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　　共(gong)濟失調是由什么原(yuan)因引起的？

　　發病原因：

　　(1)周(zhou)(zhou)圍神經病變：如各種病因(yin)所致的周(zhou)(zhou)圍神經炎。

　　(2)脊(ji)髓后索性(xing)(xing)病(bing)變：如(ru)脊(ji)髓癆，亞急性(xing)(xing)聯合變性(xing)(xing)等。

　　(3)前庭(ting)(ting)迷(mi)路性病變(bian)如前庭(ting)(ting)迷(mi)路炎(yan)癥(zheng)。

　　(4)小腦(nao)病(bing)變：如小腦(nao)出血(xue)，小腦(nao)梗死，小腦(nao)腫(zhong)瘤，小腦(nao)炎癥等。

　　(5)大腦額(e)葉(xie)(xie)，顳葉(xie)(xie)，頂葉(xie)(xie)，枕葉(xie)(xie)，胼胝體等部位病(bing)變如出(chu)血，缺血，炎癥，腫(zhong)瘤(liu)等。

　　共濟失調除了(le)其臨(lin)床表現外(wai)，還可引起(qi)其他疾(ji)病。患者易出現心肺并發癥如(ru)心臟擴大心律失常呼吸道(dao)感染(ran)等。少(shao)數患者臥床不起(qi)而殘(can)廢。

