小舞蹈病的临床特点及误诊原因分析

Clinical Diagnosis and Misdiagnosis Analysis of Sydenham Chorea

目的:分析小舞蹈病的临床特点,以提高对小舞蹈病的认识,减少临床误诊。方法:对2005年1月-2007年7月年收治的3例小舞蹈病患者的临床资料、临床诊断及误诊原因进行分析。结果:3例中,起病前有急性扁桃体感染史1例;所有病例均有肢体的不自主运动和肌张力低下,其中伴有面部症状2例,小脑症状1例,精神症状2例;抗链球菌溶血素O增高2例。超声心动图检查发现心脏异常1例,表现为二尖瓣稍增厚伴中度二尖瓣反流、主动脉瓣稍增厚伴轻度主动脉瓣反流。3例颅脑核磁共振成像均正常。3例中仅1例获及时诊断,其余2例均有不同程度的误诊。经青霉素、氟哌啶醇等药物治疗后患者症状均有明显改善。结论:小舞蹈病患者缺乏特征性临床表现,易被临床误诊。

Objective：To explore clinical characteristics of Sydenham chorea, to improve clinical diagnosis accuracy and to reduce misdiagnosis. Methods：Three cases of Sydenham chorea enrolled at Zhongshan hospital from January 2005 to July 2007 were retrospectively analyzed, including of clinical features, diagnostic process and misdiagnosis causes. Results： In these patients, one had acute tonsil infection previous to Sydenham chorea. All of them had involuntary movements and decreased mus cular tension of the limbs, two patients with facial symptoms, one patient with cerebellar symptoms. Mental symptoms and increased titer of antistreptolysin antibody were present in two patients. One patient had slight mitral valve thickening with moderate regurgitation and slight aortic valve thickening with slight regurgitation. Cranial MRI revealed no abnormal signal in all three patients. Only one patient was timely and correctly diagnosed and the others were misdiagnosed or delayed to diagnose. Three patients＇ clinical symptoms were significantly relieved after medication with penicillin and haloperidol. Conclusion：The patients with Sydenham chorea manifest atypical clinical presentations and they are easy to be misdiagnosed.