书法和剑（神经病）个体比较大的问题的答案.docVIP

书山论剑——神经病大题答案（个人整理版） 04级八年制 名解： Lhermitte’s sign：典型的低头曲颈触电样征：多发性硬化患者被动屈颈时会诱导刺痛感或触电样感觉，从颈部放射至背部甚至到下肢的放射性触电感。头复位时，症状消失；屈颈动作愈迅速有力，触电感亦愈强烈，如屈颈动作缓慢，触电感则较轻微。是多发性硬化的特征性表现之一。is an electrical sensation that runs down the back and into the limbs which is elicited诱出 by bending the head forward. It can also be evoked引起 when the neck is flexed。( From Wikipedia) It is a sensation of electricity that is felt by the patient on passive or active flexion of the neck. It indicates a lesion of the posterior columns in the cervical portion of the spinal cord. （来自课件） Bell sign：P118常见于特发性面神经麻痹又称Bell麻痹，由于茎乳孔（面神经管）内面神经非特异性炎症导致周围性面神经瘫痪，表现为患者闭目时眼球向外上方转动而露出巩膜，称Bell征。While closing the eye, the eyeball screws upward to expose the white sclera. this is a reflex upward deviation of eyes in response to forced closure of the eyelidsis.（来自课件） 皮质盲cortical blindness：皮质盲是大脑枕叶皮质受到毒素影响或血管痉挛缺血而引起的一种中枢性视功能障碍，以血管痉挛性损害最为常见。临床表现为双眼视觉完全丧失，瞳孔光反射正常，眼底正常，可有偏瘫等。本病常见于2～6岁小儿Cortical blindness?is the total or partial loss of vision in a normal-appearing?eye?caused by damage to the visual area in the brains?occipital cortex. This damage is most often caused by loss of blood flow to the occipital cortex from either unilateral or bilateral?posterior cerebral artery?blockage (ischemic stroke).?( From Wikipedia) 面具脸mask-like face：是帕金森的典型症面部肌肉运动减少，眨眼双眼转动减少，表情呆滞，像戴了面具一样，俗称“面具脸’s disease, the manifestations are rigor muscle of face, decreased motor of facial expression muscle, wink and rotation of two eyes reduced, expression sluggishness, just like wearing a mask. (Edit by myself) 问答 ALS肌萎缩侧索硬化amyotrophic lateral sclerosis的临床表现。P238 答：（1）多在40岁以后发病，男性多于女性；（2）大多数患者以单侧上肢的下运动神经元损害症状起病，表现为手指运动不灵和力弱，伴同侧伸腕困难；（3）部分患者以整个或上肢近端无力起病，随后大、小鱼际肌和蚓状肌等手部小肌肉萎缩，渐向前臂、上臂及肩胛带肌发展，伸肌无力较屈肌显著。（4）逐渐出现下肢痉挛性瘫痪、剪刀步态、肌张力增高、腱反射亢进和Babinski征阳性等。（5）少数病例从下肢起病，渐延及双上肢。上肢起病者约为下肢起病者的2倍，远端肌无力较近端更常见。肌束震颤是最常见的症状之一，可在多个肢体及科舌部发生。（6）延髓麻痹通常较晚出现，可于手部肌肉萎缩不久后出现，表现为构音障碍、讲话含糊不清、吞咽和咀嚼困难、舌肌萎缩伴纤颤。（7）部分患者可出现假性球麻痹性情感障碍，如强哭强笑等。（8）肢体主观感觉异常如麻木、疼痛等，但无客观感觉障碍。（9）病程持续进展，最终因呼吸肌麻痹或并发呼吸道感染死亡