神经内科领域疾病知识.ppt

* 临床医生在门诊时，经常可遇到主诉头痛症状的患者。2002年在美国佛罗里达州召开的钻石头痛研究与教育基金会议上有Newman教授等发表的调查研究显示，这些主诉头痛的患者经确诊后76%为偏头痛患者，只有很少比例的患者为紧张性头痛和其他诊断。这份研究结果提示临床医生一旦发现主诉头痛的患者应高度怀疑是否是偏头痛，可以采用更具有针对性的治疗方法。 * Respondents were asked to self-report the severity of their headaches on this 4-item scale. Eighty percent of these symptom-defined sufferers reported severe or extremely severe headaches. * 目前止痛剂是临床上治疗偏头痛的主要选择。由于偏头痛具有反复发作的特点，患者在不十分清楚剂量和服药方法的情况下，往往随意使用止痛剂（特别是非处方药）。发表在2004年第62期《神经病学》杂志上的研究显示，有半数以上的偏头痛患者存在止痛剂过度使用现象。 偏头痛反复发作一年以上可转变为慢性，此时，过度使用止痛剂的风险更明显增加了10倍以上。 * In this question respondents were asked, “How are you usually affected by your severe headaches?” There were 4 response choices : Able to work/function normally Working ability or activity impaired to some degree Working ability or activity severely impaired Bed rest required The severe impairment and bed rest codes were combined for this analysis. In 1999, over half of migraine sufferers reported that they were severely disabled or required bed rest and 92% had some disability. The distribution of impairment scores look similar, but there was a statistically significant (p.05) shift toward higher levels of impairment between 1989 and 1999. This finding is surprising given the therapeutic advances over the last decade and may reflect greater awareness of migraine symptoms and sensitivity to disease impact. Based on national projections of this data, there are 14 million migraine sufferers who are severely disabled by their headaches. * NO 一氧化氮 CRGP 降钙素基因相关肽 * Pair-wise concordance rate 一致性比率 * * * 脑白质病变 = White matter lesions(WMLs) * 下面我们详细的介绍一下偏头痛与其共发病的关系。目前已经进行了几项大规模的试验。首先我们来讲一下偏头痛与心脑血管事件的 关系。下面的研究结果就来自两个大型的数据库。 * 关于偏头痛与脑白质病变的关系这里有两个大型的试验。一个是荷兰的CAMERA人群的MRI研究，另一个是综合了7项临床试验的荟萃分析。两个的结果都提示偏头痛患者脑白质病变的发生率增加。 * 偏头痛患者除了患某些疾病的风险增加外，发生某些功能异常的风险也高于无偏头痛者。这里主要说一下亚临床性小脑功能异常和语言功能受损 * 偏头痛具有反复发作的特点，也耗费了临床医生很多诊疗的时间。偏头痛一般发作时多为偏侧，搏动样，疼痛程度为中重度，持续4-72小时。有的患者可伴有恶心、呕吐。光线、声音以及患者日常的活动都可加重患者的头痛症状，而患者安静地休息时，头痛症状可部分缓解。 * 因此，规范治疗对偏头痛显得十分重要。在