感染性眩晕的诊断、鉴别诊断和治疗原则

感染性眩晕意指源于感染的眩晕,它既可以发生在前庭系统的周围部分,也可以发生于中枢部分.就病种而言,可以引起眩晕的疾病包括急性中耳炎、乳突炎、迷路炎、慢性中耳炎内耳并发症、听神经炎、前庭神经元炎、脑干脑炎、小脑炎、小脑脓肿和第四脑室囊虫尾蚴等.     

体位性眩晕的诊断与治疗

体位性眩晕是一种以阵发性眩晕发作为特点的疾病,一般认为是微血管压迫前庭神经颅内段,引发神经纤维脱髓鞘所致。本病的确诊应排除其它典型的眩晕性疾病,如梅尼埃病、良性阵发性位置性眩晕、偏头痛性眩晕、前庭神经元炎及半规管裂综合症等。抗癫痫类药物(如卡马西平)为本病治疗的首选,但对于难治性体位性眩晕,颅神经微血管减压术是目前唯一有效的手术治疗方法。     

青年小脑梗死伴卵圆孔未闭1例报道及相关文献复习

急性头晕/眩晕是神经内科门急诊工作的常见病与多发病,患者往往伴有恶心呕吐、眼球震颤、行走不稳等症状,持续24 h以上者总称为急性前庭综合征(Acute vestibular syndrome,AVS)。AVS的病因多样,前庭神经炎、迷路炎等周围性因素以及后循环供血区脑卒中、幕下占位等中枢性因素均可引起。发生在青年人的AVS以周围性因素居多,病程往往存在一定的自限性,总体预后良好;然而极少数却是由后循环供血区缺血性脑卒中(Ischemic stroke,IS)引起,其病因学及治疗原则完全不同于周围性AVS,-旦漏诊有可能产生严重后果。     

前庭神经元炎（附1例报告）

前庭神经元炎 (ｖｅｓｔｉｂｕｌａｒｎｅｕｒｏｎｉｔｉｓ)的病变部位虽有不少研究 ,但影像学检查方面尚未见有价值发现。本院收治 1例头颅ＭＲＩ显示脑干前庭神经核受累患者 ,现报告如下。临床资料患者　女 ,30岁 ,住院号 2 4 5 172 ,因眩晕、呕吐 2ｄ于 2 0 0 1年 10月 2 5日入院。患者 2周前曾患上呼吸道感染 ,入院前日凌晨突然眩晕 ,视物旋转 ,不能起床 ,伴恶心呕吐 ,左侧头胀痛 ,无耳鸣耳聋 ,无发热。主要体征 :眼震Ⅲ°,快相向右 ,呈水平旋转性 ,指鼻试验 (+ ) ,闭目难立征 (+ ) ,向左倾倒。主要辅助检查 :眼震电图自发性眼震Ⅲ°。…     

炎性肌病的诊断与鉴别诊断

炎性肌病是一类由免疫介导或直接由病原体感染所引起的骨骼肌的炎性病变。广义而言，它包括多发性肌炎（PM）、皮肌炎（DM）、无肌病性皮肌炎（amyopathic dermatomyositis，ADM）、包涵体肌炎（IBM）、嗜酸性筋膜炎、局灶性肌炎、肉芽肿性肌炎和感染性肌病，其中感染性肌病又可分为病毒性肌炎、寄生虫性肌炎、细菌性肌炎、真菌性肌炎和支原体肌炎等；而从狭义上来讲，炎性肌病仅指多发性肌炎、皮肌炎、无肌病性皮肌炎和散发性包涵体肌炎。除了包涵体肌炎外，其他炎性肌病均为可治愈性或可控制性疾病，因此对其早期诊断和及时治疗显得尤为重要。然而，炎性肌病并非l临床常见的神经系统疾病，尤其在不典型的情况下漏诊或误诊时有发生。因此，笔结合自己的l临床体会．就炎性肌病的诊断与鉴别诊断总结概述。[第一段]     

梅尼埃病与前庭性偏头痛的相关性研究进展

梅尼埃病和前庭性偏头痛是临床常见的两种疾病，临床表现相似，缺乏鉴别诊断的有力 手段。研究表明梅尼埃病和前庭性偏头痛在发病机制、临床特征及治疗方面存在一定的相关性。因此， 现从发病机制、临床特征、治疗方面对这两种疾病的相关性进行探讨。     

未引起重视的头晕的临床研究进展

头晕是神经科常见的临床症状,临床诊断的常见病因包括良性发作性位置性眩晕、前庭神经元炎、梅尼埃氏病、椎-基底动脉供血不足等。而其他一些头晕或眩晕的病因,包括慢性主观性头晕、周围前庭阵发症、特发性双侧前庭功能减退症、偏头痛性眩晕、及雌激素相关性头晕等,由于临床重视不够或相对少见,因此较少诊断。     

特发性炎性肌病分型诊断标准研究进展

特发性炎性肌病分型诊断以Bohan和Peter标准应用最广泛,随着免疫发病机制的研究进展,Dalakas标准提出CD8/MHC-I复合体是诊断PM特征性免疫病理标志.ENMC标准纳入了核磁共振、肌炎特异性抗体、必备的组织化学与免疫组织化学病理诊断标准,单克隆抗体免疫组织化学染色可显示浸润炎细胞的类型及MHC-I、MAC免疫标志物的表达,使特发性炎性肌病分型诊断更具准确性,临床应积极推广应用,有助提高诊断治疗水平.     

