccultbloodtestingisappropriatehealthmaintenanceaswellasoftenbeingapartoftheevaluationofthepresentingcomplaintofnightsweats.检查已知疾病加剧可能性或所得疾病经过的发作情况。病史在病人疾病中最有帮助。有出汗副作用的新药经常是盗汗的
37、魁首。病人可能需要停药及给予一段药物去除时间。盗汗可以能是某种疾病发展的早期症状，因而观察等待是有用的。应指导病人留意体重变化、发烧及睡眠和情绪变化。病人可填写一份症状日誌，它对临床医师确定能否作进一步检查很有帮助。考虑该病人年龄组常见的疾病。通过乳房X线、巴氏涂片及粪便潜血试验筛检常见恶性肿瘤，既适于健康维持，也是当前盗汗主诉检查的内容之一。医学知识双语浏览：头痛下面学习啦我为大家带来医学知识双语浏览：头痛，欢迎大家学习!Headache(cephalalgia)isacommonsymptom,oftenassociatedwithdisability,butrarelylifethreatening.Headachesmaybeaprimarydisorder(migraine,clu推荐度：