行走不稳两年 言语不清一年 眼睑痉挛四个月

病历摘要 患者男性,62岁。因行走不稳2年、言语不清1年、右眼睑痉挛4个月,于2014年2月入我院神经科。患者2012年4月无明显诱因突然出现行走不稳、步基宽,走路易向右侧偏斜,伴视物成双、视物模糊,站立时有明确的头晕症状,卧位时减轻,无恶心、呕吐,无视物旋转,无饮水呛咳、吞咽困难、言语不清,无肢体麻木、无力等症状与体征。     

典型“心型”影像征的双侧延髓内侧梗死1例

<正>1病例介绍患者男,57岁,主因"言语不清、行走不稳4 d"于2014年1月10日入院。患者4 d前无诱因突发言语不清、构音障碍,自觉下肢无力、行走不稳,无法站立,有双手麻木感,伴有头晕,无视物旋转感,无恶心、呕吐,伴有饮水呛咳,轻度吞咽困难,咽喉部有异物感,无呼吸困难,无头痛。双下肢无力症状加重,呛咳明显,就诊     

影像学表现为“Y”形的双侧延髓内侧梗死1例

<正>1病例介绍患者,男性,54岁,因"左侧肢体活动不灵伴言语笨拙7 d,加重伴右侧肢体活动不灵、饮水呛咳2 d"于2014年5月16日入我院神经内科。患者于入院前7天(2014年5月9日)无明显诱因出现左侧肢体活动不灵,表现为上肢尚可持物,下肢搀扶可行走,同时伴有言语笨拙、口齿不清,听理解正常,无视物旋转。就诊于当地医院,行头部电子计算机断层扫描(computed tomography,CT)检查未见异常高密度,考虑"脑梗死",给予相关药物(具体不详)治疗后下肢无力症状稍有好转,可自行行走。2天前(2014年5月14日)又出现右侧肢体活动不灵,上肢不能持物,下肢站立困难,同时伴有饮水呛咳、     

巨细胞病毒感染导致Adie综合征1例报道

正1病例患者,女,64岁,急性起病,因"右眼疼痛伴头昏4d"于2017年3月8日入院。患者入院前4d无明显诱因出现右眼胀痛,呈持续性,伴头昏沉,自觉上午疼痛较轻,下午症状加重,疼痛剧烈,伴流泪,无流涕,伴恶心、呕吐1次、呕吐物为内容物,无视物旋转、视物成双,无肢体乏力、麻木,无言语不清、饮水呛咳、吞咽困难。在西京医院眼科就诊,具体诊疗不详,测眼压正常。为求进一步诊治,遂来本院就诊,门诊以"右眼疼痛伴头昏待查"收入本科。既往无特殊病史。入院查体:体温36.0℃,脉搏99次/min,呼吸18次/min,血压     

并发高血压脑病的穿支动脉硬化性小卒中一例

1病例介绍患者,男,46岁,主因"突发左下肢无力伴头晕8d"于2010年7月6日收住入院。患者2010年6月28日疲劳后突发左下肢无力,行走略显不稳,伴明显头晕感,无视物旋转、恶心、呕吐,无言语不清,无耳鸣、听力减退,无吞咽困难、饮水呛咳等症状,就诊于土耳其某医院,当日发病后8h行磁共振成像(magnetic resonance imaging,MRI)检     

椎-基底动脉延长扩张症合并小脑性共济失调1例报告

1 病例简介 患者,女,64岁,于2009年4月24日入院.患者于2年前无明显诱因出现行走不稳,行走时易向右侧倾倒,有踩棉花感,以夜间行走明显,肌力无明显变化,无视物旋转,曾到国内多家医院就诊,诊断为小脑性共济失调,具体治疗不详,症状无明显改善,半年前症状加重,独自行走困难,并出现言语欠清晰、不流利,无发热、抽搐,无大小便失禁.既往饮水呛咳10余年.     

双侧对称性小脑中脚及小脑梗死患者一例

正患者男性,51岁,因"突发眩晕、行走不稳7d,加重伴饮食不能6h"于2015年2月19日入院。患者7d前生气时突然出现眩晕、行走不稳,但能够行走,伴恶心、呕吐5次,呕吐物为胃内容物,随后出现言语不利、饮水呛咳、吞咽困难,就诊于当地某医院,行头颅CT(图1)示双侧小脑中脚、小脑半球梗死,给予抗血小板聚集、他汀类及改善循环、降压等药物治疗。6h前站立时突然出现眩晕、视物旋转较前加     

单侧丘脑梗死致双侧共济失调1例

正1病例介绍患者女性,61岁,因"突发头晕、步态不稳1周"于2018年3月16日入院。患者入院前1周于家中活动时突发头晕,跌倒在地,当时未伤及头部,扶起后自觉站立时明显头晕,步态不稳,卧位时头晕可明显减轻,无明显视物旋转感,四肢活动基本正常,无肢体麻木感。发病后第2天就诊于当地医院,经治疗(具体不详)无好转,症状逐渐加重,站立行走困难,言语略含糊,遂入大连市友谊医院就诊。患病以来无发     

三维对比增强磁共振血管成像诊断复杂多发性大动脉炎1例

1病例介绍 患者男,39岁,因“突发右侧肢体无力、言语不能5d”于2010年1月6日收住我院.患者入院前5d无明显诱因活动中突发右侧肢体无力,伴右上肢麻木、持物不稳,尚能行走,但不稳,伴头晕,无视物旋转、耳鸣、听力减退,伴双额部头痛,呈阵发性搏动性,伴不能言语,但能听懂他人话意,无呕吐、视物模糊,无口角歪斜、吞咽困难、饮水呛咳,于当地医院行颅脑磁共振成像(magnetic resonance imaging,MRI)示“左侧额顶叶脑梗死”,经治疗(具体不详)后未见明显好转.于入我院2天前出现右侧肢体无力加重,不能行走、持物,为进一步诊治转我院.底节区、科医师.     