表现为前庭阵发症的椎基底动脉延长扩张症1例

眩晕常见病因有后循环缺血、良性阵发性位置性眩晕、前庭神经元炎、梅尼埃病等,而前庭阵发症(vestibular paroxysmi-a,VP)相对少见。虽然近年国外报道逐渐增多,但国内只有何兰英等[1]报告7例患者,且责任血管均为小血管襻。本文报告     

眩晕的临床诊断和治疗流程建议说明之二引起眩晕的常见疾病

眩晕为临床上的常见症状之一 ,可由多学科和多系统疾病所引起 ,现将其常见者分述如下。1　耳源性眩晕　　系指由内耳前庭感受器受到病理损伤所致 ,常伴有听力障碍和恶心、呕吐等症状 ,但无其他神经系统受损迹象。常见病因有 :1 1　Meniere(梅尼埃 )病　占耳源性眩晕的 6 6 % ,中年后发病为最常见。确切的发病原因尚无明确定论 ,可能是因自主神经功能失调 ,引起迷路动脉痉挛、迷路内淋巴液产生过多或吸收障碍 ,使迷路内淋巴积水和淋巴液压力增高 ,导致内耳前庭末梢器缺氧及敏感的耳蜗毛细胞变性等病理变化所致。以发作性眩晕、慢性进行性耳…     

Personality diagnosis and illness diagnosis

This case presented with features of affective disorder with psychosis and also of borderline, avoidant and schizotypal personality disorders. During the course of subsequent treatment there was a marked reduction not only in psychotic and depressive features, but also in criteria for personality disorder, especially borderline. Relevant literature is reviewed and the importance of treatable illness as a possible cause of apparent personality disorder is discussed.     

脊髓疾病的影像学诊断及鉴别诊断

自CT及MRI应用于临床以来，中枢神经系统影像诊断学获得飞跃发展。因为MRI的软组织分辨为优于CT，所以当前MRI是脊髓疾病的主要检查手段，下面以MRI影像表现为主，介绍脊髓常见疾病的诊断及鉴别诊断。     

Between a psychiatric diagnosis and a familial diagnosis

If the idea of a biopsychosocial model is not going to be merely a phrase, then every clinical diagnosis and therapeutic vision need to consider the familial issues. Taking the family issues into consideration has evident gains; it allows for a better understanding of the patient and allows for actions which reduce the risk of a relapse of illness. The fact that such issues are not part of the therapeutic armament, despite the effectiveness of psychoeducation, is bewildering: on one hand the families are not always invited to co-operate, on the other hand--they often give up this co-operation. In such a situation, the relation between the patient's family and the personnel needs analysis, especially common, often unconscious emotions and prejudices. They can form a dysfunctional 'knot', which does not allow for a therapeutic alliance to be formed. How to come out from such an impasse and make a common positive alliance? Paradoxically, the therapeutic possibilities are bigger when--especially in the initial phase of treatment--the psychiatrist "is able to not know" and is capable of listening into the patient's family perspective, and has an interest in the 'family story'. It is only after the knowledge on the family is gained and the family perspective is accepted, that the deconstruction of that part of the family's story that forms the problem and a common search for "positive changes" are possible. Although it may not appear to be so, such an ordeal can be very difficult for the psychiatrist who is used to controlling the situation through psychiatric theory and diagnosis, psychiatric language and the psychiatric institution. The issue presented appears to be part of a universal dilemma: what is the range of "the language power" of the psychiatrist and when is the sharing of this power with the patient and the family beneficial for the therapy.     

Multifocal motor neuropathy: diagnosis and differential diagnosis

Multifocal motor neuropathy (MMN) is an acquired immune mediated motor neuropathy with characteristic clinical and neurographic features.Clinically, MMN is characterized by progressive, predominantly distal and asymmetrical limb weakness.Neurographic recordings demonstrate features of multifocal demyelination with or without conduction block.Sensory nerves are not affected. Due to strict diagnostic criteria,MMN may be underdiagnosed in patients with motor neuropathies. Since intravenous immunglobulins are an efficient therapy for MMN,clinical and electrophysiological differentiation from other neuromuscular disorders is mandatory to prevent progressive impairment of motor function. We present a patient with MMN and review the clinical, electrophysiological, and histological features. In addition,pathogenesis, differential diagnosis and treatment of MMN are discussed.     

小脑血管网织细胞瘤MRI诊断与鉴别诊断

目的探讨小脑血管网织细胞瘤MRI表现特点，总结其诊断和鉴别诊断要点。方法回顾分析经手术病理证实的30例小脑血管网织细胞瘤MRI表现。结果30例中发生于右侧小脑半球15例，左侧13例。双侧1例，小脑蚓部1例。其中囊性肿瘤26例．实质性4例。肿瘤最大径25～60mm。26例囊性肿瘤中25例平扫表现为圆形或类圆形脑脊液样长T1、长T2信号，1例肿瘤合并出血在T1WI及T2WI均呈明显高信号；23例可见壁结节，直径3～18mm；增强扫描所有病变囊壁和囊液均不强化，24例显示强化壁结节；4例实质性肿瘤呈稍长T1、长T2信号，增强扫描均明显强化。23例肿瘤边缘或内部可见1～2条流空血管影。结论囊性小脑血管网织细胞瘤MRI表现颇具诊断特征性，但有时需与小脑星形细胞瘤鉴别，实质性肿瘤需注意与转移瘤、髓母细胞瘤及脑膜瘤鉴别。     

Dual diagnosis

Dual diagnosis in psychiatry and addiction refers to the presence of a substance use disorder coexisting with another major psychiatric disorder. This article reviews the prevalence and timing of occurrence of the various disorders and their combinations. The problems in diagnosis and management associated with these diagnoses are explored both from the point of view of the patient and of the treatment providers. The paper outlines a general management strategy for dual diagnosis cases and discusses specific strategies for treating particular psychiatric diagnosis combinations.