医学知识双语阅读：头痛

1、医学知识双语阅读：头痛下面 为大家带来医学知识双语阅读：头痛，欢迎大家学习 ！Headache (cephalalgia) is a com mon symptom,ofte nassociated with disability, but rarely life threate ning. Headaches may be a primary disorder (migraine, cluster, or tension headache) or a sec on dary symptom of such disorders as acute systemic or in tracra ni

2、al in fecti on, in tracra nial tumor, head injuries, severe hyperte nsion, cerebral hypoxia, and many diseases of the eyes, nose, throat, teeth, ears, and cervical vertebrae. Sometimes no cause is found.头痛是一种常见症状，常常与功能障碍有关，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)，也可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

3、、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。Headaches may result from stimulati on of, tracti on of, or pressure on any of the pain-sen sitive structures of the head: all tissues covering the cranium; the 5th, 9th, and 10th cranial n erves; the upper cervical n erves; the large in tracra nial veno

4、us sinu ses; the large arteries at the base of the bra in; the large dural arteries; and the dura mater at the skull base. Dilatio n orcontractionof blood vessel walls stimulates nerve endings,caus ing headache. The cause of most headaches is extracra nial rather than intracranial.Stroke, vascular a

5、bnormalities,andvenous thromboses are un com mon causes of headache.对头咅 B任何疼痛敏感结构的刺激、牵引或压迫都能引起头痛，这些结构包括 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 激神经末梢，弓I起头痛。大多数头痛的病因为颅外性而非颅内性。因 脑卒中、血管畸形与静脉血栓形成引起的头痛并不常见。DiagnosisThe frequency, duration, location, and severity of the headache;

6、the factors that make it better or worse; associated symptoms and sig ns, such as fever, stiff n eck, nausea, and vomiting; and special studies help identify the cause of headache.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；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。Secondary headaches may have specific

7、characteristics. An acute whole-cra nial, severe headache associated with fever, photophobia, and stiff neck indicates an infectious process, such as meningitis, until proved otherwise.Subarachnoidhemorrhage also causes acute headache with symptoms andsig ns of menin gealirritatio n.Space-occupy ing

8、lesi ons ofte ncause subacute, progressive headache. New- on set headache in an adult > 40 yr always requires thoroughevaluation.With space-occupy inglesi ons,the follow ingmay occur:headache on awake ning or at ni ght, fluctuati on of headache with postural changes, and nausea and vomiting.

9、Additional neurologiccomplaints, such as seizure, confusion, weakness,or sensory cha nges, may occur late and are omino us.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。占位性病变常常 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

10、。其他神经性疾病主诉， 如惊厥发作、精神错乱、无力或感觉异常变化等，出现较迟，为恶性 症状。Tension headache tends to be chronic or con ti nu ous and com mon ly origi nates in the occipital or bifron tal regi on, the n spreads over the entire head. It is usually described as a pressure sen sati on or a viselike con stricti on of the skull. Febr

11、ile ill nesses, arterial hyperte nsion,and migra ine usually causethrobb ing pain that can occur in any part of the head.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，常被病人描述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，可出现在头部任何部位。Useful tests in elude CBC, STS, serum chemistry profile, ESR,CSF exam in ati on,and, f

12、or specific symptoms, ocular tests(acuity, visual fields, refraction, intraocular pressure) or sinus x-rays. If the cause of rece nt, persiste nt,recurre nt,orin creas ingheadache rema ins in doubt, MRI an d/or CT isappropriate, especially if abno rmaln eurologicsig ns arepresent.有用的检查包括血常规、梅毒血清试验、血

13、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。如对最近发生的持续、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，特别是出现异常神经体征时。Treatment Many headaches are of short duration and require no treatment other than mild analgesics (eg, aspirin, acetaminophen)and rest.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。Treatmen

14、t of primary headaches is discussed under the specific disorders, below. Alternative approaches, such as biofeedback, acupuncture, dietary manipulations, and some less conventional modes, have been advocated for thesedisorders. None of these treatmentshas shown clear-cut ben efits in rigorous studie

15、s. However, to the exte nt that an alter native treatme nt poses little risk, it may be tried, with the idea that effective headache man ageme nt is multidime nsion al.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，如生物反馈、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明其明确的疗效。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，因为有效的头痛治疗本来 也是多种多样的。Tr

16、eatme nt of sec on dary headaches depe nds on treatme ntof the underlyingdisorder. For meningitis,prompt antibiotictherapy is critical. Subsequently,symptoms can be relievedwith an algesics, in clud ing acetam in ophe n, NSAIDs, or opioid narcotics. Certain disorders require more specific treatment;

17、eg, temporal arteritis is treated with corticosteroids, and headache due to benign intracranialhypertensionis treatedwith acetazolamide or diuretics and weight loss. Subdural hematomas or brain tumors may be treated surgically.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

18、缓解头痛症状。有些疾病则需要更专门的治疗。女口, 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。Stress man ageme nttaught by a psychologist ofte nreduces the incidenee of headaches. However, mostpatientsare helped by an understandingphysician who accepts thepain as real, sees the patient regularly,and

19、 encouragesdiscussion of emotionaldifficulties, whether they are thecause or the result of chronic headaches. The physician can reassure the patient that no organic lesion is present and recomme nd en vir onmen tal readjustme nts and the removal of irritants and stresses. For particularly difficult

