Mumenthaler M
Schweiz Med Wochenschr. 1975 Mar 22;105(12):353-61.
In"cerebral arteriosclerosis" the diffuse sclerotic involvement of the cerebral vessels may produce acute softening of cerebral tissue. However this paper concentrates mainly on the clinical symptomatology which, in the absence of major vascular accidents, is characterized from the psychopathologic viewpoint by acute confusional states, aggressive behaviour, fluctuating loss of memory, disturbances of concentration and finally dementia. The chief neurologic symptoms are motor disturbance with short-stepping gait, stooped position of the body, pseudobulbar symptoms with dysarthric speech and disturbances of swallowing, and increased perioral reflexes. A complete case history and a thorough neurologic and psychopathologic examination are the most important factors in diagnosis, while ancillary methods are of value only for differential diagnosis. Prophylaxis and therapy (cardiotherapy, treatment of diabetes and hypertension, lowering of serum cholesterol and sedation) are discussed. In the differential diagnosis of dementia in the elderly patient consideration should be given to chronic vascular diseases, degenerative cerebral atrophies, brain tumors, low pressure hydrocephalus, progressive paralysis and some other rare brain conditions.
在“脑动脉硬化”中，脑血管的弥漫性硬化累及可导致脑组织急性软化。然而，本文主要关注临床症状学，在无重大血管意外的情况下，从精神病理学角度来看，其特征为急性意识模糊状态、攻击行为、波动性记忆丧失、注意力障碍，最终发展为痴呆。主要的神经症状包括运动障碍，表现为步态短小、身体姿势弯腰驼背、假性球麻痹症状（言语不清和吞咽障碍）以及口周反射增强。完整的病史以及全面的神经学和精神病理学检查是诊断的最重要因素，而辅助检查方法仅对鉴别诊断有价值。文中还讨论了预防和治疗方法（心脏治疗、糖尿病和高血压治疗、降低血清胆固醇以及镇静）。在老年患者痴呆的鉴别诊断中，应考虑慢性血管疾病、退行性脑萎缩、脑肿瘤、低压性脑积水、进行性麻痹以及其他一些罕见的脑部疾病。
