伴有精神症状的脊髓亚急性联合变性共病甲减：个案报道及文献复习

发布时间：2018-03-19 09:46

本文选题：脊髓亚急性联合变性　切入点：精神症状　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的报道1例伴有精神症状的脊髓亚急性联合变性(SCD)共病甲状腺功能减退症的临床病例,并结合国内外文献,总结该病的临床特点,提高对该病的认识。方法报道一例广西医科大学第一附属医院收治的伴有精神症状的SCD共病甲减的病例,并结合文献分析此病的临床特点、检查结果、治疗方法和转归情况。结果患者中年男性,有甲亢后甲减病史,不规律服药治疗,此次发病主要表现为发作性心慌、视物旋转、昏倒感,有行走不稳、言语含糊等症状,检查提示大细胞性贫血、甲减,考虑甲减所致精神障碍,予优甲乐及对症治疗,疗效不佳,渐出现意识清晰度下降、不能行走、排尿困难等,回顾分析病例资料并结合相关文献,考虑维生素B12 (VitB12)缺乏所致SCD伴精神症状可能,予补充VitB12,患者症状减轻,支持SCD诊断。结论以精神症状为首发症状的SCD在临床上比较少见,容易误诊,诊治延误可造成永久性神经功能损害,进行全面细致的查体和血常规、血清VitB12、脊髓MRI等检查有助于尽早明确诊断。
[Abstract]:Objective to report a case of hypothyroidism associated with subacute combined degeneration of spinal cord (SCD) with psychiatric symptoms and to summarize the clinical features of the disease. Methods A case of hypothyroidism with mental symptoms of SCD was reported in the first affiliated Hospital of Guangxi Medical University. Results the patients had a history of hyperthyroidism after hypothyroidism and irregular medication treatment. The main symptoms of the disease were paroxysmal palpitation, visual rotation, fainting sensation, unsteady walking, vague speech and so on. The examination indicated that large cell anemia, hypothyroidism, mental disorder caused by hypothyroidism, treatment with euthyroidism and symptomatic treatment, poor curative effect, decreased consciousness, inability to walk, difficulty in urination, etc. To review and analyze the case data and related literature, consider the possibility of SCD with mental symptoms caused by vitamin B12) deficiency, supplement VitB 12, reduce the symptoms of patients and support the diagnosis of SCD. Conclusion SCD with mental symptoms as the first symptom is relatively rare in clinic. It is easy to misdiagnose, delay in diagnosis and treatment can cause permanent neurological damage, comprehensive and meticulous physical examination and blood routine examination, serum VitB 12, spinal cord MRI and so on can help to make a definite diagnosis as soon as possible.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.6;R581.2

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