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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Peripheral neuropathy,Peripheral neuropathy,The peripheral nervous system(PNS)includes all neural structures lying outside the pial membrane of the spinal cord and brain stem.,Not include,the,optic nerves and olfactory bulbs,Composed of Cranial nerves(10 pairs)and Spinal nerves(31 pairs),The peripheral nervous syst,Myelinated fibers:coated with the membrane of one Schwann cell every 250 to 1000,m in concentric way,forming the insulated myelin(a multilayer sheath).Each segment is called node of Ranvier,permitting the conduction of the nerve impulse saltatory and therefore rapidly,Injury of the myelin causes the destruction of node of Ranvier leading the slow down of nerve conducting velocity,Unmyelinated fibers:bundles of fibers is capsulated by a single Schwann cell.,No sheath slow propagation of electric flow of nerve impulse.,Myelinated fibers:coated with,Etiology,Connective tissue diseases:lupus erythometosis,Trauma/entrapment,Intoxication:pesticide,Nutrition deficiency/metabolic disturbance,Tumor-related,Hereditary diseases,Inflammation,cryptogenic,EtiologyConnective tissue dise,NEUROPATHY,Segmental demyelination:Focal degeneration of the myelin sheath with sparing of the axon,Wallerian degeneration:the nerve degenerates from the point of axonal damage outwards,Axonal degeneration:the axon degenerates from the distal-most site to the proximal site(both axon and myelin),Neuropathy:Secondary degeneration due to neuron necrosis,NEUROPATHYSegmental demyelinat,Clinical symptoms,Impairment of motor function,LMN paralysis,Stimulus symptoms:fasciculation,Sensory impairment,anaesthesia,paraesthesia and pain,Autonomic dysfunction:Anhidrosis and orthostatic hypotension,Clinical symptomsImpairment of,Clinical patterns,Mononeuropathy:weakness and sensory loss in the territory of a single peripheral nerve,Mutiple mononeuropathy:more than one peripheral nerve are involved,Polyneuropathy:symmetric weakness of limbs and areflexia,symmetric loss of sensory,autonomic dysfunction in the affected area,Clinical patternsMononeuropath,Auxiliary examination,NCV and EMG are helpful to the diagnosis of the peripheral nerve disease.,Discover the preclinical nerve impairment,Find out whether the disease is caused by the axon degeneration or demyelination,Distinguish muscle disease from neuropathy,Auxiliary examination NCV and,Idiopathic Trigeminal Neuralgia,Idiopathic Trigeminal Neuralgi,Trigeminal neuralgia is a disease characterized with transient and recurrent severe pain within the distribution of trigeminal nerve.,神经病学教学ppt课件：Peripheral-neuropathy,Etiological factor and Pathology,Usually idiopathic.Some may be due to the compression of tortuous blood vessel.,Etiological factor and Patholo,Clinical manifestation,Women:men=3:2.Much higher in elderly;,Paroxysmal in nature,Unilateral and limited to one or two divisions(mandibular and maxillary branches are more involved)of trigeminal nerve territory,Intensity to make patients grimace or tic,Presence of initiating or trigger point,Lack of demonstrable sensory or motor decit.,Clinical manifestationWomen:m,Diagnosis and differential diagnosis,According to the location and nature of the pain,trigger point and without positive signs of nerve system examinations.,Symptomatic trigeminal neuralgia;,Dental neuralgia;,Diagnosis and differential dia,Treatment,Anticonvulsant drugs,Gabapentin,Pregabalin,Carbamazepine,Phenitoin,Valproic acid,Tricyclic Antidepressants,Vitamin B12 and Vitamin B1,Pimozide,Nerve blocking therapy,Stereotactically controlled thermocoagulation of the trigeminal roots,Vascular decompression,TreatmentAnticonvulsant drugs,Idiopathic facial paralysis,Idiopathic facial paralysis,idiopathic facial paralysis is also called facial neuritis or Bell palsy,which is peripheral facial paralysis due to the non special inflammation of facial nerve.,idiopathic facial paralysis is,Etiology and Pathology,The cause is still unclear.Maybe is related with virus infection,especially herpes zoster.Compression from the osseous facial canal after the edema formation also participates pathologic process.,The first pathological change of cranial nerve is the edema of nerve and demyelination,in serious condition axonal degeneration occurs.,Etiology and PathologyThe caus,Scheme of facial nerve,Scheme of facial nerve,Clinical manifestation,The disorder affects men and women more or less equally and occurs at all ages and all times of the year.,The onset is acute,Pain behind the ear may precede the paralysis by a day or two.,Symptoms according the lesion position,Stylomastoid foramenparalysis of muscles of facial expression,Junction of the chorda tympani bers to geniculate ganglia Impairment of taste.,Nerve to the stapedius muscle hyperacusis or distortion of sound in the ipsilateral ear(paralysis of the stapedius muscle),Above geniculate gangliareduction of lacrimation and salivation.,Clinical manifestationThe diso,Treatment,Prednisone:40-60mg/day,Medica
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