神经内科学-格林巴利综合征.ppt

,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,*,急性感染性多发性神经炎,acute infectious,polyneuritis,AIDP:Acute inflammatory,demyelinating polynerropathies,GBS,Guillain,-,barre,syndrome,它是多发性神经病中的一种特殊类型，除广泛侵犯的神经干及末稍外，还累及神经根，颅神经。,病因,病因未明,疑为与病毒感染有关,自身免疫性疾病,临床表现：,运动障碍,A,肢体瘫痪：四肢对称性下运动神经元性瘫痪,B,躯干肌瘫痪：颈肌，肋间肌，膈肌也可出现瘫痪,C,颅神经麻痹：舌咽，迷走和面神经周围性瘫痪多见，其次为动眼，滑车，外展神经。,临床表现：,感觉障碍：以主观感觉障碍为主，肌肉可有明显压痛，仅部分病人可有手套、袜套式感觉障碍。,植物神经功能障碍：多汗，汗臭，初期可有短期尿储留，大便常秘结。,Diagnostic criteria for G-B syndrome,Required for diagnosis,(1)Progressive weakness of more than one limb,(2)Loss of the deep tendon reflexes(,areflexes,)or,hyporeflexes,Supportive of diagnosis-I,(1)Progression for up to 2-4 weeks,(2)Relatively symmetric deficits,(3)Mild sensory involvement,(4)Cranial nerve(especially,VII,)involvement,(5)Recovery beginning within 4 weeks after progression stops,Supportive of diagnosis-II,(,6),Autonomic,dyfunction,cadic,tachycardia,(7)No fever at onset,(8)Increased CSF protein after 1 week,(9)CSF white blood cell count less than 10/mm,2,(10)Nerve conduction slowing or block by several weeks,Against diagnosis,(1)Markedly asymmetric weakness,(2)Bowel or bladder dysfunction(at onset or persistent),(3)CSF(,cerebrospinal fluid),white blood cell count 50,(4)Well-demarcated sensory level,Excluding diagnosis,(,1),Isolated sensory involvement,(2)Another,polyneuropathy,that explains clinical picture,诊断要点,一 急性或亚急性起病，病前常有感染史,。,二 四肢对称性下运动神经元性瘫痪。,三 感觉障碍轻微或缺如。,四 部分患者有呼吸肌麻癖。,五 多数脑脊液有蛋白-细胞分离现象。,鉴别诊断,一 脊髓灰质炎,二 急性脊髓炎,三 周期性麻痹,治疗,一 急性期,脱水及改善微循环,大剂量丙种球蛋白治疗,激素治疗,神经营养药治疗,加强呼吸功能的维护和肺部并发症的防治,治疗,二 恢复期,真性球麻痹和假性球麻痹,