每日一题_2023.09.29

A 55-year-old man presented with 10 years of progressive handwriting impairment and rapid, slurred speech. In his thirties, he had worked as a welder without access to personal protective equipment. Neurologic examination was notable for reduced facial expression, blepharospasm, and cluttered, dysarthric speech. Postural reflexes were mildly impaired. MRI imaging of the head showed a nonenhancing, T1-weighted, hyperintense signal in the basal ganglia on both sides. Ceruloplasmin and iron levels were normal. What treatment should be administered?

一名55岁男性因10年来进行性书写障碍和快速、不清的言语就诊。30多岁时，他在没有个人防护装备的情况下做过电焊工。值得注意的是神经系统检查显示面部表情减少、眼睑痉挛和杂乱的构音障碍。姿势反射轻度受损。头颅MRI示双侧基底节区T1加权像呈不增强高信号。铜蓝蛋白和铁水平正常。应该给予什么治疗?

A. Carbidopa-levodopa 卡比多巴-左旋多巴

B. Chelation therapy 螯合疗法

C. Cholinesterase inhibitors 胆碱酯酶抑制剂

D. Manganese repletion 

E. Phlebotomy 放血

答案解析：

正确的答案是螯合疗法。根据患者的职业接触史、帕金森综合征和眼睑痉挛，诊断为锰中毒。静脉滴注EDTA祛螯合治疗6个月后，患者症状及MRI异常表现减轻。

正确答案：B