Will lose character

Introduction Mental retardation varies greatly among patients. Recent memory loss is the most obvious feature. Patients often show sluggishness, spontaneous or active activities decline, talk, reading, writing, hobbies and creativity are weakened, and family care and indifference Or cold, lonely, and inefficient. Some people call these complex activity anomalies the loss of temperament. The loss of will character is one of the clinical symptoms of normal intracranial pressure hydrocephalus. Normal intracranial pressure hydrocephalus refers to normal intraventricular pressure and enlarged ventricles. The clinical manifestations of gait instability, unresponsiveness and urinary incontinence are the main symptoms, and have a certain effect on gait instability and mental retardation after shunt treatment.

Cause

The cause of the loss of will personality:

(1) Causes of the disease: The cause can be divided into two categories, one is a clear cause, such as subarachnoid hemorrhage and meningitis, and the other is sporadic and no obvious cause. The main pathological change of the disease is The ventricular system is enlarged, the subarachnoid adhesion and occlusion of the cerebral convex surface or the brain base, the most common cause is subarachnoid hemorrhage, followed by intracranial tumors, and familial normal cranial hydrocephalus. Paget disease sometimes occurs. The subarachnoid space on the underside of the brain is extensively blocked. Meningeal infections, such as tuberculous meningitis, are prone to arachnoid adhesions in the later stages of the lesion; traumatic subarachnoid hemorrhage and intracranial hemorrhage into the subarachnoid space can be produced. Hydrocephalus, it has recently been suggested that the stenosis of the midbrain is also a more common cause.

(B) the pathogenesis: under normal cranial pressure, the mechanism of ventricular enlargement is still not fully clear, and currently it is mainly the cerebrospinal fluid dynamics theory.

1. Formation of pressure gradient in the brain: When the arachnoid granules are blocked, no hydrocephalus is produced, but a benign intracranial pressure is increased. When the cerebrospinal fluid increases the flow resistance in the ventricular system and the subarachnoid space, the ventricle enlarges. Hydrocephalus, which suggests the formation of pressure gradients on the ventricles and cerebral cortex, is the cause of ventricular enlargement. This model of pressure gradient formation has been demonstrated using a clay-induced cat hydrocephalus experimental model.

2. Cerebrospinal fluid pulse pressure increased: Some people measured normal intracranial hydrocephalus, the average cerebrospinal fluid pressure did not increase, but there may be increased cerebrospinal fluid pulse pressure, so that the ventricle is enlarged, under normal circumstances, the cerebral parenchyma in the brain parenchyma, cell gap protein and Lipids have a sponge-like elastic substance in which the liquid component can be squeezed out when the intracranial pressure is raised. Under a certain degree of pressure, the brain parenchyma can be compressed. This pressure is called the brain tissue bioelastic value at which the value The following intracerebral pressure only acts on the brain tissue without any liquid extrusion in the brain parenchyma, but the pressure around the ventricle is greater than the pressure in the brain parenchyma, which results in ventricular dilatation.

3. Principle of closed elastic container: It has been suggested that the initial intracranial pressure of patients with normal intracranial hydrocephalus is increased, resulting in ventricular enlargement, according to the Lapace principle, that is, the liquid pressure (P) in the closed elastic container and the area of the container wall (A) The product is equal to the wall endurance of the container (F, F = PA). Thus, once the ventricle is enlarged, although the brain pressure returns to normal, the pressure on the brain wall is still increased. It is also suggested that normal intracranial pressure hydrocephalus is due to brain tissue compliance. The ventricle enlargement manifested by sexual change, Welch et al reported that hypertensive arteriosclerotic cerebrovascular disease is more than three times higher than that of patients of the same age group. It is speculated that changes in the elasticity of the cerebral vascular wall increase brain tissue compliance and may have a pressure gradient on the brain surface. A significant change has taken place.

At present, the pathophysiological changes of brain tissue in normal cranial pressure hydrocephalus are mainly studied: 1 cerebral blood flow caused by compression of brain tissue is reduced; 2 abnormal neurobiochemical substances in brain tissue, such as glial fibrin increase and vascular intestinal peptide Reduction; 3 secondary neuronal damage.

an examination

Related inspection

State of consciousness international standard intelligence test

Examination of the loss of volitional personality:

Based on medical history, clinical manifestations, and imaging-assisted examinations, a clear diagnosis can generally be made.

