principles of localisation pns vs cns外周神经系统中枢神经

PrinciplesoflocalisationIPNSvsCNSESAVSNeurologyDr.DianaHenke(DECVN)UniversitYOFbern1.1.CentralnervousBrain(forebrain,cerebellum,大脑，小脑，脑1.1.CentralnervousBrain(forebrain,cerebellum,大脑，小脑，脑2.2.Peripheralnervous1.1.CentralnervousBrain(forebrain,cerebellum,大脑，小脑，脑2.Peripheralnervous2.Peripheralnervous1.1.CentralnervousBrain(forebrain,cerebellum,大脑，小脑，脑2.Peripheralnervous2.PeripheralnervousMotor1.1.CentralnervousBrain(forebrain,cerebellum,大脑，小脑，脑Spinal 脊2.Peripheralnervous2.Peripheralnervousα-motoneuron(1)α-运动神经Nerveroot神经Peripheralnerv2外周神Neuromuscularendplate神经肌肉终Muscle(4)肌

SensoryMotorSegmentalspinal脊髓节段反通向大脊通向大脊神经运动终肌伸感觉神细胞轴屈兴奋突制突触运动神细胞轴Segmentalspinal脊髓节段反通向大脊通向大脊神经运动终肌伸感觉神细胞轴屈兴奋突制突触运动神细胞轴---Underlyingcausesforreducedreflexes:反射减弱的潜在原peripheral(afferentefferent外周（传入，传出centralspinalcord中枢（脊髓Segmentalspinal脊髓节段反通向大--Underlyingcauses--Underlyingcausesforreducedreflexes:反射减弱的潜在原peripheral(afferentefferent外周（传入，传出centralspinalcord中枢（脊髓

运动终肌伸感觉神细胞轴屈

运动神细胞轴Segmentalspinal脊髓节段反通向大--Underlyingcauses--Underlyingcausesforreducedreflexes:反射减弱的潜在原peripheral(afferentefferent外周（传入，传出centralspinalcord中枢（脊髓

运动终肌伸感觉神细胞轴屈

运动神细胞轴Segmentalspinal脊髓节段反通向大--Underlyingcauses--Underlyingcausesforreducedreflexes:反射减弱的潜在原peripheral(afferentefferent外周（传入，传出centralspinalcord中枢（脊髓

运动终肌伸感觉神细胞轴屈

运动神细胞轴Segmentalspinal脊髓节段反通向大--Underlyingcauses--Underlyingcausesforreducedreflexes:反射减弱的潜在原peripheral(afferentefferent外周（传入，传出centralspinalcord中枢（脊髓

运动终肌伸感觉神细胞轴屈

运动神细胞轴SegmentalspinalSegmentalspinalSegmentalspinalGoalGoal:LocalisationinoneofthefollowingGoalGoal:LocalisationinoneofthefollowingGoalGoal:LocalisationinoneofthefollowingGoalGoal:LocalisationinoneofthefollowingGoalGoal:LocalisationinoneofthefollowingperipheralnervesandGoalGoal:LocalisationinoneofthefollowingperipheralnervesandGoalGoal:LocalisationinoneofthefollowingperipheralnervesandGoalGoal:LocalisationinoneofthefollowingperipheralnervesandspinalcordGoalGoal:LocalisationinoneofthefollowingperipheralnervesandspinalcordGoalGoal:Localisationinoneofthefollowingperipheralnervesandspinalcord GoalGoal:Localisationinoneofthefollowingperipheralnervesandspinalcord GoalGoal:Localisationinoneofthefollowingperipheralnervesandspinalcord EVERYTIMEFOLLOWINGTHESAMEEVERYTIMEFOLLOWINGTHESAMEEVERYTIMEFOLLOWINGTHESAMENo:No:searchfornon-neurologicalYes:Yes:PNSorCNSEVERYTIMEFOLLOWINGTHESAMEYes:Yes:PNSorCNSNo:searchfornon-neurologicalCNS:BrainorspinalEVERYTIMEFOLLOWINGTHESAMEYes:Yes:PNSorCNSNo:searchfornon-neurologicalCNS:BrainorspinalSpinalcord:WhichregionBrain:WhichpartEVERYTIMEFOLLOWINGTHESAMEYes:PNSorCNS

No:searchfornon-neurologicalCNS:BrainorspinalBrain:Brain:WhichpartSpinalcord:WhichregionEVERYTIMEFOLLOWINGTHESAMEYes:PNSorCNS

No:searchfornon-neurologicalCNS:BrainorspinalBrain:Brain:WhichpartSpinalcord:Whichregion

*C1C5颈1-颈*C6Th2颈6-胸*T3L3胸3-腰*L4S3腰4-骶*CaudaequinaLesionLesionintheCNSorLesioninLesionintheCNSor??? 1.1.LesioninCNSor 1.1.LesioninCNSorGeneral(all4limbs)reduced 1.Lesion1.LesioninCNSorGeneral(all4limbs)reduced是 1.Lesion1.LesioninCNSorGeneral(all4limbs)reduced是 是1.LesioninCNS1.LesioninCNSorGeneral(all4limbs)reduced是否 1.LesioninCNS1.LesioninCNSorGeneral(all4limbs)reduced是否 ?General(all4limbs)?General(all4limbs)reduced1.1.LesioninCNSor否是 否是-mostoftenefferentpartofthereflex-mostoftenefferentpartofthereflexarcGeneralreducedreflexesSynonymous:generalizedlowermotorneuronallall4limbs(oftenpelviclimbsfirstaffected)-Mostoftenextensorandflexor Cranialnerves(eg.palpebralreflex)possiblyaffectedtooDiseaseoftheperipheralnervoussystemGeneralreducedreflexesSynonymous:等同generalizedlowermotorneuron-most-mostoftenefferentpartofthereflexarcDiseaseoftheperipheralnervoussystemGeneralreducedreflexesSynonymous:等同generalizedlowermotorneuron-most-mostoftenefferentpartofthereflexarcDiseaseoftheperipheralnervoussystemSymptomsDependingonDependingonseverityofthe取决于损伤的严重程Tetraparesis四肢轻瘫/四肢麻Proprioceptive本体感受缺Reducedmuscle肌张力下Muscle肌肉萎Reducedsegmentalspinal脊髓节段反射减

WheelerundSharp,SmallAnimalSpinalDisorders,1.1.LesioninCNSorPNS?1.1.LesioninCNSorPNS?DoesDoesthepatientdisplayamonoparesiswithreducedbutalltheotherlimbsare y1.1.LesioninCNSorPNS?DoesDoesthepatientdisplayamonoparesiswithreducedbutalltheotherlimbsare y1.1.LesioninCNSorPNS?DoesDoesthepatientdisplayamonoparesiswithreducedbutalltheotherlimbsare y1.1.LesioninCNSorPNS???ybutalltheotherlimbsareDoesthepatientdisplayamonoparesiswithreducedegthoraciclimb如：前 Plexusbrachialis 臂神经Nervusradialis 桡神经损1.1.LesioninCNSorPNS?1.1.LesioninCNSorPNS?Doesthepatientdisplayanexerciseinduced1.1.LesioninCNSorPNS?DoesthepatientdisplayanexerciseinducedYES1.1.LesioninCNSorPNS?DoesthepatientdisplayanexerciseinducedYES1.1.LesioninCNSorPNS??Doesthepatientdisplayanexercise-mostlikelya-mostlikelyafunctionalproblemoftheneuromuscularendplate(eg.myastheniagravis)非常类似于神经肌肉终板的功能性碍（如重症肌无力myopathy肌-metabo