摘要
一位21歲男性發生車禍撞擊下背後，產生漸進式的下肢無力、感覺缺損及小便功能障礙。由於脊髓影像及電學檢查沒發現任何與症狀配合的病灶，而且該患者臨床表現無法以神經病灶解釋，而高度懷疑爲轉化症。經過復健治療後，該患者逐漸恢復功能，4個月後可以獨立行走。之後又被診斷出被腦部左蝴蝶骨大翼的骨纖維性結構不良(fibrous dysplasia)，並接受開刀治療。該患者早期症狀類似胸髓損傷，但經一系列的檢查後，排除其他病因而被懷疑爲轉化症。及早復健治療可帶來很好的效果，最後接近完全恢復。該患者的左蝴蝶骨大翼的骨纖維性結構不良跟轉化症的關係不明，其對於顳葉的壓迫可能與轉化症有關。 轉化症爲一個罕見的臨床疾病，並會造成的身體運動機能障礙或是感覺缺損，盛行率約5-10/100,000，好發族群爲年輕人，男女比例約爲1:4。目前致病機轉仍不明。轉化症的診斷須先排除其他可能的病因，標準依據主要依循精神疾病診斷準則第4版(DSM-IV)。病患在臨床上會有一些特殊表現，如病患的表現常有漠不關心(indifference)、神經學的缺損時好時壞等。團隊治療能帶來最好的效果，如果病患有功能上的缺失則需要積極復健，其他如藥物、心理治療、或行爲療法可以合併治療。在適當治療下，轉化症的預後良好。
並列摘要
A 21-year-old man had progressive weakness and numbness of bilateral lower extremities and sphincter dysfunction after a traffic accident. The image and electrodiagnostic study showed no significant abnormal findings. Conversion paraplegia was suspected due to unusual clinical presentation, which cannot be explained by neuropathologic lesions. After intensive rehabilitation, patient's functional performance improved significantly and he could walk independently without device. But later, a fibrous dysplasia lesion was found at left sphenoid greater wing. He received an operation to remove it. The relationship between his benign brain tumor and conversion disorder is unknown, but the tumor that compressed temporal lobe might be associated with conversion disorder. Conversion disorder is a psychogenic motor or sensory deficit, with prevalence of about 5-10/100,000. It occurs mainly in young patients, affecting female 4 times than male. The mechanism of conversion disorder is unknown. The diagnosis was established mainly by excluding other causes. Diagnosis of conversion disorder depends on some special clinical signs, such as la belle indifference and unstable neurological deficits. Multidisciplinary treatment for conversion disorder is recommended and intensive rehabilitation is needed for those whose functional status is compromised. The general prognosis of conversion disorder is good.
延伸閱讀
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