47.36歲女性，最近三年有失眠的困擾。在夜間坐著，特別是躺在床上的時候，覺得兩小腿有一種非動不可的感 覺，伴隨一種難以言喻的酸麻。所以她必須不斷的伸一伸、踢一踢或起來走一走，煎熬整夜。下列何者與她 的臨床診斷最不可能相關？
(A)缺鐵性貧血（iron deficiency anemia）
(B)慢性腎臟病（chronic kidney disease）
(C)癲癇症（epilepsy）
(D)睡眠週期性肢體抽動症（periodic limb movements in sleep）

答案：登入後查看
統計： A(42), B(47), C(415), D(45), E(0) #3261111

詳解 (共 3 筆)

#6232858
不寧腿症候群（Restless Legs...
(共 153 字，隱藏中）
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#6263341

Restless Leg Syndrome

  • 女 > 男、高峰30-40歲、因為缺鐵
  • 原發性：idiopathic，但77%有家族史
  • 次發性：缺鐵、缺B12、腎衰竭、DM周邊神經病變、Parkinsonism、Multiple sclerosis、懷孕、藥物（抗憂鬱藥、Dopamine antagonists）
    • 癲癇沒有關係
  • 大腿猶如有螞蟻在爬，晚上、休息時症狀加劇，下床動一下、拍大腿會有幫助
    • 會伴隨Periodic limb movements of sleep (PLMS) 或 periodic limb movements of wakefulness (PLMW)
  • 睡眠時EEG始終呈現運動狀態
  • 治療：生活習慣改變，藥物
    • 藥物：
      • L-Dopa、Carbidopa
      • Alpha-2-delta calcium channel ligands：gabapentin enacarbil, pregabalin, or gabapentin
      • Nonergot dopamine agonist：pramipexole: , ropinirole
      • 補鐵 (if ferritin <75 ng/dL)
    • 治療underlying、停用誘發藥物、戒咖啡酒
    • 喝酒、安眠藥皆無效
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#6370628
Restless leg syndrome is a/w:

  • Chronic Kidney Disease: Particularly in patients undergoing dialysis. ​

  • Peripheral Neuropathy: Nerve damage in the limbs can be related to RLS. ​

  • Parkinson's Disease: Both conditions involve dopaminergic systems.​

  • Pregnancy: Especially during the third trimester, possibly due to hormonal changes.​

  • Iron Deficiency Anemia: Low iron levels are a significant risk factor.​ **

  • Diabetes Mellitus: Due to associated neuropathies.​

  • Multiple Sclerosis: A neurological condition that can be linked to RLS.​

  • Rheumatoid Arthritis: An autoimmune disorder associated with RLS.​

  • Thyroid Disorders: Both hypo- and hyperthyroidism have been implicated.​

  • Depression and Anxiety: Mental health conditions may coexist with RLS.​

  • Sleep Disorders: Conditions like sleep apnea are commonly associated.

Management:

  • Iron Supplementation: For patients with low ferritin levels.​

  • Dopamine Agonists: Medications that mimic dopamine effects.​

  • Alpha-2-Delta Ligands: Such as gabapentin, used for nerve pain.​

  • Lifestyle Modifications: Regular exercise, sleep hygiene, and avoidance of triggering substances.

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