【摘 要】
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会诊讨论会rn何筱仙教授:患者病史5个月,右手肌无力,肌肉逐渐萎缩.1个月前跑步时自觉双足力弱,有“肌肉跳动感”,无肢体麻木疼痛.右手分指并指力量差,对指力、握力较对侧差.
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会诊讨论会rn何筱仙教授:患者病史5个月,右手肌无力,肌肉逐渐萎缩.1个月前跑步时自觉双足力弱,有“肌肉跳动感”,无肢体麻木疼痛.右手分指并指力量差,对指力、握力较对侧差.有骨间肌萎缩,尤以第一骨间肌萎缩明显.双足背屈力弱,其余肌力、肌容积正常.四肢腱反射低,双Babinski sign(-),Chaddock sign(-),双Hoffmann sign(-).四肢关节位置觉及音叉振动觉和浅感觉正常.定位:主要是运动性损害为主,以右手为主,在下运动单位损害为主,可能包括前角细胞和运动前根.根据肌电图(EMG)有巨大电位(峰值电压7.0 mV),时限长,定位于脊髓前角细胞的可能性大.定性诊断考虑:运动神经元病(motro neuron disease,MND):表现为以运动损害为主,逐渐加重,有“肌肉跳动感”,无感觉损害.综上所述,运动神经元病可能大.本例脑脊液蛋白有些增高(70 mg/dL),此点在MND不常见,所以是否有其他免疫介导因素影响的疾病.想听听其他两位教授的意见.rn
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