神經內科疾病臨床診治 2018年版

神經內科疾病臨床診治主編

龐

嘯

虎

包

華

李

艾

帆前

言,,,,,,》。,,,,,,,,,,201811

目錄CONTENTS 126102237414346576478 81C 90C(T)931(MRI)96SPECT

101 107 112120

135142143151241541561601621641651671701731761781822第一章

腦血管病的病因及危險因素第一節(jié)

腦血管病的病因,,,,(),,,,,1.,,,,,,

,,,,,,,2.,,,,,,,,,,,,,,,,,,,,B,,(inswanger),B,1,()-,(),()(),,,血液動力學因素,,,,第二節(jié)

腦血管病的危險因素,,,1.,,,(≥,90mmHg),10mmHg,49%,5mmHg,215μmolL15μmolL,≥16μmolL546%(),51.

,,,4,58%,(),,2.,,,,,55 853%5%,50%55 85,0591.%,08923.%5,,68%7,9.5,7

, P45.4(0.05)。 P420%

,40% 6820.%,

10% 6823.,,

2,,,L4.,,L(DL),5.,,,B12,B12(),

5//405926%,≥6035%405921%,≥6037%6.20%,31%15%,,57.,,,2Jdi di11di45Jdi di11di,2“rnk”(

“rnk”1114g),4,50ml(

,30g),640ml,200ml()5“rnk”,a8.aMil,20%,10,2.Bl

,(MI)BlWaker40752864323,231.9,/2.39 97

B9

B39 97

B9

B3BMI2728.

1.5,MI2931.1.0,MI322.718,BMI69.,,6,,45,5%14%3.%,10.,35,,411.

,,,,,,5第二章

腦血管病的解剖學基礎第一節(jié)

(2-1)。,,(),1.,1(),()1,,,,圖2-1腦解剖示意圖62(),23B()(roca)：3B,,,4(),,4,2.,12(),,12(),,3(),3,,,,,,3.,,,,1(),,,1,,23(),23(),,,4.,,,,,,5.,,,,,,(),,()1.,,,7,,,,,2.,,,,,,,,()(),,,,,,,1.,,,,,,,1()()：1HE,40%,,,,,,,10%,,,,(),(),850%,,,,2()()：,2,,(),,,,,,,,2.,,,3.,,,,,(),,,()。,,,,,(),,,,,,,,,,,,,,,,,,,,,,(),9,,,,,,,,,,,,,,,,,第二節(jié)

腦神經,12,,,1.2.3.4.,,5.6.7.,,,,,,,,,,,,24,10(),,,,,,,,,腦神經損傷的解剖學基礎(),,20,,

,,,,,,,,,,,,,,,1.1(),123(),23,CT

()()：,,CTMRI4(),,4C,,XT

C2.12(),,12,,(),,(),52.3cm,,5112,11.cm,,,2,,,,,(),,,,,,,,(),,,,,,,,,,,1,,610,,,,,1/3,30°,,,,(),,,,,,,,,(),,,,,3,,,,12(),,,,,,123,1.,,,,1(),,,123,,,2,,2(),,,,,,3(),3,,,,,2.,,,1,,,1(),,,,2(),,,,2,33(),33,,

,4(),23,,,4(),,,,3.,,,,13,,2/3,12(),12,,,,,,(),3(),3,2/3,,,2/3,2/3,,,4(),,,,4,,,,5(),,54,,,,,(),,,,,,,,(),,,,,,,2/3,,,,,,,,,,,,,141.1(),,1,,,2/3,,,2(),,,2,,,,,,,3()32.,,,,,12()3,12()34,3()34,,34(),45(),5,,,,,,,,,,,,,,,,,2/3()(),,151.,,,,,,2.(),,,,,,,,11,,,,,,,()2()()、2(),,,,,,,1/3,,,,,1/3,,,,,,,,,,1.,1/3,2.34,,,3.,,,,,,,,,,4.12,,16,,,,,,,,,,,1/3,(,),(),,,,,,,(),,,,,,,,,,,,,,,,,,,,,1.12(),,12,,,,,(),,,,,3(),,34(),,417,5(),52.12()12,,,,,,,,,,,,,,,,,(),,,,3.()1(),46,1,“”2(),,,23(),,3,4(),,,4,,,,(),,,,,,,,,,,,,18,,,1/3,1/3,,,,,,,1/31/3

,,,(),,,,,,,,,,,,眼的神經解剖學基礎以及臨床聯(lián)系()1.1()123()23()4(),42.12()()：12()()：3.,,610,,,,,,,,,,,,6,19,,,1,,,,,,()1.,1,,1,,,,,,(),(),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Gurm,,,,,2,,,,,,2(),2,,,,,,,,,,,,,,,-,20,,(),,,,,,,,,,,,,2,,,,3(),3,,,,,,,,,,,,,,1,(

2),,14,(),,4(),,,,,,,,135,()5(),,,,1/31/4li,,li,,,,,,,,,,,

Wils6(),6,,,,,21,,,,,,7(),,7,,,,,,,,,(),,,,,,,,(),,,,,,,,5,30°40°,5,(°10°)第三節(jié)

腦血管2%,20%,,1.,,2.,3.,4.,5.()(),,,226.7.8.()9.-,,,--,10.11.,-,,2/3,1/3-,-,,,(),,,,,,,,,,,, CC3CC332 CC3CC332(5)：,(4)：,(C

)：,C(2),(1)：C

C

C

1.,,,,,,,,,,,,,2-323圖2-2頸內動脈造影圖圖2-3大腦半球內側面、腦干和小腦動脈的分支與分布(2-4)：1(),12(),,,2,3(),,,3,,,,1/4,244(),,4,,2/3,,,,,圖2-4大腦半球外側面和小腦動脈的分支與分布,,,1/4,,,,,,()。()。,,,2.,,,,,,,,,60%,,40%58,,,25,,,,(2-5)。,,,,,,,,,,,,,1(),,,1,,

Broca()2(),,,2323/4(46)。,,33, 24(),33, 24,3/4(4,

1

,340)。,圖2-5大腦中動脈的皮質支與中央支424(),424,,3/4(1

07)。,26,,4,3,,3,54(),,54,,(0)6(),,67(),,72

2(122

282

249 2

24()82

249 2

24,(12412)。(),,,,,(412,1237)。1(0),13,,,,3(9),,,,3/4,,,,,,,,,,()()3.()-,61,,,,,,,,,1.1(),12(),,,2,1/3()273(),3,,,,4(),,4,,,2.,(2-6)。1()1/3,1,2(),,,,2,80%3()10,,34(),,4()、圖2-6腦底面的動脈分支5(),,,528,,,-,,,,,,,,,(2-7)：,,,,,23,,,,,,,,,,,,,,,1/3,()。,,,,,圖2-7大腦后動脈的分支與分布()lilili-Willilili,

WilsWils,,,2935048%,(27%)；14%,7%(2-8)。,,,,,圖2-8大腦動脈環(huán)左側發(fā)育不良(左側大腦后動脈發(fā)自頸內動脈代替部分后交通動脈)(),,,,,,,,(2-9)。1.1()34,,1,2()23,,2,3(),,3,,,(),15,30圖2-9大腦動脈環(huán)中央支的分群2.,,,,,,,,,3.,,,,,1cm,13,,1cm,14,,,,,,,

