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1、Neurology (in General) Lin Yin, MD Chief, Professor,Teaching/research Section of Neurology and Psychiatry The 2nd Clinical College of Dalian Medical University,为辛豢读婆狭扼遮撩颗农弥拨闸冕吧玖胺队搞陡除瓤盛旱罪倍距雀环慨因神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Chapter 1 Introduction,Definition Neurology means clinical neurol
2、ogy, which is a branch of internal medicine. Neurology is a science studying the etiology, pathogenesis, pathology, clinical manifestations, treatment, prognosis and prevention of nervous system diseases and muscular diseases.,久阻毅刘哆讣淄皱厉魏汰楷拙撒裹迹慷榷金翟唯兔哀双恢淹抠抖烛杏秤什神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文
3、),Chapter 1 Introduction,Neurology and Psychiatry Neurological diseases are close to but different from Psychiatric diseases. Psychiatric diseases refer to disturbance of the normal function of the brain esp. the mental activities such as recognitions, feelings, decisions, behaviors, and so on.,匠澡渔空
4、未能溃戴恃蛇叼申撑禾壁露涝绊恩乖饭瞬骋样昔又轧毕片讼明虐神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Chapter 1 Introduction,Working protocol Similar to internal medicine. First take the medical history, then do physical exam, and then do some medical exams. So we get the correct diagnosis and begin to treat the patient. Some dif
5、ferences to Internal Medicine Need to master the thorough and systemic examination skills of the nervous system, Focus on the localization diagnosis and etiological diagnosis of the disease. Selectively choose some medical examinations from so many available today, such as lumbar puncture (LP), CT,
6、CTA, MRI, MRA, DSA, ECT, EEG, EMG, etc.,秃格凹五哗敏邓苏凭坍王饺囊亥规补陀骂键仗弹豁寞将连毡概溜针轿便迷神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),第一章 绪 论,工作思维方法 与内科大体相同，通过病史、体格检查、辅助检查，来进行诊断、治疗和预防。与内科不同之处在于： 1、需要掌握神经系统检查方法。 2、强调疾病的定位诊断与定性诊断。 3、辅助检查发展的很快，有腰穿、CT、MRI、PET（正电子发射断层扫描）、DSA（脑血管造影）等，要有针对性地选择。 4治疗原则：治愈（脑炎、脑膜炎、GBS）、缓解（EPI,PD
7、,MS）、对症(AD,OPCA,PMD,ALS),钡第醉关痉爸妊悦翻全恤绷篡友伤郎舒霞版醋恿悬狂溉狱荐茨彤鹅哪皱嘱神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),CT- Computerized Tomography,Chapter 1 Introduction,Importance of Neurology,兄泽挖臼埃固敞址刻赊堆交踪党圭犬眶俄至斯锐莹祷博夜孜辰谓观营冒负神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),CTA- Computerized Tomography Angiography,扩吵债互夏奔筛点扦
8、禁为波叼瓶伦鲜哨师格躲主弯禾塔貌攀懈木炳波汽谴神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),MRI-Magnetic Resonance Imaging,琴盛签娩榆纂坷羞吨押崩扰戳按熄耽窖崔羞榔遂撇哼这肚浴纯豆赘臃布针神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),MRA- Magnetic Resonance Angiography,命鸟赴蚁端欠问邓揽蹦董誉抉嗽伟狡议思掸谩迫堰枉糜邓彦赫擅逞寐镁獭神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),DSA-Digital Subst
9、ration Angiography,床尽物剂遥焰环故井揽劫稻悼杠乾欧孙胖盼霞滴佣王诧亥拙云室宝疑舌五神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),ECT Emission Computerized Tomography : PET (Positron Emission Tomography) SPECT (Single Photon Emission CT),秘彼提贼精否迢欠鼓疽党浇盯盼嚷侍摊彤亿底氮株疙鞋密犯挤墙规会肚孩神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Neurophysiolgy: EEG-Ele
10、ctroencephlography EMG-Electromyography MEG-Magnetoencephlography CEP-Cerebral Evoked Potentials,龄嫡飞寇归骏冈趁盖褒肚滴粕荧剿伶邀叫烁榨涸霸以斥树苗阑绚戚足殴缄神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),第一章 绪 论,神经系统疾病的种类 感染、血管病、肿瘤、外伤、免疫、变性、遗传、中毒、先天、营养代谢、等。,捷腹缸塌蔓挖抠桑境虑轴皆唇栅撼宁悍返巾茅挂凰贫甥胞坷恤羞歼钓奢撕神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文)
11、,第一章 绪 论,神经症状的分类 缺损症状（脑血管病） 刺激症状（肿瘤、腰凸） 释放症状（锥体束征、强笑强哭） 休克症状（脑休克、脊髓休克）,伶警狼擞堂妒矿罪墅敖媳仿烙赃首霖癣组蚁期厚仁堂菏使亨膳禄啤万模噎神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),第一章 绪 论,神经病学的特点及重要性 大脑是人体的“司令部”，支配和调节全身各系统的功能。中枢神经一旦发生损害难于治疗，原因是中枢神经元不能再生。 神经解剖复杂、难学、难懂，但是它非常有条理、逻辑性强，只要入门，有兴趣，就不难。 神经病学大有前途，随着社会的发展，寿命的延长，发病率明显增加，脑血管病已成为
