1、1一、目的与要求（一）掌握多发性硬化的临床表现与分型。（二）熟悉多发性硬化的治疗方法。（三）了解多发性硬化的发病机制和诊断标准。二、教学内容（一）重点讲解多发性硬化的诊断（根据多发病灶、多次发作的临床表现、临床分型、脑脊液、电生理及MRI等）及治疗方法（急性发作期、缓解期）。（二）一般介绍多发性硬化的病因、病理、发病机制、诊断标准与鉴别诊断。3PNSCNS髓鞘（髓鞘（myelin)myelin)：包绕神经轴索的：包绕神经轴索的膜性脂质结构膜性脂质结构67病因学与发病机制病因学与发病机制8病理表现病理表现910视神经炎视神经炎急性脊髓炎急性脊髓炎小脑性共济失调小脑性共济失调各种脑干受损症状各种脑
2、干受损症状11视神经：视神经：急性视乳头炎、球后视神经炎急性视乳头炎、球后视神经炎脊髓脊髓12脑干或小脑：脑干或小脑：13大脑大脑14平衡障碍平衡障碍15核间性眼肌麻痹核间性眼肌麻痹16周围性面瘫周围性面瘫核间性眼肌麻痹核间性眼肌麻痹17临床临床病程分型：与治疗决策有关病程分型：与治疗决策有关复发缓解型（复发缓解型（RRRR）继发进展型继发进展型(SP)(SP)原发进展型原发进展型(PP)(PP)进展复发型进展复发型(PR)(PR)良性型良性型18辅助检查辅助检查CSFSCSFSOCBs1920212223242526MRI:T1增强27Diagnosis of MS:The McDonald
3、 criteria（2005 revised）21Clinical relapse1(CIS)2 dissemination in space in MRI or positive CSF and 2 MRI lesions or second relapse 21 none;clinical evidence sufficient 1 year of disease progression AND 2 of the following:(1)positive brain MRI findings(2)positive spinal cord MRI findings(3)positive C
4、SF findings dissemination in time in MRI or second relapse dissemination in space in MRI or positive CSF and 2 MRI lesionsAND dissemination in time in MRI or second relapseAdditional requirements for diagnosisLesions0(slow progression)211CSF finding is no longer a requirement for the diagnosis of PPMS29303132急性发作急性发作3334353637继发进展型继发进展型38患者教育、对症治疗患者教育、对症治疗39一般治疗一般治疗40预后41
