神经病学（人卫九版）13-周围神经病.ppt

1.国外的多项临床试验结果均显示单独应用糖皮质激素治疗GBS无明确疗效，糖皮质激素和IVIg联合治疗与单独应用IVIg治疗的效果也无显著差异。2. 但在我国，由于经济条件或医疗条件限制，有些患者无法接受IVIg或PE治疗。3.对于糖皮质激素治疗GBS的疗效以及对不同类型GBS的疗效还有待于进一步探讨。 * GQlb则主要分布于动眼、滑车和外展神经等，其抗体主要通过激活补体系统直接损伤突触前膜及其周围施万细胞，造成眼外肌麻痹和共济失调等 * * 脑干外各节段损害表现，从下往上做加法。 茎乳孔以外损害：单纯周围性面神经麻痹 向上面神经管内损害累及鼓索神经：在1基础上+舌前2/3味觉障碍 再向上面神经管内损害在镫骨肌分支以上：在2基础上+听觉过敏 再向上膝状神经节损害：在3基础上+泪腺分泌障碍+耳后疼痛、鼓膜和外耳道疱疹 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Primary or secondary headache? Primary or secondary headache? Diagnostic criteriafor secondary headaches Important general rules 11. Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures 11.2.1 Cervicogenic headache 11.2.1 Cervicogenic headache 11.2.1 Cervicogenic headacheNotes 11.3 Headache attributed to disorder of eyes 11.3.1 Headache attributed to acute glaucoma 11.5 Headache attributed to rhinosinusitis 11.5 Headache attributed to rhinosinusitisNotes 11.7 Headache or facial pain attributed to temporomandibular joint disorder 12. Headache attributed to psychiatric disorderNew section in classification 12. Headache attributed to psychiatric disorderNotes 12.1 Headache attributed to somatisation disorder 12.2 Headache attributed to psychotic disorder Part 3:Cranial neuralgias, central and primary facial pain and other headaches 3. Cranial neuralgias and central causes of facial pain 13.1 Trigeminal neuralgia 13.1.1 Classical trigeminal neuralgia 13.1.2 Symptomatic trigeminal neuralgia 13.18.4 Persistent idiopathicfacial pain Previously used term: Atypical facial pain ACUTE HEADACHE IN THEEMERGENCY DEPARTMENT * * * WHEN IS PROPHYLAXIS INDICATED? According to the US Headache Consortium Guidelines, indications for preventive treatment include: Patients who have very frequent headaches (more than 2 per week) Attack duration is 48 hours Headache severity is extreme Migraine attacks are accompanied by prolonged aura Unacceptable adverse