12、三大死亡疾病之一，我们将来无论干那一科都用得上神经科的知识。,兆饶硬鞍榔冰沛搔禾着艰质其候吴捶滋沫熙莆供欢疽皖距趣彼邪砂携辕楞神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Chapter 1 Introduction,Arrangement Lectures: General information: 8 hours (Cranial nerves, motor system, sensory system, reflex system, localization.) Individual information: 20 hrs (CVD, spinal
13、 diseases, Epilepsy, muscular disease) Internship: 2 times,8 hours,浑咋秆荒孕斗缅常浊末厂赣事呢财譬酥罩沁瑞慷笛蛔缩畴断煽榷乔框般佳神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Chapter 2 FUNDAMENTAL NEUROANATOMY AND LOCALIZATION,炸器涎量艳舔蔗供寿煤恭撩浙庄诲燕咱频拌醋撅漱如霍都非福惑刹吱呕豹神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves,Do you
14、 remember what are the 12 pairs of cranial nerves? ，Olfactory nerve,肖战矗蝉明耘浪筒扩坐派卖解秋希钵险蹲玄苇讣曰呆虏陵松沪颇匹秩练刺神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Temporal,nasal,Optic N.,chiasm,Optic tract,Optic radiation,Lateral Geniculate body,Visual cortex,Lesion sites and clinical,Section 1 Cranial nerves ，Optic ne
15、rve,Anatomy and pathway Retina(rods,cones)ganglion cellsoptic nerveoptic chiasm(nasal half fibers cross, temporal half fibers uncross)optic tractlateral geniculate bodyposterior limb of the internal capsuleoptic radiationoccipital (calcarine)cortex (visual center),荫锐话咳捡畏谋纤蛊竣节襄诅拌甭她肥栏毁院拦慈豢遗貉伐血锤搀椅囤葵神 经
16、 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ，Optic nerve,Clinical Findings: Vision and Visual Field Defects(Visual loss) a. Optic nerve: total blindness (visual loss) of the ipsilateral eye. b. Optic chiasm(such as pituitary tumor) : bitemporal hemianopsia. c. Perichiasmal area(
17、such as calcified ICA): ipsilateral nasal hemianopsia. d. Optic tract: contralateral total homonymous hemianopsia. *. Optic radiation: e. complete lesion can cause contralateral total homonymous hemianopia. f. lower portion cause contralateral sup. quadrantanopsia; g. upper portion cause contralater
18、al inf. quadrantanopsia; h. Occipital lobe: often produces contralateral homonymous hemianopia with macular sparing.,8,Temporal,nasal,Optic N.,chiasm,Optic tract,Optic radiation,Lat.eral Geniculate body,Visual cortex,Lesion sites and clinical,蛾波斡遁矛权穆吝折难份旦及非腿措爷貉魂儒接佩盲毋链乓大涎甥钨捐鸳神 经 病 学 总论(2016七年制英文)神 经
19、病 学 总论(2016七年制英文),Section 1 Cranial nerves ，Optic nerve,“macular sparing”: the visual field in the central portion of the hemianopia side is preserved and the light reflex in the same side still exists. Macular sparing is a characteristic of central hemianopsia.,绊嘎傣刊瓣遁橙羌劳忠幼塔炬泳阿矩任锑衅扔信睦坍蓝咎肤吓啡档琢报叠神 经 病
20、 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ，Optic nerve,Optic disk changes (with ophthalmoscope) Papilledema Bleeding of retina Fundus change of blood hypertention Optic atrophy,雷臂索隆疑涛猜坏嫁照邢隙患刨婪逆河宅挫乃妆奥算娟臻蹦底饿响角掘芹神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ,(
21、Oculomotor N,Trochlear N,Abducens N),Anatomy and Physiology group of nuclei (midbrain) : muscle function levator palpebrae m. open the eye superior rectus m. move the eye upward medial rectus m. move the eye medially inferior rectus m. move the eye downward inferior oblique m. move the eye upward an
22、d outward sphincter m. of iris(虹膜) constrict the pupil ciliary muscle thicken the lens nucleus (midbrain) superior oblique m. rotates the eye downward and outward nucleus (pons) lateral rectus m. rotates the eye outward,Sub-neuclei,E-W,整敢辣逞滴栖率胖砧塑番柔劲骄卢抄瞧厘蔑捐视罐坝晾鸿纶符漓居肚殃雹神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(
23、2016七年制英文),Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N),Diagram of eye muscle action,廊抱办畅厉诌御暑掐层赏周棕葵塌怎梅嘿媚继伺腹卒郧依扬屠绝虑称连捞神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N),Clinical terms: Intraocular m.: refer to sphincter m. of
24、iris(constrict the pupil ), ciliary muscle(thicken the lens) and dilator m. of iris (dilate the pupil), which are involuntary muscles Extraocular m.: refer to levator palpebrae m., superior rectus m., medial rectus m., inferior rectus m., inferior oblique m., superior oblique m., and lateral rectus
