杏林荟萃之医学英语8：病例分析

在之前的医学英语栏目中我们学习了神经系统的一些基础词汇，包括神经系统解剖以及卒中、癫痫等两大常见疾病的相关内容。现在我们通过几个usmle step1中的病例题来在应用当中复习一下。

A patient is brought to a physician because of multiple episodes of "fainting." Cardiovascular evaluation prove negative, but the clinician suspects that a medical condition exists and orders an EEG, which demonstrates a abnormal spiking pattern. Which of the following types of seizure did this patient most likely experience?

A. Absence

B. Atonic

C. Myoclonic

D. Tonic

E. Tonic-clonic

Explanation:

The correct answer is B. All of the forms of seizure listed in the choices are generalized seizures. The type of seizure that would most closely resemble a fainting spell is the atonic, or "drop," seizure. In this form of seizure,the patient suddenly loses muscle tone and falls to the floor.

Absence seizures (choice A), also known as petit mal seizures, are characterized by blank stares and an absence of any change in position. They are more commonly seen in childhood.

Myoclonic seizures (choice C) are characterized by quick, repetitive jerks.

Tonic seizures (choice D) are characterized by stiffening of the muscles.

Tonic-clonic seizures (choice E), also known as grand mal seizures, are characterized by alternating stiffening and movement.

一位病人因多次晕厥发作史就诊。心血管系统评估正常，不过医生怀疑该病人有疾病存在并安排了脑电图。脑电图示异常棘波。该病人最有可能是下列哪种类型的癫痫？

A.失神发作

B.失张力发作

C.肌阵挛发作

D.强直发作

E.强直阵挛发作

解释：

正确答案是B。列出的所有选项均为全面性发作。与晕厥发作最相似的癫痫类型为失张力发作，或“跌倒”发作。在这种癫痫中，病人突然丧失肌张力并摔倒在地。

失神发作（A），也叫作癫痫小发作，以空白凝视和停止当前活动为特征。这种类型在儿童期常见。

肌阵挛发作（C）以快速反复的抽动为特征。

强直发作（D）以肌肉僵硬为特征。

强直阵挛发作（E），也叫做癫痫大发作，以肌肉僵直和抽动交替为特征。

Evaluations

A thorough history and neurological examination,as well as appropriate diagnostic studies for these disturbances(usually including blood tests,brain imaging,EEG,and sometimes ongoing EEG monitoring)are often necessary.

For complex partial seizures,cranial MRI can be indicated to detect focal brain lesions.

T2-weighted MRI identifies sclerosis of mesial temporal lobe.Gadolinium enhancement is indicated if a neoplasm or vascular malformation is suspected.In addition,special imagingprotocols can be required for subtle corticol changes.EEG should be performed in every patient who has experienced a “spell”that may be a possible seizure.Epileptiform discharges can indicate the type of seizure and site of the seizure focus.When the EEG and history are nondiagnostic ,prolonged EEG-video monitoring is useful for differential diagnosis.