血管内治疗颅内动脉瘤37例分析

目的：探讨血管内治疗颅内动脉瘤的疗效及减少并发症发生的方法。方法回顾性研究2008年01月～2013年12月血管内治疗的37例颅内动脉瘤患者（共40个动脉瘤）的临床治疗以分析其疗效及并发症防治。结果该组颅内动脉瘤成功栓塞40个,其中100%栓塞34个,95%栓塞4个,90%栓塞2个。术中动脉瘤破裂2例,术中血管痉挛12例,症状性血管闭塞2例,无术中死亡。结论血管内治疗颅内动脉瘤疗效确切,具有微创、安全等优点;提高手术操作水平,减少和正确处理术中及术后并发症有助于改善预后。     

Neuromyelitis Optica Spectrum Disorder With Hyponatremia as an Initial Presentation: A Case Report

The diagnosis of neuromyelitis optica spectrum disorder (NMOSD) is easily missed or delayed because of its multiple clinical features, especially at initial presentation. Hyponatremia is an infrequent complication of NMOSD and can present as an initial sign. Hyponatremia in a patient with NMOSD might be caused by autoimmune-related antibodies that attack the hypothalamus, causing inappropriate antidiuretic hormone secretion. Awareness of this pathophysiologic mechanism will help clinicians in the early diagnosis of NMOSD. We report a case of NMOSD with hyponatremia as the initial presentation.     

肺炎型细支气管肺泡癌误诊为肺炎一例

目的探讨肺炎型细支气管肺泡细胞癌（bronchioloalveolar carcinoma,BAC）误诊原因,提高本病早期诊断水平。方法对我院收治的1例肺炎型BAC的临床资料进行回顾性分析。结果本例因咳嗽2个月,活动后气促40d,加重半个月入院。在基层诊所及市级医院诊治20d,按结核性心包炎、社区获得性肺炎予抗结核、抗感染治疗,呼吸困难进行性加重,并出现右上肢肿胀,彩超示多发血栓形成。转本院经纤维支气管镜检查及活检,发现送检支气管黏膜和肺组织中有少量异型细胞,经病理检查证实为BAC。因病情进展迅速,呼吸衰竭死亡,在本院共住院10d。结论临床医生诊治经验不足、思维局限、对本病认识不足是导致误诊的主要原因,提示临床医生应开阔诊断思路,动态细致观察,深入询问、检查,全面分析,合理选择医技检查,避免误诊误治。     

Cough Headache Presenting as a Toothache: A Case Report

SYNOPSIS
Benign cough headache (BCH) presents as an intermittent, usually bilateral, severe bursting or explosive pain brought on by coughing. Some of the known conditions which can mimic the pain experienced in BCH are subarachnoid hemorrhage, increased intracranial pressure, intracranial tumors, and even toothache. Careful evaluation must be carried out in order to differentiate between these conditions. A case of BCH which presented as a toothache is reported. The evaluation for exertional headaches, and for headaches brought on by coughing, is discussed.     

Initial Experience of Emergency Physicians Using the Intubating Laryngeal Mask Airway: A Case Series

OBJECTIVE: Although the intubating laryngeal mask airway (ILMA) is widely available, its use by emergency physicians (EPs) has not been reported. The authors report the initial experience of EPs using the ILMA. A review of their experience and the relevant anesthesia literature provides a basis for EPs to use the ILMA more confidently and effectively. METHODS: Between January 2000 and January 2001, the ILMA was used on a convenience sample of emergency department (ED) patients undergoing "routine" intubations, and "rescue" situations, after failed rapid-sequence intubation (RSI). Patients were identified from the ED resuscitation case database. Chart review and intubating physician interviews focused on success of the device, complications encountered, and "pearls" of the device's use as perceived by the intubating physician. RESULTS: Ventilation with the appropriate-size ILMA occurred in less than 15 seconds in all "routine" intubations; tracheal intubation was subsequently accomplished in less than 1 minute. Eight of nine "routine" patients had blind tracheal intubation through the ILMA. One patient required fiberoptic bronchoscopy to guide the endotracheal tube into the trachea. Of the "rescue" intubations, all patients (n = 7) were successfully ventilated and five were successfully intubated using the ILMA. CONCLUSIONS: In this case series, the ILMA was easy to use in acute resuscitations, and proved to be invaluable in cases of failed RSI.     

经腰椎截肢患者的综合康复护理1例

经腰椎截肢（包括全骨盆切除）,是目前平面最高的下肢截肢术。2007年3月18日本科收治一名经腰椎截肢患者,经过康复医生、护士、假肢工程师与技师、康复治疗师的共同努力,成功安装下肢假肢并实现行走,康复期间未出现严重并发症,最终成功回归社会。     

森林脑炎康复治疗1例报道

报道1例33岁男性患者,森林脑炎病毒感染后出现严重的神经功能缺损,生活质量下降.通过个体化的康复治疗策略,患者的运动功能和生活质量均有明显改善.     