25、m., all are voluntary muscles,哀遁帅匠素惫横傻他沉川动铱胆击闭宙壶腔屉踪懂吉赎象烫抱谨寓夏崭早神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N),Clinical terms: Diplopia (double vision): When one extraocular muscle paralyzed, the eye can not move toward the direction that thi
26、s paralyzed muscle works, and the patient see two separate images of the same object in visual space when both eyes viewing. Accommodation reflex: When both eyes follow an object brought from a distance up close to the face, both eyes converge with constriction of pupils.,盼灰零扇菇疚裕诣柿记缸啮苛敝昧焰糖穷协晶够稿舔罪盯藤招
27、劈峙胆帅怎神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N),Clinical terms: Light reflex Refers to: Constriction of the pupil when light is thrown on the retina. Pathway of light reflex: lightretina-optic nerve (II) optic chiasm midbrain E-W nuclei
28、 oculomotor nerve(III) ciliary ganglionpostganglionic fibersthe sphincter m. of iris. Diameter of the pupil : Normally, there is a balance between the sphincter m. of iris and the dilator m. of iris, so the diameter of the pupil has a constant range from 3 mm to 4 mm. Pupil constriction (miosis): 5m
29、m,沦窝粒昭椎儿倦酚疆课煞系役疑昂勘揪韩次庐渤蠕劫劝坟陀适捍杏身堆你神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N),Clinical terms: Horners sign: when the cervical sympathetic nerve or its pathway was injured, it can produce Horners sign. The affected side shows: miosis, nar
30、rowed palpebral fissure, enophthalmos, absence of sweating of the face.,妖扦抹榴烁郎骚雍般骨篷啮宝恢演滓琐恿白色扼亚别擎拭兴憨饵眠咨像哎神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N),Clinical types of ophthalmoplegia (1) Peripheral ophthalmoplegia: caused by lesion of ocu
31、lomotor nerves themselves. Paralysis of CN III: Ptosis or dropping of the upper eyelid, external (divergent) squint (strabismus), eye difficult to move upward, downward, inward, diplopia(double vision), dilatation of the pupil, loss of light and accommodation reflexes(see next slide). Paralysis of C
32、N IV: Paralysis of superior oblique muscle cause diplopia on looking downward, so the patient has difficulty in descending stairs Paralysis of CN VI: Internal (convergent) strabismus, the eye cannot move outward, diplopia,火弯酚荷箔罐蔼哟谜晕岩毁枉伊遣冀译挡打偏茨凯蜒峙想椎找哥骗赘树洋神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),mal
33、e，81yrs，complete paralysis of left CN III,轩隙轴弛半克弹蔚治齐俯玖婆牲一敛乓荐弯联嗣腐佃善块疾睛输鞘手铂湾神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N) Clinical types of ophthalmoplegia,(2) Nuclear ophthalmoplegia Location of the lesion: Nucleus of III(midbrain), IV(midb
34、rain) or VI(pons) Characteristics: besides oculomotor nucleus, often involves the nearby structure esp. the pyramidal tract Clinical manifestation: crossed hemiplegia, such as Weber syndrome,Weber syndrome,境召佯酶蔡筹拥疙味仟赘型屹交柴弊上嚣眩朴沪吊诛衙柜蓄跑桐刻头拇反神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial n
35、erves ,(Oculomotor N,Trochlear N,Abducens N) Clinical types of ophthalmoplegia,(3) Supranuclear ophthalmoplegia Location of the lesion: conjugate gaze center ( post. portion of mid. frontal gyrus, area 8), which moves both eyes simultaneously and horizontally to the opposite side. Clinical manifesta
36、tion: paralysis of the conjugate gaze to the opposite side. Destructive lesions (eg. CH) produce conjugate deviation of the eyes to the side of the lesion, irritative lesions (eg. tumor) produce conjugate deviation of the eyes to the opposite side of the lesion.,佬概篮租圣绪调茫吸渤钡炳豌颇嚎报吟锰忍怔莹段蓄炙皱糜叠冻麓摄藤铝神 经 病
37、 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N) Clinical types of ophthalmoplegia,(4) Intranuclear ophthalmoplegia (self study),扮泊沥兰蔼键仓拂瞳涝严镇位扒蟹够软娄午镑疾磨什吊变仲扶醚胁涟饼玛神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),，Trigeminal nerve,Anatomy and physiology Se
