脊髓疾病(年制)課件

SpinalDiseases

脊髓疾病

汕頭大學(xué)醫(yī)學(xué)院第二附屬醫(yī)院神經(jīng)內(nèi)科張尤橋

SpinalDiseases

AnatomyandPhysiology

解剖生理

Theexternalstructure:

外部結(jié)構(gòu)

Theinternalstructure:

內(nèi)部結(jié)構(gòu)

AnatomyandPhysiology

解剖生Theexternalstructure:

外部結(jié)構(gòu)1.theupperandlowerbound(上下界)2.thespinalduramater(硬膜)

thearachnoid(蛛網(wǎng)膜)

thepiamater(軟膜)thesubduralspace(硬膜下腔)thesubarachnoidspace:CSF(蛛網(wǎng)膜下腔:腦脊液)3.anatomicalsegmemnts(解剖分段)4.functiongnalsegmemnts(功能分段)5.thesegmentsensation:(感覺(jué)平面/節(jié)段)6.therelationshipofspinalsegmentstothevertebralbodies:

(髓節(jié)與椎骨對(duì)應(yīng)關(guān)系)Theexternalstructure:

外部結(jié)構(gòu)anatomicalsegmemnts解剖分段：

31segments:C8,T12,L5,S5,Co1;functiongnalsegmemnts功能分段：thehighcervicalsegment:C1-4;

高頸段thecervicalintumescentia:C5-T2;

頸膨大thethoracicsegment:T3-12;

胸段thelumbarintumescentia:L1-S2;

腰膨大themedullaryconus:S3-Co1圓錐thecaudaequina:L2-Co1(10).

馬尾Nanatomicalsegmemnts解剖分段脊髓疾病(年制)課件脊髓疾病(年制)課件Theinternalstructure

內(nèi)部結(jié)構(gòu)（1）1.thegraymatter:灰質(zhì)2.thewhitemater:

白質(zhì)Theinternalstructure

內(nèi)部結(jié)構(gòu)（1thegraymatter:

灰質(zhì)①theanteriorhorn;前角；②theposteriorhorn;

后角③thelateralhorn:側(cè)角;a.C8-L2:thesympatheticnerve;C8-T1;

交感Nb.S2-4:theparasympatheticnerve;付交感N④thecentralcanal中央管:a.theanteriorcommissure前聯(lián)合；b.theposteriorcommissre.后聯(lián)合thegraymatter:灰質(zhì)①theanterithewhitemater:

白質(zhì)a.theanteriorfuniculus;前索theposteriorfuniculus;后索thelateralfuniculus.側(cè)索b.thepyramidaltract(thecorticospinaltract);

椎體束thespinothalamictract;

脊髓丘腦束thefasciculusgracilisandthefasciculuscuneatus.簿束、楔束c.thearrangementoffibers:

纖維排列：interior→outside:C,T,L,S.Fig9.內(nèi)→外thewhitemater:白質(zhì)脊髓疾病(年制)課件Spinalreflex

脊髓反射1.

Strechreflex牽張反射２．Flexorreflex屈曲反射３．Spinalshock脊髓休克(脊髓反射消失)Spinalreflex

脊髓反射1.StrechreClinicalManefestationforthedamageofspinalcord

脊髓損害臨床表現(xiàn)

1、運(yùn)動(dòng)障礙

2、感覺(jué)障礙

3、自主神經(jīng)功能障礙ClinicalManefestationfortheClinicalManefestationforthedamageofspinalcord

脊髓損害臨床表現(xiàn)

damageofthegraymater

灰質(zhì)損害damageoftheconductiontract

傳導(dǎo)束損害damageofonehalfofthespinalcord

半切損害transversedamageofthespinalcord橫貫性損害ClinicalManefestationforthedamageofthegraymater

灰質(zhì)損害

1.damageofspinalanteriorhorn:

前角損害2.damageofspinaldorsalhorn:后角損害3.damageofspinalanteriorcommissure:前連合損害4.damageofspinallateralhorn:側(cè)角損害damageofthegraymater

