慢性外伤性桥脑小脑角区血肿1例

患者 女性,35岁。因外伤后阵发性左面部麻木3年,行走不稳半年,于1986年6月10日入院。患者于3年前不慎跌倒,枕部着地,当时昏迷5分钟,醒后仅觉轻度头晕,后渐消失。伤后2个月始出现左面部麻木感,呈阵发性,每次发作时间约10分钟,伴间断性头痛及视物模糊。于半年前出现行走不稳,向左侧倾斜,伴左耳耳鸣及饮水发呛。既往体健,伤时正     

脊髓萎缩合并淋巴瘤1例报告

脊髓萎缩合并淋巴瘤临床罕见,两者的关系不清楚,现报告1例如下。1病例男,42岁。因进行性双下肢无力、麻木、行走不稳3年,左下腹无痛性包块2个月,于2005年5月17日入院。患者于3年前起出现双下肢麻木、无力、行走不稳,夜间不敢行走,对温水感觉发烫。症状进行性加重,逐渐白天也行走不稳,呈踩棉花感,小便费力。2个月前发现左下腹近腹股沟处一无痛性包块,逐渐增大,伴左下肢轻度水肿。查体:体温38·5℃,营养良好,神志清楚,皮肤黏膜无出血、溃疡,左下腹近腹股沟处扪及10 cm×6 cm×5 cm的椭圆形包块,质中、边界清、固定、无压痛,未闻及血管杂音,四…     

抑郁症致脊髓亚急性联合变性一例

患者女，53岁，因“双下肢无力、行走不稳伴感觉麻木”于2005年4月1日来我院诊治。3年前患者在其丈夫突然去世后，出现情绪低落、厌世、做事情无兴趣；饮食减少，以素食为主，极少食用动物性食品；体重逐渐下降；2年前出现贫血症状，在当地医院诊断为“巨幼红细胞性贫血”，治疗后效果不佳。近2个月以来，渐感双下肢有针刺样感觉，无力并行走不稳。既往喜素食，无手术史和重大消化系统疾病史。     

食管小细胞癌继发感觉神经元病1例报告

正1临床资料患者女,58岁,因"进行性行走不稳10个月"于2019年3月11日就诊香港大学深圳医院。患者10个月前无明显诱因出现行走不稳、摇晃,脚踩棉花感,程度逐渐加重,时有摔倒,伴有双手精细动作不能,如扣纽扣及夹菜受限,伴双上肢不灵活,双足部麻木感。无性格脾气改变,     

进行性四肢麻木 无力4年

正病例摘要患者男性,42岁,主因四肢麻木、无力4年,于2016年3月24日入院。患者4年前(2012年初)无明显诱因出现全身乏力,剧烈运动耐力下降,易疲劳,症状无日间波动;此后逐渐出现双侧手指、足趾麻木,伴双手握力下降,日常生活活动能力无明显降低,无肌肉疼痛、视物模糊等,未予重视。约3年前(2013年6月)出现双下肢麻木、无力,下山、上楼费力,有时蹲起困难,伴脚踏不实,行走不稳、呈醉酒步态;此后逐渐出现双手骨间肌萎缩,尤以虎口显著,双足略下垂,穿衣、     

脊髓痨一例报告

患者 ,男性 ,5 8岁 ,因行走不稳、双下肢乏力 2个月余 ,于1999年 10月 13日入院。 1998年 8月起 ,无明显诱因渐感左足趾发麻、低热 ,右足趾也渐感发麻 ,行走时如踩棉花样 ,乏力 ,左侧明显 ,行走不稳 ,前冲 ,不自主摔跤 ,夜间尤明显 ,外院查头颅ＣＴ、ＭＲＩ、脑血管多普勒均无异常 ,考虑“病毒感染” ,对症治疗无效 ,于某院就诊 ,诊断为“脊髓亚急性联合变性” ,予以ＶｉｔＢ12 、叶酸等药物治疗。稍好转 ,持续治疗无进展。入院前已无法单独行走 ,双手末端麻木 ,反复呃逆 ,饮水呛咳 ,双下肢阵发性抽痛 ,小便次数减少 ,每次尿量增多 ,大便无…     

干扰素-β治疗视神经脊髓炎谱系疾病两例

正1病例报告患者1,男性,64岁,因"进行性双下肢活动障碍3年"于2013-09-11入作者医院。患者于入院3年前无诱因出现双下肢膝盖远端麻木、乏力,伴双下肢发作性不自主抖动,伴尿频、尿急,可基本正常行走,未予特殊治疗;2个月后乏力感明显加重,且逐渐向肢体近端发展,伴疼痛;6个月后进展至仅能缓慢行走,予营养神经等治疗后症状仍进行性加重,无力感延至腰部,遂于外院行肌电图     

Creutzfeldt-Jakob病1例报告

1 资料 患者,女,44岁,农民.主因"左上肢抽动3个月余,加重伴意识不清40 d"于2007年10月23日入院.患者于3个月前无明确诱因逐渐出现左侧肢体不自主间断性抽动,伴头昏、视物模糊、言语不清、双下肢无力感等症状,曾于当地医院诊治(具体不详),症状无明显的改善,并逐渐出现行走不稳,反应迟钝,行动缓慢.     

