不同类型痴呆脑代谢改变图型:~(18)F-FDG PET显像

目的探讨不同类型痴呆患者基于像素水平的脑代谢图型特点。方法对最终临床诊断为阿尔茨海默病(20例)、额颞叶痴呆(20例)、路易体痴呆(10例)、进行性核上性麻痹(7例)、原发性进行性失语(3例)、皮质基底节变性(1例)和多系统萎缩(1例)等认知功能障碍患者的18F-FDG PET显像资料进行回顾分析,描述各种神经变性疾病脑代谢降低区域和程度。结果 SPM分析表明,各种神经变性疾病引起的痴呆18F-FDG PET显像均表现为皮质代谢降低,但其代谢图型变化明显不同:阿尔茨海默病组以双侧颞顶叶和额叶皮质代谢降低为主,基本感觉运动皮质、枕叶、基底节和丘脑活性保留;额颞叶痴呆组额叶和颞叶皮质不对称性代谢降低,伴部分顶叶皮质和基底节、丘脑等皮质下核团不同程度代谢降低;路易体痴呆组枕叶、视皮质和双侧颞上回前部代谢降低;进行性核上性麻痹组双侧前额叶背外侧、颞叶前外侧、中脑和双侧尾状核代谢降低;原发性进行性失语组左侧额叶Broca区、左侧颞叶皮质(除左侧颞上回后部)和右侧颞叶内侧皮质代谢降低;皮质基底节变性组双侧中央沟周围额顶叶皮质(右侧显著)、右侧基底节代谢降低;多系统萎缩组双侧小脑背外侧皮质和左侧壳核代谢降低。结论神经变性疾病所致痴呆在18F-FDG PET显像中表现出各自特征性脑代谢降低图型,18F-FDG PET显像有可能成为痴呆鉴别诊断的一种辅助手段。     

~(18)F-FDG PET显像鉴别阿尔茨海默病与额颞叶痴呆临床价值

目的探讨18F-FDG PET显像在阿尔茨海默病与额颞叶痴呆鉴别诊断中的应用价值。方法对临床明确诊断的阿尔茨海默病(20例)和行为异常型额颞叶痴呆(20例)患者的18F-FDG PET显像资料进行回顾,分析两组患者皮质代谢降低脑区间的差异。结果视觉分析显示,两组患者均表现为皮质代谢降低,阿尔茨海默病患者以双侧颞顶叶和后扣带回代谢降低明显,以及部分额叶皮质代谢降低,而基底节和丘脑不受累,18/20患者双侧大脑半球皮质代谢降低范围和程度基本对称;额颞叶痴呆患者额叶和前颞叶皮质代谢均降低,其中11例同时伴部分顶叶皮质和基底节、丘脑等皮质下核团不同程度降低,16/20患者双侧大脑半球代谢降低程度和范围明显不对称,4例以右侧为主、12例以左侧为主。结论由于18F-FDG PET显像所显示的阿尔茨海默病和额颞叶痴呆患者之皮质代谢降低图型不同,故具有较好的鉴别诊断价值。     

误诊为帕金森病的帕金森叠加综合征八例临床分析

帕金森叠加综合征(parkinsonism plus syndromes,PPS)包括一组中枢神经系统变性疾病,其中较为多见的有多系统萎缩(multiple system atrophy,MSA)、进行性核上性麻痹(progressive supranuclear palsy,PSP)、皮质基底节变性(corticobasal degeneration,CBD)、路易体痴呆     

