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病例35-2017:一名四肢感觉减退和无力的57岁女性
Case 35-2017 — A 57-Year-Old Woman with Hypoesthesia and Weakness in the Legs and Arms


Michael P. Bowley ... 其他 • 2017.11.16

病例陈述


Daniel B. Rubin医师(神经科):一名57岁女性患者因四肢出现进行性感觉减退、感觉异常和无力收治于本院。

患者在入院前18个月出现足部感觉异常,之前一直健康状况良好。入院前16个月患者经历了腰椎手术,包括L3~L4椎板切除术和椎骨关节面切除术以及L4双侧椎间孔切开术。患者称术后足部症状减轻。

本次入院前9个月足部再次出现感觉减退和无力,随后几个月间症状累及下肢和手部。患者在家中曾摔倒过几次,之后开始使用拐杖,后来又使用轮椅。入院前8个月患者曾在一家神经科诊所门诊接受检查,进行了肌电图检查和神经传导检查。推定诊断为慢性炎症性脱髓鞘性多发性神经病(CIDP),静脉给予免疫球蛋白(IVIG)。患者称下肢和手部感觉及力量出现一过性好转。接下来的6个月中每4周1次静脉给予免疫球蛋白,但感觉减退和无力症状逐步进展并累及双侧上肢。该患者出现无法再安全移动至轮椅中的情况后,她到另外一家医院的急诊科就诊。





作者信息

Michael P. Bowley, M.D., Ph.D., William S. David, M.D., Ph.D., Tracey A. Cho, M.D., and Anand S. Dighe, M.D., Ph.D.
From the Departments of Neurology (M.P.B., W.S.D., T.A.C.) and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Neurology (M.P.B., W.S.D., T.A.C.) and Pathology (A.S.D.), Harvard Medical School — both in Boston.

 

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