灰質(zhì)1、damageofspinalanteriorhorn:

前角損害segmentalparalysisoflowermotorneuron節(jié)段性下運(yùn)動(dòng)神經(jīng)元性癱瘓

lowtension肌張力降低，

weaktendonreflex腱反射減弱，muscularatrophy肌萎縮，

nopathogicsigns無(wú)病理反射。1、damageofspinalanteriorh2、damageofspinaldorsalhorn:

后角損害segmentalsensoryabnormalitylikedorsalrootdamage

類(lèi)似后根損害的節(jié)段性分離性感覺(jué)異常abnormalpainandtemperaturesensation

痛、溫覺(jué)異常，normaltouchanddeepsensation

觸覺(jué)、深感覺(jué)正常2、damageofspinaldorsalhorn3、damageofspinallateralhorn

側(cè)角損害involvesautonomicnerve累及自主神經(jīng)resultingin:引起abnomalvascularmovement血管運(yùn)動(dòng)異常、excessivesweating出汗、malnutritionoferecthairskinandnails

豎毛、皮膚、指甲營(yíng)養(yǎng)障礙3、damageofspinallateralhodamageoftheconductiontract

傳導(dǎo)束損害damageofthecorticospinaltract:pyramidalsign:皮層脊髓束損害：椎體束征damageofthespinothalamictract:

脊髓丘腦束損害damageofspinaldorsalcolumn:

后索損害damageoftheconductiontractdamageofthecorticospinaltract:

皮層脊髓束損害：pyramidalsign:椎體束征Paralysis癱瘓、Manifestinghypertonia肌張力增高、hyperreflexia腱反射亢進(jìn)、pathologicsigns病理反射陽(yáng)性damageofthecorticospinaltrdamageofthespinothalamictract:

脊髓丘腦束損害abnomalsuperficialsensation淺感覺(jué)異常damageofthespinothalamictrdamageofspinaldorsalcolumn:

后索損害

abnormalityofdeepsensation,深感覺(jué)異常、

damageofspinaldorsalcolumn脊髓疾病(年制)課件damageofonehalfofthespinalcord

半切損害

BrownSequardSyndrome.

Ipsilateralspasticparalysis同側(cè)痙攣性癱瘓、anddeepsensorydysfunction和深感覺(jué)障礙contralateralsuperficialsensorydysfunction對(duì)側(cè)淺感覺(jué)障礙mostwithnoobviousdysfunctionofthetouchsensation大多數(shù)沒(méi)有觸覺(jué)障礙damageofonehalfofthespin脊髓疾病(年制)課件transversedamageofthespinalcord

橫貫性損害(1)

highcerveicalspinaltransversedamage:

高頸段損害

cervicalintumescentiatransversedamage:頸膨大損害

transversedamageofthoracicspinalcord:

胸段損害abdominalreflex(腹壁反射)↓，Beeversign.

lumbarintumescentiatransversedamage:

腰膨大損害

cremasteric,knee,ankleandplantarreflex↓.

提睪反射、膝反射、踝反射、跖反射↓

transversedamageofthespinatransversedamageofthespinalcord

橫貫性損害(2)

(5)transversedamageofconus:

圓錐損害

saddle-likesensorydecreaseorlossinanusandperineum肛門(mén)會(huì)陰部鞍區(qū)感覺(jué)減弱或消失、andrareofslightrootpain少有根痛sexualdysfunction:性功能障礙lossofanusreflex;.肛門(mén)反射消失

retentionofurineandstools.大小便失禁(incontinence潴留)(6)transversedamageofcaudaequina:

