Tan J H, Goh B C, Tambyah P A, Wilder-Smith E
Division of Neurology, Department of Medicine, National University Hospital, Singapore.
Parkinsonism Relat Disord. 2005 May;11(3):187-91. doi: 10.1016/j.parkreldis.2004.09.003.
An important component in the diagnosis of atypical parkinsonian disorders is the exclusion of secondary causes. Paraneoplastic causes of parkinsonism are extremely rare. We describe a case which presented initially as probable progressive supranuclear palsy (PSP) but on follow-up displayed a rapidly progressive course, unexplained fever, peripheral neuropathy and an abnormal CSF. We highlight the difficulties faced in formulating a diagnosis for this unusual case prior to the discovery of an occult B-cell lymphoma, and discuss its relevance in the exclusion criteria for PSP. A paraneoplastic cause should be considered if disease progression is unusually rapid.
非典型帕金森综合征诊断中的一个重要环节是排除继发原因。帕金森综合征的副肿瘤性病因极为罕见。我们描述了一例最初表现为可能的进行性核上性麻痹（PSP）的病例，但随访时显示病情进展迅速、不明原因发热、周围神经病变及脑脊液异常。我们强调了在发现隐匿性B细胞淋巴瘤之前，对这一罕见病例进行诊断时所面临的困难，并讨论了其在PSP排除标准中的相关性。如果疾病进展异常迅速，应考虑副肿瘤性病因。