Cluster Headache as the Index Event in MS: A Case Report

We report a 42‐year‐old woman who presented with cluster headache (CH) in association with other neurological symptoms as the index event of new onset multiple sclerosis (MS). Her initial symptoms were left‐sided headache with ipsilateral lacrimation and nasal congestion associated with ipsilateral facial numbness. A subsequent similar headache attack was also associated with ipsilateral arm ataxia and gait ataxia. She had many additional short headache attacks without focal neurological symptoms. Her cluster‐like headache attacks have not recurred since intiation of dimethyl fumarate. Our patient illustrates that cluster‐like headache attacks can occur as a first symptom of MS, in our patient in association with other neurological symptoms. A striking finding in our patient was a large demyelinating lesion in the brachium pontis ipsilateral to the headaches, although additional supratentorial demyelinating lesions were also present. Although CH associated with MS is rare, our patient and the two other reported patients with MS and CH with similar ipsilateral brachium pontis lesions suggest that the lesions in this location may have played a role in the generation of the cluster‐like attacks.     

Congenital Bronchial Stenosis Presenting as Neonatal Respiratory Distress: A Case Report

BackgroundNeonatal respiratory distress has a broad differential that includes cardiac, pulmonary, anatomic, and infectious etiologies. Congenital stenotic lesions of the trachea and bronchus are rare and can occur anywhere along the tracheobronchial tree. Patients with tracheobronchial stenosis typically present in the neonatal period with respiratory distress.Case ReportWe present a case of a 10-day-old term female who presented to the emergency department (ED) with tachypnea and increased work of breathing. She was found to have congenital bronchial stenosis of her right mainstem bronchus. She was stabilized in the ED and remained in the neonatal intensive care unit until successful slide tracheoplasty was performed.Why Should an Emergency Physician Be Aware of This?Congenital bronchial stenosis is a rare etiology of respiratory distress in a neonate. Anatomic lower airway abnormalities are an important cause of neonatal tachypnea and must remain on the differential. In addition to respiratory stabilization with noninvasive or invasive support, evaluation should be directed at determining the location and anatomic characteristics of the area of stenosis.     

误诊为痛风性关节炎的布鲁菌病一例并文献复习

目的探讨布鲁菌病的临床特点,减少误诊误治。方法回顾分析1例误诊为痛风性关节炎的布鲁菌病的临床资料,并复习相关文献。结果本例以右踝关节疼痛、发热为主要临床表现,初诊考虑痛风性关节炎急性发作,经抗感染、镇痛治疗效果不明显,追溯病史了解患者近期有病畜接触史,布鲁杆菌试管凝集试验效价1∶400,虎红平板凝集试验阳性,明确诊断为布鲁菌病,予利福平、多西环素治疗,痊愈。结论对间断低热、外周单关节炎患者需注意排除布鲁菌病的可能,注意详细询问牛、羊等病畜接触史,疑诊者应及时行布鲁杆菌血清学检查以确诊。     

累及右心、肺动脉的静脉内平滑肌瘤病一例误诊并文献复习

目的提高对静脉内平滑肌瘤病(intravenous leiomyomatosis,IVL)临床特点的认识,以减少误诊误治。方法回顾性分析累及右心、肺动脉的IVL 1例的临床资料并复习相关文献。结果本例因发作性意识不清4月余入院,当地医院曾误诊为癫痫发作,经治疗无好转。后在我院行妇科及双下肢彩色多普勒超声(彩超)、下腔静脉及肝静脉彩超、肺动脉CT血管造影(CTPA)及纯静脉期CT血管造影(CTV)检查确诊为IVL。在全麻下行手术治疗,术后病理明确诊断为IVL(累及右心系统及肺动脉)、子宫平滑肌瘤及子宫静脉IVL,后病情好转出院。结论临床医师应提高对IVL的认识,详细询问病史、仔细查体、完善相关影像学检查是避免误诊的关键。     

以肾损害为首发表现的Castleman病误诊1例分析并文献复习

目的：提高对Castleman病肾脏损害的认识。方法：对1例以肾损害为首发表现的Castleman病进行病例分析,并复习国内外有关文献。结果：患者为多中心型浆细胞型Castleman病,主要表现为贫血、蛋白尿和急性肾衰、血沉增快、多克隆球蛋白血症和低白蛋白血症,经治疗好转,肾功能恢复。结论：Castleman病引起肾脏损害较少见,且临床表现不典型,如遇此种类似病例尽早行肿大淋巴结活检,以期尽早帮助明确诊断。     

Rhythmic Neck Muscle Spasms and Upper Limb Muscle Myoclonic Jerks as an Unusual Initial Presentation of Posttraumatic Cervicothoracic Syringomyelia: A Case Report

Posttraumatic syringomyelia with an initial presentation of involuntary movement is rare. We describe a 25-year-old patient who sustained complete traumatic spinal cord injury at the thoracic level and presented with rhythmic neck muscle spasms and upper limb muscle myoclonic jerks 1 month after trauma. Magnetic resonance imaging revealed syrinx formation between C3 and T1. Lumbar-peritoneal shunt and decompression were performed. The symptoms completely disappeared after surgery. This report highlights that rhythmic neck muscle spasms and upper limb muscle myoclonic jerks can be the initial and only manifestations of syringomyelia.

脑血管母细胞瘤术后共济失调康复1例报道

目的探讨脑血管母细胞瘤的临床特点及共济失调康复方法。方法报道1例脑血管母细胞瘤多次复发患者,手术后出现共济失调,给予康复训练。结果经过3个月康复后,患者Fugl-Meyer平衡功能评分由4分增加到13分;改良Barthel指数由50分提高到90分。结论康复训练能改善脑血管母细胞瘤多次复发患者日常生活能力和平衡功能。