20、problems, a team composed of a physicia n,psychotherapist, andphysiotherapist is most effective in man agi ngchronicheadache.心理医生的减压疗法常常可以减少头痛的发病率。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是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。医生可以安慰病人，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。对一些特别难处理的病情，则应交给由临床

21、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。Night sweats are dren chi ng sweats that require a cha ngeof beddi ng.盗汗为淋透性出汗，需换床单。I. Approach. The first priority is to exclude night sweats caused by fever. Sweati ng associated with fever is a separate evaluation. Before the 20th century, night sweats

22、implied in fecti on with tuberculosis. Now, many other ailme nts are associated with this symptom. Night sweats are ofte n the markof a known condition such as diabetes (especially with no ctur nalhypoglycemia), can cer, head trauma, andrheumatologic disorders. Night sweats can also be a symptom of

23、a new disorder. The investigationof a patient reportingnight sweats requires a review of past illnesses and new symptoms. 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。现在，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(特别是伴夜间低血糖者)、癌症、头外伤和各种风湿病。盗汗也可能是 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. Night swe

24、ats can be characterized by determ ining on set, freque ncy, exacerbati ons, and remissi ons of symptoms. Question patients about the current state of known disorders. Excessive sweating is associated with poor no ctur nal glycemic con trol. Flares of rheumatologic disorders(rheumatoid arthritis, lu

25、pus, juve nile rheumatoid arthritis, andtemporal arteritis） cause sweati ng too. Preg nancy temporarily cha nges the in tri nsic thermostat in many wome n who perspire excessively. Patients who are immuno-compromised are at in creased risk for in fecti ons,especially with atypical age nts.Patie nts

26、with a history of substa nee abuse n eed to be asked about needle use and contaminants. 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，导致出汗过多。免疫代偿病人感染风险增 加，特别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. Review of systems. Other symptom

27、s that can accompa ny ni ght sweats in clude flushi ng （carc inoid syn drome, pheochromocytoma）, joint pain, sleep apn ea, men strual irregularities, reflux, cough, headache, dysuria, dysp nea, rashes, fatigue,palpitations,and weight and bowel habitcha nges. 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

28、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、疲乏、心悸及体重与排便习惯改B. Exposure factors. Inquire about recent immunizationsor new medicines such as antidepressants,cholinergics,meperidi ne, estroge n in hibitors, gon adotrop in in hibitors, niacin, steroids, stimula nts, over-the-co un ter preparati ons, antipyretics,

29、and naturopathic therapies. Questionpatientsabout exposure to sexually tra nsmitted diseases (STDs), huma n immuno-deficie ncy virus (HIV), hepatitis, tuberculosis,or occupati onal and travel-related exposures. Also ask about in creases in gen eral cha nges in the ambie nt ni ght temperature.B.暴露因素。

30、询问最近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多情况。C. Psychological factors.An xiety,ni ghtmares,andpsychoactive preparati ons can precipitateni ght sweats inhealthy in dividuals. C.精神因素。焦虑、噩梦及兴奋剂可导致健康个体盗汗。D. Famil

31、y history. Patie nts who report a family history ofhereditary disorders and possible malignanciesshould haveappropriate scree nin g. 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. Physical exam in ati on. The physical exam in ati on shouldaddress the pertinent positives no ted in the patie nt& #39;s medi

32、cal history. Note thepatie nt'sweight andtemperature.Exam in ati on of the head, eyes, ears, no se, andthroat (HEENT) should focus on com mon types of in fecti on: sinu sitis, phary ngitis, and otitis. A thoroughexam in ati onoflymph no des is helpful to ide ntifyin fectio nor lymphaticabn o

33、rmalities.The cardiopulm onaryexam in ati oncan alsosignal infection, valvular disease, and stimulant use. Patients should be examined for abscesses, skin ulcers, septic joints, phlebitis, and osteomyelitis. 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。淋巴结彻底检 查有助于确认感染及淋巴

34、病变。心肺检查也可提示感染、辨膜疾病及 兴奋剂使用情况。应检查病人是否有脓肿、皮肤溃疡、关节脓肿、静膜炎和骨髓炎。IV. Test ingIV.检验。A. Clinical laboratorytesting. For patients with a knowncon diti on, testi ng for exacerbati ons is appropriate: erythrocyte sedimentationrate (infection,osteomyelitis, and temporalarteritis), C-reactive protein (rheumatologi

35、c disorders), and10hemoglob in AiC （diabetes mellitus）. Depe ndingon thepatient'ssymptoms or exposures, other appropriatetests can includepurifiedprotein derivative skin test fortuberculosis, free T4 level to rule out thyrotoxicosis, complete blood count withdiffere ntial（in fecti on）,andfol

36、licle-stimulatinghormone to investigate the possibility ofmenopause.Special tests may be required of patients withtravel-related or STD exposures. A.临床实验室检查。对有已知病症病人，应检测病症是否加剧：血沉（感染、骨髓炎和颞关节炎）、C 反应蛋白（风湿性疾病）和血红蛋白AIC（糖尿病）。根据病人症状及暴 露情况决定是否进行其他检查，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

37、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. Imagi ng. Chest x-ray studies are useful in the evaluati on of ni ght sweats in patie nts with a smok ing history, in dustrial exposure, or a cough. These patie nts n eed to be scree ned for occult malig nan cy. Computed tomography sca ns are gen erally not appropriateuni ess other sig ns or symptoms dictatefurther evaluation. 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扫描通常并不合适，除非其他症状或体征提示要作进一步检查。V. Diag no Stic assessme nt. Ni