多发性硬化合并虹膜睫状体炎一例报告

患者男性 ,5 2岁 ,1992年出现言语不流利 ,口角歪斜 ,右侧肢体轻度无力 ,拟“脑梗死”治疗 2周后痊愈。 1997年 5月出现视力下降、眼红 ,眼科诊断为虹膜睫状体炎 ,用激素治疗10ｄ后症状缓解。此后反复因视物不清、眼红就诊 ,并 2次住院用激素治疗后症状缓解。 2 0 0 0年 2月再次出院言语欠清、不流利 ,右下肢轻度无力 ,口角歪斜 ,拟“多发性脑梗死”治疗无好转 ,并出现左眼红 ,转我院就诊。查体 :一般检查无异常 ,眼科检查 :左右眼视力 1 2 ,左眼鼻侧球结膜局限性充血 (++) ,角膜荧光染色 (+) ,角膜后沉着物 (- ) ,神经系统 :意识清 ,口角左…     

基底动脉尖综合征并发尿崩症1例

<正>基底动脉尖综合征(TOBS)是指基底动脉尖端缺血或闭塞而出现的一组临床综合征。TOBS国内外报道较多,但尚未见并发尿崩症的病例,现报告1例如下。1病例男,58岁,因"视物成双7 d,不能言语、右侧肢体无力41 h,意识不清16 h"于2012年2月28日入院。入院前1周无明显诱因出现视物成双,自行服用"白加黑"后无好转。41 h前患者出现不能言语,右侧肢体无力。当地医院行头颅CT示左枕叶低密度灶,按脑梗死给予"丹红、奥扎格雷钠、醒脑静"等药物治疗,未见好转。16 h前出现意识不清,呼之不     

高颅压、截瘫(临床病理讨论十三)

病历摘要贲××,女19岁。以头痛、呕吐视物不清一月余,双下肢截瘫七天于1983年7月23日入院。入院前一个月起出现低烧,阵发性头痛、时有恶心、腰背疼、视物模糊。当地卫生院诊断为“风湿性腰背神经痛”。给予去痛片治疗无明显好转。转县医院,确诊为脑膜炎,经用雷米封、青霉素治疗,症状无好转而且逐渐加重。入院前半个月,突发右下腹及腰背部疼痛,七天后突然双下肢截瘫,痛觉消失,尿便潴留。收入本院。检查:体温37.6℃,血压90/70mmHg,脉搏     

急性缺血性卒中后非痴呆认知障碍1例分析

<正> 1 病例简介患者,男,71岁,因"突发右侧肢体无力伴言语不清6天"急诊以"脑梗死"于2009年8月8日入院。患者于6天前夜间起床排尿时突然出现右侧肢体无力,右上肢不能抬起、抓握,右下肢不能行走,同时伴有言语不清,但能理解家人说话。当时无头痛头晕、恶心呕吐、无发热,无视物旋转、视物成双,无吞咽困难,急到我院就诊,诊断为"脑梗死",急诊给予抗血小板聚集、改善循环等治疗,症状略有好     

口服复方妥英麻黄茶碱片致苯妥英钠中毒性小脑性共计失调3例报告

现报告3例口服平喘药物复方妥英麻黄茶碱片致苯妥英钠中毒如下. 1 病例 1.1 例1女,26岁.因"头晕、恶心、言语不清、走路不稳、视物成双2年"于2006年11月8日入院.2年前患者出现头晕、恶心,未吐,当地医院给予一般治疗后症状缓解.1年前再次出现头晕、恶心,并逐渐出现言语不清、走路不稳、视物模糊,而入本院治疗,当时腰穿脑脊液及头颅MRI检查均未见异常.入院期间出现哮喘发作,给予糖皮质激素治疗,哮喘症状消失后出院.近6个月再次出现上述症状入院.     

硬皮病合并颅内系统性血管炎一例

临床资料患者女性,30岁,因"复视、头痛1年,左侧偏身麻木无力1个月"于2008年8月11日入院.既往史:24年前患"硬皮病",经治疗后好转,未复发.患者于1年前无明显诱因出现头痛,以右侧眼眶部为著,视物成双,下视时明显,右眼活动受限.在外院按"多发性硬化"给予激素治疗(具体不详)后无好转.此后患者在上海某医院按"海绵状血管瘤"给予口服"银杏叶片、阿司匹林"等药物治疗,复视逐渐好转.入院前1个月患者出现左侧偏身麻木、无力.     

