Visual hallucinations in the differential diagnosis of parkinsonism.
Visual hallucinations in the differential diagnosis of parkinsonism.
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DOI：
10.1136/jnnp-2011-300980
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发表时间：
2012-04
期刊：
影响因子：
--
通讯作者：
Williams DR
中科院分区：
文献类型：
--
作者：
Bertram K;Williams DR
幻视（VH）通常发生在帕金森病（PD）和路易体痴呆（DLB）中，但在帕金森综合征的其他神经退行性原因中报告的频率要低得多，如进行性核上性麻痹，多系统萎缩和皮质基底节变性综合征。当考虑帕金森综合征患者的鉴别诊断时，这种临床体征可能是有帮助的。VH可能特异于路易体病理学的观察结果可能反映了与其他疾病相比，视觉系统对PD和DLB神经变性的更大脆弱性。病理学中的地形差异可能是路易体病中产生VH的主要因素，而不是特异于α-突触核蛋白积累的神经生理学变化。VH与边缘系统的病理学相关，更具体地说，与杏仁核相关，杏仁核在PD和DLB中经常受到影响，但在其他形式的帕金森综合征中相对保留，经常被误诊为PD。在这篇综述中，发表的频率VH在这些不同的条件下进行比较，把背景下的概念VH作为一个临床线索，潜在的路易体病理。
Visual hallucinations (VH) occur commonly in Parkinson's disease (PD) and dementia with Lewy bodies (DLB) but are reported much less frequently in other neurodegenerative causes of parkinsonism, such as progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration syndrome. This clinical sign may be helpful when considering the differential diagnosis of patients with parkinsonism. The observation that VH may be specific to Lewy body pathology probably reflects a greater vulnerability of the visual systems to PD and DLB neurodegeneration compared with other diseases. Topographic differences in pathology are probably the major factor producing VH in Lewy body diseases, rather than neurophysiological changes that are specific to α-synuclein protein accumulation. VH correlate with pathology in the limbic system and more specifically the amygdale that is frequently affected in PD and DLB but relatively preserved in other forms of parkinsonism often misdiagnosed as PD. In this review, the published frequencies of VH in these different conditions are compared to put into context the notion of VH as a clinical clue to underlying Lewy body pathology.
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