1、神经系统疾病概论Clinical Neurosciences卜碧涛华中科技大学同济医学院附属同济医院神经科 1Neurological and psychiatric disorders 神经祖母细胞神经祖母细胞特定神经细胞遗传修饰的干细胞遗传修饰的神经祖母细胞特定神经细胞2Major diseasesn Strokesn Brain tumorsn Epilepsyn Muscular diseases(myopathies)n CNS infectionn Peripheral neuropathiesn Degenerative diseasesn Genetic diseases n
2、Schizophrenia n Depression3Noble Prize winnersn Dr.Carleton Gaidusek，KURUn Dr.Stanly Prusiner，CJDn Dr.Carlsson，Dopamine theoryn Dr.Mansfield,MRI4Piron diseasesn Kuru a deadly disease in New Guinea,n Transmissible to Apes.n Agent?n Termination of cannibine ritual n Agent:devoid of nucleic acidn Prion
3、:proteinaceous infectious particles5Spongiform encephalopathyDopamine theorynDopamine,neurotransmitter ndopamine receptors nTreatment Parkinsons disease Schizophrenia7Clinical Neurosciences p Neuroanatomyp Neuro-physiologyp Neuropathologyp Symptom-based neurologyp Neurological examinationp Diagnosti
4、c procedures8Case study p Male,50yrs。p Right arm weakness for 3 hrs。p Hypertension for yrs。p Signs:aphasia paralysis on the right decreased sensation on the right9Interpretating manifestationn Aphasia,paralysis and sensory loss on the rightLeft hemisphere10Localize the lesion n Left hemisphere,invol
5、ving the regions for language and sensorimotor function.11Pathological processp Stroke:sudden onset（neurologic deficits）p Ischemic?p Hemorrhagic?12How to demonstrate your guess?n CSF?n CT?n MRI?n MRA?n DSA?n SPECT?n PET?n EEG?n TCD?13CT,MRA 14Determination of therapyp Decision-making of treatment p
6、thrombolysis with r-tPA?p (time-window)p p individualization15The cause of stroke?p Blockage of a vessel p Risk factors p Heart disease?p Hyper-coagulation?p Others?p How to prevent?16Diagnostic processp History,symptoms,signs p Interpretation p Anatomic diagnosis（定位诊断)(Where?)p Pathological diagnos
7、is(定性诊断)(What?)p Etiologic diagnosis(病因诊断）(How?)17pVascularpDemyelinationpTraumapCompressionpInflammationpInfectionpNeoplasmpMalnutritionpIntoxicationpautoimmunepGeneticEtiology of neurological diseases18Diagnostic procedures p Routinep Cerebral spinal fluid study p Electrophysiological：EEG,EMG,EPp
8、Transcranial doppler(TCD)，ultrasoundp Immunological p Neuroimaging:CT,MRI,angiography，PETp Biopsies：skin,muscle,nerve,blood vessel,meninges,brainp Genetic diagnosis 19CSF studyIndicationsIndications：inflammation,bleeding,demyelinationinflammation,bleeding,demyelinationContra-indication:Contra-indica
9、tion:ICP,local infection ICP,local infection 20pCT pMRIpAngiographypSPECTpPETNeuroimagying21CT22MRI(CNS,muscles,nerves)23CTA，MRA，MRV，DSAAngiography24SPECTInvestigating CBF,ictal foci 25Metabolism of neural tissues,FFI PET26p Hemodynamics of cerebral blood vesselsp Monitoring the showers of thrombus
10、TCD27Untra-sound of blood vessels o Plagueso Narrowing or stenosis 28ElectroencephalographyRoutine,video EEG,Epilepsy 29EMG and NCV30p 躯体感觉诱发电位，SEPp 视觉诱发电位，VEPp 脑干听觉诱发电位，BAEPp 运动诱发电位，MEPp 事件相关电位，ERPEvoked potentials31p 神经心理量表p Cognitionp Emotion p BehaviorNeuropsychological Scales32Biopsies33Big adv
11、ances!34Stroke Unitn Setting for stroke patients 35p Effective p Time-window,3 hrsp Pnumbra Thrombolysis,t-PA36p Endarterectomy p Stentingp By-pass Stenosis37Stenting before after38Aspiration of ICH before after 39Novo7(ICH)p Enlargement of hematomap rFVIIa（Novo 7）p Intracerebral Hemorrhage trial40A
12、neurysm p SAHp DSAp Embolizationp Clipping 41Parkinsons disease(PD)p Dopamine replacementp Dopamine agonistsp Anti-cholinergic agentsp Deep brain stimulation42Alzheimers disease(AD)p ACHEI:donepzil，galataminep Memantinep Vaccines:beta-amyloid p Mb:anti-beta amyloid43Multiple sclerosis(MS)p Corticost
13、eroids p DMDs44Myasthenia Gravis(MG)p Immuno-modulationp Thymectomy 45Epilepsyp New drugs p Surgical therapy46Wilsons diseasep Abnormal deposition of copperp BALp Penicillemine47Amyotrophic lateral sclerosis48RilutekSchizophrenia p Dopamine blockersp Traditional drugsp New drugs:effective,safe Olanzepine Qietiapine 49Depression o Tricyclinc antidepressantso New:SSIRs50However,there is a long way to goSuch as51WELCOME!52