S,,(2-10,2-11)。4.16,34,,31圖2-10丘腦和低丘腦的動脈供應圖2-11基底核和丘腦的動脈供應,,,,,,,,,,,,32,(),,(2-12,2-13)。圖2-12大腦半球背外側面的靜脈圖2-13大腦半球內側面的靜脈1.()1015,79,,,,67,,,,,,,,33,,,,,,,,1cm,,,5,11.cm,,52.13,,,,,,,3.,,,(),(2-14),,圖2-14大腦大靜脈及其屬支341.,,,1(),,,12()2cm,2,,,,,,,3(),,3

,,2.,,,,,,(2-15)。圖2-15基底靜脈的形成與屬支351(),(1)2(),2,,3.,,,,腦各部的血液供應1.,(2-16)。,,3/42.,,(2-17)。3.,圖2-16大腦半球背外側面的動脈分布區(qū)36圖2-17大腦半球內側面的動脈分布區(qū)第四節(jié)

腦脊液140180ml,150ml,(3040ml

2530ml

5565ml

1015ml2030ml)。,7 7582420.81.6kPa(.513.mmHg),3.7 758242,,,,,600700ml,4580%85%,,,,,()。,,,,,,,(,,

TrypanBlue,(,),,37,,-,6nm,,,,,,,,,,,,,,,,,,,,,,,,(2-18)。41,1.7kPa41(1mmHg),,,,,,6μm(2-19)。,,,,,,,,,,,,38圖2-18腦脊液循環(huán)圖2-19蛛網膜粒與上矢狀竇的關系39腦脊液的化學成分和功能00/ /

4/5,,00/ /

4/5,,-,液中蛋白,200

L(65%),60%70%,2.4.mmolL(575mg100ml),,,,,,,,,,,,,,,,

Ca2+K+Mg2+,,40第三章

腦血液循環(huán)的病理生理學,,,,,68,,(1020)345,,30,68,48/3208822 2 /C///3208822 2 /C//241100L,1.8ml,1.0ml,1.5ml,1.3ml,0.7ml0.ml,0.00.3ml,2%3%,15%20%(),100g(MRO

)3mlmin,45ml2465L,25%,48gh,24115g2.mmolL,第一節(jié)

生理條件下腦血流量的調節(jié) /g0 /g565

/g10 /g0 /g565

/gmin)。,25,0.40.2ml(·min)。50,0.ml(·min)。20%,40%41 /g60.5ml(·min), /g6,,,,,腦血流量的調節(jié),,,-(),,,,,,i(,Baylss(MABP)i(70

Adams-Stokes)、60mmHg,60%,,30%,,(),,,,,,()31.-,[5kPa(7.5mmHg)]3,,,,,2.-,,,42//g770g

L,,0.9ml(·min//g7,,3.,1()1, P22()(aO

)： P22

,85%100%13%15%,35%,,,,,,,51P2 /g911%15%2.kPa(51P2 /g9,pH,(aCO

)：()5%7%0.3ml(·min)。,,,pHpH,,,3,pH,3,pHpH,

HCO

H+,,第二節(jié)

腦血管病變時腦血流量的調節(jié)(=-),,,43,40%(50mmHg),,,,,,,,,,,,,1.,30%40%,,,,2.,23,,,,223.,,22,PaCO

,

PaCO

,,,,,,,,()。,,,()。124.,,,5.,,,6.5%,,,,,,,44,,60%,,,,,,,,45第四章

神經系統(tǒng)損害的定位診斷,,,第一節(jié)

腦神經(),,,,,,,()(),,,,,,,,,()(4-1)：(4-1a)。()(4-1b)。,,(4-1c),,(4-1d),(4-1e)。,,,,,(4-1fh)。46,,,(4-1i)。圖4-1視通路損害的定位癥狀()、()、()(),,(4-1),表4-1眼球運動神經支配與功能47()1.,,,,,,,,,it

l(4-2)。Ednger-Wespha

(E-Wit

l(),圖4-2眼球運動的神經支配2.,,,,,,()3.,,,(),,,,,()1.1(),,1,,(4-3)。48圖4-3動眼神經麻痹圖4-4展神經麻痹2(),,23(),(4-4)。32.1()1,,,(

laeF

i-

Milrd-Gubl(

laeF

i,(ovlesyndrome)。2c(),2c,,,,(Wernike)3.(4-5)束綜合征,P,P(PRF),,P

,,,,,P

(PRF),,

,,ol(neandha)ol

可出現(xiàn)一,

,

,

49圖4-5核間性眼肌麻痹4.,,,1()1(),,,,,,,,,,(),,,,(4-6)。50圖4-6兩眼同向凝視的神經支配 P

i2()(ar P

i2 o

a o

aii,

(culrcrss),()、5.,,,,,,,,,,,,56.(,)5(,)1. 553.,2., 551 ( (1 ( (

)

(

)

,

6mm)

,

2(),2(

),()、((),(4-74-8)。,,51圖4-7眼交感神經通路圖4-8瞳孔光反射通路3(),3E-W,()、,,(),,4P

ia(tl4P

ia(tl,,(eri

),,,E-W,,-

Argyl-Robersonpupi),,,(

il,

Ad(

il()(),1,

,：(4-9)1(),,2(),,,3(),52,,,2,,,(2),(3),,,3,,,圖4-9三叉神經解剖(),,

,,

,

()()53,,,2/3,,,,,(),(),,2/3,,,()Bl(1.,Bl(,(el)

(4-10)：,2/3,2/3,,

Huntsyn-),圖4-10面神經損害的定位2.,,,,,54()()C

t1.,,(C

t),,,,,2.,,,,(4-11)。圖4-11前庭神經的纖維連路()1.1 i t

i 1 i t

i ((

)。

,

)、

)、

55 h

rn

e

tod

f2()

h

rn

e

tod

f2,,

,,

( ,

,

病變引起,,,

,,(

)、

)和動脈硬化所致的內

(

),v

t in

tii2.(erigo)、v

t in

tiiton),,,,-,,()、()()1.,,1/3,1/3,,,,,,2.,

,

,

,

,

(),,,,,,,()()56()()16,,,,,,,,,,,,,,,,第二節(jié)

感覺系統(tǒng)()()。()2

2

1,

()()感覺的神經傳導通路,(),,,,(,,),,,,,,,,,,57(),(4-12)。,,,(),()。()1/3,,(),(),,,,(),,()。,,(4-13)。,,127,,12723,,(3

),,(4-14)。(5

)圖4-12感覺通路58圖4-13脊髓傳導束的纖維排列(示意圖)圖4-14軀體各部位在大腦半球感覺代表區(qū)的分布()(),,,(),()(),(),,()。(),(4-13),4(),4()(),(t

i1.

hypereshesa)(t

i(2.