馬尾N損害

severelegpain;劇烈腿痛

flaccidparalysisofbothlegs;雙腿弛緩性癱

lossofkneeandanklereflex;膝反射、踝反射消失incontinenceandretentionofurineandstools大小便潴留和失禁

transversedamageofthespinaAcuteMyelitis

急性脊髓炎

Definition定義EtiologyandPathology病因病理ClinicalManifestation臨床表現(xiàn)LaboratoryFindings輔助檢查Diagnosis診斷要點(diǎn)DifferentialDiagnosis鑒別診斷Treatment治療Prognosis:預(yù)后AcuteMyelitis

急性脊髓炎DefinDefinition

定義Acutetransversemyelitis;急性橫貫性脊髓炎

Postinfectiousmyelitis;

感染后脊髓炎Postvaccinalmyelitis；

疫苗接種后脊髓炎2Definition

定義AcutetransveEtiologyandPathology

病因病理

Unknown;病因未明。

Postinfectiousallergicreaction;

感染后變態(tài)反應(yīng)。T3-5spinalsegmentsmaybeswollenorslightlyenlarged;脊髓腫脹/增粗3EtiologyandPathology

病因病理UnClinicalManifestation臨床表現(xiàn)(1)

1.respiratoryinfectionorvaccination;呼吸道感染/接種史2.tocatchacold,fatigue,injury;受涼、疲勞、外傷3.rootpainatthelesionlevel,受損平面根痛，numbnessandweaknessofthefeetandlegs雙下肢麻木、乏力(lessoftenofthehandsandarms)(手和臂常少受累)4.belowthelesionlevel.病變平面以下theparalysisofextremities,肢體癱瘓，lossofsensation,各種感覺(jué)障礙，dysfunctionsofbowelandbladder大小便障礙7ClinicalManifestation臨床表現(xiàn)(ClinicalManifestation臨床表現(xiàn)(2)5.involvesautonomicnerve,自主神經(jīng)功能障礙resultingin:abnormalvascularmovement,血管運(yùn)動(dòng)異常、excessivesweating,出汗少、無(wú)汗malnutritionoferecthair,skinandnails.

堅(jiān)毛、皮膚、指甲營(yíng)養(yǎng)障礙6.spinalshock:1～2week;2～4week.脊髓休克7.return:恢復(fù)3～4week;3～6months

8.ascendantmyelitis:上升性脊髓炎ClinicalManifestation臨床表現(xiàn)LaboratoryFindings

輔助檢查

1.CSF腦脊液;2.MRI磁共振;LaboratoryFindings

輔助檢查1.CSDiagnosis:

診斷要點(diǎn)1.2.3.4.

Diagnosis:

診斷要點(diǎn)1.2.3.4DifferentialDiagnosis鑒別診斷

neuromyelitisoptica;

視N脊髓炎2.spinalhaemorrhage(bleeding)脊髓出血3.缺血性脊髓血管病4.spinalcordcompression:

脊髓壓迫癥：spinalepiduralabscess硬膜外膿腫、tumor腫瘤脊柱結(jié)核5.Guillain-Barresyndrome格巴DifferentialDiagnosis鑒別診斷急性脊髓炎

格巴病變部位

胸段脊髓

N根、周?chē)鶱癱瘓截癱、硬癱(休克期軟癱)四肢軟癱感覺(jué)障礙明顯、傳導(dǎo)束型輕或無(wú)、末梢型大小便障礙明顯、早出現(xiàn)一般無(wú)、輕或短暫顱N障礙無(wú)有CSF

多數(shù)正常，少數(shù)蛋白/細(xì)胞數(shù)輕↑蛋白～細(xì)胞分離電生理

SSCV↓MCV↓、H反射、F波↓

急性脊髓炎格巴Treatment

治療（1）

1.drugs（藥物）:①DXM,prednisone;甲強(qiáng)龍地塞米松、強(qiáng)的松

②免疫球蛋白

③VitB;維生素B④Dibazone,nimodipine;地巴唑、尼莫地平⑤20%mannitol;

甘露醇⑥antibiotic;

抗菌素Treatment治療（1）1.drugs（藥物）:Treatment治療（2）

2.nursing護(hù)理：skin,respiratorytract,urine,stool.皮膚，呼吸道，尿，大便。3.nutrition;營(yíng)養(yǎng)

