脊髓疾病-中英对照PPT.ppt

辅助检查 Laboratory 脑脊液 Cerebrospinal fluid： Colorless and transparent White cells and protein normal or slightly increased Glucose and chloride normal MRI： Enlarged spinal cord Acute myelitis 鉴别诊断 Differential Diagnosis（一） 视神经脊髓炎 Neuromyelitis optica 有视力下降 Vision↓ 病变常不完全对称 Lesions are commonly incomplete symmetry 病情常有缓解及复发 Remission-relapse 可出现多灶性体征 Multifocal sign Acute myelitis Differential Diagnosis（二） 急性硬膜外脓肿 Acute epidural abscess 有化脓感染史 focus of infection 发热、根痛明显 fever, root pain 椎管阻塞明显 obstruction of vertebral canal 脑脊液细胞和蛋白增高 white cell and protein↑ MRI可帮助鉴别 MRI used for identify Acute myelitis Differential Diagnosis（三） 脊髓出血 Hematomyelia 起病更急sudden 剧烈背痛 severe back pain 血性脑脊液 bloody CSF MRI MRI or myelography Acute myelitis 治疗 Treatment 精心护理 Careful nursing 防褥疮，保持呼吸道通畅 药物治疗 Drug treatment 糖皮质激素、维生素B族、抗病毒药等 康复治疗 Early rehabilitative management Acute myelitis 预后 Prognosis 3－6个月内能恢复生活自理 1/3病人基本恢复 1/3病人能行走，但步态异常、大小 便障碍 1/3病人持续瘫痪、尿失禁 Acute myelitis 第三节 脊髓压迫症 Compressive myelopathy Compressive myelopathy Definition and Etiology Clinical manifestation Laboratory findings Diagnosis Treatment Acute myelitis 概念 Definition ： 是由于椎管内的占位性病变引起脊髓受压的临床综合征，病变进行性发展，导致不同程度的脊髓横贯性损害和椎管阻塞。 Compressive myelopathy is a symptom result from compression of spinal cord by occupying lesion in spinal collum, with progressive of the lesion, it can result variety degree of transverse lesion of spinal cord and spinal columm obstruction. Compressive myelopathy 病因 Etiology 肿瘤 Tumor：胶质瘤、神经鞘瘤、转移瘤 先天性异常 Congenital abnormality： 颅底凹陷症 外伤 Trauma：椎间盘突出、脱位、骨折 炎症 Inflammation：脊柱结核、硬膜外 脓肿、蛛网膜炎症 脊髓出血 Myelorrhagia Compressive myelopathy 临床表现 Clinical Manifestation（一） 多表现为慢性脊髓压迫,以占位病变较 多见. 起病形式 Episode:隐袭,进展缓慢 根性疼痛 Root pain:髓外压迫 Compressive myelopathy Clinical Manifestation（二） 感觉障碍 Sensory disturbance ： 脊髓丘脑束:受损平面以下对侧躯体痛温觉消失 后索:受损平面以下同侧躯体深感觉消失