1、Introduction of neurology Jia,Jianping What is new?The 6th edition The new board What is new?Coping with the clinical practice Accord to the clinical sequence Reinforce new concept Refer to new criteria Run by concise 人口老龄化人口老龄化问题日益突出，脑老化与认知功能障碍患者增加迅速问题日益突出，脑老化与认知功能障碍患者增加迅速。全国和北京市65岁以上老年人口比例（%）我国认知障
2、碍疾病的患病率（%）研究背景研究背景 我国脑血管病发病率逐年递增我国脑血管病发病率逐年递增 中国-MONICA 25-74岁人群脑卒中发病率 年龄标化发病率(1/100000)我国现有脑血管病患者我国现有脑血管病患者1300余万人，每年有余万人，每年有150万万-200万万新发脑卒中患者，新发脑卒中患者，年发病率（年发病率（116-219）/10万人口万人口 中华神经科杂志.2010;43(2):1-7.中国心血管病报告(2008-2009)2002年我国成人高血压患者1.6 亿，患病率达18.8 中国高血压防治指南(2005年修订版)中国高血压防治指南(2009年基层版)我国历次全国调查高血
3、压患病率(%)20.00%16.00%12.00%8.00%4.00%0.00%1959 1980 1991 2002 我国高血压患病率持续增长我国高血压患病率持续增长 2006年中国高血压人数2亿，每年新增高血压患者1000万 中华医学会糖尿病分会 2007.6-2008.5 中华医学会糖尿病学分会.中华内分泌代谢杂志,2008;24:2a1-22 N Engl J Med 2010;362:1090-1101.9.7%患病率（患病率（%）中华医学会糖尿病学分会最新流调数据显示：年龄标化的总糖尿病（既往诊断的和既往未诊断的糖尿病）患病率为9.7%；糖尿病前期（空腹血糖受损或糖耐量受损）患病率
4、为15.5%。中国成年人中国成年人 9240万万有糖尿病有糖尿病!中国糖尿病患病率逐年上升中国糖尿病患病率逐年上升 What is Neurology?Neurology is an art,technique and science of studying of the cause,pathology,pathogenesis,clinical manifestation,diagnosis,treatment and rehabilitation of nervous and muscular diseases.神经病学是研究神经系神经病学是研究神经系统疾病与骨骼肌疾病的病统疾病与骨骼肌疾
5、病的病因、病理、发病机制、临因、病理、发病机制、临床表现、诊断、防治、康床表现、诊断、防治、康复和预防的一门临床学科。复和预防的一门临床学科。Neurology is a member in Neuroscience family Neurology is a one in Neuroscience family.It is related and linked to neuroanatomy,neuropathology,neuroembryology,neurophysiology,neurobiochemistry,neuropharmacology,neurobiology,neuro
6、genetics,neuroimmunology,neuroendocrinology,neuroradiology,neuropsycology,neuroophthalmology,otoneurology,and neurosurgery.神经病学是神经科学的一个重要组神经病学是神经科学的一个重要组成部分，它与神经解剖学、神经病成部分，它与神经解剖学、神经病理学、神经组织胚胎学、神经生理理学、神经组织胚胎学、神经生理学、神经生物化学、神经药理学、学、神经生物化学、神经药理学、神经生物学、神经遗传学、神经免神经生物学、神经遗传学、神经免疫学、神经内分泌学、神经放射学、疫学、神经内分泌学、神
7、经放射学、神经心理学、神经眼科学、神经耳神经心理学、神经眼科学、神经耳科学和神经外科学互相联系、互相科学和神经外科学互相联系、互相渗透、互相促进。渗透、互相促进。Position Neuroscience Clinical Basic Neurology Neurosurgery Neuropediatries Senile Neurology Neuroanatorny Neurophysiology Neuropathology Neuropharmacology Neurobiology Neuropharmacology 1.The Task of Neurology To devel
8、op the Neurological theory with new concept parallel to advanced countries To elevate the level of diagnosis and treatment of neurological diseases so as to culture eligible doctor in Neurology To reduce incidence and prevelence of neurological disease 发展神经病学理论水发展神经病学理论水平，与世界接轨平，与世界接轨 培养合格的神经科医培养合格的
