7脊髓病kl.ppt

2. 前角细胞受累出现相应节段肌萎缩\肌束颤动 \肌张力减低腱反射减弱 颈膨大空洞双手肌萎缩明显,空洞水平以下出现 锥体束征 病变侵及C8~T1侧角交感神经中枢出现Horner征 临床表现 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 3. 关节痛觉缺失可致神经源性关节病: 关节磨损 \萎缩畸形, 关节肿大, 活动度增加, 运动时有摩 擦音而无痛觉, 即夏科(Charcot)关节 常见皮肤营养障碍, 如皮肤增厚\过度角化 痛觉缺失区表皮烫伤\割伤→顽固性溃疡疤痕形 成, 指\趾节末端无痛性坏死脱落(Morvan征) 晚期出现神经源性膀胱尿便失禁 临床表现 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 4. 延髓空洞症很少单独发生, 常为脊髓空洞的延伸, 多不对称, 症状体征多为单侧性 累及三叉神经脊束核→面部洋葱皮样痛温觉缺 失, 自外侧向鼻唇部发展 累及疑核→吞咽困难饮水呛咳 累及舌下神经核伸舌偏向患侧\同侧舌肌萎缩 肌束颤动 累及面神经核→周围性面瘫 前庭小脑通路受累→眩晕\眼震步态不稳 临床表现 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 脊髓空洞症常合并其他先天性畸形,例如 脊柱侧弯或后突畸形 隐性脊柱裂 颈枕区畸形 小脑扁桃体下疝 弓形足 临床表现 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 脑脊液常规动力学检查无特征性改变 空洞较大可引起椎管轻度梗阻CSF蛋白↑ 辅助检查 1. 脑脊液检查 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. ①MRI矢状位可清晰显示空洞位置\大小范围,是 否合并Arnold-Chiari畸形等, 是确诊的首选方法, 有助于选择手术适应证设计手术方案 ②应用水溶性造影剂的延迟脊髓CT扫描(DMCT), 注射后6\12\18\24h脊髓CT检查, 可显示高密度 空洞影像 ③X线平片可发现 脊柱侧弯或后突畸形 隐性脊柱裂 颈枕区畸形和Charcot关节 辅助检查 2. 影像学检查 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 辅助检查 脊髓空洞症: 颈胸段髓内空洞 2. 影像学检查 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 脊髓空洞症伴Arnold-Chairi畸形 (小脑扁桃体下疝畸形) 辅助检查 2. 影像学检查 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 青壮年期隐袭起病, 缓慢进展 节段性分离性感觉障碍\肌无力肌萎缩\皮肤 关节营养障碍等 常合并其他先天性畸形 MRI或延迟CT扫描发现空洞可确诊 诊断鉴别诊断 1. 诊断 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty L