tremor is a part or all of the body through a certain direction, involuntary, rhythmic or non-rhythmic vibration. More common in the hands, feet, tongue, mouth and other eyelid. Head, leg coherent rare. Functional tremor: tremor magnitude larger than the physiological, the naked eye can detect, its causes can be found in hypoglycemia, pheochromocytoma, hyperthyroidism, alcoholism, poisoning, etc. Also found in normal human emotion, fatigue, fear, anger, stage fright, and other strenuous exercise. plague tremor also fall into this category, the tremor often irregular, location is not fixed, often accompanied by mental retardation and other signs of distemper.[Cause]
1. in medicine, this disease is Evils intrusive body, injury context, spillover from the blood by the mucous membrane from the skin. The cause of the feelings of evils, diet disloyal, blood stasis, chronic illness mainly deficiency of blood loss, clinical evidence to sun, heat syndrome, evidence for multiple, if persistent endless, repeated episodes of the performance of the actual situation of the card mix and xu Zheng. Department of allergic purpura early feelings of evils, burns caused by blood contact, and even then the resulting heat-toxin to be filled, forcing the blood wang Xing. If unhealed course, or repeated attacks, in turn manifested as blood deficiency, blood stasis context, into the intractable disease.
2. western view, allergic purpura are autoimmune diseases, because the body is allergic to certain substances which cause allergic capillary permeability and fragility increase, lead to subcutaneous tissue, mucous membranes and internal organs, hemorrhage and edema. allergens may be due to many factors, but for each specific case to find the exact cause, often with some difficulty. Usually with a variety of predisposing factors that may be relevant, but often difficult to direct certain risk factors.
(1) factors, the most common bacterial infection in the β-hemolytic streptococcus infection, followed by staphylococcus aureus, mycobacterium tuberculosis, typhoid bacillus, pneumococcus and pseudomonas bacteria, upper respiratory tract inflammation is more common, can also be seen in pneumonia, tonsillitis, scarlet fever, dysentery, urinary tract infection, impetigo, tuberculosis and infectious lesions (skin, teeth, mouth, ear), etc. There rubella virus infection, influenza, measles, chickenpox, mumps, and hepatitis. parasitic infections can also cause the disease to roundworm infection is more common, as well as hookworm, whipworm, tapeworm, schistosomiasis, trichomonas vaginalis, parasite infections.
(4) other factors, insect bites, pollen, cold, trauma, menopause, tuberculin test, vaccination, and spiritual factors can cause. Also in hemodialysis patients, lymphoma patients after chemotherapy and in patients with guillain-barre syndrome, allergic purpura have been reported.
(B) the pathogenesis
1. rapid onset allergy allergens into the body, combined with the formation of protein antigens, antigen after a certain incubation period (5 to 20 days), to stimulate immunohistochemistry, and plasma cells produce IgE. ige adsorbed on the body's mast cells in various organs (blood vessels around the stomach, skin). When the re-encounter the same antigen, the antigen will be adsorbed on the mast cells with ige on the combined activation of the enzyme system in the cells, mast cells to release a series of biologically active substances such as histamine ,5-TH, bradykinin, slow-reacting substance allergies (SRS-A), but also excited sympathetic to release acetylcholine. SRS-A by leukotriene C4 (LTC4) and its metabolites LTE, LTD4 formed. LTC4 in γ glutamyl peptidase role, into LTD4, the latter under the action of the dipeptidase into LTE4. This series of biologically active substances, a major role in the smooth muscle, causing small arteries, telangiectasia, increased permeability, tissue, organs, hemorrhage, edema.
2. antigen - antibody complex reaction which is the main pathogenesis. allergens stimulate the plasma cells produce igg (also produced igm and IgA), the latter with the corresponding antigen to form antigen-antibody complex, the small portion of the molecule is soluble in the blood vessel wall or can be deposited on the glomerular basement membrane, activation of the complement system generated C3a, C5a, C5, C6, C7 can attract neutrophils, which engulf antigen - antibody complex, the release of lysosomal enzymes, causing vasculitis, involving the corresponding organs. Another part of the immune complexes, antibody than antigen, molecular weight compound, is insoluble and precipitate were down sheets macrophage clearance system, generally do not produce pathological changes.
