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1、Neurology,Department of Neurology, The 2nd affiliated hospital, Harbin Medical University,Chapter 1. Introduction,神经病学 ( Neurology),The Objects of Neurology: CNS、PNS and muscular disorders The contents of study: Etiology and Pathogenesis Pathology Clinical features Diagnosis and Differential diagnos
2、is, Treatment and Prevention Prognosis,Nervous system,Central nervous system: brain spinal cord Peripheral nervous system: cranial nerves spinal nerves,Nervous system,Neurology is a part of neuroscience, including: Neuroanatomy, Neurophysiology, Neurobiochemistry, Neuropathology, Neurogenetics, Neur
3、oimmunology, Neuroepidemiology, Neuroiconography神经影像学, Neurophamacology, Neuropsychology, Experimental Neurology, Neurobiology, Molecular Biology,Catalogue of the neurological diseases,Vascular diseases Infectious diseases Tumors Traumatic diseases,Catalogue of the neurological diseases,Autoimmune d
4、iseases(some of them are demyelinative diseases脱髓鞘疾病) Hereditary and metabolic disorders Congenital dysplasia先天性发育障碍 Intoxication Nutritional disturbances,Symptoms of Nervous System could divided to four classes:,Deficit symptoms deficits or loss on the normal functions (hemiparalysis, aphasia) Irri
5、tative symptoms excessive excitements that nervous structures appeared when they were stimulated (seizures, radical pain),Symptoms of Nervous System could divided to four classes:,Liberated symptoms When the higher centers were impaired, the function of the lower center that normally controlled by t
6、he former was liberated(pyramidal signs锥体束征).,Symptoms of Nervous System could divided to four classes:,Shock Symptoms CNS急性局部严重病变，引起与之功能相关的远隔部位神经功能短暂缺失 Brain shock: cerebral hemorrhage Spinal shock: in the acute stage of total cord transverse, there is a flaccid paralysis with loss of tendon and ot
7、her reflexes, accompanied by sensory loss below the level of the lesion and by urinary and fecal retention.,Supplemented exam in neurological diseases,1. Lumbar puncture and CSF analysis: Appearance, Pressure, Dynamics Routine exam Biochemical examinations CSF-IgG index, OB Cytologic exam Specific a
8、ntibodies(MBP, AChR),Supplemented exam,2. Imaging studies: plain X-rays of the skull and the spine, myelography CT, MRI (magnetic resonance imaging), MRA DSA (digital subtraction angiography),Supplemented exam,3. Electrophysiologic studies: EEG(electroencephalography) EMG (electromyography) NCV(nerv
9、e conduction velocity) VEP(visual evoked potentials) BAEP(brianstem auditory evoked potentials) SEP(somatosensory evoked potentials) 4. Transcranial doppler(TCD),Supplemented exam,Radioisotope examinations(放射性同位素) SPECT(single photon computed tomography) PET(positron emission tomography) Immunologic
10、 and virologic detections(免疫学及病毒学检测)：such as MBP、AChR and cysticercus antibodies, (HSV)PCR Biopsy: muscles, nerves and brain,Chapter 2. Symptomatology of the Neurological Diseases,Section 1. Disorders of Consciousness,Disturbances of the Level of Consciousness,Consciousness is awareness of the inter
11、nal or external world. 意识(awareness) 指大脑的觉醒(arousal)程度，是机体对自身和周围环境的感知和理解功能，并通过语言、躯体运动和行为表达出来；是CNS对内、外环境刺激应答反应的能力。 该能力减退或消失就意味着不同程度的意识障碍(disorders of consciousness)。,意识(consciousness)-Concept,Consciousness describes that sets of neural processes that allow an individual to perceive, comprehend, and a
12、ct upon the internal and external environments. It is usually envisioned in two parts: arousal and awareness.,Arousal describes the degree to which the individual appears to be able to interact with these environments; the contrast between waking and sleeping is a common example of two different sta
13、tes of arousal.,Arousal requires the interplay of both the reticular formation and the cerebral hemispheres. The reticular components necessary for arousal reside in the midbrain and diencephalon; the pontine reticular formation is not necessary for arousal.,Awareness reflects the depth and content
14、of the aroused state. Awareness is dependent on arousal, since one who cannot be aroused appears to lack awareness. Awareness does not imply any specificity for the modality of stimulation. This stimulation may be external (e.g., auditory) or internal (e.g., thirst).,Attention depends on awareness a
15、nd implies the ability to respond to particular types of stimuli (modality-specific).,Stupor refers to a condition in which the patient is less alert than usual, but can be stimulated into responding.,Obtundation (意识模糊) describes a patient who appears to be asleep much of the time when not being sti
16、mulated. This eyes-closed state is not electroencephalographic sleep, however.,Stuporous/obtunded patients will respond to noxious stimuli by attempting to deflect or avoid the stimulus.,Patient with Coma lies with eyes closed and does not make an attempt to avoid noxious stimuli. Such a person may display various forms of reflex posturing, but does not actively try to avoid the stimulus.,Vegetative state, in which the eyes open and close, the patient may appear to track object