表现为短暂性肢体抖动综合征的烟雾病一例报道

正1病例资料患者女性,51岁,因"发作性左侧肢体抖动4月余,加重2 d"入院。患者于入院4月前(2016年2月)无明显诱因出现发作性左侧肢体抖动,每次持续1~2 min,休息后可自行缓解,有时会伴有同侧肢体麻木、乏力感,上述症状每天发作1~2次,在站立、迈步或长距离行走后容易出现。发作时无头痛、头晕,无视物双影,无吞咽困难、饮水呛咳,无意识不清、肢体抽搐,无二便失禁。6月初至当地医院就诊,考虑"脑梗死",予阿司匹林     

Evidence for Interventions for Young Offenders

Young offenders are an issue of global concern. Despite a greater understanding of the aetiology of conduct disorder and juvenile delinquency, the research on treatments and the use of evidence-based methods of interventions has not kept pace. This review critically and selectively examined interventions for young offenders, and organises them based on levels of care. The challenge is to intervene using empirical strategies that are implemented based on our emerging understanding of aggression.     

Lower threshold for referral for psychiatric treatment for adopted adolescents.

Epidemiological data on a national sample of 3,698 adolescents, of whom 145 were adopted, indicate that adoption significantly increases the likelihood of referral for psychiatric treatment even after controlling for the fact that adoptees display more behavior problems and come from more educated families. This is accounted for by the fact that adoptees are significantly more likely to be referred when they display few problems. Thus, contrary to popular myth and clinical lore, the overrepresentation of young adoptees in clinical settings is not attributable solely to the fact that adoptees are more troubled. Rather, adoptees do display more problems but they are also referred more readily even after controlling for extent of problems.     

Growing Evidence for Psychodynamic Therapy for Depression

Psychodynamic therapy (PT) for depression is the least examined treatment method for depression, compared to cognitive-behavioral therapy (CBT) and interpersonal therapy. This article, consisting of five randomized clinical trials of short psychodynamic supportive psychotherapy (SPSP) conducted over the last 25 years in Amsterdam, will review the trial results to provide answers to the question about which role SPSP can play in the treatment of depression. The researchers conclude that it is justified to qualify SPSP an empirically supported therapy form of PT for depression. In particular, adding SPSP to pharmacotherapy yields better results than pharmacotherapy by itself. Adding medication to SPSP may have a significant added value, but it is not as large as in the first comparison. The results also confirm no difference in efficacy between CBT and SPSP.     

The need for regulatable vectors for gene therapy for Parkinson's disease

Gene therapy is now a very promising approach for the treatment of Parkinson's disease, for which there are currently few treatment options. However, gene therapy is invasive and irreversible, and its long-term effects are not yet known. Regulatable vectors allow the expression of the introduced gene to be adjusted or stopped by changing the dose of an oral inducer drug, thus adding an important safety mechanism as well as the ability to tailor the dose to an individual patient's needs. Although the use of conventional gene therapy should not be delayed until regulatable systems are available, clinical trials of regulatable gene therapies are imminent. Regulatable systems provide the best hope for safely delivering effective, flexible treatments over the long course of Parkinson's disease, and their development should be actively supported.     

A decision-making model for pre-sentence evaluations for juveniles

Forensic mental health assessments (FMHAs) are requested by the courts to assist in the sentencing process and can have a major impact upon the life of the person evaluated. Completing these assessments is a core competency for forensic psychologists. However, some FMHAs are undertaken by psychologists who have no forensic training. Despite this, there are no formalised Australian minimum standards to ensure reports are helpful to the courts and reflect sound evaluation methodologies. Drawing upon a critical review of the literature and recent research findings, we propose a 10-step decision-making model for pre-sentence evaluations of juveniles. Our model provides a framework for decision-making and highlights the key elements of an evaluation. The model provides a basis for developing practice guidelines and professional standards. The next step is to test the model in the field to determine its impact on the quality of psychological pre-sentence reports.     

Need for palliative care for neurological diseases

The new concept of palliative care supports the idea of palliation as an early approach to patients affected by disabling and life-limiting disease which focuses on the patient’s quality of life along the entire course of disease. This model moves beyond the traditional concept of palliation as an approach restricted to the final stage of disease and widens the fields of intervention. There is a growing awareness of the importance of palliative care not only in oncological diseases but also in many other branches of medicine, and it appears particularly evident in the approach to many of the most frequent neurological diseases that are chronic, incurable and autonomy-impairing illnesses. The definition and implementation of palliative goals and procedures in neurology must take into account the specific features of these conditions in terms of the complexity and variability of symptoms, clinical course, disability and prognosis. The realization of an effective palliative approach to neurological diseases requires specific skills and expertise to adapt the concept of palliation to the peculiarities of these diseases; this approach should be realized through the cooperation of different services and the action of a multidisciplinary team in which the neurologist should play a central role to identify and face the patient’s needs. In this view, it is paramount for the neurologist to be trained in these issues to promote the integration of palliative care in the care of neurological patients.