长期四肢无力-肌肉酸痛-反复发作呼吸肌麻痹  

Long term fatigue, myalgia complicated with refractory respiratory paralysis

作　　者：涂来慧[1] 吴涛[1] 蒋建明[1] 张仁琴[1] 蔡建英[1] 

机构地区：[1]第二军医大学长海医院神经内科,上海200433

出　　处：《第二军医大学学报》2003年第11期1182-1183,共2页Academic Journal of Second Military Medical University

摘　　要：1例43岁女性患者,自诉四肢无力、肌肉酸痛约18年,呼吸困难3个月,于2001年10月24日再次入院。其母发现该患者5岁开始即易跌倒,举手过肩困难,未介意。自1983年起四肢无力症状逐渐加重,多家就诊,诊断不明。于1994年1月19日首次入院,纵隔CT扫描发现前上纵隔脂肪块影,提示脂肪胸腺瘤,被忽略。后于外院经股四头肌活检、烟酰胺腺嘌呤二核苷酸四氯唑还原酶(NADH-TR)染色确诊为中央轴空病。本次住院前3个月反复呼吸肌麻痹,入院后经静脉注射甲泼尼龙及胸腺切除,恢复自主呼吸。病理检查确诊为重症肌无力伴脂肪胸腺瘤。本文主要分析和评述该病例的诊断过程、确诊的根据和教训。A 43 years old female patient was hospitalized for the second time on 24 October 2001 because of four limbs weakness, myalgia for about 18 years and repeated respiratory paralysis for 3 months. She was found to fall down easily and have difficulty to raise her shoulders since 5 years old, but no attention had been paid. She was previously hospitalized on 19 January 1994 due to limbs weakness and becoming worse for 9 years, but the cause was still unclear. A fatty mass was found by mediastinum CT scanning suggesting lipothymoma, but was also neglected. Later she was diagnosed as having central core disease by femoral muscle biopsy and NADH-TR staining. During second hospitalization, the patient received intravenous injection of methylprednisolone and thymectomy, and myasthenia crisis was relieved. Myasthenia gravis combined with lipothymoma was confirmed. This paper comments on the difficulty of diagnosis, the evidence for confirming diagnosis and lessens from mistakes.

关 键 词：四肢无力 肌肉酸痛 反复发作 呼吸肌麻痹 重症肌无力 脂肪胸腺瘤 

分 类 号：R746.1[医药卫生—神经病学与精神病学] R736.3[医药卫生—临床医学]