1 / 76

Section Ⅰ

Section Ⅰ. Disorders of consciousness. 刘海若. 伦敦火车出轨事故 凤凰卫视金牌主持脑死亡     中国日报网站消息：据法新社 5 月 12 日报道，在 10 日伦敦火车出轨的事故中丧生的 7 人里，包括两名台湾电视媒体工作人员。曾经在台湾电视网 TVBS 工作、现为香港凤凰卫视咨询台主持人的刘海若头部受到重创，已被诊断为脑死亡。 . 刘海若不是脑死亡 凌锋教授赴英会诊有结果 2002 年 05 月 20 日 17:04 北京晚报.

kirkan
Download Presentation

Section Ⅰ

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Section Ⅰ Disorders of consciousness

  2. 刘海若

  3. 伦敦火车出轨事故 凤凰卫视金牌主持脑死亡    中国日报网站消息：据法新社5月12日报道，在10日伦敦火车出轨的事故中丧生的7人里，包括两名台湾电视媒体工作人员。曾经在台湾电视网TVBS工作、现为香港凤凰卫视咨询台主持人的刘海若头部受到重创，已被诊断为脑死亡。 伦敦火车出轨事故 凤凰卫视金牌主持脑死亡    中国日报网站消息：据法新社5月12日报道，在10日伦敦火车出轨的事故中丧生的7人里，包括两名台湾电视媒体工作人员。曾经在台湾电视网TVBS工作、现为香港凤凰卫视咨询台主持人的刘海若头部受到重创，已被诊断为脑死亡。 

  4. 刘海若不是脑死亡 凌锋教授赴英会诊有结果 2002年05月20日17:04 北京晚报 • 前往英国为凤凰卫视记者刘海若会诊的北京宣武医院凌锋教授昨天下午1时3分返京。据凌教授介绍：刘海若的伤情已有转机，目前有自主呼吸，不是脑死亡。 • 　　宣武医院神经外科主任凌锋教授与英国的医生一起检查了刘海若的全身状况，并仔细讨论了病历及CT片。 凌教授认为，刘海若已有自主呼吸，另外对刺激有收缩反应，并且有咳嗽，这些都证明她不是“脑死亡”，生存下来是可能的。

  5. 刘海若苏醒创医学奇迹 八方援手力催凤凰重生2002年08月16日每日新报 • 三个月前在英国因车祸陷入昏迷的凤凰卫视女主播刘海若，不久前已在北京宣武医院恢复神志。 • 8月上旬，海若已经可以清晰地做出各种表情反应了，当医生说出数字时，海若已经能用手比划出动作了。主治医生凌锋表示，海若的病情有了质的变化，虽然距离正常人反应的灵敏程度还相差很远，但她已经不是植物人了，确切地说———海若已经醒了。

  6. Ⅰ.Consciousness • the state of the patient’s awareness of self and environment and his responsiveness to external stimulation and inner need.

  7. Content of consciousness • Orientation • percepbility • attitudes • emotions • active

  8. Structural basis • 1.ascending reticular activating system, ARAS reticular formation thalamus cerebral hemisphere alert state • 2.cortex

  9. Ⅱ clinical manifestation 1.according to level of consciousness 2.according to content of consciousness

  10. 1.level of consciousness (1) Somnolent (2) Stupor (3) Coma lesser degree deep

  11. Somnolent

  12. stupor Can be roused only by vigorous and repeated stimuli, when left unstimulated they quickly drift into a sleeplike state.

  13. coma • The patient who appears to be asleep and at the same time incapable of being aroused by external stimuli or inner need. • lesser degree coma: reflex (+) • Deep coma: no reaction of any kind is obtainable, corneal, pupillary, pharyngeal, tenden reflex (-)

  14. 2.content of consciousness Confusion Delirium Special Type Decorticated Syndrome Akinetic mutism

  15. confusion • “clouding of the sensorium” • Inability to think with customary speed • Marked by some degree of inattentiveness and disorientation accompanied by illusions

  16. Delirium state • Hallucination, hyperactivity • High fever, atropine overdose, alcohol

  17. Decorticated syndrome • Neocortical death • ARAS is normal, arousal-nonarousal cycle • Open eyes, blink, swallow, eyes move • Coma, Show no signs of awareness of the environment or inner need • Vegetative state, decerebrate rigidity 12 in 45 awakened in 2 weeks, >3 month:PVS

  18. Akinetic mutism • The term akinetic mutism has been applied to yet another group of patients who are silent and inert as a result of bilateral lesions of the anterior parts of the frontal lobes, leaving the intact of the motor and sensory pathways; the patient is profoundly apathetic, lacking to an extreme degree the psychic drive or impulse to action(abulia). The abulic patient registers most of what is happening about him and forms memories.

