神经病学（英文）.ppt

神经病学 — 头痛 (Headache) 哈尔滨医科大学附属第二医院 神经病学教研室 第一节 概 述 Headache is one of the most  common clinical symptoms. Its  pathogenesis is more  complicated. Pathogenesis Pain-Sensitive structures of the brain 1) Brain skin, subcutaneous tissu,etc. 2) Arteries and muscles; 3) Venous sinuses and meningeal arteries; 4) The trigeminal(V), glossopharyngeal(IX); vagus(X), etc. 1. Acute(2w) ,subacute(3m) or chronic(>3m); 2. Mild, morderate or severity; 3. Original(migraine, cluster, tension); secondary(trauma,infection,tumor); Classification of the headache 1. Family history, state of mind and sleeping; 2. Speed of onset, attack time,quality, position, relapsing and the factors of becoming severity. 3. Omen and accompany symptoms; 4. Performing a careful physical examination, select some suitable assistant tests. Diagnosis Treatment 1. Family history, state of mind and sleeping; 2. Speed of onset, attack time,quality, position, relapsing and the factors of becoming severity. 3. Omen and accompany symptoms; 4. Performing a careful physical examination, select some suitable assistant tests. 第二节 偏头痛 (migraine) 1. Etiology : ① Heredity; ② Endocrine and metabolism; ③ Other factors. 2. Pathogenesis 1) Blood vessel theory; 2) Nerve- vessel theory; 3) Nerve-transmitter theory. Clinical Manifestations 1. Migraine with Aura (Classic Migraine) ① Proemial stage ② Aura stage ③ Headache stage ④ Later stage of headache 2. Migraine without Aura (common Migraine) 2. Special-type of Migraine 1) Ophthalmoplegia 2) Hemiplegia 3) Basilar-type 4) Later-onset 5) 等位发作 1. Common type (1988 diagnostic criteria) 1) 符合下述2～4项，至少发作5次以上。 2）如不治疗 ，每次发作持续24小时。 3）具有以下特点至少两项：单侧性；博动性；不敢 活动；活动后头痛加重。 4）发作期间有下列之一：恶心及呕吐；畏光和畏声。 5）无其它已知类似疾病；病史躯体正常。 Diagnosis 1）符合下述两项，至少发作2次。 2）具有以下特征至少3项：局限性脑皮质或脑干功能 障碍1或1个以上先兆症状;至少有一个先兆症状， 逐渐发展持续4分以上；或相继发生2个或2个以上