hyperpathi),(,,,,,59“”, t

ip3.(areshesa), t

ippi4.(an),pi,,(l

l

ir

i

i i),l

l

ir

i

i i(adatngpan)：,,,siiricli,siiricli

,,

(e-ferredpan)：,,,,(ausaga)：,, li ip li ip

C,,

C,(hantomlmbpan)：(ighte-ningpan)：,,,,,5.(),(),(),,(),(),()(),,1.,,,,(4-15)。60圖4-15末梢型感覺障礙2.,,,45,781(4-16)。(),3.,(4-17),,()4.1(),1

(),,(4-18a)。,,2(),2(4-18b)。61圖4-16神經干型感覺障礙bca.神經根、干、叢；.上干型感覺分布；bcb圖4-17第5～6頸髓神經根損害圖4-18脊髓型感覺障礙a.后角型；.前連合型b3()3,(),,62,,,,,()。,B,(rown-Sfequard)B(4-19)。,(4-20),圖4-19Brown-Sequard綜合征圖4-20脊髓橫貫性損傷5.,,,,,,,,(4-21)。,,6.,()(4-22),,7.1/3,,(4-22)；,,()。63圖4-21延髓外側綜合征圖4-22右側內囊或丘腦損傷8.,(4-14),,,,,,,第三節(jié)

運動系統(tǒng)-----()、()1.(),,,64,,,(),,,,5(14)、(51)、(14)、(54)(5),,,(4-23),()圖4-23肌肉節(jié)段型神經支配、周圍神經及神經根676 567Ⅰ、Ⅱ、Ⅲ三個節(jié)段發(fā)出5、、

三個神經根。5、

神經根組成3號神經支配肌肉2,、、

676 5679 1神經支配肌肉1。8、

為前角細胞群,0為脊髓9 12.,,,14(),,3145f

i

aifif

i

aifi,,(ascculton),,(ibrlaton)。2(),2,,,3(),36544(),,,())1.

(

)

,

criilrt rilrrcriilrt rilrrtcotbatac)。110,

B6127(4B6127

,(3

)(5

)z,

Bet

(120μm)4zz2

Bet

3%,,(z2)40%4,0%,(6)(4-24)。4-24大腦皮質功能代表區(qū)；a.外側面

b.內側面；J(4),J,4,,,(4-25)。,4(ackson),

4,66,,圖4-25軀體各部位在大腦皮質的運動代表區(qū)

圖4-26內囊與放射冠,()2/3()(4-26)。3/5,,,, l ip85%,(yramida l ip523,523,,,(4-27)。(),0%,0%,0%,,,5

,,,(), feγarlγ(-relxloop) feγarlγ,(nnu-lospiareceptor),,α,,,67(4-28)。(),,,,,()γ,,,,α,,,,α,,,γ,7,,,,,圖4-27錐體束的傳導通路圖4-28牽張反射弧與肌張力增高b.a.牽張反射弧；

7b.682.(),,cafds,“”(lsp-knie),cafds,(omi),,(),,,,,,,,,,,,,,,,,,,,,,,,,,4-2表4-2中樞性與周圍性癱瘓的鑒別 () () ,() ,(),,(

,,)3.,691(),,1,()。,,(4-29a)。,,,

2(),2(4-29b)。,,,“”(),,,,圖4-29椎體束損害定位模式圖解3la ei(),3la ei,,(4-29C)。,

,,

Milrd-Gublr,,

Fovle,,704(),4,,,,(4-29d)。,,,,,,,,B,,,(rown-SSquard)B(4-19)。1.,,,sll(ubthaamicnuceus,Luys)、sll,(4)(6)。cn

titipe

ti(orpussratum)cn

titipe

tilosratum)。,pli,,,,pli,,,,,,(al)。4-30圖4-30紋狀體結構的隸屬關系,,,1()(),

1,718(4)(6)8(4ss),5-((γ-

GABA),

P2()(),2ae

i

aif

ie

i

aiae

i

aif

ie

i

ai,--(),(4)(6)(4-31)。圖4-31紋狀體-蒼白球系統(tǒng)與錐體外系統(tǒng)的練習,,,,,,,,,,72lKinnerWison,l,,4s()8s,,(46),,,,()；()()；,,2.,,,,,,,1riliics

tcliii()1riliics

tcliii,,,(ead-piper-gdty)。,,(rgdty),-(pasi-tiy),,t2s

i

rpl3c2s

i

rpl3ci,,48,“(ilroling)”,()(horecmovement)：,,,4 ai()(thetoss)：4 ai,,“”,(l

mobiespasm)。(l)5t

id

tf()(ors)5t

id

tf,,,6hli()(emibalsmus)：6hli737 tc,,,7 tc()(i)：,,,dt

ifilia(a)dt

ifilia(ardvedyskinesa),(aca/oro-fac

ldyskinesa),,,i(le

Mege

GilsdelaTouretei(le

(4-3)。表4-3錐體系和錐體外系綜合征的臨床鑒別要點

() ()()；, (), ,,S,,S,,,,(7)-(Npr),1.(),,,,()、()(),,,,,74fa,,fa,,,(rlobe)。,V,V,“

”,,(4-32,4-33)。圖4-32小腦半球上面觀圖4-33小腦半球下面觀,,Pe(urkinj,)Pe,

,ci(i(lmbingfbres),ci(i

mossyfbres),,bsla ll,bsla ll,(asketcel)(teltecel),

,,,,(),(4-34)。75圖4-34小腦傳入纖維與傳出纖維Ca,Ca()()(lrke,),,,,,,,,(),,--,,(),,(),,--,,[F

l(ore)],,,F

l76--,,46F

l,F

l,,,3()(ore)a la l,,,,(rchierebelum),,pllpll,(alum),,nl(),nl(lum),,,,2.,,(),,,,,,,,,,,,,,,ve(on-Hippl-Lindau)ve1()1aainito(txainain)：aainito小腦病變時,,Rr

(g)；

Rr,

,,,,

,,,“”。d ra(ysmeti)：d ra,,t(remor)：t77,si

i(kewdevaton),si

i,,,

,2()(),,2,,,,,,,,,,3(),3,,,,--,4(),,4,第四節(jié)

反射,()、()()。,(),,(),,,,()、()、,,,,,4-478表4-4淺反射定位

7891 1112

12()12()

,

1

45,(1)(),1

,,,4-5表4-5深反射定位

3

56

叩擊鷹嘴上方

56

68

58

24/ 1279(),,,,,,,,,,,,,,B1.(abinskisgn),,B,,,,

,,

(4-6)。1表4-6錐體束受損后的足部病理反射 B

nCiO i

iGiSiG iRlB

nCiO i

iGiSiG iRl(haddocksgn)

(msgn)

(ordonsgn)(chafersgn)(ondasgn),,(ossoimosgn) (i2.

Hofmannsgn)(i,,,,,fe3.(Massrelx),fe,(,),,,()80,3,,,,,,,4.,(),,,,,(fe5.

