教学查房最终版.ppt

紧跟医院建设步伐 再创科室事业辉煌Beijing Chaoyang Hospital病例分析 case analysis病史特点：病史特点：（1）中年男性，病前病中无发热 Middle-aged man,no fever（2）急性、动态起 It was an acute case。（3）前庭性眩晕，失平衡伴轻微的植物神经症状vestibulo vertigo，loss of equilibrium，with autonomic nerve Beijing Chaoyang Hospital病例分析case analysis病史特点：病史特点：（4）不伴耳蜗症状（耳鸣、耳聋）without symptom of cochlea(no tinnitus or deafness )（5）不伴复视、黑矇、视野缺损 Without diplopia、amaurosis、defect of visual field（6）虽有头痛（三天后），但颅内高压症状不明显Eventhough he had headache after 3 days,symtomps of acute intracranial hypertension is not obvious.Beijing Chaoyang Hospital病例分析 case analysis病史特点：病史特点：（7）有血管病的危险因素（高血压、血脂异常、腹型肥胖、不良生活习惯）Risk of vessel disease（hypertension、hyperlipemia、abdominal fat、bad living habit )（8）既往无类似病史，无耳疾史 No siminal medical history,no disease history of earBeijing Chaoyang Hospital病例分析 case analysis体征体征 physical sign：（1）左视有轻微水平眼震 slight level nystagmus when he looks left（2）左手轮替运动轻微笨拙 Alternating movements of his left hand is slight unskilled.Beijing Chaoyang Hospital病例分析 case analysis影像影像 images：头CT示左小脑半球大面积低密度灶 Head CT showed large low density area in his left cerebellar hemisphere.Beijing Chaoyang Hospital病例分析 case analysis定位诊断定位诊断 topical diagnosis （1）根据症状性前庭性眩晕、失平衡定位于前庭小脑系统（损害）vestibulo vertigo，loss of equilibrium located at vestibulo cerebellum(injury）Beijing Chaoyang Hospital病例分析 case analysis定位诊断定位诊断 topical diagnosis（2)根据左手轮替运动轻微笨拙、头CT左小脑半球低密度灶，定位于左小脑半球受损slight unskilledly alternating movements of his left hand and large lower density area in his left cerebellar hemisphere showing by his head CT scan located at his left cerebellar hemisphere.Beijing Chaoyang Hospital病例分析 case analysis定性诊断定性诊断 etiologic diagnosis：（1）根据中年男性，病前病中无发热;急 性、动态起病；有血管病的危险因素 -定性为急性脑血管病（脑卒中）Beijing Chaoyang Hospital病例分析 case analysis定性诊断定性诊断 etiologic diagnosis：（2）根据颅内高压症状不明显；头CT示左 小脑半球大面积低密度 -定性为后循环缺血(posterior circulation ischemia -小脑梗塞（动脉粥样硬化性atherosclerotic）Beijing Chaoyang Hospital病例分析 case analysis鉴别诊断鉴别诊断 differential diagnosis：（1）椎基底动脉供血不足 Vertebrobasilar insufficiency（2）蛛网膜下腔出血（以眩晕为首发症状）subarachnoid hemorrhageH:C脑蛛下血1b.jpg（3）小脑炎（急性小脑性共济失调）cerebellitis（acute cerebellar ataxia）（4）小脑出血 Cerebellar hemorrhage Beijing Chaoyang Hospital病例分析 case analysis鉴别诊断鉴别诊断 differential diagnosis（5）小脑肿瘤 cerebellar tumorH:髓母1c.tif H:髓母2a.tif（6）突发性耳聋 sudden hearing loss （7）体位性低血压（直立性低血压）postural hypotensionBeijing Chaoyang Hospital病例分析 case analysis诊疗计划诊疗计划 plans of therapy（1）检查计划 头MRI；头CTA；TCD，颈动脉椎动脉彩超，心脏彩超Beijing Chaoyang Hospital病例分析 case analysis诊疗计划诊疗计划 plans of therapy:(1)检查计划：血常规，血脂，血糖，肾功；心电图，肾动脉超声；尿常规（白蛋白尿）Beijing Chaoyang Hospital病例分析case analysis（2）治疗计划）治疗计划 1）一般治疗 general therapy 2）降颅压 lower ICP 3）消栓 thrombolysis 4）脑保护 craniocerebral protecting 5）二级预防治疗：降压、抗血小板 调脂 decompression、antiplatelet melody cholesterolH:卒中他汀.jpg H:卒中血小板.jpgBeijing Chaoyang Hospital