A Case of Rapidly Progressive Dementia with Multifocal Brain Lesions

與多處腦部病灶可能有關快速進展的失智症－個案報告

黃斯聖(Si-Sheng Huang) ； 黃正平(Jen-Ping Hwang)

《台灣老年醫學暨老年學雜誌》 3卷3期 (2008/08) Pp. 213-221

https://doi.org/10.29461/TGG.200808.0005

摘要

目的：描述與討論1位與多處腦部病灶可能有關的快速進展的失智症病患所呈現的臨床表徵。
病例報告：病人爲65歲已婚男性，因爲近來迷路兩次而住院評估治療。病人自住院前四個月開始工具性日常生活功能(IADL)、日常生活功能(ADL)、和瞬間或即時記憶與近期記憶皆快速退化。腦部電腦斷層檢查指發現輕微腦萎縮與腦下垂體腫大，但是在核磁共振檢僅發現有腦部多發性病灶。病程中沒有觀察到有妄想、幻覺、或憂鬱。
結論：此個案彰顯臨床處理進展快速失智症病患時，詳細評估的重要性。當病患的認知呈現不尋常的退化病程時，雖然腦部電腦斷層攝影沒有明顯的發現，仍需考慮更進一步精細的影像學檢查（如核磁共振檢查）。

關鍵字

失智症 ； 腦部病灶 ； 核磁共振

並列摘要

Objective: The purpose of this article is to describe and discuss the clinical manifestations of a patient with the rapidly progressive dementia which may have been caused by multifocal brain lesions.
Case Report: A 65-year-old man developed rapidly progressive dementia 4 months prior to presentation. He had a large decline in the immediate and recent memories, as well as abilities in basic and instrumental activities of daily living (ADLS and IADLS), within a short period of time. However, the other features of dementia, such as delusions, hallucinations, and depression, were not found. Computed tomography (CT) of the brain showed only mild brain atrophy, an enlarged pituitary gland, and on the contrary, multifocal brain lesions were detected by magnetic resonance imaging (MRI).
Conclusion: The case reminded us the importance of a thorough evaluation on an unusual patient experiencing rapidly progressive dementia. Even though brain CT indicates only non-specific findings, further delicate imaging studies (brain MRI) should be performed to evaluate those with unusual clinical course of cognitive decline.

並列關鍵字

dementia ； brain lesion ； magnetic resonance imaging MRI