A 33-Year-Old Man with Progressive Diffuse and Focal Neuropsychiatric Signs without Localizing Correlates on Brain Imaging: A Systematic Approach to Diagnosis.
A 33-Year-Old Man with Progressive Diffuse and Focal Neuropsychiatric Signs without Localizing Correlates on Brain Imaging: A Systematic Approach to Diagnosis.
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DOI：
10.26502/jppd.2572-519x0113
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Rao V
中科院分区：
文献类型：
--
作者：
Moussawi K;Gholipour T;Rao V
新的昂贵的诊断测试正在迅速出现。然而，最复杂的临床表现的答案往往是从系统的方法来推断的鉴别诊断。这在神经精神障碍中尤其如此，其表现为神经和精神症状的混合。本病例报告填补了文献中的空白，提供了一个系统的鉴别诊断，这种神经精神表现与非局灶性脑成像。一名33岁的非裔美国男子，表现为意识模糊、虚弱和震颤。他最初注意到记忆问题，在接下来的六个月里逐渐变得混乱，出现语言困难和左侧无力和震颤。在检查中，他主要是abulic，但间歇性和极端的情绪不稳定。他缺乏洞察力，注意力也不集中。他有轻度面部无力和痉挛性偏瘫，左侧有动作震颤。脑磁共振成像显示非特异性弥漫性实质体积损失。他的血清和脑脊液研究快速血浆反应素和性病研究实验室试验分别呈阳性，表明诊断为麻痹性神经梅毒。这是一例年轻男性神经梅毒患者，表现为进行性亚急性认知功能下降，伴有局灶性神经系统体征，但脑成像显示无局灶性病变。神经梅毒经常在内科、精神科和神经科住院单位被误诊。在这份报告中，我们提出了一种方法来概念化类似的情况下，并提供了鉴别诊断，这将有助于更有效地达到准确的诊断。此外，它还提高了人们对神经梅毒的认识，这是一种毁灭性但容易治疗的疾病。
Novel expensive diagnostic tests are rapidly emerging. However, the answer to the most complex clinical presentations is often inferred from a systematic approach to the differential diagnosis. This is especially the case in neuropsychiatric disorders that present with a mix of neurologic and psychiatric symptoms. This case report fills a gap in the literature by providing a systematic differential diagnosis of such neuropsychiatric presentations associated with non-focal brain imaging. A 33-year-old African-American man presented with confusion, weakness, and tremors. He initially noted memory problems and over the following six months progressively became confused, developed speech difficulties and left sided weakness and tremors. On exam, he was predominantly abulic but with intermittent and extreme mood lability. He lacked insight and his attention was poor. He had mild facial weakness and spastic hemiparesis with action tremors on the left side. Magnetic Resonance Imaging of the brain demonstrated non-specific diffuse parenchymal volume loss. His serum and cerebrospinal fluid studies were positive for Rapid Plasma Reagin and Veneral Disease Research Laboratory tests, respectively, suggesting a diagnosis of paretic neurosyphilis. This is a case of a young man with neurosyphilis who presented with progressive subacute cognitive decline, associated with focal neurological signs but no focal lesions on brain imaging. Neurosyphilis is often misdiagnosed on medicine, psychiatry, and neurology inpatient units. In this report, we present an approach to conceptualize similar cases and provide a differential diagnosis that will help reach an accurate diagnosis more efficiently. Further, it raises awareness regarding neurosyphilis, a devastating but easily treatable condition.