神经病学英文1symptomatologyofneurologicaldiseases.ppt

定性诊断应注意的问题 高度重视疾病的演进过程 例如，一高血压病人，情绪激动时突然发生讲话含糊不清、右侧肢体活动不灵，半h 来医院时曾呕吐一次，Bp180/120mmHg，患者示意左侧头痛，检查发现右侧中枢性面、舌瘫，右侧上下肢肌力(myodynamia)均为2级(grade)，右偏身感觉障碍。 (mercury) 此患可能是左基底节区出血 定性诊断应注意的问题 An elderly patient，felt numbness and slight weakness on his right hand and upper limb just after siesta，his folks found that his symptom aggravated after dinner，so the patient was accepted vascular dilating medicine intravenously in a clinic neighborhood. But he was admitted to the hospital on the next morning because of slur speech and severe hemiparalysis。 History: several years’ history of diabetes and cerebral arteriosclerosis，no hypertension. 定性诊断应注意的问题 Physical examination：Central facial nerve and hypoglossal nerve palsy on the right side. Muscle power of the right upper limb is 0 grade，2~3 grade of the right lower limb, positive Babinski sign on the right side, and hemihypoesthesia on the right side of the body. Diagnosis: cerebral infarct on the left hemisphere supplied by the left middle cerebral artery was suspected * Topical Diagnosis-Flaccid Paralysis 前根(Anterior root) flaccid paralysis on segmental distribution. When there were posterior root involvement, it may produces impairment of cutaneous sensation in a segmental pattern and radicular pain. Etiology: usually occur in compression by extramedullary tumors, perimyelitis or vertebra changes. Topical Diagnosis- Flaccid Paralysis Anterior horn cells segmental paralysis without sensation disturbance. Topical Diagnosis-Spastic Paralysis 上运动神经元不同部位病变引起不同的临床表现 图2-17 1. 皮质(cortex)： 局限破坏性病损(destructive lesion) may produce a focal motor deficit involving, for example, a single limb paralysis on contralateral side, weakness may be restricted to the contralateral arm and the lower part of the contralateral face. A more extensive lesion will produce hemiparalysis. Topical Diagnosis-Spastic Paralysis 刺激性病变(irritative lesion) 对侧躯体相对应部位出现局限性阵发性抽搐，如杰克逊(Jackson)癫癎。 Topical Diagnosi