临床推理:57岁男子与亚急性步态困难和手震颤

一个57岁的人面对进步很难走了2周,1周休息的手颤抖,少量的演讲2天。最初,他开始行走困难。很快,他发达short-stepped步态与全体下降前进的历史。在2周内发病,他成了卧床。虽然躺在床上,他仍然非常僵硬,不能坐或两侧。他也曾在他的上肢动作颤抖。演讲成交量减少,但他总是保持一致的。没有肠道或膀胱参与,屈肌痉挛,或束勒感。病人被治疗强直性脊柱炎(AS)与非甾体类抗炎药物4年来因为腰痛,逐步增加向前倾步态,并在x射线硬化的骶髂关节。在考试之外,他还有一个面具的脸。 His blink rate was 1 to 4 blinks per minute. His Mini-Mental State Examination score was 29 of 30. He had hypophonic monotonous speech. His eye movements showed slow saccades and broken pursuit movements. Examination of motor system revealed normal muscle bulk, cogwheel rigidity of the upper limbs, and lead-pipe rigidity in the legs. His strength could not be tested because of profound muscle stiffness. Coarse action tremors were noticed in both hands. The patient had fixed-flexion deformity at the hip joint. Deep tendon jerks could not be elicited because of profound muscle rigidity. Plantar responses and abdominal reflexes also could not be elicited.