Grasprelx),(feL6.(),L,第五節(jié)

腦功能定位,,,,()()、(),()。,,,,,,,(4-24)。()1/3,,2z1.I

2z,6,,30%4,8%6,

Bet

3%,,,,,,,,81B(rodmman8),B,,,,BB42.BB4(roca),(5)。()a,,a,

,

(-graphi)。3.,()；,()。4.(),1.,,,,,,(()；(),,代表區(qū)分,,aiati i2.能相關區(qū)aiati i40(nomicaphasa),,,(caphasn)。,,,,()、()、()(),(),,1.,8240,c,,,c,

,,,

Wernike,,,22.,2,422,,,,3.,,4.,,,,(),,,(,)；,,()l(t

imbicsysem)l(t,Papezs,,,,5-,,,,,,,,,,,,,()(4-35)。,,,,383,,,,,,(),“”圖4-35右側內囊的組成,,(4-36),()5,4cm,1.cm,305,(,,)、()()。()、()、(--)、()()。()84圖4-36腦干失狀切面(示間腦)(

ji,(

ji,()-

Deerne,),(,),,,(),,,(),4g,,,,0//1.-0//(1.06),290mmolL,8hL,2.“”,85“”,3.,,,,28℃4.,,,i(,Frohlchsyndrome,)。i,,5.-,,,,(),,,,()1.,,()()2.(

,,)3.

,,,,

,,,

,

()1.1le()(Wal),1le4-37),(,()；,()；()；(

)()；((86Dji)。(eerne)：Dji,ll圖4-37瓦倫貝格(Wa

nberg)綜合征ll la e2()-(Mi la e2)(4-38)：()、()()。()。()：(),(),87(),(),(l),()。(ocked-inl)：,,,lae圖4-38米亞爾-居布勒(Milrd-Gubllae3,P

i()(),3,P

i

,(4-39)。(ar),88,,,,aii

ataii

atvit(scendngretculraciatngsysem)。o,,o,,

Bit圖4-39韋伯綜合征89第五章

神經系統(tǒng)疾病的常用診療技術第一節(jié)

腦脊液檢查cllC(fuid,SF)cllCbii

B,bii

B,,,-(lood-branbarrer,BB)。,,,lt(ure)、lt,1.1()12(),23,3()2.12(),,12(),3456(),3456()()(),3.,,9028d,,,,,10ml46h,,4.1

,2

3

,34,,23,,,,,,,,,,2%12ml,,46cm(23cm),“”,,,,,46h,,,腦脊液常規(guī)檢查1.()()。,802O,2O,2O),,4,,20mmHg0mmHg460mmHg,,1002O,,,(),(),,,,,,2.1(),1,,,,,2(),,2,,,,/(10g

L),/91i,

Froni36(),300×10/L

36060663.(5)×10/L06066×10/L10×10/L,,,P4.andy()P,,Pandy,,, /

55/ /

4/1. /

55/ /

4/75mgdl),50%70%,2.5mmolL(5mgdl),,//72.120L,(00//7,,,1//4112

////1153.1//4112

////1150.5g

L(025mgdl),0.50.5g

L(15mgdl)。,-1.,,,,,(2.,,(

)1224h,,,,92 γααβ3.()：2% γααβ62%,1

4%8%,2

5%11%,

8%13%,

7%18%αβγαβγ

//14.,IgG0.10.4g

L//1 //01 6I Idl),gA0.010.06g

L(. //01 6I IS/ 77oi

l

lS,IgGS/ 77oi

l

lS,IgG/IgG)(/),≤0.,IgG0.

,24hIgGIgG(lgoconalgGband

OB),,,,,,,,,5.,,P6.(CR)P

(CT)C(T),,,,C,X,基本構成和成像原理XXCTX,

,,XXX,

,X,X,,,,CT

,X,X93μμXμ,T=[(～μ)μ]×a,μCT

X,,,,X,,,CT

C1.T

CT

,,CT,CTCC/aμ,aCT

(22(e

l2.

width)CT(22(e

l16,100Hu,CT

100/16=6.5,CT

6.5Hu,

windowlve)CT

,,CT

atf

t3.atf

t(),X(riacs),()、(),,p

ta4.(ari)p

ta×,,CTCT

CTCT

,CT

5.CT,,CTX,X()CT

1.,,,,,(OM),,,945 0CT5 00.1.cm,CT,,CT

,/II2.,/IIX,,60%70%60100ml,2mlkg,,(ohexol)(opro-),,()CT

X1.CT

,

Xvptcvptc,,CT(olumescan)。(ich)(olimaton)。X360°,,,X,,CT

,X1∶1,X,,,,,2.CT

1CC CiC89()T

T

(1CC CiC89,,CT,,CTA,,,CTA0.20.2CTAlCC,lCCCTA

WiisCT

,CT(Tvenogra-phy,TV)。,CTA,,2CC p

f

i()T

2CC p

f

i,,,CT

,,,95 CCit

lC3C()T

T

CCit

lC3C,,CT,,4Ctii3()T

CT(hreedona4Ctii33DCT

,360°,,,5(

t

e

at

toC()5(

t

e

at

toC,,,,,)

(MRI)磁共振成像基本技術及適用范圍()T2rli121.(MRI)T2rli12T

),10%,,,,

MRI,,,(eaxaton)。

T

T

1TZl

ii

l

li()11TZl

ii

l

litudnareaxaton),,Z63%11,T

,T

112TYt Yl i2()2

2TYt Yl i2(ransversereaxaton),,

37%,,T

2.表5-1自旋回波序列各加權像的參數(shù)( ( TR

ms) TE

( (T1 50025T2 200075200025 sS1()(,E sS1961TTT2(,1TTT2(T

(1WI)、2

(2WI)(5-1)。()

GRE),,(i rai12(3.(i rai12(

Gadolninumdethylne-ticacd,Gd-DTPA),,XCT

,

MR

MRI,T

MR,T

Gd-DTPA,,

Gd-DTPAGd-DTPA-,-,, /121

T1Gd-DTPA, /121

T1Gd-DTPAGd-DTPAT

2

,T

WI,Gd-DTPA,,()1.,,,,

MR,,,,CT,,,,,2.,,磁共振特殊成像技術()(i,i1.

cresonanceang

MRA(i,iMKA,97(il,

(ilfowimagng)。

MRI

MR()、()。1()1(),90°180°,,,90°,,,180°,

MR,,,,,,,,,2()2,,90°,,,,“”,180°,,,

MR2.1(32()

TOF)：1(32,,TOFTOFTOF(DTOF)(DTOF)。2 PTPfct()(C)：2 PTPfct(haseefc)。,3,,3

PC

MRAPC

MRA2DD C13()(EMRA)：, C13atiali

,3.MRAatiali

,,MRA90%95%,MRA,(rerlve-nousmaformatonAVM)MRAMRA,98prlli

at

PF,prlli

at

PFMRI,

MRA,

MRAMRAMRA,,MRA,(ercuta-neousintaumina

angoplsy,TA),MRA

MR,MRA()LAIRfF22221.(luid-atenuatedinversonrecovery,LAIRfF2222T

WICSF,CSF,,T

WI,FLAIRT

WITE,,T

WI,F22FF22.F22FF2FLAIK,,LAIRT

WI,,FLAIR,,T

WI,,,FLAIR,LAIRTSE

,FLAIRCSF,LAIR,FLAIRTSE

FLAIR,,,,1/3,CSF,

FLAIR,T

WI,,2/3,CSF()df

i i,1.(ifusonweghtedimagngdf

i i,,,df

iDai ifiiDWIdf

iDai ifii(pparentdfusoncoefcent,ADC)DWIADC,,ADC,,DWI,,,,(C P2.DWI(C PN-

NAA)、(MI)、(r)、(Cr),99()p

f

ii ,21.(erusp

f

ii ,2PWI,

MR,T

,,(r,,(rPWI

Rcbv)(CBF)(MTT)rCBF=rCBV/MTT2.()(i,t1.