　　共(gong)濟(ji)失(shi)調通(tong)過(guo)患(huan)者(zhe)(zhe)的(de)日常(chang)(chang)生活動(dong)作(zuo)(zuo)來觀察，如(ru)穿衣、系扣、端水、書寫(xie)、進(jin)食、言語、步(bu)(bu)(bu)態(tai)等。行走不(bu)(bu)(bu)(bu)穩(wen)(wen)，步(bu)(bu)(bu)態(tai)蹣跚.動(dong)作(zuo)(zuo)不(bu)(bu)(bu)(bu)靈活，行走時(shi)(shi)兩腿(tui)分得很寬；成年發病(bing)(bing)(bing)者(zhe)(zhe)，步(bu)(bu)(bu)行時(shi)(shi)不(bu)(bu)(bu)(bu)能直(zhi)線。忽左(zuo)忽右呈(cheng)曲(qu)線前(qian)進(jin)，表(biao)(biao)現(xian)(xian)(xian)為剪刀(dao)步(bu)(bu)(bu)伐，呈(cheng)“Z”形(xing)前(qian)進(jin)偏(pian)斜，并努力用雙上肢協(xie)助維持身(shen)體(ti)的(de)平穩(wen)(wen)。睡覺有時(shi)(shi)為不(bu)(bu)(bu)(bu)停震(zhen)顫(zhan)。肌張(zhang)力的(de)改變(bian)(bian)隨(sui)病(bing)(bing)(bing)變(bian)(bian)可(ke)由降(jiang)低而(er)轉(zhuan)變(bian)(bian)為痙(jing)(jing)攣(luan)狀(zhuang)(zhuang)態(tai)，共(gong)濟(ji)失(shi)調步(bu)(bu)(bu)態(tai)也可(ke)隨(sui)之(zhi)(zhi)轉(zhuan)變(bian)(bian)為痙(jing)(jing)攣(luan)性(xing)(xing)共(gong)濟(ji)失(shi)調步(bu)(bu)(bu)態(tai)。站(zhan)立(li)不(bu)(bu)(bu)(bu)穩(wen)(wen)，身(shen)體(ti)前(qian)傾或(huo)(huo)(huo)左(zuo)右搖晃，當以足尖站(zhan)立(li)或(huo)(huo)(huo)以足跟站(zhan)立(li)時(shi)(shi)，搖晃不(bu)(bu)(bu)(bu)穩(wen)(wen)更(geng)(geng)為突出(chu)，易摔倒(dao)常(chang)(chang)是(shi)患(huan)者(zhe)(zhe)早期(qi)的(de)主(zhu)訴。患(huan)者(zhe)(zhe)常(chang)(chang)常(chang)(chang)說到：“走小(xiao)路(lu)或(huo)(huo)(huo)不(bu)(bu)(bu)(bu)平坦的(de)路(lu)時(shi)(shi)，行走不(bu)(bu)(bu)(bu)穩(wen)(wen)更(geng)(geng)明顯，更(geng)(geng)易摔倒(dao)”。隨(sui)病(bing)(bing)(bing)情的(de)進(jin)展，患(huan)者(zhe)(zhe)可(ke)表(biao)(biao)現(xian)(xian)(xian)起(qi)坐不(bu)(bu)(bu)(bu)穩(wen)(wen)或(huo)(huo)(huo)不(bu)(bu)(bu)(bu)能，直(zhi)至臥床。動(dong)作(zuo)(zuo)缺乏次序(xu)或(huo)(huo)(huo)條(tiao)理(li)，不(bu)(bu)(bu)(bu)規(gui)則(ze)，混亂(luan)和(he)不(bu)(bu)(bu)(bu)協(xie)調的(de)一(yi)種表(biao)(biao)現(xian)(xian)(xian)。是(shi)促動(dong)肌失(shi)去(qu)了拮抗肌收(shou)縮(suo)調整所致。包括(kuo)靜態(tai)性(xing)(xing)共(gong)濟(ji)失(shi)調和(he)動(dong)態(tai)性(xing)(xing)共(gong)濟(ji)失(shi)調兩種。前(qian)者(zhe)(zhe)主(zhu)要表(biao)(biao)現(xian)(xian)(xian)于軀體(ti)的(de)靜止(zhi)狀(zhuang)(zhuang)態(tai)下，即平衡(heng)障礙(ai)；后(hou)(hou)者(zhe)(zhe)主(zhu)要表(biao)(biao)現(xian)(xian)(xian)于肢體(ti)的(de)動(dong)作(zuo)(zuo)過(guo)程(cheng)中所出(chu)現(xian)(xian)(xian)的(de)一(yi)種辯(bian)距障礙(ai)--動(dong)作(zuo)(zuo)起(qi)動(dong)緩慢，速度和(he)力量不(bu)(bu)(bu)(bu)均，常(chang)(chang)不(bu)(bu)(bu)(bu)達(da)預定目標或(huo)(huo)(huo)停止(zhi)不(bu)(bu)(bu)(bu)及而(er)越出(chu)。臨(lin)床上常(chang)(chang)在睜眼及閉眼下分別(bie)用指(zhi)鼻、指(zhi)指(zhi)、輪(lun)替(ti)和(he)跟膝脛等試(shi)驗或(huo)(huo)(huo)觀察洗梳、書寫(xie)等精細動(dong)作(zuo)(zuo)以檢(jian)查之(zhi)(zhi)。小(xiao)腦病(bing)(bing)(bing)變(bian)(bian)時(shi)(shi)睜閉眼癥(zheng)(zheng)(zheng)狀(zhuang)(zhuang)相同，后(hou)(hou)索病(bing)(bing)(bing)變(bian)(bian)時(shi)(shi)睜眼癥(zheng)(zheng)(zheng)狀(zhuang)(zhuang)不(bu)(bu)(bu)(bu)明顯，僅(jin)閉眼后(hou)(hou)出(chu)現(xian)(xian)(xian)癥(zheng)(zheng)(zheng)狀(zhuang)(zhuang)，并伴有深感覺障礙(ai)。本征應與肌無力或(huo)(huo)(huo)肌張(zhang)力過(guo)高(gao)時(shi)(shi)所致的(de)動(dong)作(zuo)(zuo)不(bu)(bu)(bu)(bu)協(xie)調相簽別(bie)。

　　1.控制體重。應通過(guo)控(kong)制(zhi)飲食(shi)(尤其(qi)是高能量的食(shi)物)和體(ti)育鍛(duan)煉控(kong)制(zhi)體(ti)重避免危險因素的發生。

　　2.膳食營養要均衡。多(duo)吃(chi)蔬菜、水果和谷類食品，減(jian)少飽和脂肪酸(suan)和膽固醇的(de)攝(she)入;食鹽攝(she)入每天控制在6克以下。

　　3.堅持鍛煉。堅持鍛煉能降低20％的復(fu)發(fa)危險，每天(tian)至少進行30分鐘中(zhong)度體力(li)活動，例如散(san)步、慢跑、太極拳、騎自行車等，每周5-7次。

　　4.定期查體和咨詢。患者應定時(shi)檢查血(xue)(xue)壓、心電圖、血(xue)(xue)糖和血(xue)(xue)脂等，并(bing)根據自(zi)己的(de)檢查結果咨(zi)詢神經內科醫師，幫助解決遇見的(de)各種問題。

