98例神经肌肉病的临床、肌电图与病理研究

目的 探讨肌电图（EMG），肌活检对神经肌肉病的诊断价值。比较EMG，肌活检及初始临床诊断3者之间的关系。方法 将98例神经肌肉病分成肌病。重症肌无力和运动神经元病3组进行研究。结果 肌病组（80例），68.8%(55/80)肌活检，75%（60/80）EMG呈肌源性损害；重症肌无力组（10例）；针极EMG（不包括重视频率电刺激）及肌活检均未显示特异性改变；运动神经元病组（8例），75?/8）肌活检，100%（8/8）EMG呈神经源性损害。结论 肌活检对肌病明确诊断可提供直接信息。对运动神经元病只能做出神经源性损害结果。缺乏特异性。EMG对神经肌肉病只能做出分类诊断；单纯凭借初始临床资料易导致该类疾病误诊。     

重症肌无力的电生理研究

目的探讨重症肌无力（ＭＧ）患者的电生理特征及其诊断价值。方法应用针极肌电图（ＥＭＧ），重复神经电刺激（ＲＮＳ）和激发重复神经电刺激（ＡＲＮＳ）方法，对４７例ＭＧ患者的肌肉和神经肌肉传递功能进行研究。结果部分患者的肌肉见到病理自发电位及短小动作电位，具近端肌分布特征。ＡＲＮＳ阳性率（９０．６％）较ＲＮＳ阳性率（８３．０％）高。Ⅰ型患者肢体肌群存在多项电生理异常。结论适当、综合应用电生理检测技术有助于ＭＧ的早期诊断     

重复电刺激检查在神经肌肉接头病变诊断中的临床应用研究

目的：研究神经重复电刺激检查对神经肌肉接头病变的诊断价值。方法：用Ｎｅｕｏｍａｔｉｏｃ２０００Ｃ型及Ｋｅｙｐｏｉｎｔ型肌电图／诱发电位仪，检查９３例神经科肌无力患者１８８条神经的重复电刺激，按临床诊断分为重症肌无力（ＭＧ）组组和非重症肌无力组。结果：ＭＧ组神经重复电刺激诱发的波幅衰减阳性率显著高于ｎＭＧ组。９７．５％的ＭＧ患者在低频刺激时即可获得阳性结果，波幅衰减最大的刺激频率为５ＨＺ而非３ＨＺ，     

神经电生理检查判断眼肌型重症肌无力的敏感度分析

目的：分析眼肌型重症肌无力（OMG）患者的神经电生理特点,为临床诊断提供有价值的依据.方法：对42例临床诊断为OMG患者进行单纤维肌电图、重复神经电刺激和肌电图检测.结果：伸指总肌的单纤维肌电图34例异常,重复电刺激异常23例;肌电图示14例肌源性损害.结论：OMG患者单纤维肌电图是一种敏感度较高的检测方法,其次为重复神经电刺激,其肌肉检测阳性率高低依次为眼轮匝肌、肱二头肌及小指展肌.     

甲亢性神经肌肉病变的临床及电生理研究

目的 观察甲状腺功能亢进症(甲亢)患者神经系统病变特点及电生理的改变,探讨电生理在甲亢性神经肌肉病变中的应用价值.方法 对60例甲亢患者行神经系统病史询问及体格检查;行针极肌电图、神经传导测定;部分行神经重复电刺激检测.结果 60例甲亢患者出现不同的神经肌肉症状;部分患者的肌电图出现异常,表现运动单位动作电位(MUAPs)时限缩短、多相波增多、波幅降低、干扰相、病理干扰相等,尤以(MUAPs)时限缩短明显.轻收缩时MUAPs时限缩短的发生率男性患者高于女性,且与病程长短无关.少部分出现周围神经的损害,主要以感觉传导异常为主,见于病程较长的患者.结论 甲亢患者中部分病例可出现神经肌肉损害,电生理可协助诊断;同时电生理还可检测亚临床甲亢性肌病和神经病变,MUAPs时限改变为肌肉受损较敏感和客观的指标之一.     

我国50年来肌电图和脑诱发电位技术的发展历程与未来展望

肌电图(EMG)和脑诱发电位(EPs)是目前广泛应用于临床的电生理诊断技术。EMG于 20世纪 50年代开始应用于临床,而EPs的应用则是 20世纪70年代以后的事。目前EMG被公认为神经系统疾病定位诊断的延伸,是诊断和鉴别诊断神经肌肉病及神经肌肉接头病变的客观检测手段,是组织化学、分子生物学、基因检测和影像学检查均不能取代的检测技术。下面将EMG和EPs的发展历程、现状和未来展望简介如下。一、EMG和EPs的起步20世纪 50年代末 60年代初,我国少数神经病学家开始了解先进的EMG技术,但未能推广。至80年代,EMG开始在全国推广应用。关…     

糖尿病患者神经肌肉电生理改变（附56例临床分析）

糖尿病患者神经肌肉电生理改变（附５６例临床分析）史广萍，邢福泰糖尿病性神经病的发生率很高，任何周围神经包括植物神经均可受累且发病较早，甚至隐性糖尿病即有周围神经病变。神经肌肉电生理检查有助于糖尿病性神经病的早期诊断，现将５６例糖尿病患者的电生理检查结...     

肌萎缩侧索硬化与脊髓型颈椎病的神经电生理检查

目的 探讨神经电生理检查在肌萎缩侧索硬化（amyotrophic laleral sclerosis，ALS）及脊髓型颈椎病（cervical spondylotic myelopathty，CSM）鉴别中的价值。方法 对28例初步诊断为ALS组、34例CSM组及两者鉴别困难者5例，这三组病人进行肌电图检查。结果 ALS组胸锁乳突肌及上、下肢肌肌电图都表现为神经源性损害；而CSM组仅表现为上肢脊神经根所支配的相应区域的神经源性损害，胸锁乳突肌及下肢肌无一例异常；而两者鉴别困难者组通过肌电图检查发现有4例存在颈、腰椎神经根病变，有1例为颈椎病合并ALS。本文同时对下胸段脊旁肌（T9．T10、T11）进行检查发现AIS组中阳性率为75％，而颈椎病组无一例异常。结论 神经电生理检查能帮助ALS及CSM的诊断及鉴别诊断。     

重症肌无力诊断与治疗最新进展

<正>重症肌无力(myasthenia gravis,MG)是一种神经肌肉接头传递障碍疾病,以骨骼肌无力、晨轻暮重、症状有波动为主要临床特点。近年来老年MG的发病率逐年增加,新发现的一些抗体(anti-MusK和anti-LRP4)能诊断原抗体检测难以诊断的MG,新的电生理诊断方法(单纤维肌电图和双神经刺激试验)能发现常规肌电图不能发现的神经肌肉接头处突触传递障碍,新涌现的治疗药物(单抗隆抗体和粒白细胞集     

肌管聚集性神经肌肉病二例报告

目的 报道２例类似重同无力的肌管聚集性神经肌肉病的神经肌肉接头形态改变。方法 对２例病人进行临床、电生理和肌肉病理检查。结果 例１为５３岁男性，主要表现为进行性肌无力和肌疲劳现象。血清抗乙酰胆碱受体抗体阴性，重复神经刺激出现肌电图波幅低频递减，远端肌电图显示神经源性损害。例２为２０岁男性病人，表现为肌无力和肌疲劳现象，肌电图重频刺激出现明显递减现象。２例病人的肌肉病理检查均发现，在Ⅱ型肌纤维内出现     

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。     

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.     

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.     

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.