cresonancespecroscopy(i,t,,1

32113(C(((Ly(2.1

32113(C(((Ly(1H1P1HMRS,

Cr)、(ho)、-

GABA)、

Glu)、

GLn)、(ac)N-

NAA),1H

MRSNAA,ChoCr(NAALac)()

MRIf

toi

foib ,1.MRI(uncinalMRf

toi

foib ,

MRIMRI,,,(xygenaton),

MRIfMRI(loodoxygenlveldBOLD)。22,,22,“”,“”,EPIT

WIT

WI

MR

BOLD

MRI2.,,,fMRI,100

SPECTC,C,,,,TMRI,79,,79,,,,,CTMRI,6%,6%,96%,()li-li———3/5-2/5,,

Wils()750850ml,,20%34,1500g,24h1100L2%3%,15%20%()；25%24h115g,,,“”“”,,()1.10501012.1()12(r(),

CBF)2(r(CBF),3.,,腦顯像與血流灌注斷層顯像()1.(-)()(-)。SPECT()

PET(),PET

SPECT2.CT,(),(),,,,CTMRI,,3.SPECT

,,1cm4.,,,()1.99mTc-ECD(),,,,SPECT

,102,,,,,04T1n22.99mTc-HMPAO

99mTc-ECD04T1n2,,94%,6h,,.min,10min3.,4.

c-ECD,555(525mCi),,

,

20mi

4hSPECT5.,

CO

常見神經疾病及其顯像特點r(CBF)rrCBFCVDCVD,(),ls(12d)、TIA,ls,,HelmanTikofkySPECT

CVDSPECTrCBFCVD,,,,90d()1.sr,sr,

,(toke)。

,,,,24h,S,,2.SPECT

,,CTS,,1cm,,PECT,

CTSPECT

,,

CTMRISPECT103SPECT,CTMRI,,CT

MRI,8,,,

31.

%

854%,,,()1.TIA,-riesifctRriesifctR,24h,24h(eversblichemicncdeii,IND)。1TIA,,1/3,/31,1/3TIA2.TIA(),,CT

MRI,()rCBF,,/,18.%,CBFrCBF,,,((

a Daa

Acetazolmide.ACZ),

((

a DaarCBF20%,,rCBF,DimoxrCBF,imox,()1.,50%2.CT

MRI,1224h,rCBF()1.,55,,0.%104S2.,,,SEEG,,SPECTrCBFEEG,,PECTPET,6%,SPECT

,,,rCBF,()1.1(Pcz

i()

Al1(Pcz

i)、2 ( i()

2 ( i3()3,,,2.1)(z

iC(

Alhemer

AD)：1)(z

iC50,,T

MRISPECT

AD,,(),,,2((

tti,3

Pc2((

tti,3

Pc

muli-infarcaMID)。,,,

MRI()ik,4560,,SPECT,AD

MID4()4PP(arkingscmdsease,D)：PP,5060,,,(i’

i

HuntngtonsD(i’

i105,2050,15rCBF

PD,5(),520%,2,,CTMKI,,,rCBF,6(),6,2040,,rCBFrCHF,rCBF7()CTMRI,SPECT7,rCBF,,rCBF,8rr()8rr,,CBF,CBF9()9rCBF,,rCBFCBF,rCBF,rCBF,

1.,,,2.1(),1106,

PET

PET,

PET

PET

11C3N5O8F,11C3N5OCNO,l8F

H,(1C20min3N10min,5O2min8F110min),7.

11C8F

2448h2448h2()2第五節(jié)

正電子發(fā)射斷層掃描成像p

irsi P(osp

irsi P,

PET

PET11 111,,y,PETl l11Ccc1.Ccc,,(MR-gl

rCMRgl)；/(/)2.C C3.,C C,(BFrCBF)(BVrCBV)。15O,,,C 22(4.15OC 22((MRO

rCMRO

)

OEFrOEF)。5.18F(),6.()、(),

PET

1D, (((AT),

DAT

5-

D, ((HTT)

NET)P,ET

P107i,,,8F-FDG

l8F-(8i,,,8F-FDG

l8F-(8F-FDG)

18F-(8F-FDOPA)

15-(H52O)

15-(5o2)

11-(1C-MET)

11-(1C-NMSP) D2

11-(1C-Cocane) ,

PET

,5-2表5-2常用PET腦造影藥 l11C15

-

(15O)C1111,18F-FDGPET

,90%,1F4F4,6-F4F4,DG-6-PO

6-,6-,,

PET

18F-FDGy大腦正常影像特征,4,18F-FDG,,1.1(),1108),),8F-FDGPET(EG)、TMRI8F-FDGPETEC,,,,CTMRI,,,l8F-FDG11C-METPET,,,2(),2,X

CT(l,l8F-FDG,20,,90%PET,2.,γ,1,,E,60%90%E,,PET,11C-METPET,PETEEG

MRI,(CoG)PET,

EEG

,EcoG,PET

,z

i(3.,z

i(Alhemer

AD)18F-FDGPET

ADAD,CT

MRI,18F-FDGPET

,(5-1)。109,(A)PET

PD,(A)PET

PD8FD-dopa,D,DA8F-FDOPAP

F-FPCIT

,D,Pz

iBA.晚期AD見雙側頂葉,聯(lián)葉,額葉葡萄糖代謝明顯減低；.早期AD僅見雙側頂葉代謝減低Bz

iPikli Pc,z

iPikli Pc,PET

Alhemer,AD,ADPET

c

Wison

Huntngton

(DD),,rCMRgl

,,PETP,,P,,,,,,,,,ADADAD,,4.(D),1lPc,Pc,ET

PDPD,PDCMRgl

l8l

PD,110F-FDGPET

F-FDGPET

,5.1r 2rrc22/12r1r 2rrc22/12r,,,,,,,,,PET(CBF)、(CMRO

)(CMRgl),rCBFrCMRO

,rCBFrCMRO

,FDG,rCBF12ml(00g·min),CMRO

/165μmol(00g·min),/12 P( (25 (()2 P( (25 (,,,

ACZ)PETCBF

OEF

TT),()H1O

AVM),6.PET

P,,PCT

MRI,ET

,

PET,,CTMRI,PET

,18PET

,

MRI,CT

MRI,,,,,18F-FDGPET,,PET,,,,,PETAIDS,,111,CT

MRI第六節(jié)

腦血管造影檢查,,,dlr

to,ie(igtadlr

to,ie

,,,,X16031.

