每日一题_2023.06.11

An 80-year-old man is brought to the emergency department by his daughter after suffering a seizure. For months he has taken exceptionally short steps, unable to raise his legs. He is incontinent of urine and does not “know when to go.” His recent memory is also impaired, and he denies having fallen despite evidence to the contrary. There is no history of stroke or intracranial mass lesions. On neurologic examination cranial nerves are intact, muscle strength is normal, and sensorium is normal. The patient sways during Romberg’s test with eyes open or closed. A CT scan of the head is shown in the image. Cerebrospinal fluid pressure is normal. What is the most likely etiology of the dilated ventricles?

一位80岁的老人在癫痫发作后被女儿带到急诊室。几个月来，他的步伐异常短促，无法抬起双腿。他有尿失禁，不知道什么时候该走。他最近的记忆也受损了，他否认跌倒，尽管证据与此相反。无卒中或颅内肿块病史。神经系统检查显示颅神经完整，肌力正常，感觉正常。在Romberg’s检查期间，患者睁眼或闭眼时发生摇晃。图中显示了头部的CT扫描。脑脊液压力正常。脑室扩张最可能的病因是什么?

(A) Choroid plexus papilloma脉络丛乳头状瘤

(B) Communicating hydrocephalus 交通性脑积水

(C) Hydranencephaly 无积水

(D) Hypervitaminosis A 维生素A过多症

(E) Noncommunicating hydrocephalus 非交通性脑积水

答案解析：

该患者有正常压力脑积水(NPH)，这是一种以脑室慢性扩张为特征的老年人疾病。NPH患者通常表现为以下临床三联征:尿失禁、步态困难和智力下降(记住:“湿、摇晃和古怪”)。虽然确切的机制尚不清楚，但NPH被认为是一种交通性脑积水，其中脑脊液(CSF)重吸收在蛛网膜绒毛受损。

正确答案：B