多模态分子影像学在路易体痴呆诊断中的应用

目的探讨多模态分子影像学技术在路易体痴呆诊断中的应用价值。方法共5例可能的路易体痴呆患者,进行详细的临床病史采集、神经心理学测验、头部MRI检查,以及~(11)C-甲基-N-2β-甲基酯-3β-(4-氟苯基)托烷(~(11)C-β-CFT)、11C-匹兹堡复合物B(~(11)C-PIB)和18F-脱氧葡萄糖(~(18)F-FDG)PET显像。结果路易体痴呆患者早期认知功能障碍和幻视较为明显。~(11)C-β-CFT PET可见双侧壳核和尾状核多巴胺转运体摄取降低;~(11)C-PIB PET可见双侧额颞顶枕叶皮质弥漫性淀粉样蛋白摄取升高;~(18)F-FDG PET可见双侧顶枕叶葡萄糖代谢降低。结论多模态分子影像学技术可以显著提高路易体痴呆临床诊断的特异性,有望实现生前明确诊断。     

帕金森病/帕金森综合征~(18)F-FDG PET脑显像技术操作及报告解读要素

~(18)氟-脱氧葡萄糖正电子发射断层扫描(~(18)F-FDG PET)脑显像通过呈现脑部葡萄糖代谢的分布特征,可反映大脑局部的突触活性以及与疾病发生、进展特异相关的生理病理学改变,已被证实在帕金森病/帕金森综合征的鉴别诊断中具有较好的临床应用价值。文中在强调重视~(18)F-FDG PET脑显像技术操作规范的基础上,总结综述了原发性帕金森病、多系统萎缩、进行性核上性麻痹、路易体痴呆、皮质基底节变性等~(18)F-FDG PET脑代谢特征,并提出相关影像学数据分析软件的潜力和局限性,旨在对帕金森病/帕金森综合征患者~(18)F-FDG PET脑显像的报告解读及其在疾病鉴别诊断中的临床应用提出基本的指导性建议。     

路易体痴呆26例临床分析

目的总结路易体痴呆(dementia with Lewy bodies,DLB)的临床特征及神经影像学特点。方法收集2012年2月-2018年11月于新乡医学院第一附属医院诊治的26例"可能的"或"很可能的"DLB患者的临床资料进行回顾性分析。结果本组患者男19例,女7例,平均发病年龄(66. 73±7. 58)岁。以认知症状为首发者占65%,帕金森样症状首发者占19%,38%的患者认知障碍波动明显,77%的患者出现帕金森样症状,62%的患者出现幻觉,50%的患者出现快速眼球运动期睡眠行为障碍,65%的患者伴随自主神经功能障碍。59%(13/22)患者的头部核磁检查显示海马结构无萎缩或轻度萎缩,7例患者的18F-FDG PET检查均表现为以双侧顶枕叶为著的脑代谢减低模式,2例患者的11C-CFT PET检查均表现为双侧基底节转运体摄取减低。结论 DLB多数以认知症状起病者,帕金森样症状、幻觉、快速眼动期行为障碍和精神症状是其主要表现,神经影像学检查有助于DLB的临床诊断。     

皮质基底节变性综合征四例临床及影像学分析

目的 探讨皮质基底节变性综合征的临床特征、影像学表现和治疗.方法 对4例临床诊断皮质基底节变性患者的资料进行回顾性分析.结果 4例患者的首发症状均为单侧肢体的帕金森样表现,对左旋多巴治疗无反应,4例均有肢体失用、构音障碍,3例伴肌阵挛,2例伴有痴呆,1例伴不自主运动.4例患者头部MRI扫描均显示受累肢体对侧脑皮质萎缩,以额顶叶显著;头葡萄糖代谢正电子发射断层扫描(FDG-PET)检查均显示不对称的大脑皮质和基底节区葡萄糖代谢减低.结论 皮质基底节变性综合征患者的临床特征为不对称的帕金森样表现,可伴有认知功能障碍、失用、构音障碍、肌阵挛和不自主运动等症状;头MRI、FDG-PET检查有助于诊断;目前尚无有效治疗方法.     