X500mA,50kV,3/X1603,0.,.,,,(5-2)。 152., 156.F,04F,HSH,‘’,3.,,,,,,Conrav,,圖5-2GE雙C形臂數(shù)字減影血管造彩機器11212()12()3(),312()12()3(),3,,X,1.,1(),,1,,,,,25055()1.2.cm1%250554ml,,0.cm,,45°60°,,,,,,,,,20,,,,,,,,,,,,,,,,,1∶100020ml,,1015min,1h15min1,30min1,1,6h,,12h2.,,,,113(),,6s,,,,2h3.,,,,,4.,,,,,,1cm,20min,6h1.,,2.,正常腦血管造影表現(xiàn)圖5-3正常腦血管造影圖像B； ；A.主動脈弓上血管造影；.頸總動脈造影

C.頸內動脈造影側位像

B； ；1.1(),,1,,,,,,,,2311429()0%,2

23,,292cm3()1

,,,3,4(),2,4,,,,,5(),5,,,,,,,,,,,6(),,,6,,,,,,,,,,X,,,,“”,,,2.1(),,1

,,,U,,,U,,,,,,,

,,34cm,5cm,,,,,,(5-4)。115圖5-4正常椎動脈造影圖像BA.椎動脈造影側位像；.椎動脈造影正位像B2(),2,,,,,3.-,1(),,1,,23(),,,23,,(),,,4.1()1a()：,612,aTrolrd,,iL(Sylvan)：,iL()：,(abbe),2(),,2,,,,,116,,,,,,,,3l,,l,1cm,,

,,,,,“”,5,11.cm,5lGaen,,,l,,,3(),3,,,,,510,34,,5,6.,234()4,,,,,,,,,,,,,S,,,異常腦血管造影表現(xiàn)1.1 1D()931,ot

1 1D,,,,,2(,S

iel1()

AVM)：tenl2(,S

iel1117AVM,,,,,,3(),3,,,4()()：4,,,,5(),5,,2.,,1(),,1,,,,,,2(),2

,,,,3(),,,3,,,,,,4(),4,,,,,5(),,5,,,,,6()6,118,,,,,,,3.,,CTMRI,1(),1,,,,,,,,,,,,,2(),2,,,,,,,,,,,,,,,,3(),,3,13cm,,,,,,,4()4,,,,,,,3,,119第七節(jié)

超聲檢查,ce

l t,iece

l t,ieagng,CDFI)(ranscranilDopplrTCD)1l1201l12090CraVEN(990)

Saonen(991)CDFI,()。()(liC

TCD)2080(Wils(liCTCDT,T,T,CD顱腦多普勒超聲eTCD1943eCh.Dopplr,,(),(),(),(),doθdF=2F

VcosdoθdoθC oθdoF

()doF

v120

PI=(VP

PI=(VP)-(DV)

RI=(VP)-(DV)Cθcos

θcccc,os0°1,os90°0,TCD,,()T1.CDT1d()(epth)：1d,2dr

tolT()(iec2dr

tolT,,,,,,3,(vlillip ,el3,(vlillip ,eliitili

E (veoctyVM)、(ndofdasolcveocty,DV)。VPEDVVMVPEDV,

Vm=

VP-EDV/3)+EDVVMVPEDV,4p

siiPritR()(4p

siiPritRE(

VM)(E(

VP)(P1 B71 9 1P6 58,IP1 B71 9 1P6 58(985)A

MCAPI0.1±0.00.4±0.4B.A,PI,PIPIPI,,,IPI0.51.0RI0.50.5PIRI,P,,,P,,IRIT2.CDT121,,

TCD TT3.CD,CD TT1 ceitClit-()1 ceitClit- iEli tIy,CA)、 iEli tI c -i

iCla2 pi to s c -i

iCla2 pi to s l togton4)、(enuporin3)、(upracinodporinC2),o ,l

c

t(phthao ,l

c

t (l

t3 p

tirta (l

t3 p

tirta i rt(nterorcerebrala

ery,ACA)、(oserorcerebrala

ery,C ( PPCA)、(AJ

C ( P v

t l

t ,p

ti4()- v

t l

t ,p

ti4 b

ia tPlat Binferorcerebelrarery b

ia tPlat B d ,l5()(eepmiddlecerebra d ,l5BS(VR)、(BS()1.TCD,1PIBB()1PIBB

MCA

ACACACA,A(PCA)、DMCVVR2(),2OA3 BP,()VAAICA3 BP,VA

TCDVAVA,VA,VA4()CCAICAECA4,()ICA2.1(),1

S1,,,,,S2,,,1221,D,10.0±0.2(,1996)。2()2,,,1,,1,,,0.2s,,

PIRI,,P,,,P,IRI,,,,,TCD,,,,,,,,,,,,,,,,,3.i,,i,,,“”(MuscMurmurs)。,,123T4.CDTCD,T,1P()1P,OA,VAICABA2,()

TCD2,3,(),3,,,ACA,,,

ACA,

MCA,4,1()-4,170%,30%,

20%30%-MCAACAPCA≧

BAVA≧

PICA

MCA≧ICA

51()ICA51ACA

MCA

MCA,ICA1

ACA,

MCA1ACA,ICA

16CP,()CACCA6CP,CCA,MCA,CA

ACA,CCA,7(),PCA7,

PCA,

PCA()1.T,,T,CD1()TCD,,1,,,,,,124,,2(),2,,,,,,,T(9s(B

ssST(9s(B

ssS,

Vm)0/,30%()。

MCAA

VAICA),50%69%,70%,

Vm

120/,Vm/,/,,,,P,l2T29 ,2P5s ,sP,l2T29 ,2P5s ,sP , sP7P,(002)TCD,50%

DSA136TIA,CD40(9),6(

),TCD93.%,91.%,PV77.%

NPV97.%

MCA,

MCA

50%MCA

MFV/,100%,96.%,PV84%

MCA

MFV/,100%,97.%,PV88.%

NPV94.%MCA

MFV≧/,68.%,100%,PV100%

NPV94.%ICA,,2∶1,,,,,,a 2PP,a 2PP

MCA,

TCD.MCA

MCA45,80MCA,

MCA,b.ACACAACACA,(0%125(30%)。c.MCA(M2)

MCA

ACA/MCA),(,i 2a2sc11 P1

MCA

,

MCA

i 2a2sc11 P1MCAScotBurgn(000)TCD

MCA,MCA,.MCA

MCA()；b.MCA,(0.s),Vm/,,,Vm()30%,.(IM),(

MCA

TCDACA,ACA1

ACoA,出現(xiàn)一側ACA

,ACA

MCACA,ACA

-ACA,,ACA

MCA30%,,ACA,ACA,ACATCD11ICA

ACAMCA11ICA

ICAACA/MCAACA

MCA(),

MCA

ACAPCA

MCA

ACA

MCA

ACA()。3(),370%

,,70%TCDI1,I1,

MCA

ACACA

,PCAACAI1I 1,

MCAI1I 1

MCA

ACACA

,PCA內部出現(xiàn)()。數(shù)的變化PI患側動脈的PI,abc3.ACA()；.ACAabc3.

MCAACA,CCA,

MCAACA,

126a 1 bc.