4.support;支持5.recoveredtreatment:康復(fù)治療Prognosis:

預(yù)后Treatment治療（2）2.nursing護(hù)理Whataretheclinicalmanifestationsoftheacutemyelitis?Whataretheclinicalmanifest

Compressive

myelopathy

壓迫性脊髓病

Compressive

myelopathy

壓迫性脊髓

Difinition:

定義refertoanumberofneurologicdiseaseswithspinaldysfunction,causedbysomeoccupationsinthevertebralcavitywhichresultedinthecompressedinjuryofthespinalcord,rootsofspinalnervesandtheirbloodvessels.由于椎骨椎管內(nèi)占位性病變而產(chǎn)生的脊髓受壓的一大組病征

Etiology:

病因:1.腫瘤

2.炎癥

3.脊柱外傷

4.脊柱退行性病變

5.先天性疾病

pathogenesis：發(fā)病機(jī)制

脊髓受壓早期可代償,外形有明顯改變,但傳導(dǎo)徑路并未中斷,不出現(xiàn)神經(jīng)功能受損.后期失代償,出現(xiàn)明顯癥狀和體征.

受壓病變的性質(zhì)和速度可影響代償機(jī)制.

病變部位對(duì)損傷影響.

ClinicalManifestation

臨床表現(xiàn)(1)分型：acutespinalcordcompression:

急性脊髓壓迫癥(1)

transversedamageofthespinalcord;

(2)

spinalshock.chronicspinalcordcompression慢性脊髓壓迫癥

progressive進(jìn)行性;Threestages三個(gè)期:

rootpains;(stimulantperiod)根痛(刺激期)

partialcompressionofspinalcord部分受壓期

(Brown-Sequard’ssyndrome).finallycompletecompressionofthecord

(transversedamageofspinalcord)橫貫性損害期

ClinicalManifestation

臨床表現(xiàn)(1)ClinicalManifestation

臨床表現(xiàn)(2)表現(xiàn)：Radicularsymptomsandsigns:神經(jīng)根癥狀和體征Sensorydisturbances:感覺(jué)障礙(髓內(nèi)病變,髓外病變)Motordisturbances：運(yùn)動(dòng)障礙Thereflexes：反射Autonomicsymptoms:自主神經(jīng)癥狀I(lǐng)rritativesymptomsofspinalmeninges:脊膜刺激癥狀ClinicalManifestation

臨床表現(xiàn)(2)LaboratoryFindings

輔助檢查

1.lumbarpuncture:

腰穿①thepressureistested:itisraised壓力↑(80-180mmH2Oisnormal).②cellcountisnormal細(xì)胞數(shù)正常；③proteinisraised,xanthochromia,Froinsign.蛋白↑黃變④Queckenstedttest:(+)奎根試驗(yàn)(壓頸試驗(yàn))2.X-ray3.vertebraltubeangiography:

椎管造影4.CTorMRLaboratoryFindings

輔助檢查1.lumDiagnosis

診斷yesornot?

是不是？whereitis?

在哪里？Whichdiseaseitis?

什么??？Diagnosis

診斷yesornot?是不是Diagnosis診斷(1)1.Thefoundationofdiagnosis(basisfordiagnosis):

根據(jù)①manifestationofthespinalcordcompression:

臨床表現(xiàn)②vertebraltubeblocked;

椎管阻塞③CT/MR;2.toshowthepositionofthecompression:

定位

verticalsection;

縱向

crosssection:

橫向insideoroutsideofthespinalcord:12髓內(nèi)與外insideoroutsideofthespinalduramater:4硬膜內(nèi)與外3.toshowthenature;

定性Diagnosis診斷(1)1.Thefoundati

3.定性診斷:急性壓迫:多為外傷性.慢性壓迫:髓內(nèi)和髓外硬膜內(nèi)以腫瘤常見(jiàn).脊髓蛛網(wǎng)膜炎硬膜外病變以轉(zhuǎn)移瘤多見(jiàn),椎間盤(pán)突出癥.