具有帕金森样症状患者相关疾病探讨

目的探讨具有帕金森样症状(PLS)患者的相关疾病。方法收集我院近3年来因PLS而住院的78例患者的临床资料(病史、临床表现和辅助检查结果),按中华医学会神经病学分会运动障碍及帕金森病学组制定的诊断标准确定诊断。结果本组78例患者,出院诊断分别为:帕金森病(PD)36例,继发性帕金森综合征(PS)26例(血管性16例、脑外伤后3例、CO中毒后3例、脑炎后2例,杀虫剂中毒后2例),多系统萎缩(MSA)4例,进行性核上性麻痹(PSP)4例,路易体痴呆(DLB)2例,肝豆状核变性(WD)2例,特发性震颤(ET)2例,基底节钙化症(BGC)1例,皮质基底节变性(CBD)1例。结论具备PLS的疾病谱很广,其中PD大约占60%,另有30～40%的非PD患者具有类似表现,称为非典型帕金森综合征(AP),如多系统萎缩(MSA)、进行性核上性麻痹(PSP)、Wilson病(WD)、路易体痴呆(DLB),基底节钙化症(BGC)、皮质基底节变性(CBD)等,容易误诊,应注意鉴别。     

帕金森叠加综合征的临床特点和鉴别要点

目的 探讨帕金森叠加综合征的临床特点、影像学特点及鉴别要点. 方法 选择自2004年1月至2009年4月间在天津医科大学总医院和天津市环湖医院神经内科锥体外系门诊就诊的原发性帕金森病(IPD)、多系统萎缩(MSA)、路易小体痴呆(DLB)、进行性核上性麻痹(PSP)和皮质基底节变性(CBD)患者共172例进行研究.对所有入组患者进行详细的病史问卷调查、体格检查和头部CT/MRI检查,对部分研究对象采用了脑18F-FDG正电子发射断层扫描(PET)检查. 结果 (1)临床资料:各组患者主要临床特点除姿势异常外,差异均具有统计学意义(P＜0.05).(2)头MRI检查:59例MSA患者接受头MRI检查,其中MRI显示橄榄桥脑小脑萎缩48例(81.4％),T2加权像上的壳核低信号4例(6.8％),桥脑“十字征”30例(50.8％).15例PSP患者中3例(20.0％)头MRI正中矢状位显示中脑特征性“蜂鸟样”改变.全部6例CBD患者头MRI检查显示不对称的皮质萎缩(特别是额顶区),1例(16.7％)显示T2加权像上壳核低信号.(3)头部18F-FDG PET扫描:各组患者示踪剂分布存在差异. 结论 (1)各帕金森叠加综合征均有其特异性临床特点,可藉此与原发性帕金森病相鉴别.(2)头部MRI、18F-FDG PET检查可辅助诊断及鉴别IPD和帕金森叠加综合征.     

具有帕金森样症状患者的相关疾病探讨

目的探讨具有帕金森样症状(PLS)患者的相关疾病。方法收集本院近3年来因PLS而住院的78例患者的临床资料(病史、临床表现和辅助检查),参照现行权威神经病学教科书、专著和最新文献,作出诊断。结果本组78例患者出院诊断分别为帕金森病(PD)36例,继发性帕金森综合征(PS)26例(血管性16例、脑外伤后3例、CO中毒后3例、脑炎后2例,杀虫剂中毒后2例),多系统萎缩(MSA)4例,进行性核上性麻痹(PSP)4例,路易体痴呆2例,Wilson病2例,特发性震颤2例,基底节钙化症1例,皮质基底节变性1例。结论具备PLS的疾病谱很广,其中PD大约占60%,PS占10%,其余为非典型帕金森综合征(AP),临床医师较陌生,容易误诊,如MSA、PSP、Wilson病、路易体痴呆,基底节钙化症、皮质基底节变性等,应注意鉴别。     

Prevalence,demographic and clinical characteristics of body dysmorphic disorder among psychiatric outpatients with mood,anxiety or somatoform disorders