9、神经科医师师 减少神经科疾病的发减少神经科疾病的发生率和患病率生率和患病率 2.The Characteristics of Neurology 1-The complexity of the disease Nervous system and muscle structure is very complicated,if several parts of both of them damaged,the symptoms will overlap This is why we usually make direction,localization,qualitation diagnosis
10、 2.The Characteristics of Neurology 2-The extensiveness of symptoms One disease can have different symptoms Example:Encephalitis can include headache and epilepsy Same symptom can origin from different disease Example:Headache can be caused by encephalitis,also by tumors 2.The Characteristics of Neu
11、rology 3-The Dependence of diagnosis Scientific development makes the Neurologist more and more dependent on auxiliary examination:CT:Cerebral hemorrhage MRI:Multiple sclerosis Serology:Syphilis 脑脑CT扫描提示颈扫描提示颈内动脉血栓形成内动脉血栓形成致左侧大脑半球致左侧大脑半球低密度梗死（箭低密度梗死（箭头），同侧脑室头），同侧脑室受压变小受压变小 脑脑CT扫描提示右扫描提示右侧大脑半球出血性侧大脑半
12、球出血性梗死，即低密度的梗死，即低密度的梗死灶（星号）周梗死灶（星号）周围伴有点片状高密围伴有点片状高密度出血灶（箭头）度出血灶（箭头）脑脑CT扫描提示溶栓扫描提示溶栓后发生的右侧大脑后发生的右侧大脑半球出血性梗死，半球出血性梗死，即在低密度梗死灶即在低密度梗死灶（星号）内伴发大（星号）内伴发大片高密度出血灶片高密度出血灶（箭头）（箭头）脑脑MRI提示脑干梗提示脑干梗死（箭头）呈长死（箭头）呈长T2信号信号 脑脑CT扫描提示扫描提示多发性脑栓塞多发性脑栓塞致双侧大脑半致双侧大脑半球多发性脑梗球多发性脑梗死（箭头）死（箭头）脑脑CT扫描提示扫描提示左侧基底节区出左侧基底节区出血呈均匀高密度血呈均
13、匀高密度病灶（箭头）病灶（箭头）脑脑CT扫描提扫描提示脑干出血示脑干出血（箭头）呈（箭头）呈高密度病灶高密度病灶 脑脑CT扫描提示左扫描提示左侧大脑半球的脑侧大脑半球的脑叶出血（箭头）叶出血（箭头）并破入脑室（星并破入脑室（星号），均呈均匀号），均呈均匀性高密度病灶性高密度病灶 脑脑CT扫描提示蛛扫描提示蛛网膜下腔出血，网膜下腔出血，脑干周围的环池脑干周围的环池为高密度病灶为高密度病灶（箭头）（箭头）2.The Characteristics of Neurology 4-The severity of the disease More acute and severe neurologica
14、l emergency,such as cerebral hemorrhage,cerebral infarction Need to develop ability to handle emergency 2.The Characteristics of Neurology 5-The Refractoriness of the disease Some disease curable:most Inflammation Some disease treatable:epilepsy,Parkinsons disease and cerebrovascular disease Some di
15、sease untreatable:malignant tumor 3.The Practice of Neurology The procedure of diagnosis:Careful asking case history and making through physical examination Usage of knowledge of anatomy and physiology,to find the lesion parts Usage of auxiliary examination,to confirm,and make a final dianosis 3.The
16、 Practice of Neurology The ability of interpretation of auxiliary:CT,digital subtraction angiography,MRI,evoked potentials,EMG,EEG,TCD,carotid artery ultrasound,PET,MEG,nerve and muscle tissue biopsy,cerebrospinal fluid cells and biochemical tests,blood-specific antigen and antibody tests,genetic testing positioning of qualitative However,any additional tests are not a substitute for medical examination and clinical analysis 28 我国城乡脑卒中我国城乡脑卒中 发病率约为发病率约为200/10万万 患病率患病率约约为为400/10万万 死亡率为死亡率为冠心冠心病的病