3. The role of cytokines has been reported in patients with allergic purpura TNFα and soluble TNF receptor (sTNFR) in the normal range, while sIL-2R levels. Associated with kidney damage in the kidney in patients with allergic purpura local tissue cells, a variety of proinflammatory cytokines such as IL-1α, IL-1β, tnf-α and LT and other expression. Recently there have been reports of allergic purpura patients, especially in the acute phase serum il-4 levels were significantly increased, the upper limit of normal levels of 5 to 40 times, suggesting that cytokines involved in the pathogenesis of allergic purpura. il-4 for ige synthesis, it may be an important factor in the disease process.[Sign]
1. symptoms and signs
(1) skin symptoms: the lower limbs and hip joints in groups appear near symmetric distribution, size, ranging from rash-like purpura was mainly distributed in the lower limb extensor side and buttocks, often symmetrical, a few involving the face and trunk. purpura may be prominent leather, with a slight itching, first as a bright red, then dark red, brown, also the performance of urticaria, angioedema, erythema multiforme, or ulcers such as necrosis and hemorrhagic bullae. rash of different sizes, can be integrated into the film, in batches, can be repeated seizures, and some may be associated with localized or diffuse edema, such as head, face, eyelids, etc. After skin purpura usually about two weeks and gradually subsided.
(2) joint symptoms: Clinical, said the joint type. joint pain can be mild to significant redness, swelling, pain and movement disorder, may have single or multiple, migratory joint pain or arthritis, and sometimes local tenderness, lesions often involving large joints, the knee, ankle, elbow, wrist and other joints more common, can be presented migratory, often easily mistaken for "rheumatism." Mainly around the joint disease, can be repeated attacks, but without leaving the joint deformity, disease, also known as Schönlein-type, in children of patients with joint symptoms associated with the scrotum while more involved, can help identify the diagnosis of atypical allergic purpura .
(3) gastrointestinal symptoms: about 2 / 3 patients, and since bloody fluid into the intestinal wall, abdominal pain often has colic, and more in the right lower abdomen, and Cullen, also throughout the whole abdomen, but rarely muscle tension, may be associated with nausea, vomiting, bloody diarrhea and mucus stools, etc., irregular intestinal peristalsis, can lead to intussusception, which is more common in children, such as abdominal symptoms not associated with purpura, often misdiagnosed. "acute abdomen." abdominal symptoms, also known as Henoch-type type. Clinical abdominal said.
(4) kidney symptoms: purpura usually in 2 to 4 weeks gross hematuria or microscopic hematuria, proteinuria and tubular urine, can also be seen in the rash subsided or quiescent disease. Usually recover in a few weeks, can occur with severe renal dysfunction, azotemia, and hypertensive encephalopathy. A few cases, hematuria, proteinuria or hypertension sustainable than 2 years. Clinical renovascular said.
(5) a small number of patients with neurological symptoms after the symptoms of purpura, lesions involving the cerebral and meningeal blood vessels can also be expressed as the central nervous system symptoms such as headache, vomiting, dizziness , vertigo, trance, irritability, delirium, paralysis, intracranial hemorrhage, and coma.
2. may have a common complication of intussusception, intestinal obstruction, intestinal perforation, hemorrhagic necrosis, enterocolitis, intracranial hemorrhage, multiple neuritis, myocarditis, acute pancreatitis , orchitis, and pulmonary bleeding.
1. blood often go check: mild to moderate increase in blood cells, normal eosinophils or increased, the amount of bleeding can be more anemia, clotting time, platelet count, clot contraction time were normal.
2. ESR: esr majority of patients.
3. anti-O: can be increased.
7. fecal occult blood: gastrointestinal bleeding, the positive type.
8. capillary fragility test: about half of the patients was positive.
the disease is no uniform diagnostic criteria.
(1) american College of Rheumatology diagnostic criteria developed in 1990 include the following four: ① skin purpura than leather, not associated with thrombocytopenia; ② onset age ≤ 20 years old; ③ gripes, showed diffuse, increased meal, or intestinal ischemia, usually accompanied by bloody diarrhea; ④ biopsy, a small artery and small vein infiltration of neutrophils.
comply with the above four in two or two or more to diagnose the disease.
① clinical manifestations:
B. in the vicinity of joints of lower limbs and buttocks appear symmetrically in groups ranging in size of the rash-like purpura based, may be associated with urticaria or edema, pleomorphic erythema.