发作性头晕、意识不清、视物模糊

病历摘要患者男,47岁。因发作性头晕、意识不清2年余,渐进性加重伴视物模糊6个月,于2002年1月10日入院。患者2年前无明显诱因出现发作性头晕、眼前发黑,发作时视物模糊,无抽搐,无视物旋转及耳鸣、耳聋。每次发作持续约10s,发作无规律,间隔数天、数十天或数月不等发作一次。患者于7个月前劳累后突感头晕,随即倒地,意识丧失,伴双上肢抽搐,双眼上窜,牙关紧闭,无大小便失禁。约2min后缓解,醒后不能回忆当时情况,伴头痛视物模糊,数日后视力好转,但仍有头痛,为双颞部胀痛,夜间或凌晨加重。1个月后又数次发生类似发作,曾有小便失禁。视物模糊持续存…     

视物不清 失用

<正>患者女性,58岁。主因视物不清5年、不能完成简单日常生活活动2年伴病情加重3个月,于2012年5月12日就诊。患者为退休干部,5年前出现视物不清且无法分辨日常熟悉事物,但不影响正常生活和活动。至专业眼科医院就诊,考虑为白内障,行手术治疗,术后双眼视物不清症状并未     

家族性线粒体脑肌病（附一个家系报告）

近年有关线粒体脑肌病的报道逐渐增多 ,但家族性病例较少 ,其临床症状复杂 ,易误诊。下面报告一个家系 2例被长期误诊为癫痫的病例。1　病例摘要例 1,男 ,19岁 ,学生。因反复发作意识丧失、两眼上翻、四肢抽搐 10个月而来我院就诊。患者于 1年前突发双眼上视、四肢抽搐意识丧失 ,约数分钟后缓解 ,发作后伴双眼视物不清、头痛、呕吐、听力下降。急来我院急症室就诊 ,查 :面色苍白 ,双瞳孔散大 ,对光反射迟钝 ,双眼左侧凝视 ,双眼黑朦。4小时后恢复正常。给予苯妥英钠 0 .1tid抗癫痫治疗。此后患者又多次出现同样发作 ,每次发作持续数分钟至 1…     

肥厚性硬脑膜炎并静脉窦血栓1例

患者，女，61岁，因反复发作性头晕2年，头痛3个月于2002年7月入院。2年前于晨起时突发头晕，有视物旋转感，伴恶心、呕吐，持续数分钟好转，后反复发作。3个月前患者出现头痛，左颞枕部著，劳累及活动后加重。既往左耳渗出性中耳炎病史4年。查体：意识清，双眼向左注视时有眼球震颤，左耳神经性耳聋，余颅神经（-），四肢肌力V级，腱反射双侧对称，痛觉双侧对称，左上肢快复轮替动作笨拙。颈轻度抵抗，克氏征（＋）。血沉42mm／h。血生化及血常规无异常。     

Customer, Client, Consumer, Recipient, or Patient

Since the arrival of managed care, there has been a trend toward changing the basic terminology used to address clinicians and patients. Instead of the term patient, third party payors frequently use terms such as customer, client, consumer or recipient. One study demonstrated that patients prefer to be called patients. To investigate the preferred term to refer to patients and to be referred to by patients, we mailed a questionnaire to 100 physicians in four medical specialties each and to 100 psychologists. The overall response rate was 61%. Physicians overwhelmingly preferred to refer to patients by the patient's last name, their second preference was the patient's first name. Psychologists preferred to refer to the patients by first name, their second preference was the patient's last name. No group favored using terms such as client, customer, consumer, or recipient. Most physicians and psychologists preferred being referred to as doctors and nobody favored the term provider.     

Fasciitis, perimyositis, myositis, polymyositis, and eosinophilia

Several groups of cases of fasciitis and myositis with eosinophilia are reported. The common features are inflammation into fascia and/or perimysium, and/or muscle fibers; eosinophilia in blood and/or in muscle biopsy. The following classification of 24 cases is suggested: at one end of the spectrum are fasciitis with eosinophilia: diffuse fasciitis (Shulman syndrome): 10 cases (3 with hematological complications); 2 cases of diffuse fasciitis with muscle atrophy; 3 cases of restricted fasciitis. Relapsing perimyositis with eosinophilia belong to the same spectrum, either diffuse (5 cases) with myalgias, or localized (2 cases). Other cases are focal myositis or multiple myositis, polymyositis with eosinophilia. The relationship among these cases is discussed. There is a continuum among the different groups. The pathophysiology remains unknown.     