脊髓疾病(年制)課件脊髓疾病(年制)課件脊髓疾病(年制)課件Diagnosis

診斷(2)髓內(nèi)髓外1.N根痛晚早2.感覺(jué)分離可有無(wú)3.癱瘓肌萎縮椎體束征

4.痛溫覺(jué)障礙上肢→下下肢→上

5.側(cè)別雙側(cè)一側(cè)→雙

6.大小便早晚

7.CS旦白↑±+～+++

8.奎根-+9.椎骨痛-+

10.X片-+11.椎管造影梭狀缺損杯狀缺損

12.CT/MR

髓內(nèi)髓外Diagnosis診斷(2)Diagnosis診斷(3)

硬膜內(nèi)

硬膜外

1.病程慢快2.側(cè)別半切橫貫3.CSF++++～++4.X片-+Diagnosis診斷(3)DifferentialDiagnosis

鑒別診斷急性脊髓炎脊髓空洞癥:病程長(zhǎng),多位于下頸部及上胸部.分離性感覺(jué)障礙,MR示脊髓內(nèi)長(zhǎng)條形空洞.DifferentialDiagnosis

鑒別診斷急Treatment

治療

1.operation;

手術(shù)

:椎板減壓術(shù)2.antibiotic;抗菌素,抗癆治療3.recoveredtreatment.

康復(fù)治療

Treatment

治療1.operation;手Whatarethechiefsymptomsandsignsofthecordcompression?脊髓疾病(年制)課件謝謝！謝謝！SpinalDiseases

脊髓疾病

汕頭大學(xué)醫(yī)學(xué)院第二附屬醫(yī)院神經(jīng)內(nèi)科張尤橋

SpinalDiseases

AnatomyandPhysiology

解剖生理

Theexternalstructure:

外部結(jié)構(gòu)

Theinternalstructure:

內(nèi)部結(jié)構(gòu)

AnatomyandPhysiology

解剖生Theexternalstructure:

外部結(jié)構(gòu)1.theupperandlowerbound(上下界)2.thespinalduramater(硬膜)

thearachnoid(蛛網(wǎng)膜)

thepiamater(軟膜)thesubduralspace(硬膜下腔)thesubarachnoidspace:CSF(蛛網(wǎng)膜下腔:腦脊液)3.anatomicalsegmemnts(解剖分段)4.functiongnalsegmemnts(功能分段)5.thesegmentsensation:(感覺(jué)平面/節(jié)段)6.therelationshipofspinalsegmentstothevertebralbodies:

(髓節(jié)與椎骨對(duì)應(yīng)關(guān)系)Theexternalstructure:

外部結(jié)構(gòu)anatomicalsegmemnts解剖分段：

31segments:C8,T12,L5,S5,Co1;functiongnalsegmemnts功能分段：thehighcervicalsegment:C1-4;

高頸段thecervicalintumescentia:C5-T2;

頸膨大thethoracicsegment:T3-12;

胸段thelumbarintumescentia:L1-S2;

腰膨大themedullaryconus:S3-Co1圓錐thecaudaequina:L2-Co1(10).

馬尾Nanatomicalsegmemnts解剖分段脊髓疾病(年制)課件脊髓疾病(年制)課件Theinternalstructure

內(nèi)部結(jié)構(gòu)（1）1.thegraymatter:灰質(zhì)2.thewhitemater:

白質(zhì)Theinternalstructure

內(nèi)部結(jié)構(gòu)（1thegraymatter:

灰質(zhì)①theanteriorhorn;前角；②theposteriorhorn;

后角③thelateralhorn:側(cè)角;a.C8-L2:thesympatheticnerve;C8-T1;

