周?chē)窠?jīng)病進(jìn)展2課件

周?chē)窠?jīng)病研究新熱點(diǎn)第二軍醫(yī)大學(xué)上海長(zhǎng)海醫(yī)院第二軍醫(yī)大學(xué)周?chē)窠?jīng)病診治中心管陽(yáng)太提要小纖維神經(jīng)病診斷進(jìn)展周?chē)窠?jīng)活檢技術(shù)進(jìn)展痛性周?chē)窠?jīng)病診治規(guī)范化周?chē)窠?jīng)病專(zhuān)病中心建設(shè)小纖維神經(jīng)病診斷進(jìn)展周?chē)窠?jīng)活檢技術(shù)進(jìn)展痛性周?chē)窠?jīng)病診治規(guī)范化周?chē)窠?jīng)病專(zhuān)病中心建設(shè)1UpdateonSFNCCM原理0μm10μm30μm40μm60μm100μm300μm550μm1UpdateonSFN上皮層基質(zhì)層神經(jīng)纖維內(nèi)皮層丁卡因麻醉鏡片消毒Viscotears眼膠覆蓋調(diào)節(jié)及觀察軟件處理1UpdateonSFN反應(yīng)DM患者周?chē)窠?jīng)損害程度1,2,DM患者纖維長(zhǎng)度（NFL）及密度（NFD）降低3T1DM患者也有類(lèi)似改變4酶替代治療的Fabry患者及雜合子神經(jīng)纖維密度顯著降低51KallinikosP.InvestOphthalmolVisSci20042MalikRA.Diabetologia20033ElisabethM.GraefesArchClinExpOphthalmol20104HertzP.DiabeticMedicine20115TavakoliM.Muscle&Nerve2009小纖維神經(jīng)病診斷進(jìn)展周?chē)窠?jīng)活檢技術(shù)進(jìn)展痛性周?chē)窠?jīng)病診治規(guī)范化周?chē)窠?jīng)病專(zhuān)病中心建設(shè)2UpdateonNervebiopsy傳統(tǒng)神經(jīng)活檢的缺陷感染疼痛麻木感覺(jué)缺失2UpdateonNervebiopsy2UpdateonNervebiopsy對(duì)照DMDMDM（sural）小纖維神經(jīng)病診斷進(jìn)展周?chē)窠?jīng)活檢技術(shù)進(jìn)展痛性周?chē)窠?jīng)病診治規(guī)范化周?chē)窠?jīng)病專(zhuān)病中心建設(shè)3UpdateonPainfulperipheralneuropathyToxicAlcoholMetals:

Thallium;

ArsenicMedications:cis-platinum;

Disulfiram;

Ifosfamide;

Nitrofurantoin;

Perhexiline;

Taxol;

Thalidomide;

VincaalkaloidsMushroom:

ClitocybeacromelalgaImmuneAcuteonsetGuillainBarréDiffusepainduringacutecourseDistalpainwithincompleterecoveryImmobilityAcute

panautonomicIgMantibodyassociatedpolyneuropathiesTS-HDSSulfatideIgGantibodyassociatedpolyneuropathiesPotassiumchannel-complexantibodies:CASPR2&OtherM-proteinGanglionopathiesSj?gren'sParaneoplastic(Hu)CryoglobulinemiaConnectivetissuediseaseHIV(DILS)VasculitisHereditaryα-galactosidase(Fabry's)GM2gangliosidosis:Late-onsetSensoryNeuropathyI:LancinatingpainsMotor-SensoryNeuropathyI&II:FootdeformitySCN9ABurningfeetsyndromeSmallfiberneuropathyErythromelalgiaAmyloidosisPolyneuropathy:Pain&ParaesthesiasinlegsCarpaltunnelsyndrome:PaininhandsPorphyriaEpisodicpainsyndromes,Familial

(FEPS)Restlesslegssyndromes:SomewithPNSinvolvementHereditary(Acromelalgia)

:12qHSN1HMSN5CMT2Huntingtondisease-like1

Also:

RenalfailureMetabolicDiabeticAcute:LumbarorThoracicradiculopathy;DistalsensoryChronic:"Smallfiber"neuropathyAlcoholic:AcutePellagra(niacin)Beriberi(thiamine)Strachansyndrome(Cubanneuropathy)PostgastroplastyHypertriglyceridemiaChronicmountainsicknessIdiopathicDistalsensorypolyneuropathysyndromesErythromelalgiaMononeuritismultiplexMotordisorderswithpainDiabeticamyotrophyPolioInfectionsPolioHIVLocalizeddisordersNervelesions:TrigeminalBrachialplexusLumbosacralplexopathyThoracicoutletsyndromeMedianPosteriortibial

(Tarsaltunnelsyndrome)Radiculopathies:

Upper

&

Lower

ExtremitiesBurningmouthsyndromeDiabeticAmyotrophyReflexSympatheticDystrophy

(Complexregionalpainsyndrome)Infections:

HerpeszosterNeoplasticinfiltration:BurningpainwithdysesthesiainareaofsensorylossPostsurgicallocalizedpainsyndromesAcuteonsetofpain&paresthesiasAcuteporphyriaToxic:

Thallium;

Arsenic;

Perhexiline;

VincaalkaloidsGuillain-BarréAcutesensoryneuropathies

Spinal:

Myelopathy;RadiculopathyPAINFULNEUROPATHIES:DifferentialDiagnosis3UpdateonPainfulperipheralneuropathy中華神經(jīng)科雜志，20123UpdateonPainfulperipheralneuropathy評(píng)分VAS現(xiàn)時(shí)疼痛強(qiáng)度評(píng)分SF-MPQ臨床表現(xiàn)評(píng)定量表神經(jīng)經(jīng)病理性疼痛自評(píng)量表Leeds神經(jīng)病理性痛癥狀和體征評(píng)價(jià)表DN4輔助檢查電生理NCVEMGSSRQST自主神經(jīng)功能活檢影像血液、CSF3UpdateonPainfulperipheralneuropathy診斷流程治療用藥PAIN20133UpdateonPainfulperipheralneuropathy其它指南.uk/CG173ClinProc.2010小纖維神經(jīng)病診斷進(jìn)展周?chē)窠?jīng)活檢技術(shù)進(jìn)展痛性周?chē)窠?jīng)病診治規(guī)范化周?chē)窠?jīng)病專(zhuān)病中心建設(shè)4周?chē)窠?jīng)病專(zhuān)病中心周?chē)窠?jīng)病臨床神經(jīng)電生理神經(jīng)病理神