神經(jīng)病學英文2.headach課件

1、神經(jīng)病學（英文）2.headach1神經(jīng)病學神經(jīng)病學 頭痛頭痛 (headache)哈爾濱醫(yī)科大學附屬第二醫(yī)院哈爾濱醫(yī)科大學附屬第二醫(yī)院神經(jīng)病學教研室神經(jīng)病學教研室神經(jīng)病學（英文）2.headach2第一節(jié)第一節(jié) 概概 述述 headache is one of the most common clinical symptoms. its pathogenesis is more complicated. 神經(jīng)病學（英文）2.headach3 pathogenesisathogenesis pain-sensitive structures of the brain 1) brain skin

2、, subcutaneous tissu,etc. 2) arteries and muscles; 3) venous sinuses and meningeal arteries; 4) the trigeminal(v), glossopharyngeal(ix); vagus(x), etc.神經(jīng)病學（英文）2.headach4 1. acute(2w) ,subacute(3m) or chronic(3m); 2. mild, morderate or severity; 3. original(migraine, cluster, tension); secondary(trau

3、ma,infection,tumor);classification of the headache神經(jīng)病學（英文）2.headach5 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 s

4、ome suitable assistant tests. diagnosis神經(jīng)病學（英文）2.headach6treatment1. 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

5、 suitable assistant tests.神經(jīng)病學（英文）2.headach7第二節(jié)第二節(jié) 偏頭痛偏頭痛 (migraine) 1. etiology : heredity; endocrine and metabolism; other factors.神經(jīng)病學（英文）2.headach8 2. pathogenesis 1) blood vessel theory; 2) nerve- vessel theory; 3) nerve-transmitter theory.神經(jīng)病學（英文）2.headach9 clinical manifestations 1. migraine

6、with aura (classic migraine) proemial stage aura stage headache stage later stage of headache 2. migraine without aura (common migraine) 神經(jīng)病學（英文）2.headach102. special-type of migraine 1) ophthalmoplegia 2) hemiplegia 3) basilar-type 4) later-onset 5) 等位發(fā)作神經(jīng)病學（英文）2.headach11神經(jīng)病學（英文）2.headach12 1. com

7、mon type (1988 diagnostic criteria) 1) 符合下述符合下述24項，至少發(fā)作項，至少發(fā)作5次以上。次以上。 2）如不治療）如不治療 ，每次發(fā)作持續(xù)，每次發(fā)作持續(xù)24小時。小時。 3）具有以下特點至少兩項：單側(cè)性；博動性；不敢）具有以下特點至少兩項：單側(cè)性；博動性；不敢 活動；活動后頭痛加重。活動；活動后頭痛加重。 4）發(fā)作期間有下列之一：惡心及嘔吐；畏光和畏聲。）發(fā)作期間有下列之一：惡心及嘔吐；畏光和畏聲。 5）無其它已知類似疾?。徊∈奋|體正常。）無其它已知類似疾??；病史軀體正常。diagnosis神經(jīng)病學（英文）2.headach13 1 1）符合下述兩項，

8、至少發(fā)作）符合下述兩項，至少發(fā)作2 2次。次。 2 2）具有以下特征至少）具有以下特征至少3 3項：局限性腦皮質(zhì)或腦干功能項：局限性腦皮質(zhì)或腦干功能 障礙障礙1 1或或1 1個以上先兆癥狀個以上先兆癥狀; ;至少有一個先兆癥狀，至少有一個先兆癥狀， 逐漸發(fā)展持續(xù)逐漸發(fā)展持續(xù)4 4分以上；或相繼發(fā)生分以上；或相繼發(fā)生2 2個或個或2 2個以上個以上 癥狀；先兆癥狀持續(xù)癥狀；先兆癥狀持續(xù)6f. quality: diffuse, band-like, dull headache. position: bilateral occipital, frontal. course: days or yea

9、rs. accompany symptoms: vertigo,insomnia, anxious and depression. part of the patients have daily chronic headache. 神經(jīng)病學（英文）2.headach21神經(jīng)病學（英文）2.headach22 th classification of iha (1988): 1. th attack: 10times, time180days/yr, 15d/m; 2. th attack with disease around skull muscles: attach pain of the

10、 bone and muscles around the skull. emg activation increase. 3. th attack without disease around skull muscles: without attach pain of the bone and muscles around the skull. emg is normal. 4. chronic headache:time of headache180d/yr, 15/m. tension headache-diagnosis神經(jīng)病學（英文）2.headach23 drugs used in

11、tension headache should be personalize : insomnia should give benzodiazepines such as diazepam; depression and anxious should give amitriptyline, imipramine and fluoxetine. acute attacks may response to aspirin, nonsteroid anti-inflammatory drugs (acetaminophen, ergotamine)treatment神經(jīng)病學（英文）2.headach

12、24 第四節(jié)第四節(jié) 低顱壓頭痛低顱壓頭痛 （intracranial hypotension headache） intracranial pressure 90mmh2o etiology and pathogenesis： original: csf secret disorder. secondary: csf leaking (lumbar puncture, trauma, operation, meningitis, severe infection, etc. )神經(jīng)病學（英文）2.headach25clinical manifestations position: occipi

13、tal and frontal. quality: mild or sever dull and beating pain. position of the body: severity when standing, lighten when lying. accompany symptoms: nausea, vomiting, vertigo, tinnitus, rigidity, etc.神經(jīng)病學（英文）2.headach26diagnosis and differential diagnosis 典型臨床表現(xiàn)典型臨床表現(xiàn) ct/mri 腰穿腰穿 與腦、脊髓腫瘤、腦室梗阻、寄生蟲感與腦、脊髓腫瘤、腦室梗阻、寄生蟲感 染、腦靜脈血栓形成、亞急性硬膜下血染