交感Nb.S2-4:theparasympatheticnerve;付交感N④thecentralcanal中央管:a.theanteriorcommissure前聯(lián)合；b.theposteriorcommissre.后聯(lián)合thegraymatter:灰質(zhì)①theanterithewhitemater:

白質(zhì)a.theanteriorfuniculus;前索theposteriorfuniculus;后索thelateralfuniculus.側(cè)索b.thepyramidaltract(thecorticospinaltract);

椎體束thespinothalamictract;

脊髓丘腦束thefasciculusgracilisandthefasciculuscuneatus.簿束、楔束c.thearrangementoffibers:

纖維排列：interior→outside:C,T,L,S.Fig9.內(nèi)→外thewhitemater:白質(zhì)脊髓疾病(年制)課件Spinalreflex

脊髓反射1.

Strechreflex牽張反射２．Flexorreflex屈曲反射３．Spinalshock脊髓休克(脊髓反射消失)Spinalreflex

脊髓反射1.StrechreClinicalManefestationforthedamageofspinalcord

脊髓損害臨床表現(xiàn)

1、運(yùn)動(dòng)障礙

2、感覺(jué)障礙

3、自主神經(jīng)功能障礙ClinicalManefestationfortheClinicalManefestationforthedamageofspinalcord

脊髓損害臨床表現(xiàn)

damageofthegraymater

灰質(zhì)損害damageoftheconductiontract

傳導(dǎo)束損害damageofonehalfofthespinalcord

半切損害transversedamageofthespinalcord橫貫性損害ClinicalManefestationforthedamageofthegraymater

灰質(zhì)損害

1.damageofspinalanteriorhorn:

前角損害2.damageofspinaldorsalhorn:后角損害3.damageofspinalanteriorcommissure:前連合損害4.damageofspinallateralhorn:側(cè)角損害damageofthegraymater

灰質(zhì)1、damageofspinalanteriorhorn:

前角損害segmentalparalysisoflowermotorneuron節(jié)段性下運(yùn)動(dòng)神經(jīng)元性癱瘓

lowtension肌張力降低，

weaktendonreflex腱反射減弱，muscularatrophy肌萎縮，

nopathogicsigns無(wú)病理反射。1、damageofspinalanteriorh2、damageofspinaldorsalhorn:

后角損害segmentalsensoryabnormalitylikedorsalrootdamage

類(lèi)似后根損害的節(jié)段性分離性感覺(jué)異常abnormalpainandtemperaturesensation

痛、溫覺(jué)異常，normaltouchanddeepsensation

觸覺(jué)、深感覺(jué)正常2、damageofspinaldorsalhorn3、damageofspinallateralhorn

側(cè)角損害involvesautonomicnerve累及自主神經(jīng)resultingin:引起abnomalvascularmovement血管運(yùn)動(dòng)異常、excessivesweating出汗、malnutritionoferecthairskinandnails

豎毛、皮膚、指甲營(yíng)養(yǎng)障礙3、damageofspinallateralhodamageoftheconductiontract

傳導(dǎo)束損害damageofthecorticospinaltract:pyramidalsign:皮層脊髓束損害：椎體束征damageofthespinothalamictract:

脊髓丘腦束損害damageofspinaldorsalcolumn:

后索損害damageoftheconductiontractdamageofthecorticospinaltract:

皮層脊髓束損害：pyramidalsign:椎體束征Paralysis癱瘓、Manifestinghypertonia肌張力增高、hyperreflexia腱反射亢進(jìn)、pathologicsigns病理反射陽(yáng)性damageofthecorticospinaltrdamageofthespinothalamictract:

脊髓丘腦束損害abnomalsuperficialsensation淺感覺(jué)異常damageofthespinothalamictrdamageofspinaldorsalcolumn:

后索損害

abnormalityofdeepsensation,深感覺(jué)異常、

damageofspinaldorsalcolumn脊髓疾病(年制)課件damageofonehalfofthespinalcord

半切損害

BrownSequardSyndrome.

