1例误诊为原发性精神病的额颞叶痴呆病例讨论

A case of frontotemporal dementia misdiagnosed as primary psychosis and literature review

目的:报道1例早期误诊为原发性精神病的额颞叶痴呆患者诊疗过程并进行讨论分析。方法:对1例行为变异型额颞叶痴呆患者的临床和神经影像学表现进行分析。结果:本病例为中年女性,首发表现为精神异常,在外院先后诊断为抑郁症、精神分裂症,予药物治疗后效果不佳,行头颅MRI示双侧额颞叶萎缩,左侧明显。头颅18F-FDG PET示:双侧侧额叶、颞叶外侧代谢减低。FTD相关基因检测发现该患者存在易感基因突变。结论:这是1例典型的bvFTD病例,早期被误诊为原发性精神病,这提示在精神异常的诊断过程中,需与bvFTD鉴别诊断。

Objective:To report a case of frontotemporal dementia who was misdiagnosed as primary psychosis.Methods:To analyze the clinical and neuroimaging features of a patient with behavioral variant frontotemporal dementia.Results:This case included a middle-aged female with mental abnormality at first,and was diagnosed as depression and schizophrenia successively in other hospitals.After treatment with related drugs,the effect was poor.Head MRI in our hospital showed bilateral frontotemporal lobe atrophy,with the left side obvious.Cranial 18F-FDG PET showed decreased metabolism in bilateral lateral frontal and temporal lobes.Ftd-related genetic testing found that the patient had a susceptibility gene mutation.Conclusion:This is a typical case of bvFTD,which was misdiagnosed as primary psychosis at an early stage,suggesting that the possibility of bvFTD should be considered in the diagnosis of mental disorders.