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1、周围神经病周围神经病华山医院神经内科卢家红概述概述n n组成（颅神经、脊神经）n n神经元结构神经干神经干神经束神经束神经纤维神经纤维神经外膜神经外膜神经束膜神经束膜神经内膜神经内膜n n周围神经的变性n nWallerian degeneration，瓦勒变性，沃勒变性dying back neuropathy，逆行死亡性神经病n naxonal degeneration，轴突变性n nsegmental demyelination，节段性脱髓鞘n n神经病（neuropathy）、神经炎（neuritis）、神经痛（neuralgia）n n周围神经病分类：n n病程病程n n突出症状突出
2、症状n n临床常用分类（部位）临床常用分类（部位）n n对称性多发性神经病对称性多发性神经病n n单神经病或多数性单神经病单神经病或多数性单神经病多发性神经病（炎）多发性神经病（炎）polyneuropathyn n病因n n感染感染n n代谢及内分泌障碍代谢及内分泌障碍n n营养障碍营养障碍n n药物及毒物药物及毒物n n感染后感染后n n结缔组织病结缔组织病n n遗传遗传n n癌性及不明原因癌性及不明原因n n共同临床表现n n感觉、运动、植物神经多同时受累感觉、运动、植物神经多同时受累n n多为四肢远端对称性多为四肢远端对称性格林巴利综合征格林巴利综合征Guillain Barre sy
3、ndromeGuillain-Barre syndrome is a disorder in which the bodys Guillain-Barre syndrome is a disorder in which the bodys immune systemimmune system attacks part of the attacks part of the peripheral nervous systemperipheral nervous system.The first symptoms of this disorder include varying degrees of
4、 The first symptoms of this disorder include varying degrees of weakness or tinglingweakness or tingling sensations in the legs.In many instances the sensations in the legs.In many instances the weakness and abnormal sensations spread to the arms and upper weakness and abnormal sensations spread to
5、the arms and upper body.When severe,the patient is almost totally paralyzed.In body.When severe,the patient is almost totally paralyzed.In these cases the disorder is life threatening-potentially these cases the disorder is life threatening-potentially interfering interfering with breathingwith brea
6、thing.Such a patient is often put on a respirator to.Such a patient is often put on a respirator to assist with breathing.Most patients,however,assist with breathing.Most patients,however,recoverrecover from even from even the most severe cases of Guillain-Barre syndrome,although the most severe cas
7、es of Guillain-Barre syndrome,although some continue to have a certain degree of weakness.some continue to have a certain degree of weakness.n n病因感染后自身免疫病n n病理神经根、周围神经脊神经、颅神经节段性脱髓鞘、轴索变性n n临床表现n n年龄（可发生于任何年龄，儿童、老年人）年龄（可发生于任何年龄，儿童、老年人）n n性别（无明显差异）性别（无明显差异）n n前驱感染前驱感染n n首发症状（下肢无力、四肢远端麻木）首发症状（下肢无力、四肢远端麻
8、木）n n运动（无力、反射运动（无力、反射、病理征、病理征-）n n感觉（较运动障碍轻）感觉（较运动障碍轻）n n颅神经（颅神经（、）n n植物神经（心率、血压、皮肤营养、括约肌）植物神经（心率、血压、皮肤营养、括约肌）n n病程病程n n实验室检查n n电生理电生理 神经传导速度减慢神经传导速度减慢n n脑脊液脑脊液 蛋白细胞分离蛋白细胞分离n n诊断、鉴别诊断n n急性脊髓炎急性脊髓炎n n重症肌无力重症肌无力n n脊髓灰质炎脊髓灰质炎n n周期性麻痹周期性麻痹n n治疗n n静脉丙球、血浆交换静脉丙球、血浆交换n n激素激素n n呼吸机呼吸机面神经炎面神经炎Bell palsyn n病因
9、（茎乳孔）n n临床表现Facial nerve paralysis:SignsFacial asymmetry Eyebrow droop Loss of forehead&d nasolabial folds Drooping of corner of mouth Uncontrolled tearing Inability to close eye Lips cannot be held tightly together:Difficulty keeping food in mouth Facial muscle atrophy（Late）n n鉴别诊断n n格林巴利格林巴利n n糖尿病
10、性糖尿病性n n腮腺病变等腮腺病变等n n后颅窝病变后颅窝病变n n治疗三叉神经痛三叉神经痛trigeminal neuralgian n病因原发性原发性继发性继发性n n临床特征（原发性）n n部位部位n n疼痛特点疼痛特点n n触发点触发点n n无明显阳性体征无明显阳性体征n n鉴别诊断n n牙痛牙痛n n舌咽神经痛舌咽神经痛n n继发性继发性n n治疗n n药物药物n n射频射频n n阻滞阻滞n n手术手术坐骨神经痛坐骨神经痛sciaticaL4-S2n n病因（原发性、继发性）继发性继发性n n根性根性腰椎间盘突出、椎管狭腰椎间盘突出、椎管狭窄、蛛网膜炎、椎管内窄、蛛网膜炎、椎管内肿瘤肿瘤n n干性干性骶髂关节、髋关节、盆骶髂关节、髋关节、盆腔、注射腔、注射n n临床表现n n腰背痛（根性）腰背痛（根性）n n沿路疼痛（干性明显）沿路疼痛（干性明显）n n咳嗽、排便加剧咳嗽、排便加剧n n脊柱侧弯脊柱侧弯n nLasegue sign Lasegue sign（干性明显）（干性明显）n n体征体征