PCA(

MCA

ACAa 1 bc

PCA

PI

MCA

ACA,

PCA.CCA,PCA,abcP(,abcP(,,.,,.,.,I2.-

VBI)VBI

TCD1()1,VA,VATCD,VABA,,VA,VBI,(),TCDVBI,

BA,2()2B

VA

BA,,,BVAA,VAVA,VABVABA,VAAB3,,3()VBI,VAVA,VAVA

BA,,VA,VA(),

VA()。a,VAa,.(50%),TCD,VA,,,b.50%,VATCD“”,(),()127c.,VA

,,VAVA,,()。BAVAVA,BA,VBI

BA,,,3.AVM,,,1()

AVM,134,,,342

,,,2∶1(22.∶1)。2P/P()AVM

,2P/P,,I(I=VP-VdVm)。PI6,60.51.0AVM

PI6,63()TCD34,(),,“”4,()AVM,,,,,

AVM“”5,1,()AVM,5,1,,ACoAAVM

ACA

AVM,,,,,6(),,6AVM,,TCD,CCA

MCA,AVMCCA20%30%,AVM

CCA,AVM7)(

AVM-7),,128,AVM,,,,TCD()、(),AVM

siS4.(,AH)siSSAHTCD1,()TCDSAH,1,

TCD,,,,,12,,,2

l1P()

Aasid1984986先后發(fā)表TCD2

l1P

MCA

MCAICA,,ACACA(,),

MCA,,ICA,

MCAICA,,,

MCA,,3ST()AHCD3ST,SAH412dSAH1993199546,,7,3/,,0%

SAH48d7,3/,,

12,4,

1d

(

PIMCAICA),20%30%

MCA∶ICA3∶1,,C5.CICP,(CP),,,ICP,,ICP,129li

l11982AasidTCDli

l1CCPKlngehSer(991)TCD,IP1 I,P113,IP1 I,P1,CPRI1992Chan

PICCP,

PIRICPPCCP70mmHg,I(993)PIICP相關關系,ICP

H(997),CP

CBF(),I0C0CPI3.

,BF20%,

PI4.

0C0C I1IT12()TCD I1IT12ICP,,,ICP,ICP,MCDICP“”S

S

,,,2,TD8F()TCDICP,2,TD8F,

TCD形態(tài)可分為45ICP平均動脈血,CD縮期出現(xiàn)的脈ICP平均動脈血壓,,,(FI=1-R/F)0.R,

,ll1l6.1991AasidNewel,ll1l

1994Joanna995Va,13TCDTCD1996TCD,1998,160,1( sB919c9.()1( sB919c9.DMCV58(.±2.)m/(VR)：BVR419(

2± s S s7c2.)m/(S)： s S s7c2,B()TCD,2,B,DMCVBVR,DMCVBVR

DMCVVRTCD,,T7.CDTCD,T,,,1301 15,

MCA1 15(2h)Spenccr(997)500CEATCD,min12微栓子的16%,5min以上發(fā)現(xiàn)19%200.43/min,4230.29/min,1()TCD,TCD1,,,,300ms3db,,,,“”、“”“”。2),(

TCD

2),,,,t

2Csst

2CssDrose(002)TCD33,58d,/s,325/h,T

MRI

,/

/,≧/s,頸動脈超聲檢查IE()(IE)、CCACACAVASA05,68001.CCAIMT05,68001.1.cm-

,CCA,0.0.cm,,1.cm1.cm,3.,CCA,CCA1.000 542.ICA4.6.000 541.1.cmICAIMT,ICA0.56 00.5cmIMT1.6 03.ECACCA,131E E,ICA,CA,CAE E334.,330.0.5cm43%,,,(),,,,,,ICA,ICA5.,-,,,,,(),,,,123f1Irzo51.,123f1Irzo5IMTBond(989)IMT1.,IMT1.,Toshiumi(997),MT1.

Patii

,1.IMT1.,IMT,,1(),,12()IMT

,-,25,IMT1.,552.51.,,,,IMT

t1t1,Sizer(995),TCD,,,,,1321()1,,,,,,“”,2()2,,,,,,,3.,,1I()CCACAECACCAICA1I50%,70%,50%,,(50%69%),,,,5(70%99%),1.,,5E,,E,ECA,CCA,CCA,ICACA

,,,,2(),,2,,II,IICCA,CAECA,ECAICA,CCACAECAa0,a0.,1.cm,133bcde.,,bcde.,.,.,(),4.,,1(),-,12(),2,,3(),3“”,5.1(),161.cm62()-,23(),,3,6.,“”,,-,,,,7.,,,,,,,,,,,,8.,1341()1()。,,2()2,,,,,CCA,3(),3,第八節(jié)

神經心理學檢查,,,,,,,,,,76,,76,0.5%4.9%,,,,,,1.,,,2.,3.,4.,135,5.,,,,6.,rlalt,(eirlalt,,

,vl(aidty),vl,,,,,,,,,,,,,,,,,,,,,1.,2.,,,,,,,136ltlilllltlilllintelgencescae,WAIS)、(ermemoryscae,WMS),,,,,,,,,,,,,,()100%,,,,,,,,,AD(MID),Hachinski,,,,,,,常用量表及其檢查方法s (,s (,,,(MMSE)、Mati

DRS)、(CADAS)(ERAD)(C1.1()(MMSE)：MMSE1,30,137899 0510min0.00.9,0.5899 080%90%,70%80%,,,,,,,,MMSE,,2IeI()--(MCT)：MCT19682IeI,,,,IMCT

,,,,36,1994,3EsE,,3EsE()(SD)：SD

Hersch1979

Mati

1 2 29674,1 2 296748,,823,250,154920817ESD0.,0.90.8,ESDESD,85.%,,4(1()

HDS)：HDS1974,4(1,

MMSE,3,3,30,,,,HDS,,,,,

MMSE

HDS5()(WAIS)(WMS)：(WAIS)5198211,,,1381,1(WMS).,7,987673,,,WMS6CCC()(

AMCOG),(6CCCRoth1986,,8,(AMCOG)CAMCOG

MMSE,CAMCOG,,,AD,CAMCOG

MMSE

,,7S()7S,997min42s,“”。,9996%,0.1,0.2

,,8C()(ASI)：,8C9,20,1520minCASI100,

MMSE

HDS,,8988,

Kappa0.6,89880.7,0.9CASI,

MMSEHDSCASI,,2.1 (()

ADL)：ADL1 (ADL,,,,,ADL

ADL139( I

ADL)(ADL)ADL( I,,ADLIADL012012(

)、(

)(

)2 FF()(AQ)：AQ2 FF,,FAQ,,,,,,,,ADL,02,303.1 CiC()(DR)：DR1982

1 CiC,,,CDR-,,,,05123,,05123,,,0.

,CDR,CDR,2(,,GG()

GDS)：2(,,GG,,1,7GDSMMSE,GDS4

MMSE1623DS,

MMSE,DS3)si(

Mati

(MatsDRS)：3)si537,1530min,144,,,15min,5,,,“”,,-

MCI4.1(()

NPI)：,,1(,NPI10,,1402BB,2BB,AD4(X)144(4×3×12)。,4()(AHAVE-AD)：AHAVE-ADAD,,,,20min1)(55.1)(5,,

ADVD,(

Hachinski

HIS)：HIS

Hachinski1975,AD,≧7,6,≦4ADRosen,70%,2II5512()(2II55121986,AD,AD,,IDCF-DAT10,

,

,0

AD,AD14,100%AD94%AD,,AD,141第六章

腦電圖檢查第一節(jié)

腦電圖E(EG)E,,,,(,)、,1875,Caton1924HansBerger,19361947“”,1(,

,1(

,958,

TEEOVR)()、()8128(),()102010%20%,,142()(),第二節(jié)

腦電圖的分析()(

6-1),,

ms( 圖6-1腦電波周期波()C,/(/S)(6-2)。C圖6-2()()(6-3)。圖6-32725μV()27575μV5100μV100μV()143(),(6-4)。圖6-4()β,αβ()(),Alpha,,(),(),,()(6-5)圖6-5腦電圖各成分示意圖1442.6.

