神经内科英文课件特发性面神经麻痹

1、神经内科英文课件特发性面神经麻痹神经内科英文课件特发性面神经麻痹Definition Idiopathic Facial palsy is also called Bells palsy or Facial neuritis. It is characterized by a rapid onset of facial palsy of peripheral typeDefinition Idiopathic Facial Etiologythe cause is unclear yetIt may be(1)Chill(2)inflammation of virus vasoconstric

2、tion-ischemia-edema (3)instability of autonomic nerveEtiologythe cause is unclear ypathology:swelling of facial nerveDemyelination and degeneration of the axonpathology:神经内科英文课件特发性面神经麻痹Clinical FeaturesIt may occurs at any age usually in young adults males are commoner then females. The onset is acu

3、te. At the onset there may be pain in the mastoid region or around the angel of the jaw. The symptoms usually produce its maximum effect within several hours or one to two days. The features is paralysis of the unilateral muscles of expression.Clinical FeaturesIt may occursClinical Featuresthe upper

4、 facial paralysisthe wrinkles of the brow are smoothed out Frowning and raising the eyebrow are impossiblethe palpebral fissure is wider and closure of the eye is impossible because of the paralysis of the orbicularisClinical Featuresthe upper facBells phenomenon the palpebral fissure is wider and c

5、losure of the eye is impossible because of the paralysis of the orbicular ,when the patient attempt to close the eye ,the eye globe rolls upwards and slightly out .Bells phenomenon the palpebraClinical Featuresthe lower facial paralysisthe nasolabial furrow is smoothed out and the mouth is dropped a

6、nd drawn over to the sound side the patient is unable to purse the lips and whistleOwing to paralysis of the buccinator the food tends to accumulate between the teeth and cheek. Dribbling may occur.Clinical Featuresthe lower facDiagnosis and Differential DiagnosisAccording to the rapid onset of faci

7、al palsy of peripheral typeDifferential Diagnosis 1 Guillain - Barre - Syndrome 2 Otitis media. labyrinthitis 3 posterior fossa diseaseDiagnosis and Differential DiaTreatmentAcute phase prednisone 10mg tid po. 510days VitamineB1.B12 physiatrists the protection of the expose corneaTreatmentAcute phas

8、eTreatmentrecovering phase exercise of the paralyzed facial muscles acupuncture physiatrists facio-hypoglossal anastomosis.Treatmentrecovering phase prognosis The prognosis is usually good. After one to two week .the patient begin to recover .After one to two month .the patient recover prominently.

9、About seventy fine percent of causes can recover completely. If the patient can not recover in six month, he will suffer from the disability. prognosis The prognosis is usAcute inflammatory demyelinating polyneuropathy (AIDP)Guillain-Barre Syndrome Acute inflammatory demyelinatiDefinition It is a ra

10、pidly progressive polyneuropathy. The damaged region is usually the spinal roots and peripheral nerves, occasionally the cranial nerves .the pathologic change is segmental demyelination . The manifestation is characterized by a symmetric tetraplegia.Definition It is a rapidlyEtiology postinfective a

11、llergic diseaseEtiology postinfective allePathology the damaged region is usually the spinal roots and peripheral nerves ,particularly ventral roots, occasionally the cranial nerve.Segmental demyelination of the spinal roots and peripheral nerves. perivascular inflammatory infiltration mainly is lym

12、phocyte and monocyte .Pathology the damaged region iClinical Features The onset is acute or subacute. Before one to four weeks of the onset ,there may be symptoms of the upper airway infection or gastrointestinal infection .Clinical Features The onset iClinical Features symmetric tetraplegia it is o

13、ften the first symptom. The paralysis is flaccid. The muscular tonus is low , tendon reflexes are diminished or lost and pathologic reflexes are negative. When respiratory muscles are affected, respiratory failure may occur.Clinical Features symmetric Clinical Features sensory disturbance paresthesi

14、as : numbness ,tingling ,tenderness .peripheral sensory impairment: stockingglove pattern the sensory symptoms are always present it is slighter than paralysis of the limbs.Clinical Features sensory disClinical Features cranial nerves paralysis the paralysis of the facial nerves on both sidesbulbar