C. in the course of the disease may have hemorrhagic colitis or joint pain, a small number of patients with abdominal pain or joint pain may occur in the first 2 Zhou Fasheng purpura. Often purpura nephritis.
③ histology: affected parts of the dermis layer of the small blood vessels around the neutrophil aggregation, blood vessel wall may have focal fiber necrosis, epithelial cell proliferation and leakage of red blood cells extravascular, immunofluorescence examination showed vasculitis lesions IgA and C3 in the vessel wall dermis calm.
meet the clinical manifestations, particularly non-thrombocytopenic purpura, a palpable and of the typical rash, can exclude other types of purpura who can confirm the diagnosis. Differential diagnosis can be difficult indeed for pathological examination.
2. Diagnostic assessment of the american College of Rheumatology diagnostic criteria sensitivity of 87.1%, specificity of 87.7%. However, the significance of each standard are not equal, the most typical skin purpura sensitivity and specificity, followed by age of onset. In addition, all patients at the onset of heavy or light or almost all of the skin purpura. Hence, if the "line 2 or 2 above can be diagnosed" to "shall have the first ① plus other one or one or more can be diagnosed," it seems more reasonable. biopsy do not have the specificity of the pathology, which is not necessary for diagnosis. Typical clinical manifestations and results of routine laboratory tests to diagnose the disease usually only in the differential diagnosis is indeed difficult to do when considering pathological examination. In addition, about 30% of patients renal damage, but the american College of Rheumatology criteria did not include this point, is the shortcoming of the Department. zhang Nan editor of the "blood disease diagnosis and treatment standards," a book developed country, although lengthy diagnostic criteria, but taking into account these shortcomings, it seems more reasonable.
past, often based on the main clinical manifestations, the type of the disease into the skin (purpura simplex type), abdominal, joint type and type nephritis (nephritis), if two or more types in combination referred to as mixed. organ damage due to some more insidious, sometimes difficult to exclude the current type is no longer emphasized. It should be clear that a different location and extent of involvement, the prognosis is very different. The worst prognosis, such as kidney damage. Therefore, the condition should be constantly reassessed repeatedly location and extent of involvement.[Aftertreat]
side a fried peanut child
Usage: the two flavor water decoction, 1, 2 service.
effects: blood, cooling blood, stop bleeding.
side 2 Malan eggs and
effect: yin Jiang Huo, security network to stop bleeding.
usage: on the shamisen plus Shuijianbi day l agent, taken 2 times.
effect: qi blood.
effect: yin and blood.
2, eat more fruits and vegetables.
4, should eat more high-C, C has reduced the role of capillary permeability and fragility, patients to eat more of these contribute to recovery. C-rich with grapefruit, oranges, citrus, apple, lemon, strawberry, kiwi fruit, tomatoes and a variety of green leafy vegetables.
1, eat Feigan throat taste, spicy products prevent gastrointestinal accumulated heat;
functional tremor should be how to prevent?
1, more rational movement.
2, be happy.[Treat]
prevention of this disease, "avoid the gas" measures mainly in the following areas:
3. regulate emotions to feel relaxed and happy.
syndrome: short duration, the color red or purpuric purpurin, come and go quickly, or windy group of skin itching, fever red face, five upset hot, sore throat, mouth thirsty, urinate red then dry, hematuria, or scarlet red tongue, thin yellow tongue coating, rapid pulse.
Governing Law: detoxification, cooling chills.
Recipe: yin qiao San and rhino horn to yellow Decoction. Fang silver Flower, Forsythia, to the small, hot Sichuan berberine detoxification, rhino horn, Dan, habitat, red peony cooling blood detoxification, adding poria light penetration dampness, prunella clear diarrhea anger. lithospermum plus severe rash, heat Touzhen oneself; skin itching plus Kochia scoparia, white moss skin; sore throat plus Arctium; abdominal pain plus white peony, licorice; epigastric discomfort plus liquorice, jujube; epistaxis plus multiple intersecting, Biota orientalis; hematuria increased thistle, Rhizoma Imperatae; proteinuria plus Motherwort.
syndromes: duration of principal, repeated attacks, haunted retardation, purpura dark purple color, or purple, joint pain and abdominal pain, dark green surface and the lower eyelids, rough skin, white purple or purple cloth bloodshot eyes, throat, tongue dark or ecchymosis, thin white or thin yellow veins astringent or string.