  19. Ⅲ differential diagnosis Abulia Locked-in syndrome

  20. abulia • The patient are silent and inert as a result of bilateral lesions of the anterior parts of the frontal lobe, leaving intact the motor and sensory pathways, the patient is lacking to an extreme degree the psychic drive or impulse to action.

  21. Locked-in syndrome • Lesion of the ventral pons (basis pons) • Interrupts the corticobulbar and corticospinal pathways • depriving the patient of speech and the capacity to respond in any way except by vertical gaze and blinking • wakefulness

  22. Ⅳ brain deathHarvard medical school committee1968 • 1. Absence of cerebral function • 2. Absence of brainstem function • including spontaneous respiration • 3. Irreversibility

  23. Brain death • 1. Absence of cerebral function: Deep coma, total lack of spontaneous movement, and of motor and vocal responses to all visual auditory and cutaneous stimulation • 2. No spontaneous respiration • 3. Absence of brain stem function: Dilated midposition fixed pupils, corneal reflex, oculocephalic and oculovestibular test, gag reflex(-), last for 12 hours • 4. EEG: flat or isoelectric (<2μV) during a 30-minutes recording • 5. Spinal reflex may persist • 6. Exclude intoxication, hypothermia, metabolic disturbance

  24. Section Ⅱ Aphasia, apraxia, agnosia

  25. aphasia • A loss or impairment of the production and/or the comprehension of the spoken or written language due to an acquired lesion of the brain • No higher order mental function disturbance i.e. Confusion, delirium, mental retardation • Not dysarthria • Not aphonia

  26. classification • 1.Parasylvian fissure aphasic syndrome Broca aphasia, Wernicke aphasia Conduction aphasia • 2.Transcortical aphasia Transcortical motor, sensory, mixed • 3.Global aphasia • 4.Anomic aphasia • 5.Subcortical aphasia syndrome thalamic aphasia, basal ganglion aphasia

  27. Broca aphasia • Primary deficit in speech production • Dominant hemisphere • Inferior frontal gyrus, posterior portion

  28. Wernicke aphasia • Primary deficit in comprehension • Paraphasia: literal: the grass is greel verbal: the grass is blue • Disturbance in repetition • Wernicke area: posterior portion of supratemporal gyrus

  29. Transcortical aphasia • Watershed area • Repetition is remarkably preserved

  30. Anomic aphasia • The patient lose only the ability to name people and objects • Middle temporal lobe

  31. Global (Total) aphasia • Left middle cerebral artery occlusion • All aspects of speech and language are affected • Can say only a few words

  32. Subcortical aphasia • Thalamic aphasia • Basal ganglion aphasia: nonfluent, dysarthric, paraphasic

  33. apraxia • The term apraxia is applied to a state in which a clear-minded patient with no weakness, ataxia or other extrapyramidal derangement and no defect of the primary modes of sensation loses the ability to execute highly complex and previously learned skills and gestures.

  34. apraxia • Ideomotor apraxia • Ideational apraxia • Melokinetic apraxia • Constructional apraxia • Facial-oral apraxia • Dressing apraxia

  35. agnosia • A highly-ordered perceptual disturbance, no elementary sensation disturbance, can not interpret sensations correctly. • Due to disorders of the association areas in the parietal lobes.

