神经
词汇介绍
拓展阅读
解析
bulbar 英 ['bʌlbə] 美
释 义 adj. 延髓的；球根的
例 句 Aspiration of bacteria from the oropharynx may follow dental anaesthesia and can occur in bulbar palsies. 自口咽中吸入细菌可在牙科麻醉时发生，亦可在延髓麻痹时发生。
palsy 英 ['pɔːlzɪ; 'pɒl-] 美 ['pɔlzi]
释 义 n. 麻痹，麻痹状态；中风
vt. 麻痹；使瘫痪
同根词 palsied adj. 中风的；颤抖的
palsied v. 瘫痪；麻痹（palsy的过去式）
例 句 The incidence rate of conscious disturbance and death increases in patients with gaze palsy. 伴有凝视麻痹的患者，意识障碍和死亡的发生率增高。
概述
概述
延髓麻痹亦称球麻痹，是指由延髓的神经（舌咽神经、迷走神经、副神经及舌下神经）麻痹时产生的言语、构音、吞咽等障碍。根据病损部位，延髓麻痹可分为真性与假性延髓麻痹两大类。前者系由延髓神经核及其周围神经损伤所致，而后者系由皮质延髓束损害所引起，延髓神经本身没有损害。通常所说之延髓麻痹为真性延髓麻痹。
病因
延髓麻痹的病变部位可在一侧或双侧的舌咽神经、迷走神经、副神经、舌下神经的神经核、神经根或神经干。根据病程可分为急性与慢性进行性两类。急性者可见于小脑后下动脉血栓形成、基底动脉血栓形成、急性多发性神经根神经炎、多发性硬化等。慢性进行性者可见于运动神经元病、颅底及枕骨大孔区肿瘤、延髓空洞症、颅底凹陷症、小脑扁桃体下疝畸形（Arnold-Chiari畸形）等。临床上以急性多发性神经根神经炎、运动神经元病及延髓空洞症为多见。
临床表现
延髓麻痹的临床表现为构音困难、语音不清、有鼻音、声音嘶哑、吞咽困难、吞咽缓慢或呛咳。进食时食物由鼻孔呛出，重者则完全不能吞咽。检查时可发现一侧或双侧软腭不能提升，咽反射消失，并常有咽部感觉减退或丧失。伸舌无力，舌肌萎缩，可伴有舌肌颤动。胸锁乳突肌和斜方肌萎缩则很少见。
鉴别诊断
本病应与中枢性（假性）延髓麻痹相鉴别。后者为核上性延髓麻痹，系双侧皮质延髓束受损所致。其临床表现与延髓麻痹相似，主要为言语不清，而吞咽困难较轻，舌肌容积较小，但无舌肌颤动和萎缩，吸吮反射、咽反射存在或亢进，下颌和掌颌反射阳性，常伴有强哭、强笑等情感障碍。假性延髓麻痹常见于脑动脉硬化、多发性脑梗死及运动神经元病。此外，后组脑神经麻痹还应与重症肌无力、吉兰一巴雷综合征、多发性肌炎或皮肌炎等所致的延髓肌无力相鉴别。
治疗
延髓麻痹患者的治疗，首先应明确诊断，尽可能找到病因，针对病因治疗。对于尚无病因治疗（如进行性延髓麻痹等）者应加强护理，推荐糊状饮食，必要时尽早做胃造瘘或鼻饲饮食，以防止吸人性肺炎的发生。
复制标题临床和神经传导功能吉兰-巴雷综合征患者与寨卡病毒感染库库塔，哥伦比亚
发表时间：2018-04-25
影响指数：4.4
作者： Antonino Uncini
期刊：EUR J NEUROL
BACKGROUND AND PURPOSE:Zika virus (ZIKV) infection has been associated with an increased incidence of Guillain-Barré syndrome (GBS) but the relative frequency of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and axonal GBS subtypes is controversial.METHODS:Twenty GBS patients diagnosed according to the Brighton criteria during the ZIKV outbreak in Cúcuta, Colombia, were evaluated clinically and electrophysiologically. The electrodiagnosis of GBS subtypes was made according to a recently described criteria set that demonstrated a high diagnostic accuracy on the basis of a single test. The electrophysiological features of 34 Italian AIDP patients were used as control.RESULTS:All patients had symptoms compatible with ZIKV infection before the onset of GBS and ZIKV infection was laboratory confirmed through a plaque reduction neutralization test (PRNT ) in 100% of patients. The median time from onset of ZIKV infection symptoms to GBS was 5 days (interquartile range 1-6 days). Cranial nerve palsy was present in 85% of patients (facial palsy in 75%, bulbar nerve involvement in 60%), autonomic dysfunction in 85%, and 50% of patients required invasive mechanical ventilation. AIDP was diagnosed in 70% of patients. 40% of nerves of AIDP patients showed a prevalent distal demyelinating involvement but this pattern was not different from the Italian AIDP patients without ZIKV infection.
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