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  

The Clinical and Imaging Characteristics Analysis of 5 Cases of Uremic Encephalopathy with Starting Symptoms for Movement Disorders

作　　者：谢春[1] 胡瑛[1] 高小平[1] 梁辉[1] 杜影[2] 

机构地区：[1]湖南省人民医院(湖南师范大学第一附属医院)神经内科,湖南长沙410005 [2]大连市疾病预防控制中心,辽宁大连116021

出　　处：《医学与哲学（B）》2015年第8期38-39,50,共3页Medicine & Philosophy(B)

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。To discuss the clinical and imaging characteristics of uremic encephalopathy with starting symptoms for movement disorders, to broaden the clinical doctors diagnosis and to improve the clinical doctors＇ knowledge of rare clinical presentation of uremic encephalopathy. To analyze 5 patients age, gender, primary disease, clinical symptoms and auxiliary examination data with uremia encephalopathy whose first symptoms were movement disorders. 2 cases of men and 3 cases of women, aged 36~79 （62. 2 ± 14. 9）. 3 cases of patients with primary disease of diabetes, 1 chronic nephritis and hypertension in another. The main clinical manifestations of these 5 patients were choreic movement, tremor, jaw and limbs muscle involuntary shaking. All the five patients were examined by EEG but epilepsy wave was not found. Head MRI revealed basal ganglia, thalamus and the bilateral periventrieular white matter with abnormal signal focal. Uremic encephalopathy is one of the important complications of end-stage renal disease involving the central nervous system. Cases with movement disorders as first symptom are rare and could be easily misdiagnosed as epilepsy. MRI revealed lesions concentrating in the basal ganglia and thalamus in line with the predilection site of the movement disorders. Clinical doctors should pay highly attention to it and avoid misdiagnosis.

关 键 词：首发症状 运动障碍 尿毒症脑病 

分 类 号：R741[医药卫生—神经病学与精神病学]