The main symptoms are gait instability, memory impairment and urinary incontinence. Most patients have progressive progressive development. Some patients have a disease course of several months or years after the condition appears. The patient has no obvious headache, but has behavioral changes, epilepsy or pa Jinsen's disease, although the extraocular muscle activity is sufficient, but there may be nystagmus, continuous constant walking difficulty, slow limb movement, slightly increased sputum reflex, unilateral or bilateral Babinski's sign, and late exploration And strong grip reflexes, gait instability is often the primary symptom, many months or years before other symptoms, some patients with gait instability and intellectual changes can occur at the same time, but also occur after other symptoms, its performance from Mild walking is not stable enough to walk, or even standing, and often has a history of falling, patients have difficulty lifting their legs, can not do anti-gravity activities, small stride, wide step, unbalanced walking, can not be two consecutive sequential activities, The Romberg test showed sway, but there was no cerebellar ataxia. The mental retardation was different in each patient. The recent memory loss was the most obvious feature. Spontaneous or active activities decline, conversation, reading, writing, hobbies and creativity weaken, do not care about the family, indifference or indifference, solitude, poor work efficiency, some people call these complex activities abnormal, called will lose personality, have experiment It is found that the patient's vocabulary ability is basically retained, and the use of non-vocabulary abilities, such as drawing, copying, table arrangement, and difficult test, has a large degree of obstacles. As the disease progresses, it does not respond to the questions raised by the surrounding people. Short or partial answers, slow or delayed autonomy, in some early patients with intellectual impairment, anxiety and complex mental dysfunction, such as arrogance, fantasy and incoherence, but also slow, rigid, similar to Parkinson symptoms, Urinary incontinence is very urgent in some patients, but most patients show a feeling of urinary sensation or urinary movement, and fecal incontinence is rare.

Differential diagnosis

Differential diagnosis of symptoms of volitional personality confusion:

1. Depression: The mood is low, and it is not commensurate with the situation. It can be from sullen and unhappy to grief and even stupor. In severe cases, psychotic symptoms such as hallucinations and delusions may occur. Anxiety and motility agitation in some cases are significant.

2, memory impairment: refers to the individual in a state that can not remember or recall information or skills, may be due to pathophysiological or contextual causes of permanent or temporary memory impairment. Memory includes memorization, retention, and reproduction, and is closely related to neuropsychological function. According to neurophysiological and biochemical studies, memory is divided into transient memory (in minutes, seconds) short-term memory (days) and long-term memory (months, years). Memory and forgetting are accompanied, and forgetting has time and selectivity. The newly memorable materials are the fastest to forget, and gradually develop into distant things, and things that have caused high attention are hard to forget.

3. Consciousness disorder: Consciousness disorder refers to a state in which people's perception of their own and the environment is impeded, or the mental activity of people's perception of the environment is impeded.

4, severe emotional disorders: severe emotional disorders, refers to long-term emotional or behavioral responses are significantly abnormal, seriously affecting the life of the adaptation; its obstacles are not directly caused by factors such as intelligence, sensory or health. Symptoms of mood disorders include mental disorders, affective disorders, anxiety disorders, attention deficit hyperactivity disorder, or other persistent emotional or behavioral problems.

Based on medical history, clinical manifestations, and imaging-assisted examinations, a clear diagnosis can generally be made.

The main symptoms are gait instability, memory impairment and urinary incontinence. Most patients have progressive progressive development. Some patients have a disease course of several months or years after the condition appears. The patient has no obvious headache, but has behavioral changes, epilepsy or pa Jinsen's disease, although the extraocular muscle activity is sufficient, but there may be nystagmus, continuous constant walking difficulty, slow limb movement, slightly increased sputum reflex, unilateral or bilateral Babinski's sign, and late exploration And strong grip reflexes, gait instability is often the primary symptom, many months or years before other symptoms, some patients with gait instability and intellectual changes can occur at the same time, but also occur after other symptoms, its performance from Mild walking is not stable enough to walk, or even standing, and often has a history of falling, patients have difficulty lifting their legs, can not do anti-gravity activities, small stride, wide step, unbalanced walking, can not be two consecutive sequential activities, The Romberg test showed sway, but there was no cerebellar ataxia. The mental retardation was different in each patient. The recent memory loss was the most obvious feature. Spontaneous or active activities decline, conversation, reading, writing, hobbies and creativity weaken, do not care about the family, indifference or indifference, solitude, poor work efficiency, some people call these complex activities abnormal, called will lose personality, have experiment It is found that the patient's vocabulary ability is basically retained, and the use of non-vocabulary abilities, such as drawing, copying, table arrangement, and difficult test, has a large degree of obstacles. As the disease progresses, it does not respond to the questions raised by the surrounding people. Short or partial answers, slow or delayed autonomy, in some early patients with intellectual impairment, anxiety and complex mental dysfunction, such as arrogance, fantasy and incoherence, but also slow, rigid, similar to Parkinson symptoms, Urinary incontinence is very urgent in some patients, but most patients show a feeling of urinary sensation or urinary movement, and fecal incontinence is rare.

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