高海拔地区缺血性卒中患者单核 细胞/HDL-C比值与脑动脉粥样硬化性狭窄的相关性

目的 研究高海拔地区缺血性卒中患者单核细胞/HDL-C比值（monocyte/HDL-C ratio,MHR）与颅内动脉粥样硬化性狭窄（intracranial atherosclerotic stenosis,ICSA）程度的相关性。 方法 回顾性连续纳入2017年6月-2021年6月在青海省人民医院住院治疗的高海拔地区（海拔2260～4080?m）的急性缺血性卒中患者,依据DSA上脑血管狭窄程度（以狭窄最严重的动脉为准）分为无狭窄组、轻度狭窄（狭窄率≤50%）组、中度狭窄（狭窄率50%～70%）组、重度狭窄（狭窄率≥70%）组及闭塞（100%）组。比较5组患者的临床资料、实验室检查指标和MHR,并采用logistic回归模型计算不同程度血管狭窄的独立危险因素。 结果 共纳入349例患者,其中无狭窄组69例、轻度狭窄组78例、中度狭窄组41例、重度狭窄组84例、闭塞组77例。5组中年龄、性别分布、吸烟、饮酒、高血压、糖尿病比例方面差异均有统计学意义,实验室检查中白细胞、单核细胞、中性粒细胞、血小板计数以及血红蛋白、HDL-C水平和MHR差异也有统计学意义。多因素logistic回归分析显示,相对于无动脉狭窄,高龄为脑血管轻度狭窄（OR?1.061,95%CI?1.027～1.097,P＜0.001）,中度狭窄（OR?1.057,95%CI?1.017～1.099,P＝0.005）,重度狭窄（OR?1.096,95%CI?1.057～1.137,P＜0.001）,闭塞（OR?1.036,95%CI?1.001～1.072,P＝0.046）的独立危险因素;相对于无动脉狭窄,高MHR为轻度狭窄（OR?1.041,95%CI?1.009～1.074,P＝0.011）,中度狭窄（OR?1.082,95%CI?1.045～1.119,P＜0.001）,重度狭窄（OR?1.096,95%CI?1.062～1.131,P＜0.001）,闭塞（OR?1.101,95%CI?1.067～1.136,P＜0.001）的独立危险因素;相对于无动脉狭窄,单核细胞计数升高是中度狭窄（OR?1.684,95%CI?1.569～2.725,P=0.027）、重度狭窄（OR?3.529,95%CI?1.541～5.766,P=0.002 ）和闭塞（OR?5.446,95%CI?4.453～6.917,P=0.002）的独立危险因素。 结论 高龄、高MHR和单核细胞计数升高在高海拔地区对急性缺血性卒中患者的脑动脉粥样硬化性狭窄程度具有一定预测价值。     

Frontal lobe psychopathology: mania, depression, confabulation, catatonia, perseveration, obsessive compulsions, and schizophrenia

The frontal lobes can be subdivided into major functional neuroanatomical domains, which, when injured, surgically destroyed, or reduced in activity or volume, give rise to signature pathological and psychiatric symptomology. A review of case reports and over 50 years of research, including magnetic resonance imaging, positron emission tomography, and single photon emission computed tomography scans, indicates that apathy, "blunted" schizophrenia, major depression, and aphasic-perseverative disturbance of speech and thought are associated with left lateral as well as bilateral frontal (and striatal) abnormalities. Impulsiveness, confabulatory verbosity, grandiosity, increased sexuality, and mania are associated with right frontal (as well as bilateral) disturbances. Gegenhalten, catatonia, and disturbances of "will" are indicative of medial frontal injuries. Disinhibitory states and obsessive-compulsive perseverative abnormalities are more frequently observed with orbital frontal lobe dysfunction, including frontal-striatal disturbances. These associations, however, are not always clear-cut as patients with the same diagnosis may demonstrate different symptoms that may be due to an additional abnormality in a different region of the brain. Moreover, as the frontal subdivisions are richly interconnected, and as frontal lobe abnormalities are not always discrete or well localized, a wide array of seemingly divergent waxing and waning symptoms may be manifest, sometimes simultaneously, including manic depression and what has been referred to as the "frontal lobe personality."