神经病学（人卫九版）1-神经病学绪论.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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 这张世界地图是09年发表的，标化后的全球卒中死亡率的示意图。红色越深的地方，卒中死亡率越高。可以看到，中国在全球来讲，是属于卒中死亡率最高的国家之一。 * * * 本病由Carl Wernicke （德国神经病学家）于1881年首先报道。 当时描述的3例病人，特点为急性起始的疾病，以精神障碍、眼肌麻痹和共济失调性步态为主要症状。第一例是一个喝硫酸企图自杀的裁缝，结果导致了幽门梗阻，长期营养不良出现了症状。 另外两例都是酗酒。3例均以死亡为结局。他首次做了病理解剖，发现第III、IV脑室及中脑导水管处灰质有很多点状损伤。但当时并没有和维生素缺乏联系起来。后来二战期间才开始怀疑WE与维生素有关系。盟军战俘由于挨饿出现类似症状，被俘的医生识别出来，后来用维生素治好了，逐渐才把WE和B1联系起来。 WE如果能够想到它，治疗非常再简单不过，并且安全有效。及时治疗可以完全恢复。但是治疗不及时可继续进展出现昏迷甚至死亡。 * * Drugs Dose (mg/d) Anti-convulsant Sodium valproate 600-1200 Anti-histaminic Cyproheptadine 4-8 PREVENTIVE THERAPY FOR MIGRAINE (CONTD.) ROLE OF BETA BLOCKERS IN MIGRAINE PROPHYLAXIS ‘Gold standard’ in migraine prophylaxis Established efficacy and safety in migraine prophylaxis Especially preferred if hypertension or anxiety co-exist ROLE OF PROP