#16
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Íåñêîëüêî íàïîìèíàåò:
What are the symptoms of dementia with Lewy bodies? Dementia with Lewy bodies is a progressive disease. This means that over time the symptoms will become worse. In general, DLB progresses at about the same rate as Alzheimer's disease, typically over several years. A person with DLB will usually have some of the symptoms of Alzheimer's and Parkinson's diseases. They may experience problems with attention and alertness, often have spatial disorientation and experience difficulty with 'executive function', which includes difficulty in planning ahead and co-ordinating mental activities. Although memory is often affected, it is typically less so than in Alzheimer's disease. They may also develop the symptoms of Parkinson's disease, including slowness, muscle stiffness, trembling of the limbs, a tendency to shuffle when walking, loss of facial expression, and changes in the strength and tone of the voice. There are also symptoms that are particular to dementia with Lewy bodies. In addition to the symptoms above, a person with DLB may: experience detailed and convincing visual hallucinations (seeing things that are not there), often of people or animals find that their abilities fluctuate daily, or even hourly fall asleep very easily by day, and have restless, disturbed nights with confusion, nightmares and hallucinations faint, fall, or have 'funny turns'. |
#17
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Äåìåíöèÿ ñ òåëüöàìè Ëåâè, êàê-òî íå ïîäõîäèò. Èç êîãíèòèâíûõ äèñôóíêöèé ïðè ýòîé äåìåíöèè íàèáîëåå ÿðêèì ÿâëÿåòñÿ íàðóøåíèå êîíöåíòðàöèè âíèìàíèÿ (èìåííî ýòîò ñèìïòîì íàèáîëåå ðàííèé è ïîñòîÿííûé íà âñåõ ñòàäèÿõ áîëåçíè, à ó äàííîãî ïàöèåíòà èç êîãíèòèâíûõ ïðåâàëèðóåò ñíèæåíèå ïàìÿòè). Ïðèòîì, ñèìïòîìàòèêà êîëåáëåòñÿ â òå÷åíèå äíÿ (óõóäøåíèå â âå÷åðíåå âðåìÿ). Ïëþñ íåìàëîâàæíûì êðèòåðèåì "ïåðâîãî ðàíãà" òàêæå ñëóæàò èëëþçîðíî-ãàëëþöèíàòîðíûå ðàññòðîéñòâà (â ýòîì ñëó÷àå è ýòîãî ñèìïòîìà íåò). Äèññîìíè÷åñêèå ðàññòðîéñòâà, îñîáåííî â REM-ôàçå, òàêæå ÷óòü ëè íå îáëèãàòíûé ïðèçíàê äàííîé äåìåíöèè (êîøìàðû, ïñèõîìîòîðíîå âîçáóæäåíèå ïî íî÷àì, ñèìïòîì "ñîííîãî îïüÿíåíèÿ").
