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1、周围神经病PeripheralNeuropathy中国协和医科大学Peripheralneuropathyisalargegroupofdiseases:Damageofnervesoutsideofthespinalcordandbrain.Dysfunctionofthesenerves.CausedbyanyofriskfactorsAnatomyandfunctionofperipheralnerve——basictounderstandneuropathyAnatomycranialnerveolfact
2、orynerveopticnerveoculomotornervetrochlearnervetrigeminalnerveabducentnervefacialnervevestibulocochlearnerveglossopharyngealnervevagusnerveaccessorynervehypoglossalnerveSpinalnervesHistologyElectrophysiologyUnmyelinatednervefiberMyelinatednervefiberFunctionsMo
3、tornerveSensorynerveAutonomicnervereflexStep1:Clinicalfeaturesofneuropathies——historyandexaminationofpatientisthecluestodiagnosisofneuropathyMuscleweaknessWeaknessinthearmsorlegs：difficultywalking,running,climbstairs,Stumblingortiringeasily.Difficultieswithcar
4、ryingaloadofgroceries,openingjars,turningdoorknobs,orcombinghair.Cranialnerveparalysis:ophthalmoplegia,facialweakness,dysarthria,RespiratoryinsufficientMuscleatrophy.Reflexlost.tips:LowermotorneurogenicdamageAnatomicdistributionSymmetricproximaldistalAsymmetri
5、csinglenerve multiplenerve plexus nerverootSensoryabnormalitiesParesthesiasSpontaneoussensations,numbness,tingling,pinsandneedles,prickling,burning,cold,pinching,sharpdeepstabs,andelectricshocksorbuzzing.DysesthesiasUnpleasantabnormalsensationsbroughtonbytouch
6、ingorotherstimuli.Anesthesiaalackofsensation,leadingtoinjuries,cutsandburnsduetothelackofnormalwarningsensations.alackofsensationofposition,whichleadstouncoordinatedandunsteadywalking.tips:Hearingpatient’sdescriptionAnatomicdistributionSymmetric“GloveandStocki
7、ng”distributionAsymmetricsinglenervemultiplenerveplexusnerverootAutonomicNerveDamageblurredvisiondecreasedabilitytosweat(anhidrosis)decreasedabilitytoregulatebodytemperaturedisturbancesofbladderfunctionorthostatichypotensionConstipationdiarrhea,nauseaaftermeal
8、s,abdominalbloatingsexualdysfunction(impotence)thinningoftheskin,witheasybruisabilityandpoorhealing.Step2:Laboratoryfindingsnerveconductionstudycanconfirmneuropathyanddistinguishbe