Ipsilateralspasticparalysis同側(cè)痙攣性癱瘓、anddeepsensorydysfunction和深感覺(jué)障礙contralateralsuperficialsensorydysfunction對(duì)側(cè)淺感覺(jué)障礙mostwithnoobviousdysfunctionofthetouchsensation大多數(shù)沒(méi)有觸覺(jué)障礙damageofonehalfofthespin脊髓疾病(年制)課件transversedamageofthespinalcord

橫貫性損害(1)

highcerveicalspinaltransversedamage:

高頸段損害

cervicalintumescentiatransversedamage:頸膨大損害

transversedamageofthoracicspinalcord:

胸段損害abdominalreflex(腹壁反射)↓，Beeversign.

lumbarintumescentiatransversedamage:

腰膨大損害

cremasteric,knee,ankleandplantarreflex↓.

提睪反射、膝反射、踝反射、跖反射↓

transversedamageofthespinatransversedamageofthespinalcord

橫貫性損害(2)

(5)transversedamageofconus:

圓錐損害

saddle-likesensorydecreaseorlossinanusandperineum肛門(mén)會(huì)陰部鞍區(qū)感覺(jué)減弱或消失、andrareofslightrootpain少有根痛sexualdysfunction:性功能障礙lossofanusreflex;.肛門(mén)反射消失

retentionofurineandstools.大小便失禁(incontinence潴留)(6)transversedamageofcaudaequina:

馬尾N損害

severelegpain;劇烈腿痛

flaccidparalysisofbothlegs;雙腿弛緩性癱

lossofkneeandanklereflex;膝反射、踝反射消失incontinenceandretentionofurineandstools大小便潴留和失禁

transversedamageofthespinaAcuteMyelitis

急性脊髓炎

Definition定義EtiologyandPathology病因病理ClinicalManifestation臨床表現(xiàn)LaboratoryFindings輔助檢查Diagnosis診斷要點(diǎn)DifferentialDiagnosis鑒別診斷Treatment治療Prognosis:預(yù)后AcuteMyelitis

急性脊髓炎DefinDefinition

定義Acutetransversemyelitis;急性橫貫性脊髓炎

Postinfectiousmyelitis;

感染后脊髓炎Postvaccinalmyelitis；

疫苗接種后脊髓炎2Definition

定義AcutetransveEtiologyandPathology

病因病理

Unknown;病因未明。

Postinfectiousallergicreaction;

感染后變態(tài)反應(yīng)。T3-5spinalsegmentsmaybeswollenorslightlyenlarged;脊髓腫脹/增粗3EtiologyandPathology

病因病理UnClinicalManifestation臨床表現(xiàn)(1)

1.respiratoryinfectionorvaccination;呼吸道感染/接種史2.tocatchacold,fatigue,injury;受涼、疲勞、外傷3.rootpainatthelesionlevel,受損平面根痛，numbnessandweaknessofthefeetandlegs雙下肢麻木、乏力(lessoftenofthehandsandarms)(手和臂常少受累)4.belowthelesionlevel.病變平面以下theparalysisofextremities,肢體癱瘓，lossofsensation,各種感覺(jué)障礙，dysfunctionsofbowelandbladder大小便障礙7ClinicalManifestation臨床表現(xiàn)(ClinicalManifestation臨床表現(xiàn)(2)5.involvesautonomicnerve,自主神經(jīng)功能障礙resultingin:abnormalvascularmovement,血管運(yùn)動(dòng)異常、excessivesweating,出汗少、無(wú)汗malnutritionoferecthair,skinandnails.

堅(jiān)毛、皮膚、指甲營(yíng)養(yǎng)障礙6.spinalshock:1～2week;2～4week.脊髓休克7.return:恢復(fù)3～4week;3～6months

8.ascendantmyelitis:上升性脊髓炎ClinicalManifestation臨床表現(xiàn)LaboratoryFindings

輔助檢查

1.CSF腦脊液;2.MRI磁共振;LaboratoryFindings

輔助檢查1.CSDiagnosis:

診斷要點(diǎn)1.2.3.4.

