医学课件--肝性脑病.pptVIP

Jiwsh, Dept Dig Dis, WFMU * Alzheimer type II astrocytes: edema → degeneration → necrosis Fibrosis Jiwsh, Dept Dig Dis, WFMU * From a 51–yr–old alcoholic patient with cirrhosis who died in a coma (hepatic encephalopathy [HE]). The image shows both normal astrocytes (N), which have dark nuclei, and Alzheimer type II astrocytes (Alz), characteristic of HE, which have pale, enlarged nuclei. Jiwsh, Dept Dig Dis, WFMU * MRI of a healthy control subject (C) and an alcoholic cirrhotic patient of the same age (P). In the alcoholic patient, abnormally intense signals (arrow) were detected on both sides of globus pallidus. This phenomenon has been attributed to deposits of manganese in this area. SOURCE: Lockwood et al. 1997 Jiwsh, Dept Dig Dis, WFMU * 【临床表现】 原肝病性质、轻重缓急、以及诱因 急性：暴发性HF，发展快，分期不明显 慢性脑病，LC和PSS，反复发作性木僵和昏迷，常有诱因，分期较明显 分期依据：精神症状，神经系统表现，EEG Jiwsh, Dept Dig Dis, WFMU * 早期表情淡漠，反应迟钝。随后出现扑翼样震颤。接着烦躁不安，要打架。几天之后，昏迷不醒。 Jiwsh, Dept Dig Dis, WFMU * 分期 精神症状 神经体征 脑电图 Ⅰ期 前驱期 性格改变：抑郁或欣快 行为改变：无意识动作 睡眠行为：昼夜颠倒 扑翼样震颤（+） 生理反射正常， 无病理反射 正常α波 Ⅱ期 昏迷前期 Ⅰ期表现加重，出现对人、地、时的概念错误，语言书写障碍 扑翼样震颤（+） 肌张力亢进， 病理反射（+） θ慢波 Ⅲ期 昏睡期 昏睡，但可唤醒， 精神错乱，语无伦次 扑翼样震颤（+） 肌张力明显亢进 病理反射（+） θ慢波 Ⅳ期 昏迷期 完全昏迷， 可有阵挛性抽搐 扑翼样震颤（-） 反应反射消失， 病理反射（+/-) 高波幅δ波 WIKIPEDIA G1 - Trivial lack of awareness; euphoria or anxiety; shortened attention span; impaired performance of addition or subtraction G2 - Lethargy or apathy; minimal disorientation for time or place; subtle personality change; inappropriate behaviour G3 - Somnolence to semistupor, but responsive to verbal stimuli; confusion; gross disorientation G4 - Coma (unresponsive to verbal or noxious stimuli) Jiwsh, Dept Dig Dis, WFMU * Jiwsh, Dept Dig Dis, WFMU * Table 1 West Haven Criteria of Altered Mental Status In Hepatic Encephalopathy Stage Consciousness Intellect and Behavior Neurologic Findings 0 Normal Normal Normal examination; impaired psychomotor testing 1 Mild lack of awareness Shortened attention span; impaired addition or subtraction Mild asterixis ortremor 2