Please enable JavaScript.

Coggle requires JavaScript to display documents.

lower limb weakness, , ?, - Coggle Diagram

- - - - 臨床症狀
        
        motor
        
        Masseter bulk symmetric.
        
        difficult in swallowing and making facial expression was noted 2
        days before
        
        Dysarthria + (labial). Dysphagia +, Diplopia -.
        
        MP: 5/5/5/5.
        
        FNF: no dysmetria.
        
        Tongue, uvula no deviation.
        
        Masseter bulk symmetric.
        
        Neurological Examination: GCS:15, LR: +/+. Facial diplegia (Right side worse).
        
        ascending paralysis：from distal to proximal, most prominent in proximally (nerve root)
        
        general weakness, poor appetite and vomiting
        
        Sensory
        
        Angina-like chest pain
        
        Symmetric pinprick and light touch over face
        
        Pinprick sensation: symmetrical decrease over bilateral foot.
        
        No obvious dermatome distribution. Joint position sharp over thumb and toe.
        
        enhanced cold
        sensation
        
        absent perianal
        sense while wiping and difficulty voiding
        
        bilateral upper limbs numbness
        
        reflex
        
        Abd superficial reflex absent.
        
        areflexia
        
        DTR: general +. Hoffman -/-
      - 可發生於感染性疾病、疫苗接種（vaccination）或者外科處理後
      - 空腸彎麴菌(Campylobacter jejuni)感染與本病可能有關，還可能與CMV、EBV、MPn（肺炎支原體）、HBV和HIV等感染有關。
      - 流行病
        
        各個年齡層，發生率會隨年齡的上升而增加
        
        男性略多於女性
      - 細胞-蛋白分離(cytoalbuminologic dissociation)是特徵性表現
    - - fasciculation
      - tone：decreased
      - Atrophy:present
      - distribution of weakness：distal/segmental
      - muscle stretch reflex：hypoactive/abscent
      - Babinski: normal
  - - - tone：spastic
      - muscle stretch reflex：hyperactive
      - distribution of weakness：pyrimidal/regional
      - barbinski sign
      - Atrophy：none
      - fasciculation：none
  - - - NPH triad
        
        cognitive impairment
        
        gait disturbance(shuffling steps)
        
        urinary incontinence
      - 其他症狀
        
        Frequent fall down
        
        decreased lower limb muscle power bilaterally
      - 診斷
        
        NPH triad
        
        Cognitive function test
        
        CASI
        
        MMSE
        
        result
        
        dementia
        
        poor repetition and executive
        function
        
        CT or MRI
        
        ventricular enlargement disproportionate to cerebral atrophy
        
        periventricular hyperintensity
        
        thinning and elevation of the corpus callosum
        
        widening of temporal horns without hippocampal atrophy
        
        Evans' ratio
        
        maximum ventricular width divided by the largest biparietal distance between the inner tables of the skull
        
        Evans' ratio>0.3
        
        CSF opening pressure <24 cm of water.
      - Possible cause
        
        cerebral artery infarction and hypertension
        
        injury
        
        infection
        
        brain tumor
        
        unknown
        
        surgery
- - - - 症狀
        
        vertigo
        
        loss of balance
        
        Nausea
        
        Vomiting
        
        起床或轉頭時突發性眩暈，感覺天旋地轉
        
        無法站穩或走路，發作前可伴耳鳴。
      - 病生理
        
        因核相鄰，迷走神經核易受到前庭神經核影響
        
        當前庭神經核電位變化，迷走神經張力變化
      - 流病
        
        良性陣發性位置性眩暈是最常見的一種周圍性眩暈，病變多在後半規管。以Epley手法可減輕或緩解眩暈不適症狀。
        
        1921年Barany首次報導本病，是最常見的一種周圍性眩暈
        
        most common cause of positional vertigo
    - - 症狀
        
        Recurring episodes of vertigo
        
        Progressive hearing loss: irreversible, from low frequency
        
        tinnitus
        
        aural fullness
        
        患者常會抱怨怕聽到吵雜的聲音
      - 病理
        
        Improper fluid drainage, perhaps because of a blockage or anatomic abnormality
        
        Abnormal immune response
        
        Viral infection
        
        Genetic predisposition
      - 藥物治療不理想，嚴重影響到患者的生活者，可以選擇手術治療
      - 流病
        
        男女發病率無明顯差異
        
        多為單側，2/3 患者以眩暈為主要症狀
        
        常見於 30~50 歲成年人
        
        有 1/3 的患者在 2~5 年後會發生雙側性的梅尼爾氏症。
      - 診斷
        
        Two or more episodes of vertigo lasting at least 20 minutes each
        
        Tinnitus
        
        Temporary hearing loss
        
        A feeling of fullness in the ear
  - - - 肌肉酸痛無力、常抽筋和心悸的症狀，其他還包括四肢刺痛或麻木、難以移動手臂或腿部、噁心嘔吐、便祕、口渴、頭昏(低血壓）
  - - - 小腦
    - - vertical
        
        central lesion
      - horizontal
        
        兩側都有
        
        central
        
        偏向一側
        
        peripheral
    - - Proprioception
      - Vestibular sense
      - Visual