15、paralysisothers: trigeminal hypoglossal oculomotor trochlear and abducens nerves .Clinical Features cranial nerClinical Features the symptoms of vegetative nervous systems sweating , flushing ,swelling and nutritional disturbance of the skin tachycardia , variety of the blood pressure the sphincter

16、disturbance is rarely occasionally there may be slight retention of urine.Clinical Features the symptomClinical Features The disease usually produces its maximum in one to two weeks. It is a selflimiteddisease. About 85% of patients would have a complete recovery .the most important complications ar

17、e : a. respiratory muscles paralysis. b .pneumonia. C .heart failure . when the patients have all these complications, the prognosis is not very good. Clinical Features The diseaseLaboratory Aids CSF: dissociation albuminocytologique the change is a great excess of protein with a normal cell count t

18、he high protein is most prominent after the third week of the onset and may persist for many weeks after recovery.Laboratory Aids CSF: Laboratory Aids peripheral blood phase : the white cells count may be high .Laboratory Aids peripheral blDiagnosis:The history of a recent infectionThe onset is acut

19、e or subacute Symmetric flaccial tetreplegia Damage of the cranial nerves CSF: dissociation albuminocytologique Diagnosis:The history of a recDifferential DiagnosisAcute PoliomyelitisAcute MyelitisPeriodic ParalysisMyasthenic GravisDifferential DiagnosisAcute PoTreatmentEtiological treatment :Plasma

20、 exchange: 40ml/kgIntravenous immunoglobulin, IVIG : 0.4g/(kgd) ,5 daysCorticosteroids : Symptomatic treatment :TreatmentEtiological treatmentreatmentRecovery stage1.exercise of the limbs2.acupuncture3.physiatrics4.massotheraohytreatmentRecovery stageAcute myelitisAcute myelitisDefinitionAcute myeli

21、tis is an acute non-specificity inflammation of several segments of the spinal cord ,the cause is unkown yet, the manifestation is characterized by that of atransverse lesion of the spinal cord including motor,sensory and autonomic disturbance.DefinitionAcute myelitis is aEtiologyThe cause is unkown

22、 yet.Maybe the inflammation of virus or immunization induce the auto-immune reaction.EtiologyThe cause is unkown yepathologyTo the naked eye :the lesion is edema hyperemia and softening.Microscopically: the lesion is infiltrated with inflammatory cells ,degenaration of the axon and demyelination.pat

23、hologyTo the naked eye :theClinical featuresAcute myelitis often occurs in youth and adults ,the onset is acute ,before a few weeks or after days of the onset ,the infective symptoms of the upper airway may occur ,the earliest symptom is usually the weakness or numbness of the legs.Clinical features

24、Acute myelitiClinical featuresAcute stage (1)motor disturbanceSpinal cord shock : Flaccid paraplegia: the muscular tonus is low , tendon reflexes are diminished or lost ,pathological reflex is negative , retention of urine.Clinical featuresAcute stage Clinical featuresAcute stage (2)sensory disturba

25、nceAll sensations below the level of the lesion are diminished or lost There may be a zone of hyperaesthesia between the area of the sensory loss and that of normal sensibilityClinical featuresAcute stage Clinical featuresAcute stage (3)autonomic disturbanceImpairment of sphincter control : the rete

26、ntion of urine;others : hypohidrosis, dermal edema , dryness Clinical featuresAcute stage Clinical featuresAscending myelitis :It is severe when the lesion involves the upper cervical cord and medulla ,tetraplegia and dyspnea may occur ,the patient often dies from respiratory failure ,the mortality

27、is very high.Clinical featuresAscending myeClinical featuresRecovering stageAfter three or four weeks of the onset , the acute stage is over and the patient becomes recovering . The clinic symptoms depends on the severity of the lesion and absence or presence of the complication.Clinical featuresRec

28、overing stClinical featuresRecovering stage(1)motor disturbance : the upper motor neuron paraplegia , the muscular power progress gradually ; tendon reflexes are increased; pathological reflexes are present.(2)sensory disturbance :the level descends gradually ,the recovery of sensory disturbance is slower than that of motor disturbance ;(3)autonomic disturbance :reflex urinationClinical featuresRecovering stLaboratory aidsCSF :the CSF is commonly abnormal. it is crystal cle