Recipe: Taohongsiwu Tonga flavor. Fang peach kernel, safflower, angelica root, red peony blood circulation, habitat yin cooling, this side optional add Lithospermum, dandelion, skullcap and other heat Touzhen of the goods, in order to remove more than evil. joint pain, frankincense, myrrh; abdominal pain, the Canadian dollar Hu, Toosendan; proteinuria plus Motherwort.
syndrome: purpura repeated, delayed healing. purpura scattered faint, lighter color, tired after the increase, Shenpi fatigue, palpitations, shortness of breath, proteinuria, pink tongue, thin white moss or less moss, thin veins empty.
Recipe: Bazhen Tonga flavor. Fang Codonopsis, Atractylodes, Poria, licorice Spleen, angelica root, habitat, red peony blood circulation cooling, all parties were played up with the power of qi and blood. May be appropriate to increase shikonin, Rhizoma Imperatae, madder, etc. to enhance cooling blood detoxification. proteinuria were significantly add astragalus, motherwort; severe hematuria plus ligustrum lucidum, eclipta prostrata.
acupuncture main point: the song pool, Zusanli; prepared hole: gu, a sea of blood . First with the main points, the result is not ideal preparation when you add points. abdominal pain plus thorn Sanyinjiao, Taichong, off.
1. due process to eliminate pathogenic factors, infection control, get rid of parasites, to avoid allergic foods and drugs, which is to prevent recurrence and fundamental measures to cure the disease. Possible de-worming treatment.
2. general treatment
(1) anti-histamine drugs: promethazine hydrochloride can be used (not that root), chlorpheniramine (chlorpheniramine), pizotifen, to hydroxyzine chloride (Katsutoshi hydrochlorothiazide), or terfenadine tablets. Also with 10% calcium gluconate intravenously, but its efficacy is variable. Chlorpheniramine: 8mg, 3 times / d, orally; astemizole: 10mg, 2 times / d, orally.
(3) hemostatic: Kabbah crowe (An Tenuo new security network of blood) 10mg, 2 ~ 3 times / d, intramuscularly, or 40 ~ 60mg adding glucose solution intravenously. etamsylate (bleeding min) 0.25 ~ 0.5g, intramuscular injection, 2 to 3 times / d or intravenously. If kidney lesions antifibrinolytic drugs should be used with caution.
3. glucocorticoid inhibition of antigen - antibody reaction with anti-allergy and improve the role of vascular permeability. type of joint, abdominal, and skin-type effect is better, but void of hormones on the kidney lesions, some people think that not shorten the course, usually prednisone (prednisone) 30mg / d, in divided doses, such as one week rash subside and can be added to the 40 ~ 60mg / d, gradually reducing until symptom control disabled, you can also use hydrocortisone 100 ~ 200mg / d, her condition improved after the switch to oral.
4. immunosuppressive agents concurrent allergic purpura nephritis, or poor condition of hormone therapy may increase with prolonged immunosuppression, and hormones to commonly combined, can be used cyclophosphamide, azathioprine, etc., but it should be noted that concurrent infection.
5. anticoagulant therapy for rapidly progressive glomerulonephritis, nephrotic syndrome cases, in addition to use of corticosteroids, cyclophosphamide (CTX), but also with anticoagulant therapy, such as heparin 10 ~ 20U / (kg · h) × 4 weeks, so to maintain aptt 1.5 to 2.0 times the normal value.
7. other now, there have been reports of foreign hormones and immunosuppressive agents ineffective for severe allergic purpura patients aminophenyl sulfone may be an effective treatment. therapeutic dose of 100mg / d, should be checked before treatment G-6-PD level. It should be noted during treatment blood methemoglobin levels. Usually after 2 weeks of treatment, the typical symptoms can be under control. China has not been reported.
(b) the prognosis
most favorable prognosis of the disease, duration of usually 3 to 6 months, one seizure for 1 week to 6 months. Only joint and skin symptoms, short duration, were significantly longer duration of abdominal symptoms. If progress is complicated by nephritis, renal failure, or cerebral hemorrhage with brain lesions were serious prognosis. Ruijin Hospital statistics of the 350 cases of allergic purpura, discharged cured 181 cases (57.71%), improved in 153 cases (43.72%), healed in 15 cases (4.29%), death in 1 case (0.28%). The cause of death as nephritis progressed to renal failure, with pulmonary infection and sepsis.[Examine]
functional tremor which checks should be done?
