每日一题_2022.12.15

A 78-year-old man comes to the physician for evaluation after falling five times in two months. An x-ray skeletal survey reveals no fractures, but the patient admits to worsening urinary incontinence over the previous four months. His wife states that his memory and concentration have deteriorated recently. The patient’s vital signs are normal, and his physical examination is notable for a widebased gait with short steps. A Mini-Mental State Examination results in a score of 26/30. His funduscopic examination is normal, and his neurologic examination is notable for slight bradykinesia without tremor. Laboratory tests, including serum vitamin B12, folate, and thyroid-stimulating hormone, are normal. What is the most likely etiology of this patient’s recent decline?

患者男，78岁，两个月内跌倒5次后来医生处评价。x 线骨骼检查显示无骨折，但患者承认在过去4个月内尿失禁恶化。他的妻子说，他的记忆力和注意力最近恶化了。患者的生命体征正常，体格检查显示宽基步态和短步态。简易精神状态检查结果为26/30分。他的眼底镜检查正常，神经系统检查明显可见轻微运动迟缓，无震颤。实验室检查（包括血清维生素B12、叶酸和促甲状腺激素）是正常的。该患者近期衰退的最可能病因是什么？

(A) Alzheimer disease阿尔茨海默病

(B) Hypothyroidism甲状腺功能减退症

(C) Multi-infarct dementia多梗死性痴呆

(D) Normal pressure hydrocephalus 常压性脑积水

(E) Parkinson disease帕金森病

答案解析：

该患者有潜在可逆的痴呆病例：正常压力性脑积水 (NPH)，伴有失禁、步态困难和精神衰退（“湿性、摇摆和怪异”）三联征。NPH 患者经常表现出轻度运动迟缓，他们的步态被描述为“磁性”，因为他们的脚似乎贴在地板上。简易精神状态检查 (MMSE) 评分26/30仅表明存在一些轻度异常。无论如何，患者应接受磁共振成像以排除可能引起相似症状的占位病变。NPH 的病理生理学尚不十分清楚，但认为神经元拉伸继发于脑脊液过度分泌、吸收减少或两者引起的脑室扩张。识别这些患者势在必行，因为及时进行脑室腹膜分流术干预可以逆转痴呆和衰退。

正确答案：D