神经内科教学_Acute Inflammatory Demyelinating Polyneuropathy.ppt

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1、caseMale,35yearsold,complainedofweaknessoffourlimbsfor1dayonadmission.Hehadacold2weeksbeforeadmission.theweaknessbecamesevereandleadtotetraplegiaonthe3day.Aphagiaappearedalmostthesametime.Numbnessoffingersandtoeswasmentioned.Hehadnodifficultiesonmicturation.examCranialnerv

2、es:diminishedelevationofpalatal,gagreflexdisappearMotorsystem:muscletensiondecreased;muscleforce:0gradeofallfourlimbs.Sensorysystem:slightlystocking-glovetypepaindecreased.Reflex:areflexia.Babinski’ssign:(-).Others:normal.AcuteInflammatoryDemyelinatingPolyneuropathyGuillai

3、n-BarreSyndromezhaodongxueEtiologyandPathologyEtiology:unknown.cell-mediatedimmunologicreactionPathology:PerivascularlymphocyticinfiltratesPerivenoussegmentaldemyelinatingClinicalFeatures(I)Precedinginfection:Motorsystem:weaknessoflimbssymmeticandflaccidrespiratoryfailureC

4、linicalFeatures(II)Sensorysystem:stocking-glovetypeClinicalFeatures(III)Cranialnerves:facialdiplegia.bulbarpalsyothers.Autonomicdysfunction:tachycardialabilebloodpressuredisturbedsweatingSphincterfunction:notinvolvedusuallyLaboratoryFindingsCSF:protein-celldissociationonth

5、ethirdweekElectrophysiology:MCVandSCVslowedDiagnosisPrecedingInfectionClinicalFeaturesLaboratoryFindingsDifferentialDiagnosisPeriodicparalysisPoliomyelitisMyastheniaGravisTreatmentSymptomaticTreatmeat:EtiologicTreatment:plasmaexchangeintravenousimmunoglobulincorticosteroid