Walters Jon
Pract Neurol. 2017 Oct;17(5):369-379. doi: 10.1136/practneurol-2017-001695. Epub 2017 Aug 4.
The physical examination always begins with a thorough inspection and patients with potential neuromuscular weakness are no exception. One question neurologists routinely address during this early part of the assessment is whether or not there is muscle enlargement. This finding may reflect true muscle hypertrophy-myofibres enlarged from repetitive activity, for example, in myotonia congenita or neuromyotonia-or muscles enlarged by the infiltration of fat or other tissue termed pseudohypertrophy or false enlargement. Pseudohypertrophic muscles are frequently paradoxically weak. Recognising such a clinical clue at the bed side can facilitate a diagnosis or at least can narrow down the list of potential suspects. This paper outlines the conditions, both myopathic and neurogenic, that cause muscle enlargement.
体格检查总是从全面检查开始，有潜在神经肌肉无力的患者也不例外。在评估的早期阶段，神经科医生经常会问到的一个问题是是否存在肌肉增大。这一发现可能反映真正的肌肉肥大——例如，在先天性肌强直或神经性肌强直中，肌纤维因重复活动而增大——或者是因脂肪或其他组织浸润而增大的肌肉，称为假性肥大或假增大。假性肥大的肌肉常常自相矛盾地表现为无力。在床边识别出这样的临床线索有助于诊断，或者至少可以缩小潜在可疑病症的范围。本文概述了导致肌肉增大的肌病性和神经源性病症。