　　一、病史

　　1、起(qi)(qi)病(bing)急(ji)(ji)緩(huan)及病(bing)程，一(yi)(yi)般急(ji)(ji)性(xing)(xing)(xing)起(qi)(qi)病(bing)的(de)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)并(bing)且呈發(fa)(fa)作性(xing)(xing)(xing)，以(yi)(yi)前庭系統(tong)病(bing)變(bian)及眩(xuan)暈性(xing)(xing)(xing)癲(dian)癇的(de)可(ke)(ke)能性(xing)(xing)(xing)較(jiao)大。起(qi)(qi)病(bing)較(jiao)急(ji)(ji)，短時間(jian)內(nei)惡(e)化者(zhe)，經(jing)治療后很(hen)快好轉者(zhe)以(yi)(yi)急(ji)(ji)性(xing)(xing)(xing)小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)病(bing)變(bian)、中(zhong)樞神(shen)經(jing)系統(tong)炎癥(zheng)及腦(nao)(nao)(nao)(nao)(nao)外(wai)傷多(duo)見(jian)(jian)。起(qi)(qi)病(bing)較(jiao)急(ji)(ji)，并(bing)且迅速惡(e)化者(zhe)，有(you)時可(ke)(ke)危及生命(ming)的(de)以(yi)(yi)腦(nao)(nao)(nao)(nao)(nao)血(xue)(xue)(xue)管病(bing)、腦(nao)(nao)(nao)(nao)(nao)外(wai)傷尤其是小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)出血(xue)(xue)(xue)多(duo)見(jian)(jian)。酒(jiu)精中(zhong)毒及維生素(su)缺(que)乏導(dao)致(zhi)的(de)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)在(zai)改善營養狀(zhuang)況后可(ke)(ke)使共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)改善。有(you)緩(huan)解與復發(fa)(fa)的(de)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)以(yi)(yi)多(duo)發(fa)(fa)性(xing)(xing)(xing)硬化多(duo)見(jian)(jian)。2、年齡與家(jia)族史兒(er)童(tong)期(qi)(qi)以(yi)(yi)先天性(xing)(xing)(xing)小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)發(fa)(fa)育(yu)不全、遺(yi)傳性(xing)(xing)(xing)疾病(bing)、兒(er)童(tong)期(qi)(qi)急(ji)(ji)性(xing)(xing)(xing)小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)、腦(nao)(nao)(nao)(nao)(nao)炎等(deng)多(duo)見(jian)(jian)。青(qing)年期(qi)(qi)發(fa)(fa)病(bing)者(zhe)可(ke)(ke)見(jian)(jian)于少年型(xing)脊(ji)髓型(xing)遺(yi)傳性(xing)(xing)(xing)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)癥(zheng)、遺(yi)傳性(xing)(xing)(xing)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)、多(duo)發(fa)(fa)性(xing)(xing)(xing)神(shen)經(jing)炎、肌萎縮(suo)型(xing)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)癥(zheng)、肥大型(xing)間(jian)質(zhi)性(xing)(xing)(xing)神(shen)經(jing)病(bing)、脊(ji)髓空洞癥(zheng)等(deng)。青(qing)年與壯年發(fa)(fa)病(bing)者(zhe)可(ke)(ke)見(jian)(jian)于齒(chi)狀(zhuang)核(he)(he)紅(hong)核(he)(he)萎縮(suo)癥(zheng)、橄(gan)(gan)欖橋(qiao)(qiao)腦(nao)(nao)(nao)(nao)(nao)小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)變(bian)性(xing)(xing)(xing)、亞急(ji)(ji)性(xing)(xing)(xing)聯合(he)變(bian)性(xing)(xing)(xing)、毛細(xi)血(xue)(xue)(xue)管擴張共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)癥(zheng)等(deng)。中(zhong)老(lao)年多(duo)見(jian)(jian)于小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)萎縮(suo)、椎一(yi)(yi)基底動脈(mo)供血(xue)(xue)(xue)不足、小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)出血(xue)(xue)(xue)、腦(nao)(nao)(nao)(nao)(nao)血(xue)(xue)(xue)管病(bing)等(deng)。共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)部分(fen)有(you)遺(yi)傳因素(su)如先天性(xing)(xing)(xing)小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)發(fa)(fa)育(yu)不全、兒(er)童(tong)期(qi)(qi)急(ji)(ji)性(xing)(xing)(xing)小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)、少年型(xing)脊(ji)髓型(xing)遺(yi)傳性(xing)(xing)(xing)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)癥(zheng)。遺(yi)傳性(xing)(xing)(xing)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)多(duo)發(fa)(fa)性(xing)(xing)(xing)神(shen)經(jing)炎、肌萎縮(suo)型(xing)共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)癥(zheng)、肥大型(xing)間(jian)質(zhi)性(xing)(xing)(xing)神(shen)經(jing)病(bing)、齒(chi)狀(zhuang)核(he)(he)紅(hong)核(he)(he)萎縮(suo)癥(zheng)、橄(gan)(gan)欖橋(qiao)(qiao)腦(nao)(nao)(nao)(nao)(nao)小(xiao)(xiao)(xiao)腦(nao)(nao)(nao)(nao)(nao)變(bian)性(xing)(xing)(xing)、毛細(xi)血(xue)(xue)(xue)管擴張共(gong)(gong)(gong)(gong)(gong)濟(ji)(ji)失(shi)(shi)(shi)(shi)調(diao)(diao)癥(zheng)等(deng)。