  36. agnosia • Visual agnosia: object, face, verbal • Auditory agnosia: verbal • Sensory agnosia • Body image disturbance non-dominant parietal lobe • Gerstmann syndrome finger agnosia, right-left confusion, dysgraphia, Dyscalculation Dominant hemisphere angular gyrus

  37. 伦敦火车出轨事故 凤凰卫视金牌主持脑死亡    中国日报网站消息：据法新社5月12日报道，在10日伦敦火车出轨的事故中丧生的7人里，包括两名台湾电视媒体工作人员。曾经在台湾电视网TVBS工作、现为香港凤凰卫视咨询台主持人的刘海若头部受到重创，已被诊断为脑死亡。 伦敦火车出轨事故 凤凰卫视金牌主持脑死亡    中国日报网站消息：据法新社5月12日报道，在10日伦敦火车出轨的事故中丧生的7人里，包括两名台湾电视媒体工作人员。曾经在台湾电视网TVBS工作、现为香港凤凰卫视咨询台主持人的刘海若头部受到重创，已被诊断为脑死亡。 

  38. 刘海若不是脑死亡 凌锋教授赴英会诊有结果 2002年05月20日17:04 北京晚报 • 前往英国为凤凰卫视记者刘海若会诊的北京宣武医院凌锋教授昨天下午1时3分返京。据凌教授介绍：刘海若的伤情已有转机，目前有自主呼吸，不是脑死亡。 • 　　宣武医院神经外科主任凌锋教授与英国的医生一起检查了刘海若的全身状况，并仔细讨论了病历及CT片。 凌教授认为，刘海若已有自主呼吸，另外对刺激有收缩反应，并且有咳嗽，这些都证明她不是“脑死亡”，生存下来是可能的。

  39. 刘海若苏醒创医学奇迹 八方援手力催凤凰重生2002年08月16日每日新报 • 三个月前在英国因车祸陷入昏迷的凤凰卫视女主播刘海若，不久前已在北京宣武医院恢复神志。 • 8月上旬，海若已经可以清晰地做出各种表情反应了，当医生说出数字时，海若已经能用手比划出动作了。主治医生凌锋表示，海若的病情有了质的变化，虽然距离正常人反应的灵敏程度还相差很远，但她已经不是植物人了，确切地说———海若已经醒了。

  40. 刘海若住院实况首次播放 恢复很快已能开口说话2002年09月07日北京娱乐信报 • 　　信报讯(记者张迪) “真没想到海若的病情会恢复得这么快，当我听见女儿对我说，‘爸爸，生日快乐’时，心里真高兴啊。”昨天，凤凰卫视女主持人刘海若的父亲刘凤翰兴奋地说。 • 　　昨天，宣武医院首次向媒体播放海若在医院里拍摄的录像，但为了尊重海若及其家人，海若的面容被“隐藏”起来。海若身穿浅蓝色条纹的住院服装，能很清晰地讲话，她对前 来看望她的市卫生局的金局长说：“谢谢金局长，谢谢大家对我的关心！”刘父说：“8月18日那天，第一次听到了她叫‘爸爸’，前几天过生日，她对我说，‘爸爸，生日快乐’。”

  41. Section 3 A.Disturbance of Vision B. Disturbance of Ocular Movement

  42. A Ⅰ. Visual pathway • Retina→optic nerve→ optic chiasm→optic tract →lateral geniculate nucleus (LGN)→optic radiation→occipital lobe(calcarine sulcus) • Optic chiasm: fibers from the nasal retinas cross over

  43. Ⅱ reduced vision 1. One eye • Central retinal artery occlusion • Amaurosis fugax • Retro-bulbar optic neuritis multiple sclerosis, neuromyelitis optica • Foster-Kennedy syndrome anosmia, optic atrophy on one side Papilledema on the other side , seen in frontal lobe tumor

  44. Ⅱ reduced vision 2. Two eyes • Cortical blindness : dilated pupil, light reflex is preserved • Toxic: methyl • Deficiency: pernicious anaemia

  45. Ⅲ visual field defect 1. Optic nerve: uniocular blindness

  46. Ⅲ visual field defect 2. Optic chiasm: • bitemporal hemianopia • seen in pituitary tumor, craniopharyngioma

  47. Ⅲ visual field defect 3. Optic tract: homonymous hemianopia

  48. Ⅲ visual field defect 4. 5. Optic radiation: quadrant anopia

More Related