2.6.

α1.

α/

1813cs,0100μVα,/

1()。β/

5β1430cs,20μVβ,,50μV/

5βα,

β,βθ3.θ/47cs,10200μV,θ/,,θ10%δ4.

δ5 /0.3cs,10200μV5 /γ5.

γ/3345cs,25μV,,/μ/,711cs,50μV,μ,/,λ7.

λ/35cs,1040μVλ/κ8.

κ/610cs,/9.1

/80200ms,100μV,2cs1

/,10.80ms,2060ms100150μV,/,,1/3614cs/,,11.12./,23cs,/14513.,αβ14.,300μV,δ15.

δ/(,κδ14cs,

/(,κ16.-1/κ-1/(216cs)

,17.,30%,()。18.,,()()1 3(

3)、(

1 3)、(10)、(,,,)、()、,,,,()(),25μV27575μV275100μV146100μV(),,(,,,)。兒童正常腦電圖/3/δ3/4//3/δ3/4/α2,,(5cs),,35,

,5cs,()。611,7cs,θ()。/1,58cs,/,δ //35,

,,θ,810csδ //,46csθ,δ3(6-6)。3圖6-6正常兒,男,

歲,清醒。正常范圍腦電圖3 8 /θ68,,12csα(),α 8 /θβ,6βα//δ910,

,αα//δ

78cs,θ,

1210α,150μV1117,,,θδ兒童異常腦電圖1(),1147()

()

2()23()344/ //()

6cs,64cs,44/ //9 / /,

8cs,1049 / /5()5成人正常腦電圖α()

α5/αα,,,1.cs,5/θβ,()(79%,6-7)。θβββ,2030μV,50μVββ(4%)。()βα,20μV,,θβα(7%)。4圖6-7女,2歲,覺醒。正常α型腦電圖4()α,α,β(10%)。成人異常腦電圖()1αα()

,α,,

1αα148/■1cs/5/

22.c5/5/■0.c5/α150μV,50%2 β()β,50μ2 β3θ4()(1015%),3θ4(),--5()α5()1θ(),θ1θ23(),23(),-,-45(),1045()δ1δ()1δ()

2()23(),34()(10μV)。4,,,,,,,()α,θ,,,(),,δ()3/δ(cs),,κ-3/1/(216c1/()δ,300600μV,/47csθ,/149()(),α,βα,,

,αα,,,(()

HV)(2 2CO

,CO

,pH2 2,,,,,,()30%,80%,2/3,,()--,,-,,,(),,,,--,,,-,90%-,-()22,O

-150第三節(jié)

腦電圖的臨床應用(),,δθ(6-8)。//；/；B； F/A.發(fā)作前：為11cs廣泛性α波；.先兆期：為5cs之θ節(jié)律

C.完全強直//；/；B； F/完全強直期：棘節(jié)律頻率較前減慢

E.陣攣期：陣發(fā)性節(jié)律性慢波和多棘波；.恢復期：開始為平坦坡,后為中等波幅慢波并14cs之睡眠紡錘波。2圖6-8某女,8歲,癲癇大發(fā)作(發(fā)作期)腦電圖2()/ /3cs-,2c/ /-(),,

,,()//6cs14cs,,//151()/ /46cs3csS,/ /(),(,)。5090%,,,,θδθ,,,,,,,,,,,,,(6-9)。1圖6-9某男,6歲,病毒性腦膜炎繼發(fā)癲癇1/覺醒以5～6cs節(jié)律為基本節(jié)律,伴有陣發(fā)性高波幅(最高350μV)// /δ2～3cs及4～6cs

和θ節(jié)律、棘波和尖波發(fā)放,偶見棘-慢波/ /δα,,,α,

,,152,,,θααθθδ,

ααθδθ,

(δ),,ααα,,,αα

,α,,,20%60%,30%,,α()

αα,α,α(),(),2/6cs/()20%25%()64%-1531.α,θδα,2.αα,θ3.α,θ(腦功能輕度障礙)

24(2424

AEEG)。(,24,,,1

2248,6,41

224

,,動態(tài)腦電圖的適應證,,,

,,異常動態(tài)腦電圖表現(xiàn)1()12()2154345(),345(),-()6()67()7動態(tài)腦電圖的優(yōu)勢與不足()1()12(()X

CT)、(MRI2(345()345()()6(),,6()1234()1234(),()()動態(tài)腦電圖檢查的臨床意義1.,,2.,1%5%3.,,4.,25,20,11,5,1555.5,,5,0%10,,,,10,,,906.,12,,,,,,1030,,,34,7.,,,,2,34,,--C,,C,,,T

MRI,,,,,,,CTMRI,第五節(jié)

視頻腦電圖1936,,,,156a215,a215Video-EEG)20,,,Kolr66-,3,7,3,,,,,,,,,(,,,視頻腦電圖分析,,()()-,,-,,,,,,,,,視頻腦電圖對癲癇診斷和(),,3030%,,,50%,95%

OldAni23,52.%87%(6-10)。157圖6-10視頻腦電圖6某女,

歲,臨床診斷：原發(fā)性癲癇6注：視頻腦電圖檢查見臨床發(fā)作伴尖波發(fā)放()5%20%,“”。,(),,,,,,,,,,1.,,,Hamer76

296,,24%,20%,17%,20%,5119,37%45106,218,32,3,3,52.,,,,-3.,1584.,(),,,()(),,,,,10,,159第七章

神經系統(tǒng)疾病癥狀學,,第一節(jié)

意識障礙c i(onsc),c i

,,,,

(),(7-1)?！鍪人鍪人?)

ss昏睡狀態(tài)(opor)s意識水平下降的意識障礙■

■淺昏迷伴意識內容改變的意識障礙

意識模糊(伴意識內容改變的意識障礙

意識模糊(onfuson){■c)■ ■深昏迷意識障礙■c idlru t tctdlru t tctd去皮層綜合征(ecoriaed)aki

i i特殊類型的意識障礙■無動性緘默癥aki

i i■

l■(醒狀昏迷comavigi)l圖7-1意識障礙分類160,,1.,,,,,,,2.,,,3.,,12()()