Kita Akira, Tsuji Tomikimi, Koh Jinsoo, Takahashi Shun, Yamamoto Masahiro, Sakamoto Yuka, Itogawa Hideaki, Kimoto Sohei
Department of Neuropsychiatry, Kinan Psychiatric Center, Tanabe, Wakayama 646-0015, Japan.
Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Wakayama 641-8510, Japan.
Exp Ther Med. 2022 Jun 1;24(1):484. doi: 10.3892/etm.2022.11411. eCollection 2022 Jul.
Rare neurodegenerative disorders may be considered in the differential diagnosis of Parkinsonism in patients with schizophrenia who show worsening signs of Parkinsonism under treatment with antipsychotics. To the best of our knowledge, the present study is the first report describing probable progressive supranuclear palsy (PSP) in a patient with chronic schizophrenia. A 64-year-old man presented with hallucinations, delusions and asociality. He had received treatment with both typical and atypical antipsychotics for ~13 years. He began experiencing short-term memory impairment and bradykinesia two years before presentation, and then showed increased dysphagia, upper-limb muscle rigidity, extrapyramidal symptoms, vision loss and photophobia. Psychological manifestations included chronic depression, irritability and, occasionally, euphoria. His gait worsened, leading to repeated falls. Antipsychotics were discontinued, and the patient was almost completely dependent on a wheelchair in daily life. In a neurology consultation, he was diagnosed with probable progressive supranuclear palsy-Richardson's syndrome presenting as vertical supranuclear gaze palsy and prominent postural instability with falls. Brain magnetic resonance imaging (MRI) revealed atrophy of the mesencephalic tegmentum, and I-ioflupane single-photon emission computed tomography (SPECT) revealed reduced bilateral striatal reuptake. Overall, PSP should be considered in patients with schizophrenia with worsening Parkinsonism, especially when it is accompanied by supranuclear ophthalmoplegia, pseudobulbar palsy, dysarthria and dystonic stiffness of the neck and upper body. In the present case, the combination of brain MRI and I-ioflupane SPECT helped to discriminate PSP from other Parkinsonian syndromes, including drug-induced Parkinsonism, in the differential diagnosis.
对于精神分裂症患者，在使用抗精神病药物治疗期间帕金森症症状恶化时，鉴别诊断帕金森症需考虑罕见的神经退行性疾病。据我们所知，本研究是首例描述慢性精神分裂症患者可能患有进行性核上性麻痹（PSP）的报告。一名64岁男性，有幻觉、妄想和社交障碍。他接受典型和非典型抗精神病药物治疗约13年。就诊前两年开始出现短期记忆障碍和运动迟缓，随后出现吞咽困难加重、上肢肌肉僵硬、锥体外系症状、视力丧失和畏光。心理表现包括慢性抑郁、易怒，偶尔有欣快感。他的步态恶化，导致反复跌倒。停用抗精神病药物后，患者日常生活几乎完全依赖轮椅。在神经内科会诊中，他被诊断为可能的进行性核上性麻痹-理查森综合征，表现为垂直性核上性凝视麻痹和明显的姿势不稳伴跌倒。脑磁共振成像（MRI）显示中脑被盖萎缩，碘氟烷单光子发射计算机断层扫描（SPECT）显示双侧纹状体摄取减少。总体而言，精神分裂症患者出现帕金森症症状恶化时应考虑PSP，尤其是伴有核上性眼肌麻痹、假性球麻痹、构音障碍以及颈部和上身肌张力障碍性僵硬时。在本病例中，脑MRI和碘氟烷SPECT相结合有助于在鉴别诊断中区分PSP与其他帕金森综合征，包括药物性帕金森症。
