中英临床推理男性34岁，头痛复视

SECTION1第一部分

A34-year-oldright-handedmanawokewithlethargy,headache,diplopia,bilateralfacialnumbness,mildrighthemiparesis,andrightarmnumbness.Afewweeksprior,hehadreceivedvaccinesforinfluenzaandhepatitis.Hishistorywassignificantforchronicsinusitis.Familyhistorywasnegativeforneurologicandautoimmunedisease.

34岁男性，右利手，昏睡可唤醒，头痛，复视，双侧面部麻木，右侧轻偏瘫，右上肢麻木。数周前有流感、肝炎疫苗接种史。既往病史值得注意的是慢性鼻窦炎，无神经系统疾病、自身免疫疾病家族史。

Onexamination,thepatientwasafebrileandnormotensive.Heexhibitedleftabducensandpartialleftoculomotorpalsies.MRIofthebrainshowedanextensiveareaoffluid-attenuatedinversionrecovery(FLAIR)hyperintensityinvolvingthebrainstembilaterallyandafewsmallerlesionsintheleftparietallobe(figure1).Therewasnoenhancementorabnormaldiffusion.

体检：患者无发热，血压正常。左眼外展神经麻痹、动眼神经部分麻痹。脑MRI显示：脑干双侧广泛受累的FLAIR高信号及左顶叶多发小灶性病变（图1），病变无强化，也无弥散异常。

Lumbarpuncturerevealednormalleukocytes(3×/L),protein,andglucose.CSFoligoclonalbandswereabsent.Serumstudiesrevealednormalerythrocytesedimentationrate(ESR)(18mm/h)andC-reactiveprotein.Markersofsystemicinflammationwerenormal.

腰穿：白细胞正常（3×/L），蛋白、葡萄糖正常，脑脊液寡克隆区带阴性。血清学检查：血沉正常（18mm/h），C反应蛋白正常。全身炎性反应标志物正常。

Diplopiaresolvedover10dayswithouttreatment.Othersymptomsimprovedwithin3weeks.Onfollow-up4monthslater,thepatient







































白癫风医院
北京中科医院