【摘要】 探讨以运动障碍为首发症状的尿毒症脑病的临床与影像特点,拓宽临床医生的诊断思路,提高临床医生对尿毒症脑病的少见临床表现的认识。对5例以运动障碍为首发症状的尿毒症脑病患者的年龄、性别、原发病、临床症状及辅助检查等资料进行分析。5例患者中男性2例,女性3例,年龄36岁~79岁[(62.2±14.9)岁]。其中,3例患者原发病为糖尿病,慢性肾炎和高血压病各1例。5例患者均以舞蹈样动作、震颤、下颌及四肢肌不自主抖动等为主要临床表现。5例行脑电图检查,均未见癫痫波。头部MRI检查提示基底节区、丘脑、双侧脑室旁白质有异常信号灶。尿毒症脑病是终末期肾病累及中枢神经系统的重要并发症。临床上以运动障碍为首发症状的少见,易误诊为癫痫,抗癫痫治疗无效。其影像学MRI检查提示病变集中在基底节区及丘脑符合运动障碍的好发部位,临床医生应高度注意,避免误诊。更多还原

【Abstract】 To discuss the clinical and imaging characteristics of uremic encephalopathy with starting symptoms for movement disorders,to broaden the clinical doctors’ diagnosis and to improve the clinical doctors’ knowledge of rare clinical presentation of uremic encephalopathy.To analyze 5 patients’ age,gender,primary disease,clinical symptoms and auxiliary examination data with uremia encephalopathy whose first symptoms were movement disorders.2cases of men and 3cases of women,aged 36~79(62.2±14.9).3cases of patients with primary disease of diabetes,1chronic nephritis and hypertension in another.The main clinical manifestations of these 5patients were choreic movement,tremor,jaw and limbs muscle involuntary shaking.All the five patients were examined by EEG but epilepsy wave was not found.Head MRI revealed basal ganglia,thalamus and the bilateral periventricular white matter with abnormal signal focal.Uremic encephalopathy is one of the important complications of end-stage renal disease involving the central nervous system.Cases with movement disorders as first symptom are rare and could be easily misdiagnosed as epilepsy.MRI revealed lesions concentrating in the basal ganglia and thalamus in line with the predilection site of the movement disorders.Clinical doctors should pay highly attention to it and avoid misdiagnosis.更多还原