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,*,中毒性周围神经病,Toxic Neuropathies,：Drugs，Metals，and organic compounds,临床和组织学共同特征,毒素影响轴索早于许旺氏细胞；,毒素通常首先累及大有髓纤维轴索，且大有髓纤维受损最严重；,发病率和周围神经病严重程度与毒素接触剂量、时间相关联；,身体最长的轴索是至足趾的感觉纤维，大多数中毒性神经病首发症状为足远端感觉障碍，且主要为大纤维，如振动觉常是早期客观发现工业或环境,重金属毒素,引起的临床综合症,周围神经病,：砷主要引起感觉神经病，无机铅引起运动神经病，有机磷化合物和铊引起混合性神经病；,脑病,：铅中毒引起共济失调、偏瘫、视神经萎缩；,视神经炎,：砷中毒引起短暂或永久性视力损害，铊中毒引起视物模糊、视野缺损；,小脑功能障碍,：有机汞出现共济失调,帕金森综合症,：锰中毒出现锥体外系征：面具脸和肌僵直；,智能衰退,：有机铅、汞出现精神异常、精神病,砷中毒神经系统损害,毒物来源：采矿、饮高砷水、中药（雄黄）、燃煤、海产品等；,无机砷代谢：肝脏,大量中毒：,早期胃肠道症状：恶心呕吐，胃肠激惹；自主神经症状：心动过速，低血压。
1020天后出现周围神经病：感觉神经（大纤维）受累为主，远端麻木或感觉异常，,病理学：远端轴索丢失/伴脱髓鞘,长期低水平砷接触（3阶段）,First stage,Chronic absorption 500-1000 g/d,Malaise;Anorexia;Vomiting,2nd stage,Membrane irritation,Hyperkeratosis,of Feet,Hypopigmentation,White,stria,(,Mees,lines),Aplastic,anemia,Renal damage,Polyneuropathy,Sensory loss:Stocking-glove;Large Small fiber,Weakness:Mild,CSF:Protein mildly increased,Pathology:Axonal loss;Distal,Recovery:Better in mildly affected,Long term:Carcinogen,Lung,skin,liver,kidney,&bladder,Diagnosis：Arsenic levels,Acute(1g/g,铅中毒神经病,Toxic Sources：,Occupational:Smelting;Battery manufacture;Demolition;Auto radiator,Ingestion:Paint;wine processed in lead,vessles,;,chinese,medicines.,Body storage,Rapid turnover pool:Blood(95%in,RBCs,)1/2 life of 1 to 20 days,Slow turnover pool:Bones;1/2 life of 7 to 20 years;95%of body lead burden,神经系统临床表现,急性中毒：周围神经损害，中毒性脑病,慢性中毒：,神经症综合症：见于早期，头晕、头痛、无力、肌肉关节酸痛、多汗、失眠等；,周围神经病：运动神经损害，伸肌麻痹出现典型的垂腕（铅手）、垂踝（双腓总神经麻痹），肱型及肩胛肱型麻痹；,进行性肌萎缩：局限性，以手部肌肉萎缩及震颤多见；,中毒性脑病：癫痫样发作、类精神分裂症、类麻痹样痴呆、震颤麻痹、共济失调等,系统损害表现,“,铅线”、“铅容”,口内金属味，恶心呕吐,腹泻或便秘，腹绞痛,肝肾功能损害,月经不调,高血压,实验室检查,周围血检查：点彩红细胞每百万红细胞超过300个、网织红细胞超过1.0%；,尿铅增高（正常上限0.08,mg/L）,Basophilic stippling of erythrocytes,汞中毒神经损害,毒物来源：汞蒸气（淘金）吸入、中药偏方（轻粉：甘汞,Hg,2,Cl,2,）、,水和食物污染（甲基汞）,亚急性无机汞中毒主要引起口腔炎及肾脏损害；有机汞中毒引起神经损害。
Subacute,:Metallic mercury vapor,Neuropathy,Motor,Axonal,Myokymia,Encephalopathy,Other:Mouth inflammation;GI;Fetid breath,Chronic,CNS:,Encephalopathy,;Psychosis;,Extrapyramidal,;Ataxia,Neuropathy:Sensory Pain&,paresthesias,Children:,Acrodynia,Encephalopathy,Autonomic:,Tachycardia,;Hypertension;Sweating on trunk,Insomnia;Weight loss;Constipation,慢性锰中毒神经系统损害,毒物来源：电焊工，机械制造业，空气中锰浓度超标,诊断依据国际,GB323282,职业性慢性锰中毒诊断标准及处理原则,临床表现,中毒性精神异常：类神经症，焦虑、忧郁症；,帕金森综合症：,构音障碍,震颤（,action tremor）,四肢肌张力增高（,rigidity）,行走困难、步态异常,腱反射亢进/病理征,性功能障碍,苯妥英钠,（,Phenytoin,）,中毒,Anti-epileptic：Blocks voltage-gated Na,+,channels,Neuropathy,Sensory:Mild;Symmetric;Distal legs,Maximum disability:Minor,Incidence:High with chronic usage,Electrophysiology,:Axonal loss,Pathology:Axonal loss,Ataxia;Gingival,hyperplasia,;,Hypertrichosis,Organophosphate compounds,有机磷中毒迟发性神经病,Toxic source：,Insecticides,，,Petroleum additives,，,Flame retardants,，,Suicide,Exposure:Absorbed through skin,respiratory,GI tract,有机磷中毒迟发性神经病,Onset,Paresthesias,&Muscle cramps,Delayed 7 to 12 days following single exposure,Motor&sensory,Distal,Pathology:Axonal loss,Distal regions of long axons,PNS&CNS,Myelopathy,:Spastic,paraparasis,Prognosis,Neuropathy:Slow improvement over time,Myelopathy,:Little or no,improvament,酒精中毒相关性神经损害,Wernicke,脑病和,Korsakoff,精神病,小脑变性,Marchiafara,-,Bignami,病,桥脑中央髓鞘溶解症,周围神经病,肌病,肝性脑病和获得性肝脑变性,胎儿酒精综合症,。