颅神经解剖要点和定位诊断.ppt

《Clinical manifestation》 一侧舌咽、迷走N受损，当发啊音时悬雍垂偏向健侧，患侧软腭上举不能， 发音时声音嘶哑有鼻音，吞咽困难，饮水返呛，咽反射减弱或消失。 舌咽、迷走神经受双侧皮质脑干束的支配，一侧中枢性病变不会产生症状，只有在双侧皮质脑干束受损或核性、核下性病变时才会出现症状。 球麻痹又称延髓麻痹，分为真性球麻痹；假性球麻痹和肌源性球麻痹。主要表现为吞咽困难和构音障碍。 三种球麻痹的鉴别诊断 Ⅺ. 副神经Spinal accessory Nerve 解剖生理 《Clinical manifestation》 1.一侧副神经受损，转颈耸肩不能。 2.颈静脉孔综合征：Ⅸ,Ⅹ,Ⅺ颅神经同时受累。 3.双侧皮层支配，一侧中枢性病变不出现症状。 Ⅻ. 舌下神经Hypoglossal Nerve 解剖生理： 图p139 《Clinical manifestation》 1.一侧舌下神经受损，伸舌偏向患侧，伴舌肌萎缩和舌肌纤颤。 2.舌下神经受损分为中枢性和周围性。 中枢性与周围性舌下神经受损的鉴别诊断 ssjsh Webers syndrome： 同侧动眼神经受损, 对侧中枢性面、舌及肢体瘫。 图p38 Millard Gubler syndrom： 同侧展、面神经周围性瘫, 对侧肢体瘫。 Foville syndrome：病灶侧外展神经麻痹，双眼向病灶侧凝视麻痹，对侧肢体瘫。 图p37 延髓： Wallenberg‘s syndrome：同侧Ⅸ、Ⅹ颅神经麻痹，交叉性感觉障碍，同侧共济失调，同侧霍纳征。 Jackson syndrome：病灶侧周围性舌下神经瘫，对侧肢体瘫。见于延髓前部橄榄体内侧病变。 图p35 * * An optic nerve with mild swelling (papilledema). Note the pathologicC-shaped halo of edema surrounding the optic disk (Grade I papilledema). * * Grade I papilledema, Another example of an optic nerve with mild papilledema. * * Grade II papilledema. The halo of edema now surrounds the optic disc. * * Grade IV papillededema. With more severe swelling in addition to a circumferential halo, the edema covers major blood vessels as they leave the optic disk (grade III) and vessels on the disk (grade IV). A subretinal hemorrhage is present at 7 oclock. * * Pseudopapilledema. A patient with an elevated optic nerve present since birth. There is no halo, no major vessel covering a small nerve with abnormal vessel branching and tortuosity. Pseudopapilledema is apparent optic disc swelling that simulates papilledema but is usually secondary to an underlying benign process. * * Light-near dissociation, refers to a condition where the light reflex is absent or abnormal but the near response is intact. There is no clinical condition in which the light reflex is present and the near response is absent. Ⅴ. 三叉神经Trigeminal Nerve 解剖生理 三叉神经传导通路 临床表现 Clinical manifestation 感觉障碍：核性损害感觉障碍呈洋葱皮样分布，并有感觉分离；核下性损害感觉障碍呈节段性分布，无感觉分离; 运动障碍：张口下颌偏向患侧,咀嚼患侧无力，患侧颞肌和咀嚼萎缩