Çà íóòðèöèîíàëüíóþ ýíöåôàëîïàòèþ (ðå÷ü î âèòàìèí Â12-äåôèöèòíîé ýíöåôàëîïàòèè) ìàëî îáúåêòèâíûõ äàííûõ. Ïîðàæåíèå òîëüêî áåëîãî âåùåñòâà áåç ïîðàæåíèÿ çàäíèõ ñòîëáîâ ñïèííîãî ìîçãà? Íó íå âåðèòñÿ, èçâèíèòå. Ìàëî-ìàëüñêè, íî çàäíå-ñòîëáîâîé ñèíäðîì èëè ñåíñîðíàÿ ïîëèíåéðîïàòèÿ äîëæíà áûòü. À ó ïàöèåíòà èõ íåò.  êðîâè åñòü àíåìèÿ, ìàêðîöèòîç? Íà ÌÐÒ ãîëîâíîãî ìîçãà äîëæíû áûòü î÷àãè äåìèåëèíèçàöèè ïðè òàêîì âèäå ýíöåôàëîïàòèè, òàê êàê ïðè íåé ïðîèñõîäèò ðàçðóøåíèå ìèåëèíà. ÂÈ×-ýíöåôàëîïàòèÿ, ñîãëàñåí, îòìå÷àåòñÿ â áîëüøèíñòâå ñëó÷àåâ óæå â òåðìèíàëüíîé ñòàäèè çàáîëåâàíèÿ. Íî ïîðîé îíà ìîæåò áûòü è åäèíñòâåííûì ïðîÿâëåíèåì áîëåçíè (ïðîöåíò íåáîëüøîé, íî îïÿòü æå ïîâòîðþñü, ëó÷øå ïåðåïðîâåðèòü - ýòî âåäü íå ãðîìîçäêîå èññëåäîâàíèå). Âû ãîâîðèòå, ÷òî íåò âåãåòàòèâíûõ íàðóøåíèé, à ïðîáû Øåëëîíãà, Ìàðòèíå ïðîâîäèëè? Åñòü ëè äðóãèå âåãåòàòèâíûå ñèìïòîìû: àêðîãèïîòåðìèÿ, ìîíîòîííàÿ òàõèêàðäèÿ, òàõèêàðäèÿ ïîêîÿ, ãèïîãèäðîç, èìïîòåíöèÿ, íàïðèìåð? _____________________________ Ñ óâàæåíèåì, È.À.Âåëè÷êî. |
#18
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Ðåçóëüòàòû îáñëåäîâàíèé
Ïî ðåçóëüòàòàì ïðîâîäèìîãî ëå÷åíèÿ â òå÷åíèè 1 ìåñÿöà.
Ê ñîæàëåíèþ íà ôîíå ëå÷åíèÿ ïàöèåíòà îñìîòðåòü íå óäàëîñü. Ñî ñëîâ æåíû îòìå÷àëñÿ ñëàáîïîëîæèòåëüíûé ýôôåêò íà ôîíå ïðèìåíåíèÿ ÒÒÑ "Ýêñåëîí" 4,6 ìã/ñóò: "ñòàë êàê-òî áîëåå ñïîêîéíûì". Äðóãèõ ýôôåêòîâ íå áûëî. Ïðåïàðàò íàçíà÷åí ïîâòîðíî, îñìîòðþ íà ôîíå ëå÷åíèÿ ÷åðåç 1-2 íåäåëè. Íîâîå ïî íåâðîëîãè÷åñêîìó ñòàòóñó. Ïðèçíàêîâ ïñåâäîáóëüáàðíîãî ïàðàëè÷à íåò (óñòðàíèë íåäîñòàòîê ïåðâîãî îïèñàíèÿ ïàöèåíòà). Ñî ñëîâ æåíû (ðàíåå íå îáðàòèëà âíèìàíèÿ) â òå÷åíèè ïîñëåäíèõ 2 ìåñÿöåâ "ðàçãîâàðèâàåò ñàì ñ ñîáîé" ïî íî÷àì, íå èñêëþ÷àþ íàëè÷èå ãàëþöèíàòîðíîãî ñèíäðîìà, íî âñå ýòî î÷åíü íå òî÷íî ïîêà. Ðåçóëüòàòû äîîáñëåäîâàíèÿ. Êðîâü íà ÂÈ× - îòðèöàòåëüíî. Êðîâü íà ñèôèëèñ - îòðèöàòåëüíî. ÎÀÊ - íîðìà. Áèëèðóáèí êðîâè îáùèé 11 ìêìîëü/ë. Õîëåñòåðèí êðîâè 4,8 ììîëü/ë. Êðåàòèíèí êðîâè - 102 ìêìîëü/ë. ÀËÒ - 15 Åä/ë. ÀÑÒ - 24 Åä/ë. Ãëþêîçà êðîâè 3,7 ììîëü/ë. |
#19
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Íåñìîòðÿ íà ïóãàþwóþ ãëóáèíó ñîäåðæàíèÿ ïîñòà 17, âñ¸ æå íå ìîãó îòêàçàòüñÿ îò ïðåäïîëaãàåìîãî ä.ä.:
Diffuse Lewy body Disease Cortical Lewy body Disease Lewy Body Dementia Senile Dementia Of Lewy Type Lewy Body Variant of Alzheimer's Disease |
#20
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Äà ,ñîãëàøóñü ñ âàìè, ïîñìîòðþ åùå â ýòîì íàïðàâëåíèè, íàâåðíÿêà åñòü êàêèå-íèáóäü äèàãíîñòè÷åñêèå êðèòåðèè áîëåçíè ñ òåëüöàìè Ëåâè.