Diagnosis:

診斷要點(diǎn)1.2.3.4DifferentialDiagnosis鑒別診斷

neuromyelitisoptica;

視N脊髓炎2.spinalhaemorrhage(bleeding)脊髓出血3.缺血性脊髓血管病4.spinalcordcompression:

脊髓壓迫癥：spinalepiduralabscess硬膜外膿腫、tumor腫瘤脊柱結(jié)核5.Guillain-Barresyndrome格巴DifferentialDiagnosis鑒別診斷急性脊髓炎

格巴病變部位

胸段脊髓

N根、周?chē)鶱癱瘓截癱、硬癱(休克期軟癱)四肢軟癱感覺(jué)障礙明顯、傳導(dǎo)束型輕或無(wú)、末梢型大小便障礙明顯、早出現(xiàn)一般無(wú)、輕或短暫顱N障礙無(wú)有CSF

多數(shù)正常，少數(shù)蛋白/細(xì)胞數(shù)輕↑蛋白～細(xì)胞分離電生理

SSCV↓MCV↓、H反射、F波↓

急性脊髓炎格巴Treatment

治療（1）

1.drugs（藥物）:①DXM,prednisone;甲強(qiáng)龍地塞米松、強(qiáng)的松

②免疫球蛋白

③VitB;維生素B④Dibazone,nimodipine;地巴唑、尼莫地平⑤20%mannitol;

甘露醇⑥antibiotic;

抗菌素Treatment治療（1）1.drugs（藥物）:Treatment治療（2）

2.nursing護(hù)理：skin,respiratorytract,urine,stool.皮膚，呼吸道，尿，大便。3.nutrition;營(yíng)養(yǎng)

4.support;支持5.recoveredtreatment:康復(fù)治療Prognosis:

預(yù)后Treatment治療（2）2.nursing護(hù)理Whataretheclinicalmanifestationsoftheacutemyelitis?Whataretheclinicalmanifest

Compressive

myelopathy

壓迫性脊髓病

Compressive

myelopathy

壓迫性脊髓

Difinition:

定義refertoanumberofneurologicdiseaseswithspinaldysfunction,causedbysomeoccupationsinthevertebralcavitywhichresultedinthecompressedinjuryofthespinalcord,rootsofspinalnervesandtheirbloodvessels.由于椎骨椎管內(nèi)占位性病變而產(chǎn)生的脊髓受壓的一大組病征

Etiology:

病因:1.腫瘤

2.炎癥

3.脊柱外傷

4.脊柱退行性病變

5.先天性疾病

pathogenesis：發(fā)病機(jī)制

脊髓受壓早期可代償,外形有明顯改變,但傳導(dǎo)徑路并未中斷,不出現(xiàn)神經(jīng)功能受損.后期失代償,出現(xiàn)明顯癥狀和體征.

受壓病變的性質(zhì)和速度可影響代償機(jī)制.

病變部位對(duì)損傷影響.

ClinicalManifestation

臨床表現(xiàn)(1)分型：acutespinalcordcompression:

急性脊髓壓迫癥(1)

transversedamageofthespinalcord;

(2)

spinalshock.chronicspinalcordcompression慢性脊髓壓迫癥

progressive進(jìn)行性;Threestages三個(gè)期:

rootpains;(stimulantperiod)根痛(刺激期)

partialcompressionofspinalcord部分受壓期

(Brown-Sequard’ssyndrome).finallycompletecompressionofthecord

(transversedamageofspinalcord)橫貫性損害期

ClinicalManifestation

臨床表現(xiàn)(1)ClinicalManifestation

臨床表現(xiàn)(2)表現(xiàn)：Radicularsymptomsandsigns:神經(jīng)根癥狀和體征Sensorydisturbances:感覺(jué)障礙(髓內(nèi)病變,髓外病變)Motordisturbances：運(yùn)動(dòng)障礙Thereflexes：反射Au