以运动障碍为首发症状的5例尿毒症脑病的临床与影像特点分析

发布时间：2019-03-05 12:07

【摘要】：探讨以运动障碍为首发症状的尿毒症脑病的临床与影像特点,拓宽临床医生的诊断思路,提高临床医生对尿毒症脑病的少见临床表现的认识。对5例以运动障碍为首发症状的尿毒症脑病患者的年龄、性别、原发病、临床症状及辅助检查等资料进行分析。5例患者中男性2例,女性3例,年龄36岁~79岁[(62.2±14.9)岁]。其中,3例患者原发病为糖尿病,慢性肾炎和高血压病各1例。5例患者均以舞蹈样动作、震颤、下颌及四肢肌不自主抖动等为主要临床表现。5例行脑电图检查,均未见癫痫波。头部MRI检查提示基底节区、丘脑、双侧脑室旁白质有异常信号灶。尿毒症脑病是终末期肾病累及中枢神经系统的重要并发症。临床上以运动障碍为首发症状的少见,易误诊为癫痫,抗癫痫治疗无效。其影像学MRI检查提示病变集中在基底节区及丘脑符合运动障碍的好发部位,临床医生应高度注意,避免误诊。
[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 卤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.
【作者单位】：湖南省人民医院(湖南师范大学第一附属医院)神经内科;大连市疾病预防控制中心;
【分类号】：R747.9;R692.5

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