北京治疗白癜风比较好专科 http://m.39.net/pf/a_4782784.html1SECTION1第一部分
A57-year-oldmanpresentedwithprogressivedifficultyinwalkingfor2weeks,restinghandtremorsfor1week,andlow-volumespeechfor2days.Initially,hehaddifficultyininitiationofwalking.Soon,hedevelopedshortsteppedgaitwithhistoryofenblocfallingforward.Within2weeksoftheonsetofillness,hebecamebedbound.Whileinbed,heremainedverystiffandcouldnotsitorturnsidesbyhimself.Healsohadtremorsinhisupperlimbsonaction.Hisspeechvolumewasreduced,buthealwaysremainedcoherent.Therewasnobowelorbladderinvolvement,flexorspasms,orzonesthesia.Thepatienthadbeentreatedforankylosingspondylitis(AS)withnonsteroidalanti-inflammatorydrugsfor4yearsbecauseoflowbackpain,progressivelyincreasingstooped-forwardgait,andsclerosisofsacroiliacjointsonX-ray.Onexamination,hehadamasklikeface.Hisblinkratewas1to4blinksperminute.HisMini-MentalStateExaminationscorewas29of30.Hehadhypophonicmonotonousspeech.Hiseyemovementsshowedslowsaccadesandbrokenpursuitmovements.Examinationofmotorsystemrevealednormalmusclebulk,cogwheelrigidityoftheupperlimbs,andlead-piperigidityinthelegs.Hisstrengthcouldnotbetestedbecauseofprofoundmusclestiffness.Coarseactiontremorswerenoticedinbothhands.Thepatienthadfixed-flexiondeformityatthehipjoint.Deeptendonjerkscouldnotbeelicitedbecauseofprofoundmusclerigidity.Plantarresponsesandabdominalreflexesalsocouldnotbeelicited.
57岁，男性，表现进展性行走困难2周，静止性手震颤1周，声音强度降低2天。病人以行走时起步困难起病，快速进展成小碎步步态，伴身体向前倾，发病2周卧床伴僵硬，不能自行坐起和翻身，活动时上肢震颤，语言较前减少，但是意识一直保持清醒。无肠道或膀胱受累，无屈肌痉挛或束带感。因为腰部疼痛，进展性前倾步态和X片上的骶髂关节硬化，病人按强直性脊柱炎应用类固醇抗炎药治疗4年。查体：面具脸，瞬目减少，1-4次/分，MMSE评分29分，说话音调低，单音节语音，眼球运动较慢及活动受限。肌肉容积正常，上肢肌张力类齿轮样强直，双腿肌张力铅管样强直，由于肌肉极度僵硬，肌力查体不配合，双手有粗大的震颤，髋关节有固定曲肌畸形，由于极度强直，腱反射未引出，足底反射和腹壁反射也未引出。
Questionsforconsideration:
1.Whatisthedifferentialdiagnosisofsubacuteparkinsonism?
2.IsthehistoryofASrelatedtoparkinsonism?
思考问题：
1.亚急性帕金森综合症的鉴别诊断是什么？
2.强直性脊柱炎病史与帕金森综合症有关吗？
2SECTION2第二部分Thepatientpresentedwithsubacuteparkinsonism.Subacuteparkinsonismismost
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