7例眼睑痉挛型Meige综合征临床误诊分析

目的 探讨眼睑痉挛型Meige综合征的临床特点、诊断、误诊原因及治疗.方法 对上海市第一人民医院神经内科收治的7例误诊的眼睑痉挛型Meige综合征患者的临床特点、误诊原因及治疗进行回顾性分析.结果 眼睑痉挛型Meige综合征典型表现为不自主闭眼,临床上易被误诊为重症肌无力、神经官能症、眼睑炎和干眼症等.误诊的原因主要是对本病认识不足.本组7例患者经治疗后症状均有明显改善.结论 眼睑痉挛型Meige综合征发病早期症状不典型,易误诊误治,要注意和其他疾病鉴别.     

Meige综合征临床误诊九例分析

目的 探讨Meige综合征的临床特点、诊断、误诊原因及治疗. 方法 对广州市第一人民医院脑系外科收治的9例误诊的Meige综合征患者的临床特点、误诊原因及治疗进行回顾性分析.结果 Meige综合征典型表现为阵发性双侧眼睑痉挛,伴或不伴有双侧口颌部及其他部位肌肉不随意、对称性、不规则阵发性收缩,临床上易被误诊为重症肌无力、面肌痉挛、神经官能症和迟发性运动障碍等,误诊的原因主要是对本病认识不足.本组9例患者经治疗后症状均有明显改善.结论 虽然Meige综合征临床特点较明显,但发病早期易误诊,要注意和其他疾病鉴别.     

Meige综合征7例临床分析

Meige综合征又称特发性眼睑痉挛-口下颌肌张力异常(BS-OMD)综合征,1910年由Henry Meige首先描述,临床较少见,易被误诊为神经官能症等,且治疗比较困难.现将我科自1991～1998年诊治的7例报告如下.     

Meige综合征6例临床分析

Meige综合征为发生于成年人的局限性肌张力障碍,其起病隐匿,是渐进性发展,神经科及眼科检查常无异常发现,诊断和治疗均十分困难,容易误诊。 临床资料 一、一般资料 自2000年1月～2001年1月我院收治6例Meige综合征患者,男2例,女     

特发性眼睑痉挛—口下颌肌张力异常综合征9例报告

特发性眼睑痉挛一口下颌肌张力异常综合征又称Meige氏病,是成人多动症的一种,1910年由Henry Meige首先描述。其临床特征为眼睑痉挛及/或口面部肌肉对称性不规则多动收缩,部分病例伴颈部、躯干或中线部位肌肉痉挛性肌张力异常,多动不可控制,睡眠时消失。多误诊为神经症。我院自1981年至1983年诊治9例,报告如下。     

单纯疱疹病毒性脑炎6例误诊分析

单纯疱疹病毒性脑炎 (HSE)是由单纯疱疹病毒 (HSV)所引起的中枢神经系统最常见的病毒感染性疾病。任何年龄、任何季节均可发病 [1 ]。由于疾病早期表现多样或病史了解不详 ,故极易误诊。我科自 1998年来共收治 HSE2 8例 ,其中 6例早期被误诊为 Meige综合征 ,高血压脑病 ,糖尿病低血糖昏迷 ,SAH2例及椎～基底动脉供应不足等 ,确诊时间 2～4天 ,现总结如下。1　临床资料6例患者 ,男 2例 ,女 4例 ,年龄 18～ 6 4岁。有糖尿病病史1例 ,高血压病史 2例 ,冠心病病史 1例 ,高脂血症 1例。就诊时发热 1例 ,头晕 2例 ,头痛、呕吐 2例 ,面部肌肉…     

婴幼儿疥疮46例诊治分析

目的 总结婴幼儿疥疮临床特点,发现误诊的原因,并提出预防误诊的措施.方法 回顾分析2004-2008年间46例婴幼儿疥疮误诊临床资料.结果 误诊为婴儿湿疹的比例最高,占63%,其余依次为过敏性皮炎17.4%,丘疹性荨麻疹10.9%,脓疱疮6.5%,痱子2.2%.误诊最长时间达4个月.结论 未详细询问病史、检查不仔细不全面、乡村医生缺乏皮肤科学知识是误诊主要原因.避免误诊的关键是详细询问病史,采用多种手段做好鉴别诊断.     

Meige综合征患者情绪障碍的研究

目的 研究Meige综合征患者抑郁的发生情况及相关的因素.方法 应用汉密尔顿抑郁量表(HAMD)对62例Meige综合征患者和40例健康体检者进行抑郁评定.结果 62例Meige综合征患者中,有34例(54.8％)伴发抑郁,其中轻度抑郁30例(48.3％),中度抑郁4例(6.5％),无重度抑郁;对照组中4例(10％)伴发抑郁,其中轻度抑郁3例(7.5％),中度抑郁1例(2.5％),无重度抑郁,两组相比较差异有统计学意义(x2=20.91,P＜0.001);但是在程度上两组间无差异(x2=0.55,P＝0.45);Meige综合征患者抑郁组与非抑郁组HAMD各因子比较显示两组焦虑/躯体化、认知障碍、阻滞、睡眠障碍及绝望感差异均有统计学意义.结论 Meige综合征患者中有较高抑郁的发生率,主要表现为情绪低落、工作和兴趣减退、忧虑、睡眠障碍、迟缓、自卑感等,抑郁的发生与Meige综合征患者病程无关,而与性别相关,女性易发生.     

脑肿瘤误诊为脑囊虫4例临床分析

<正> 脑肿瘤曾有报道误诊为脑血管病、血管神经性头痛、脑炎、脑脓肿等,而误诊为脑囊虫者报道甚少,现将我院近2年收住的脑肿瘤误诊为脑囊虫4例分析如下。 临床资料:1.性别与年龄:男1例,女3例。年龄34-72岁,平均56.5岁。 2.临床表现:4例病人平素健康,有食生肉史2     

容易误诊漏诊的硬脑膜动静脉瘘9例分析

目的 提高对容易误诊漏诊的硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的诊断水平.方法 回顾性总结9例DAVF的临床资料,结合文献进行分析.结果 9例主要临床表现及误诊情况分别为:视朦或视力下降4例,无颅内高压症状,误诊为视神经炎、颅内结核感染或特发性颅内压增高;记忆力下降1例,误诊为病毒性脑炎;双下肢无力1例,误诊为急性脊髓炎、神经鞘瘤;反复头痛1例,误诊为偏头痛、特发性颅内压增高;反复抽搐1例,误诊为正常颅内压脑积水;饮水呛咳、吞咽困难1例,误诊为脑梗死.3例满足于静脉窦血栓的诊断而忽略了DAVF.所有病例影像学均漏诊,但如仔细观察仍可发现细微的血管形态改变,提示动静脉畸形.结论 DAVF临床表现缺乏特异性,加上临床及放射科医师对本病认识不足,诊断思路狭窄,造成本病误诊、漏诊率高.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.