　　二、體格檢查

　　1、指(zhi)(zhi)鼻試驗共(gong)濟(ji)(ji)失調(diao)(diao)(diao)時(shi)(shi)(shi)則表現(xian)為(wei)動作輕重(zhong)、快慢不一，誤指(zhi)(zhi)或經過(guo)調(diao)(diao)(diao)整(zheng)后才(cai)能指(zhi)(zhi)準目(mu)(mu)標。小腦半球病變時(shi)(shi)(shi)則表現(xian)為(wei)同側(ce)越接近目(mu)(mu)標時(shi)(shi)(shi)共(gong)濟(ji)(ji)失調(diao)(diao)(diao)越明顯，因(yin)辨(bian)距不良(liang)可常超越目(mu)(mu)標。感覺性(xing)共(gong)濟(ji)(ji)失調(diao)(diao)(diao)時(shi)(shi)(shi)，睜眼(yan)共(gong)濟(ji)(ji)運動無障礙，但閉眼(yan)時(shi)(shi)(shi)則出現(xian)明顯的共(gong)濟(ji)(ji)失調(diao)(diao)(diao)。2、跟膝(xi)脛試驗小腦損害舉腿和觸膝(xi)時(shi)(shi)(shi)因(yin)辨(bian)距不良(liang)和意向性(xing)震顫，下移時(shi)(shi)(shi)常搖(yao)擺不穩；感覺性(xing)共(gong)濟(ji)(ji)失調(diao)(diao)(diao)時(shi)(shi)(shi)，患者的足跟常尋不到膝(xi)蓋，下移時(shi)(shi)(shi)搖(yao)擺不定(ding)。

　　3．快速(su)輪(lun)替試驗小腦損害時動作笨(ben)拙(zhuo)，節律不均。

　　4．反擊(ji)征 小(xiao)腦(nao)病變時(shi)．患者常導致動作過度而捶(chui)擊(ji)自(zi)己。

　　5．過指(zhi)試驗(yan)前(qian)庭性(xing)共濟(ji)失(shi)調(diao)時(shi)，上肢(zhi)下降(jiang)時(shi)偏向迷路有病變的一側；感覺(jue)性(xing)共濟(ji)失(shi)調(diao)時(shi)，閉眼時(shi)常尋不到檢查者的手指(zhi)。

　　6．趾(zhi)-指試驗患(huan)者仰(yang)臥，上舉大腳趾(zhi)來觸(chu)及伸(shen)出的(de)手指。

　　7．起坐(zuo)試驗(yan)小腦損(sun)害的患者(zhe)髓部和軀干同時屈曲，雙下肢抬起，稱聯合屈曲征。

　　三、輔助檢查

　　1．小(xiao)(xiao)腦(nao)性(xing)共濟失(shi)調(diao)應檢查腦(nao)CT或MRI，以排(pai)除小(xiao)(xiao)腦(nao)腫(zhong)瘤(liu)、轉移瘤(liu)、結核(he)瘤(liu)或膿腫(zhong)及(ji)血(xue)管(guan)病及(ji)小(xiao)(xiao)腦(nao)變性(xing)及(ji)萎縮等。