临床病理讨论 第39例——进行性双下肢无力伴尿便障碍

病历摘要　　患者男性 ,5 7岁 ,北京市人 ,因“进行性左下肢麻木 1年余 ,双下肢无力 2月余”于 1998年 12月 2 9日收入我科。患者于 1997年 10月无明显诱因出现上楼时左小腿麻木沉重 ,当时无行走困难 ,未予特殊治疗。 1998年 5月出现左大腿前内侧麻木 ,小腿麻木似有减轻 ,但同时出现大便干结 ,小便时间延长。 10月出现双下肢乏力、胀痛、行走困难 ,自诉行走 30～ 40米后需休息 ,同时麻木再次波及左小腿及左脚 ,感左下肢发凉 ,并逐渐出现双下肢消瘦 ,偶觉右手拇指、左手中指麻木 ,症状逐渐加重 ,近 1个月来已不能行走。曾先后在北京多家医院…     

头晕恶心2个月 加重伴呕吐 行走不稳20天

<正>患者女性,62岁。主因头晕、恶心2个月,加重伴呕吐、行走不稳20 d,于2014年9月11日入院。患者2个月前(2014年7月)无明显诱因出现头晕,症状呈渐进性加重,伴轻度恶心;1个月前(2014年8月)症状明显加重并伴呕吐、行走不稳,表现为步基增宽、向右倾倒且逐渐加重至站立不稳。外院头部MRI显示,大脑半球、侧脑室后角旁斑片状长     

Phenomenological evidence for two types of paranoia

OBJECTIVE: Two types of paranoia have been identified, namely persecution (or 'Poor Me') paranoia, and punishment (or 'Bad Me') paranoia. This research tests predicted differences in phenomenology--specifically, in person evaluative beliefs, self-esteem, depression, anxiety, and anger. METHOD: Fifty-three people with current paranoid beliefs were classified as Poor Me, Bad Me, or neither (classification was reliable). Key dependent variables were measured. RESULTS: All predictions were supported, except the one relating to anger, where the two groups did not differ. The Bad Me group had lower self-esteem, more negative self-evaluative thinking, lower negative evaluations about others, higher depression and anxiety. Importantly, the differences in self-esteem and self-evaluations were not fully accounted for by differences in depression. CONCLUSION: Data support the presence of two distinct topographies of paranoia. Future research is needed to explore the theory further and examine clinical implications.     

VR closure rates for two vocational models

BACKGROUND: The Individual Placement and Support (IPS) model of supported employment is an evidence-based practice for individuals with psychiatric disabilities. To be financially viable, IPS programs require funding from the state-federal vocational rehabilitation (VR) system. However, some observers have questioned the compatibility of IPS and the VR system. METHOD: Using a randomized controlled trial comparing IPS to a well-established vocational program called the Diversified Placement Approach (DPA), we examined rates of VR sponsorship and successful VR closures. We also describe the establishment of an active collaboration between a psychiatric rehabilitation agency and the state VR system to facilitate rapid VR sponsorship for IPS clients. FINDINGS: Both IPS and DPA achieved a 44% rate of VR Status 26 closure when considering all clients entering the study. IPS and DPA averaged similar amount of time to achieve VR sponsorship. Time from vocational program entry to Status 26 was 51 days longer on average for IPS. CONCLUSIONS: Even though several IPS principles seem to run counter to VR practices, such as zero exclusion and rapid job search, we found IPS closure rates comparable to those for DPA, a vocational model that screens for readiness, provides prevocational preparation, and extensively uses agency-run businesses.     

Neurophysiological evidence for two processing times for visual object identification

Event-related brain potentials (ERPs) were recorded to fragmented pictures of objects that were named correctly or were not to investigate the time course of visual object identification. The first ERP difference distinguishing identified from unidentified pictures estimates the upper limit of the time by which human brain regions have begun to activate long-term memory (LTM) representations specifying the identity of a visual object. Data from 15 young adults indicate that this time varies with the extent to which object parts are recoverable from the visual input, being approximately 200 ms earlier with recoverable than unrecoverable parts. Successful identification is evident by approximately 300 ms when object parts and overall structural configuration are readily recoverable but not until approximately 550 ms when object parts are difficult or impossible to recover (i.e. too poorly specified by the available contours to be recovered). In both cases, successful identification is associated with greater relative positivity. However, unidentified recoverable pictures are associated with an enhanced frontal negativity (N350), linked to object matching operations, not seen for non-recoverable pictures. Taken together, these results implicate two distinct processing sequences in the successful identification of visual objects.     

Characteristics of two telephone screens for cognitive impairment

We studied 56 subjects, 30 patients with a clinical diagnosis of Alzheimer's disease (AD) and 26 healthy controls, using two telephone screens for cognitive impairment, a self-report interview referred to as the TELE and the Telephone Interview for Cognitive Status (TICS). The sensitivity and specificity of the TELE to differentiate AD patients from healthy controls was 90.0 and 88.5% and those of the TICS were 86.7 and 88.5%, respectively. When receiver operator characteristic curves were constructed, the area under the curve for the TELE was 96.0% (SE 2.4%) and for the TICS 90.3% (SE 4.2%). Pearson's correlation between the TELE and the Mini-Mental State Examination (MMSE) was 0.87 (p < 0.0001) and between the TICS and the MMSE 0.86 (p < 0.0001). The correlation between the TELE and the sum of the boxes of the Clinical Dementia Rating scale (CDR-SB) was -0.71 (p < 0.0001) and -0.75 between the TICS and the CDR-SB (p < 0.0001). These results indicate that both screens are sensitive and specific instruments for differentiating AD patients from healthy controls and have a strong correlation with face-to-face measures of cognitive function.