Peterborough City Hospital, Peterborough, UK
Peterborough City Hospital, Peterborough, UK.
Clin Med (Lond). 2019 Jul;19(4):327-330. doi: 10.7861/clinmedicine.19-4-327.
Acute presentations for dementia, particularly dementia with Lewy bodies (DLB), are rare and can pose diagnostic challenges.We present a case of a 75-year-old woman who was previously fit, well and independent in all activities of daily living. She had no history of psychiatric, cognitive or memory problems. She presented with 2 weeks of sudden onset confusion, paranoia, dizziness and reduced oral intake. Thorough investigations for causes of delirium including blood tests, cerebrospinal fluid analysis obtained via lumbar puncture, electroencephalography, computed tomography, and magnetic resonance imaging were within normal limits. Further neurological examination demonstrated she had subtle Parkinsonian signs (cogwheel rigidity, bradykinesia) and was hypersensitive to small doses of antipsychotic (haloperidol and risperidone). A positive dopamine transporter scan was done confirming a diagnosis of an acute presentation of DLB. She has been commenced on a cholinesterase inhibitor (rivastigmine) and is presently settled in care.
痴呆，尤其是路易体痴呆（DLB）的急性发作较为罕见，且可能给诊断带来挑战。我们报告了一例 75 岁女性患者，她之前身体健康，日常生活活动完全自理，没有精神、认知或记忆问题。她因突发意识混乱、妄想、头晕和摄食量减少而就诊，病程仅 2 周。已对导致谵妄的病因进行了全面检查，包括血液检查、腰椎穿刺获得的脑脊液分析、脑电图、计算机断层扫描和磁共振成像，均未见异常。进一步的神经系统检查显示她有轻微的帕金森病特征（齿轮样强直、运动迟缓），并对小剂量抗精神病药物（氟哌啶醇和利培酮）高度敏感。多巴胺转运蛋白扫描阳性，确诊为急性 DLB 发作。现已开始使用乙酰胆碱酯酶抑制剂（rivastigmine）治疗，目前病情稳定，在接受护理。