　　2．深感覺障礙(ai)性(xing)共濟失調(diao)如(ru)定位(wei)(wei)(wei)病(bing)變(bian)位(wei)(wei)(wei)于周圍神經應檢(jian)(jian)查(cha)肌(ji)電圖、體感誘發電位(wei)(wei)(wei)；如(ru)考慮在后根病(bing)變(bian)或(huo)后索病(bing)變(bian)應檢(jian)(jian)查(cha)肌(ji)電圖、誘發電位(wei)(wei)(wei)、病(bing)變(bian)部(bu)位(wei)(wei)(wei)的MRI，腦(nao)脊(ji)液檢(jian)(jian)查(cha)，或(huo)脊(ji)髓造影檢(jian)(jian)查(cha)。考慮在丘(qiu)腦(nao)或(huo)頂葉時最好(hao)檢(jian)(jian)查(cha)腦(nao)CT或(huo)MRI。

　　3．大腦性共濟失(shi)調應檢查腦CT或(huo)MRI、腦電(dian)圖等。

　　4．前(qian)庭(ting)性共濟失調可檢查(cha)(cha)電測(ce)聽(ting)、聽(ting)覺誘發電位、前(qian)庭(ting)功能檢查(cha)(cha)等。

　　患者可(ke)以適量的(de)(de)(de)吃雞蛋。雞蛋中(zhong)所含的(de)(de)(de)蛋白質(zhi)是天然(ran)食物(wu)(wu)中(zhong)最優良的(de)(de)(de)蛋白質(zhi)之一(yi)，而蛋黃除(chu)富含卵(luan)磷脂外，還含有豐富的(de)(de)(de)鈣(gai)、磷、鐵(tie)以及維生素A、D、B等。意見建議：菠蘿(luo)(luo)、檸檬(meng)、香蕉菠蘿(luo)(luo)中(zhong)富含維生素C和重要的(de)(de)(de)微量元素錳，對提(ti)(ti)(ti)高人(ren)的(de)(de)(de)記憶(yi)力(li)有幫助；檸檬(meng)可(ke)提(ti)(ti)(ti)高人(ren)的(de)(de)(de)認知能(neng)力(li)；香蕉可(ke)向大腦提(ti)(ti)(ti)供(gong)重要的(de)(de)(de)物(wu)(wu)質(zhi)酪氨酸，可(ke)使人(ren)精力(li)充沛、注意力(li)集中(zhong)，并能(neng)提(ti)(ti)(ti)高人(ren)的(de)(de)(de)創(chuang)造能(neng)力(li)。

　　可(ke)用各種B族(zu)維生(sheng)素(su)、胞二磷膽堿肌(ji)注、口服卵磷脂等。國內(nei)有應(ying)用TMES療法(fa)治療共濟失調取得良(liang)好(hao)療效的報道，晚期患者應(ying)注意(yi)預防各種感(gan)染(ran)。弓形足可(ke)行矯形手(shou)術或穿矯形鞋等。

　　本病發(fa)展(zhan)緩(huan)慢(man)，如無嚴重的(de)(de)(de)的(de)(de)(de)心肺并發(fa)癥，多數不影(ying)響壽命(ming)。少數患者臥床(chuang)不起(qi)而殘廢。神(shen)經干細(xi)(xi)(xi)(xi)胞(bao)（neuralstemcells，NSCs）作為具(ju)(ju)有自我更(geng)新及分化(hua)為神(shen)經元、星形膠質細(xi)(xi)(xi)(xi)胞(bao)、少突膠質細(xi)(xi)(xi)(xi)胞(bao)潛(qian)能的(de)(de)(de)神(shen)經前(qian)(qian)體細(xi)(xi)(xi)(xi)胞(bao)，具(ju)(ju)有廣泛(fan)的(de)(de)(de)臨床(chuang)應用前(qian)(qian)景。干細(xi)(xi)(xi)(xi)胞(bao)移(yi)植(zhi)分化(hua)的(de)(de)(de)神(shen)經元補(bu)充減(jian)少的(de)(de)(de)腦細(xi)(xi)(xi)(xi)胞(bao)，分泌的(de)(de)(de)多種神(shen)經營養因子促進小腦組織(zhi)中的(de)(de)(de)神(shen)經細(xi)(xi)(xi)(xi)胞(bao)發(fa)揮功能，可以(yi)從(cong)結構(gou)及功能上修復、改善神(shen)經系(xi)統(tong)疾病，從(cong)而可以(yi)改善小腦的(de)(de)(de)控制功能障礙達到治(zhi)療共濟失調的(de)(de)(de)效果。