spinal mri examination: the spine and spinal cord diseases, the diagnostic accuracy of mri was significantly higher than CT, the disease shows that accurate positioning can be used as the preferred screening method.
magnetic resonance imaging (MRI): mri in recent years a new type of high-tech imaging method is used until the early 1980s, the clinical diagnosis of new medical imaging technology. It has no ionizing radiation (radiation) damage; no bone artifacts; can have more direction (transverse, coronal, sagittal section, etc.) and multi-parameter imaging; high soft tissue resolution capabilities; without the use of contrast agents can show vascular structures and other unique advantages.
head ultrasound: 1, B-mode ultrasound brain examination method: mainly used for less than 2 years not closed fontanelle in children, through fontanelle as the "acoustic window" for sweep investigation. 2, transcranial color Doppler imaging: The temporal window, pillow windows, windows orbital exploration, exploration and cerebral artery can be, according to intracranial vascular flow rate, bandwidth, or audio abnormal flow abnormalities determined, applied to brain blood vessels disease diagnosis and etiology.[Diff]
function in the differential diagnosis of essential tremor:
1, resting tremor refers to the muscle completely relaxed in the case, which appeared in a quiet state of tremor. have more rhythm, rhythm of 4-6 times per second, jitter, action tremor can be combined, when the increased stress, sleep disappears. common in the head, jaw, upper leg. When in the upper extremity, the hand can be seen like Counting pills or rub-like movements common in Parkinson's syndrome. rest tremor seen in the midbrain tegmentum lesions in recent cross-arm with Parkinson's tremor in the clinical rest tremor, muscle rigidity and movement is characterized by reduction and any other diseases involving the extrapyramidal system may also cause the same clinical manifestations, the collectively referred to as Parkinson syndrome or Parkinson's syndrome.
place for children or adolescents tremor, muscle rigidity, involuntary movements, mental disorders, or liver cirrhosis of unknown cause should be thought of liver degeneration, cornea KF ring and if the family history that can confirm the diagnosis. the vast majority of laboratory tests of serum ceruloplasmin and serum copper oxidase reduced, urinary copper increased. very early diagnosis of the disease meaningful.
2, exercise-induced tremor is at rest does not appear, only when movement occurs when the tremor. symptoms of exercise-induced tremor is an important part of the cerebellum with the rest tremor compared, showing no rhythm, amplitude, with the emotional stress and enhanced. ① movement tremor: when the random movement, the stationary state disappears. The main reason is the antagonist muscle co-ordination disorder, found in the brain with arm lesions. ② postural tremor (intention tremor): When the body is in a certain position in the case appeared quiescent state disappears. more common in the upper limb or head to upper obvious emphasis on the proximal distal, when the upper arm inside and outside likely to cause rotation, seen in the cerebellar dentate nucleus, or dentate nucleus lesion on the outgoing path. ③ uncertainty tremor: sometimes stationary, sometimes the action of or in combination, also seen in Parkinson's syndrome .
spine mri Check: the spine and spinal cord diseases, the diagnostic accuracy of mri was significantly higher than CT, the disease shows that accurate positioning can be used as the preferred screening method.
magnetic resonance imaging (MRI) : Magnetic resonance imaging in recent years a new type of high-tech imaging method is used until the early 1980s, the clinical diagnosis of new medical imaging technology, which has no ionizing radiation (radiation) damage; no bone artifacts; be more direction (transverse, coronal, sagittal section, etc.) and multi-parameter imaging; high soft tissue resolution capabilities; without the use of contrast agents can show vascular structures and other unique advantages.
head ultrasound: 1, B-mode ultrasound brain examination method: mainly used for 2 years of age is not closed fontanelle children, through the fontanel as the "acoustic window" for scanning 2, transcranial color Doppler imaging: The temporal window, pillow windows, windows orbital exploration, exploration and cerebral artery can be, according to intracranial vascular flow rate, bandwidth , flow abnormalities or other audio anomalies identified, applied and cerebrovascular disease diagnosis and etiology.[Disease]
functional tremor-related diseases
more limbs symptoms
"O"-shaped legs, "X"-type legs, "duck step" gait "ape hand" deformity abnormal Q-angle normal white concave pace a character of a trigger finger snapping arm pain of brachial plexus involvement flatfoot patella fracture lack of strain or developmental patella patella patella patella without patellar pain, patellar pain after patellar crepitus before emptiness
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