Ïðîñüáà âûñêàçàòü ñâîå ìíåíèå: ïî÷åìó íå êîðòèêî-áàçàëüíàÿ äåãåíåðàöèÿ? Äà, çàáûë íàïèñàòü: óðîâåíü âèòàìèíà Â12 - íîðìà. |
#21
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Äà, åòî îäèí èç ïàðàëëåëüíûõ ä.ä..
Íî. Ðåæå. Ó Âàøåãî ïàöèåíòà íå áûëî óíèëàòåðàëüíîñòè. Íóæíà ÕÎÐOØÀß ÌÐÒ. Corticobasal degeneration is a progressive neurological disorder characterized by nerve cell loss and atrophy (shrinkage) of multiple areas of the brain including the cerebral cortex and the basal ganglia. Corticobasal degeneration progresses gradually. Initial symptoms, which typically begin at or around age 60, may first appear on one side of the body (unilateral), but eventually affect both sides as the disease progresses. Symptoms are similar to those found in Parkinson disease, such as poor coordination, akinesia (an absence of movements), rigidity (a resistance to imposed movement), disequilibrium (impaired balance); and limb dystonia (abnormal muscle postures). Other symptoms such as cognitive and visual-spatial impairments, apraxia (loss of the ability to make familiar, purposeful movements), hesitant and halting speech, myoclonus (muscular jerks), and dysphagia (difficulty swallowing) may also occur. An individual with corticobasal degeneration eventually becomes unable to walk. |
#22
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Öèòàòà:
Ïåðâîå âïå÷àòëåíèå - î êîðòèêî-áàçàëüíîé äåãåíåðàöèè (Cortical Basal Ganglionic Degeneration). Áûëî áû èíòåðåñíî óçíàòü, åñòü ëè ó ïàöèåíòà àïðàêñèÿ (ìîæåò ïðîïóñòèë â òåêñòå). |
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#23
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Õîðîøåå äîïîëíåíèå èç àíàìíåçà ("ðàçãîâàðèâàåò ñàì ñ ñîáîé" ïî íî÷àì), äåéñòâèòåëüíî, âåäåò íà ìûñëü î ÄÒË. Ïîñìîòðèòå êðèòåðèè êëèíè÷åñêîé äèàãíîñòèêè ÄÒË (ïî McKeith I., Galasko D., Kosaka K. et al., 1996, 1999), â íèõ ÷åòêî âñ¸ îáîçíà÷åíî.
____________________________________________ C óâàæåíèåì, È. À. Âåëè÷êî! |
#24
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Èòîã
Äîêòîðà, ÂÑÅÌ áîëüøîå ñïàñèáî, ñîâìåñòíûìè óñèëèÿìè îïðåäåëèëèñü ñ äèàãíîçîì: Äåìåíöèÿ ñ òåëüöàìè Ëåâè.
Åñòü íåïëîõîé ïîëîæèòåëüíûé ýôôåêò íà ôîíå ïðèìåíåíèÿ ÒÒÑ "Ýêñåëîí", ïëàíèðóåòñÿ íàçíà÷åíèå Êëîíàçåïàìà äëÿ óìåíüøåíèÿ ìèîêëîíèé, äàëüíåéøàÿ òåðàïèÿ. Òåìó ìîæíî ñ÷èòàòü çàêðûòîé. |