32.3 🩺 內科專科考前版

32.3.0.1 📌 䞀頁重點

  • 22E 匷調Primary Progressive Aphasia (PPA) — FTD spectrum
  • Autoimmune encephalitis 為 acute aphasia / amnesia 重芁原因
  • Stroke aphasia rehab evidence-based

32.3.0.2 🧠 進階機蜉

32.3.0.2.1 Primary Progressive Aphasia (PPA)
  • FTD spectrum
  • 3 variants:
    • Semantic variant (svPPA): word meaning loss + 物品呜名 + 識別障
    • Non-fluent variant (nfvPPA): agrammatism + apraxia of speech
    • Logopenic variant (lvPPA): anomia + sentence repetition impaired (åžž AD pathology)
32.3.0.2.2 Autoimmune Encephalitis
  • Anti-NMDA receptor: psychiatric + memory + seizure + autonomic + 兒童女性 / ovarian teratoma
  • LGI1: amnesia + faciobrachial dystonic seizure + hyponatremia
  • CASPR2: Morvan syndrome
  • 治療steroid + IVIG + rituximab + tumor 移陀

32.3.0.3 💊 治療

32.3.0.3.1 Stroke Aphasia
  • Speech-language therapy (SLT) early
  • 矀組 / individual 治療
  • Computer-assisted therapy
  • TMS / tDCS adjunct (emerging)
  • Mirror neuron training
32.3.0.3.2 PPA
  • Symptom-targeted SLT
  • Treat behavioral symptoms
32.3.0.3.3 Autoimmune Encephalitis
  • IVIG / plasmapheresis / rituximab / cyclophosphamide
  • Tumor screen + removal
  • Long-term immunosuppression

32.3.0.4 🌟 Pearls (8)

  1. Aphasia evaluation = 4 axes
  2. PPA is increasing recognized FTD variant
  3. Anti-NMDA encephalitis in young female + tumor
  4. Aphasia rehab early — neuroplasticity window
  5. Korsakoff 倧量 alcoholic
  6. HSV bilateral temporal lobe 經兞
  7. TIA aphasia = ABCD2 high → 預譊 stroke
  8. Awake craniotomy 甚斌 dominant hemisphere tumor 保護 language

32.3.0.5 🔍 特殊情境

  • Aphasia in left-handed: 70% language still left, but 30% bilateral / right
  • TIA: transient aphasia + hemiparesis
  • Migraine aura: transient
  • Seizure aphasia: post-ictal Todd’s
  • Encephalitis acute amnesia: HSV / autoimmune

32.3.0.6 📍 台灣 Context

  • 健保 SLT 埩健限次敞
  • Stroke aphasia rehab integrated in 埩健科
  • Anti-NMDA encephalitis 認可䞊升

32.3.0.7 ⚠ 老闆地雷

  1. Aphasia 當 confusion
  2. Wernicke 當 psychiatric
  3. PPA 挏蚺
  4. Autoimmune encephalitis 挏幎茕女
  5. 䞍蜉 SLT 埩健

32.3.0.8 🎓 內專重點

  1. 8 aphasia types
  2. PPA 3 variants (22E)
  3. Autoimmune encephalitis
  4. Memory anatomy
32.3.0.8.1 跚章節
  • Ch 31 Dementia
  • Ch 442 AD/FTD
  • Ch 439 Stroke

32.3.0.9 📖 延䌞閱讀

  • Mesulam PPA Criteria
  • Anti-NMDA Receptor Encephalitis (Dalmau 2008)

32.3.0.10 📚 玢匕

⚠ AI 草皿。