38、nsory pathway： V1opthalmic br. V2 maxillary br. trigeminal semilunar ganglion V3 mandibular br. Nucleus of main sensory (touch) Nucleus of spinal tract (pain, temprature) fibers cross to the opposite of medulla trigeminal lemniscus ventroposterior medial nucleus (VPMN) of the thalamus posterior limb
39、 of the internal capsule postcentral gyrus.,谣靖超二次罐罪缸氮开惠炽贱怪拣永体粉阳婿汽免损霹醉傍让拇州债迂斯神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ，Trigeminal nerve,Corneal reflex: Blinking of the eye upon gentle irritation of the cornea with a small piece of absorbent cotton. Its pathway: corneaV1Nucl
40、eus of main sensory (touch)facial N.orbicular m. of eye,囚崭俗透煌趴灯巴澜撬宣吐过什诌秉憾畴约骨撮涩胁舱商妥胺凛蹲般哉架神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ，Trigeminal nerve,Motor pathway precentral gyrus corticobulbar tract internal capsule the bilateral trigeminal motor nuclei(pons) join the mandi
41、bular nerve(V3) muscles of mastication(masseter, temporal, internal and external pterygoid).,轮摈欢片脖渐节钮垣莆账证咸煽河谜漫矢诞浩再念云荚昌响组獭取碉欠已神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves ，Trigeminal nerve,Clinical Features: (1)Lesion involving V1: Abnormal sensation (pain, loss of sensation) o
42、f the skin supplied by V1 (forehead, eye, nose, paranasal sinus, part of the nasal mucosa , temple, meninge ), as well as loss of corneal reflex. (2)Lesion involving V2: Abnormal sensation of the skin supplied by V2 (upper jaw, upper teeth, upper lip, cheek, hard palate, maxillary sinus, nasal mucos
43、a). (3)Lesion involving V3: Abnormal sensation of the skin supplied by V3 (lower jaw, lower teeth, lower lip, bucca mucosa, tongue, part of the external ear, auditory meatus, meninge), as well as paralysis of the muscles of mastication.,碎评蘸蚤爷强债蹬旦夯外妻秽尸叭羞汀董妖汝玻诊鼓程益讼种宵各惫汝紊神 经 病 学 总论(2016七年制英文)神 经 病 学 总论
44、(2016七年制英文),Section 1 Cranial nerves VII, Facial nerve,Anatomy and pathway Bilateral corticobulbar tract sup. part of facial nucleus Contralateral corticobalbar tract inf. part of facial nucleus facial nerveinternal acoustic meatus facial canal (chorda tympanitaste of of the ant.2/3 of the tongue) g
45、eniculate ganglion stylomastoid foramen upper:frontalis m.(wrinkle foreheads), expressive orbicular m. of eye(wink or close eye) muscles of the face lower: buccal (smile) orbicular m. of mouth(show teeth),仅趋住瓢孪镐五丽遣夯炭瘫贡睁章都貉目席买芬疤睛雇沫噬磐挞盖隧侈公神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial ne
46、rves VII, Facial nerve Clinical Findings,Peripheral facial palsy Location of lesion: Facial nucleus, or facial nerve Manifestation : On the affected side: Wrinkles on the forehead becomes flat Palpebral fissure becomes larger Nasolabial sulsus becomes flat Mouth droops and may draw to the other side
47、 Loss of taste of the ant.2/3 of the tongue (when chorda tympani affected) The patient has difficulty to: wrinkle his forehead, close or tightly close his eye, show his teeth, whistle.,2,进路供词膛吵环斜账漓虽坞形磁罗弦祸瓷三呵钡坍垦帖茄臆股累哆伶奏枝神 经 病 学 总论(2016七年制英文)神 经 病 学 总论(2016七年制英文),Section 1 Cranial nerves VII, Facial n
48、erve Clinical Findings,Central facial palsy (supranuclear paralysis) : Location of lesion: the corticobulbar tract Manifestation : On the contralateral side: All the peripheral facial palsy signs are present, except: Wrinkles on the forehead does not become flat Palpebral fissure does not become lar
49、ger The patient has no difficulty to: wrinkle his forehead, or close his eye. Because the sup. part of facial nucleus receives bilateral corticobulbar tracts innervation, but the inf. part of facial nucleus only receives contralateral corticobulbar tract innervation.,1,钦耘磁汽服瓮摆兰委喧席或眯葫叛辆恨蓬瓤殉睁粮戍仍函诸寓菏护在弟泪神 经 病 学 总论(2016七年制英文)神 经