【摘要】：探討以運(yùn)動(dòng)障礙為首發(fā)癥狀的尿毒癥腦病的臨床與影像特點(diǎn),拓寬臨床醫(yī)生的診斷思路,提高臨床醫(yī)生對(duì)尿毒癥腦病的少見(jiàn)臨床表現(xiàn)的認(rèn)識(shí)。對(duì)5例以運(yùn)動(dòng)障礙為首發(fā)癥狀的尿毒癥腦病患者的年齡、性別、原發(fā)病、臨床癥狀及輔助檢查等資料進(jìn)行分析。5例患者中男性2例,女性3例,年齡36歲~79歲[(62.2±14.9)歲]。其中,3例患者原發(fā)病為糖尿病,慢性腎炎和高血壓病各1例。5例患者均以舞蹈樣動(dòng)作、震顫、下頜及四肢肌不自主抖動(dòng)等為主要臨床表現(xiàn)。5例行腦電圖檢查,均未見(jiàn)癲癇波。頭部MRI檢查提示基底節(jié)區(qū)、丘腦、雙側(cè)腦室旁白質(zhì)有異常信號(hào)灶。尿毒癥腦病是終末期腎病累及中樞神經(jīng)系統(tǒng)的重要并發(fā)癥。臨床上以運(yùn)動(dòng)障礙為首發(fā)癥狀的少見(jiàn),易誤診為癲癇,抗癲癇治療無(wú)效。其影像學(xué)MRI檢查提示病變集中在基底節(jié)區(qū)及丘腦符合運(yùn)動(dòng)障礙的好發(fā)部位,臨床醫(yī)生應(yīng)高度注意,避免誤診。
[Abstract]:To explore the clinical and imaging features of uremic encephalopathy with motor disorder as the first symptom, to broaden the diagnostic thinking of clinicians, and to improve the clinician's understanding of the rare clinical manifestations of uremic encephalopathy. The data of age, sex, primary disease, clinical symptom and auxiliary examination of 5 patients with uremic encephalopathy with motor disorder as the first symptom were analyzed. Among the 5 patients, 2 were male and 3 were female. The age ranged from 36 to 79 years [(62.2 鹵14.9) years]. There were 3 cases with diabetes mellitus, 1 case with chronic glomerulonephritis and 1 case with hypertension. The main clinical manifestations of 5 cases were dance-like movement, tremor, involuntary tremor of mandible and limb muscles. 5 cases were examined by electroencephalogram (EEG), and 5 cases were examined by electroencephalogram (EEG). No epileptic waves were found. Head MRI showed abnormal signal foci in basal ganglia thalamus and bilateral paraventricular white matter. Uremic encephalopathy is an important complication of end-stage nephropathy involving the central nervous system. The first symptom of motor disorder is rare, easy to be misdiagnosed as epilepsy, anti-epileptic treatment is ineffective. MRI showed that the lesions were concentrated in the basal ganglia and thalamus, and the clinicians should pay more attention to avoid misdiagnosis.
【作者單位】： 湖南省人民醫(yī)院(湖南師范大學(xué)第一附屬醫(yī)院)神經(jīng)內(nèi)科;大連市疾病預(yù)防控制中心;
【分類號(hào)】：R747.9;R692.5

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