《神经病学》（英文）PPT电子课件.ppt

Compressive myelopathy-  Pathology and physiology Extramedullary intradural lesions: 首先从一侧压迫脊髓, 症状进展缓慢 Extramedallary extradural lesions: 由于硬脊膜的阻挡，对脊髓的压迫作用相对轻微，症状往往发生在脊腔明显梗阻之后 3. 根动脉受压 可引起分布区脊髓缺血，静脉高压， 局部 脊髓组织水肿以及血浆蛋白渗出。 Compressive myelopathy Clinical features (1)Irritating and deficit symptoms of nerve roots (2)Sensation disturbance ; (3)Dyskinasia:extension spastic paralysis or paraplegia in flexion Compressive myelopathy Clinical features (4) Reflex disorders: (5) Sympotoms of autonomic nerves：sphincter dysfunction (6) 脊膜刺激症状： Compressive myelopathy-Examination (1) Lumbar puncture：对诊断有重要意义。 ? Froin综合征。 ? 压颈试验(Queckenstedt试验): block (2) Plain X ray of the spine: (3) Myelography: (4) CT or MRI：清晰显示脊髓受压影像 Compressive myelopathy-Diagnosis (1) Make decision of cord compression: ?The focus develops from one side Radicular pain ↓ cord hemisection developed ↓ total cord transection ?Progressive process, and the symptoms aggravate insidiously and gradually. Compressive myelopathy-Diagnosis ? Queckenstedt test at lumbar puncture may reveal block ? CSF show Protein-cell count dissociation. If CSF is xanthochromic and become autocoagulation, it is called Froin syndrom. ? MRI or myelography may show the lesion accurately. Compressive myelopathy-Diagnosis (2) Localize the segment of the lesion (3)Localize the cross section of the lesion:(intra or extradural). Compressive myelopathy-Diagnosis (4) 定性诊断： A rapid onset and progress usually occur in extradural abcess, metastatic carcinoma of the spine, or spine tubercle. The extramedullary and intradural primary tumor may be a slow onset, the process begin as radicular pain on one side, and develops partial compress, and then transection. Compressive myelopathy-Diagnosis