周围神经和肌肉疾病的鉴别诊断
- Author
- Seward B Rutkove, MD
Seward B Rutkove, MD
- Professor of Neurology
- Harvard Medical School
- Section Editor
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
- Deputy Editor
- John F Dashe, MD, PhD
John F Dashe, MD, PhD
- Deputy Editor — Neurology
- Translators
- 林洁, 主治医师
林洁, 主治医师
- 复旦大学附属华山医院神经内科
引言
有时，周围神经和肌肉疾病可根据临床情况进行诊断。例如：
- 对于一个出现典型“袜套-手套”样感觉缺失的长期糖尿病患者，糖尿病性多发性神经病的诊断相对明确。 (参见“糖尿病多发神经病变的临床表现和诊断”)
- 若患者在使用可对肌肉功能造成干扰的药物(如抗疟药、糖皮质激素和降胆固醇药)，则可就其近端无力的病因形成一个合理的临床假设。 (参见“糖皮质激素诱导性肌病”和“药物诱导性肌病”)
尽管如此，神经、肌肉或神经肌肉接头疾病的患者可表现出一系列相似的症状。此外，即便病程局限于神经，问题的根源到底是在中枢神经系统(central nervous system, CNS)或是周围神经系统也并不总是明确。
本专题将总结神经、肌肉和神经肌肉接头疾病的特征性病史和体格检查结果，并将提供一种区分中枢性与周围性神经系统疾病的方法。特定的神经系统综合征将单独作更详细的讨论。
神经、肌肉与神经肌肉接头疾病的临床差异
神经疾病(如多发性神经病)、肌肉疾病(如肌病)和神经肌肉接头疾病(如重症肌无力)可能表现为不同程度的感觉缺失和肌无力。然而，感觉和运动障碍的特定模式可能有助于对这些疾病进行区分。
Subscribers log in here
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2016-12-04.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Jabre JF, Dillard JW, Salzsieder BT, et al. The use of multiple Tinel's sign in the identification of patients with peripheral neuropathy. Electromyogr Clin Neurophysiol 1995; 35:131.
- Tasker RR, DeCarvalho GT, Dolan EJ. Intractable pain of spinal cord origin: clinical features and implications for surgery. J Neurosurg 1992; 77:373.
- Patten J. Neurological Differential Diagnosis, 2nd, Springer, New York 1996.
- Campbell WW. DeJong's The Neurologic Examination, 7th edition, Lippincott Williams & Wilkins, Philadelphia 2013.
- Rekand T, Gramstad A, Vedeler CA. Fatigue, pain and muscle weakness are frequent after Guillain-Barré syndrome and poliomyelitis. J Neurol 2009; 256:349.
- Cornblath DR, Mellits ED, Griffin JW, et al. Motor conduction studies in Guillain-Barré syndrome: description and prognostic value. Ann Neurol 1988; 23:354.
Top