Aims: To describe the prevalence, demographic and clinical characteristics of body dysmorphic disorder (BDD) compared with other psychiatric outpatients with a mood, anxiety or somatoform disorder. Method: Outpatients referred for treatment of a mood, anxiety or somatoform disorder were routinely assessed at intake. A structured interview (MINI-Plus), observer-based and self-rating instruments were administered by an independent assessor. Results: Among our sample of 3798 referred patients, 2947 patients were diagnosed with at least one DSM-IV mood, anxiety or somatoform disorder. Of these patients 1.8% (n = 54) met the diagnostic criteria for BDD. In comparison with other outpatients, patients with BDD were on average younger, less often married and were more often living alone. Highly prevalent comorbid diagnoses were major depression (in 46.3% of cases), social anxiety disorder (in 35.2% of cases) and obsessive–compulsive disorder (OCD) (in 16.7% of cases). Furthermore, patients with BDD had higher scores on the Clinical Global Impression of Severity (CGI-S) as well as lower scores on the Short Form 36 social role functioning. Conclusion: BDD is frequently associated with depression, social phobia and OCD. Patients with BDD have more distress and more impaired interpersonal functioning.     

躯体形式障碍患者的人格障碍倾向调查

目的:探讨躯体形式障碍(SD)患者的人格障碍倾向。方法:对64例SD患者(SD组)和52名正常对照者(NC组)进行人格诊断问卷(PDQ-4)评估和比较。结果:SD组中,人格障碍筛查阳性为37例(57.81%),介于阳性与阴性间10例(15.6%);以C组人格障碍类型中的强迫型最常见。NC组中,人格障碍筛查阳性4例(7.7%),介于阳性与阴性间4例(7.7%)。SD组人格障碍筛查阳性率显著高于NC组(χ2=31.54,P0.001)。结论:SD患者人格障碍筛查阳性率较高,提示人格特质异常可能与SD的发病机制密切相关。     

Incidence of DIS/DSM-IV social phobia in adults.

OBJECTIVE: The aim of the study was to estimate the incidence of social phobia in the general population. METHOD: The Baltimore cohort of 3481 subjects, sampled during the 1981 Epidemiologic Catchment Area study, was traced. A total of 1920 subjects were re-interviewed from 1993 to 1996 using the Diagnostic Interview Schedule (DIS). A subsample of 349 subjects was interviewed by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry. RESULTS: The estimated incidence of DIS/DSM-IV social phobia is 4-5/1000/year. New cases were found in all age groups, with the highest rates in subjects with baseline depressive and panic disorders. Psychiatric evaluations showed broad diagnostic concordance with DIS diagnoses in incident cases. However, validity indices were highly dependent on diagnostic thresholds. None of the psychiatrist-ascertained social phobics had received treatment for the disorder, although the majority were considered likely to benefit from treatment. CONCLUSION: New cases of social phobia occur in adults of all age groups, and are often secondary to other psychiatric conditions.     

Cross-cultural influences on psychogenic movement disorders - a comparative review with a Brazilian series of 83 cases

Objective

To describe the profile and presentation of a Brazilian series of psychogenic movement disorders (PMD) patients and to perform a comparative analysis with the previous series published worldwide.

Methods

A total of 83 patients with a clinical diagnosis of PMD were included. All patients were assessed and followed at the Movement Disorders Outpatient clinic from 2000 to 2008. Demographic, clinical, paraclinical, and treatment outcome data were collected using a standardized protocol. The Gupta & Lang criteria were used for the diagnosis of PMD.

Results

Seventy-three patients were females (87.95%), with mean age of onset of 39 ± 5.1 years. Tremor was the most frequent PMD, occurring in 42 (50.6%) patients followed by dystonia, in 27 (32.5%) patients. Cerebellar-like ataxia was seen in 3 patients (4.16%). Psychiatric co-morbidities were diagnosed in 67 (80.7%) of the patients. Thirty-five of the 58 patients (60.3%) who were managed and followed up for six months had some degree of improvement, including 22 patients (37.9%) with complete or almost complete remission.

Conclusion

In this series of patients with PMD, tremor and dystonia were most frequent PMD. Our results overlap those of the literature regarding most demographic and clinical findings, demonstrating the trans-cultural aspect of PMD.