Utsumi H, Abe K, Yoshii O, Mori H, Suda K, Mizuno Y
Department of Internal Medicine, Tokyo Medical College, Japan.
No To Shinkei. 1995 Mar;47(3):295-307.
We report a 71-year-old woman with progressive gait disturbance and dementia. The patient was well until 61 years of age (1980) when she noted a gradual onset of gait disturbance. A year later, she noted slurring of the speech and forgetfulness. In 1982, she noted difficulty in looking down and progression of her gait disturbance. In 1983, she became unable to walk alone unless supported. She was admitted to our service in 1984; neurological examination at that time revealed moderate dementia, limitation in the vertical gaze, slurred speech, and wide based ataxic gait. She was discharged for out patient follow up. Cranial CT scan in 1989 revealed cortical, brain stem, and cerebellar atrophies. On March 10, 1990, she fell down and hit her head. She developed headache on April 1, vomited on April 8, and was admitted to our service again. On admission, she was somnolent, she was unable to follow an object to any direction; oculocephalic response was elicited to horizontal directions, however, it was difficult to induce in the vertical direction. Rigidity was noted in the extremities except in the left lower extremity. Rapid alternating movement was difficult and dysmetria was noted in the finger-to nose test. Deep reflexes were exaggerated without clonus; the plantar response was extensor bilaterally. Cranial CT scan revealed bilateral subdural hematoma. She was treated with intravenous infusion of glycerol, and she became alert after this treatment; however, she was markedly demented. She was unable to walk alone. She was discharged to home, but she showed progressive loss of activities, and became bed ridden in December 1992. In January of 1993, she developed fever, dyspnea, and disturbance of consciousness, and was admitted again on January 26, 1993. On admission, her blood pressure was 70 mmHg by palpation and body temperature 38.5 degrees C. The lungs were clear. On neurologic examination, she was semicomatose; the optic fundi were unremarkable; only incomplete eye movements elicited by the oculocephalic reflex. She was passive supine in position; some spontaneous movements were observed in the extremities. Lead-pipe rigidity was noted in both upper extremities, but the muscle tone was decreased in the lower extremities. No abnormal involuntary movements were seen. Deep reflexes were exaggerated except for the ankle jerk which was diminished bilaterally. The plantar response was extensor on both sides.(ABSTRACT TRUNCATED AT 400 WORDS)
我们报告了一位71岁患有进行性步态障碍和痴呆的女性患者。该患者直到61岁（1980年）时情况良好，之后她注意到步态障碍逐渐出现。一年后，她出现言语含糊和健忘。1982年，她发现向下看困难且步态障碍加重。1983年，她除非有人搀扶否则无法独自行走。1984年她入住我院；当时的神经系统检查显示中度痴呆、垂直凝视受限、言语含糊以及宽基底共济失调步态。她出院进行门诊随访。1989年的头颅CT扫描显示皮质、脑干和小脑萎缩。1990年3月10日，她摔倒并头部受伤。4月1日出现头痛，4月8日呕吐，随后再次入住我院。入院时，她嗜睡，无法向任何方向追踪物体；水平方向能引出眼前庭反射，但垂直方向难以引出。除左下肢外，四肢均有强直。快速交替运动困难，指鼻试验存在辨距不良。深反射亢进但无阵挛；双侧巴宾斯基征阳性。头颅CT扫描显示双侧硬膜下血肿。她接受了静脉输注甘油治疗，治疗后变得清醒；然而，她仍有明显痴呆。她无法独自行走。她出院回家，但活动能力逐渐丧失，1992年12月卧床不起。1993年1月，她出现发热、呼吸困难和意识障碍，于1993年1月26日再次入院。入院时，触诊血压为70mmHg，体温38.5摄氏度。肺部清晰。神经系统检查时，她处于半昏迷状态；眼底无明显异常；仅通过眼前庭反射能引出不完全的眼球运动。她呈被动仰卧位；四肢有一些自发运动。双上肢有铅管样强直，但双下肢肌张力降低。未见异常不自主运动。除双侧踝反射减弱外，深反射亢进。双侧巴宾斯基征阳性。（摘要截取自400字）
