帕金森叠加综合征-现病史(中英对照)

帕金森叠加综合征

(现病史)

现病史：患者3年无明显诱因不爱说话，表情淡漠，与人交往减少，尚能正常参加社交活动，言语表达可，无活动障碍。在当地医院诊断为“抑郁症”，服抗抑郁剂效果差。1年前患者有逐渐出现行走小碎步，步态慌张，表情少，睡眠多，肌张力增高，书写不能，并出现行走站立时向后倾倒现象。饮水发呛，口角流涎。依然神情淡漠。神志清楚，言语迟缓。曾在北京右安门医院、301医院诊治，考虑“帕金森病、PSP？”予以小剂量多巴口服，患者肌张力及步态一过性好转，后又逐渐加重，不能行走。至1个月前患者高级智能明显下降，言语含混不清，答非所问，词不达意。日常生活不能自理，饮食、刷牙、洗脸需他人帮助。大便干，小便偶尔失禁。家人为求进一步诊治来我院，门诊以“帕金森叠加综合征PSP”收住神经内科11组，发病时，神志清楚，言语少，睡眠多，大便干结，小便偶有失禁。

History of present illness:

In past 3 years the patient has shown speech reduction without obvious incentive, and an expression of indifference, but can participate in social activities for some time, show some verbal ability, but without movement disorder. At a local hospital he was diagnosed as “depression" and gained poor curative effect after administration of antidepressant. One year ago the patient began to walk in split and panic gait and showed a series of syndromes including lack of facial expression, more sleep, hypermyotonia, agraphia, tumbling backwards during walking or standing, choking and drooling during drinking, indifferent expression, slow speech but with conscious mind. He was diagnosed and treated in Beijing You'anmen Hospital and Hospital 301 in Beijing, being considered as “Parkinson's disease, PSP?”. There he was treated with low-dose of oral dopa, and his muscle tone and gait improved to some extent for a short period of time but followed by ingravescence and abasia at last. A month ago the patient suffered from an obvious decrease of the advanced brainpower, alalia, irrelevant answers and irrelevant words for his ideas. He cannot perform daily activities by himself and needs outside help for eating and drinking, teeth brushing and face washing, and with dry stool and occasional urine incontinence. Then he, accompanied by his family members, came to Xuanwu Hospital of Capital Medical University for further diagnosis and treatment. As an outpatient of “Parkinson plus PSP syndrome”, he was admitted to Group 11 of Neurology Department of the hospital. During the attack of this disease the patient is conscious but with a group of syndromes, such as less speech, more sleep, dry stool and occasional urine incontinence.