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患者,男,53岁,干部。2年前因甲状腺机能亢进症行甲状腺次全切除术,术后因颈部血肿出现窒息。复苏后仍持续昏迷,伴频繁抽搐5天。清醒后仍有阵发性抽搐,以肢体动作过程中明显,常因肢体剧烈抽动而将欲取物品打落在地。书写笨拙,字体逐渐增大。行走困难而需搀扶。精神紧张时症状明显,安静及睡眠状态无抽搐发生。曾眼用苯妥英钠,卡马西平、苯巴比妥及舒乐安定等均无明显效果,钙剂稍可减轻症状。查体:颈部可见手术瘢痕。面神经叩击征及束臂试验均阴性。肌力及肌张力正常,指鼻及跟膝胫试验不准,主动运动时出现运动肢体粗大肌阵挛,波及肢体近端,其余肢体及躯干诸肌群。以接近动作目标时最为明显,运动停止后阵挛随之消失,伴出汗及肢体酸痛。行走时因下肢肌阵挛呈弹跳样步态。实验室检查:血、尿、便常规,血清钾、钠、氯、钙、磷,硷性磷酸酶,脑脊液常规及生化,EMG、EEG、MRI 均正常。入院后试用醋氮酰胺(0.75g/日,分3次),症状有所缓解。后加用氯硝安定(6mg/日,分3次),2日后肌阵挛消失。出院后继续服药,3个月后随访无症状发作且已恢复工作。讨论 Lance-Adams 综合征为脑缺氧后合并症。任何原因所致心脏及呼吸骤停均可引发,但多与麻醉
Patient, male, 53 years old, cadre. 2 years ago due to hyperthyroidism subtotal thyroidectomy, postoperative asphyxia due to neck hematoma. After the recovery is still coma, with frequent convulsions for 5 days. After awake there are still paroxysmal convulsions to the body during the obvious movements, often due to severe twitching limbs and want to get items knocked to the ground. Writing clumsy, fonts gradually increase. Walking difficult and need help. Mental stress symptoms, quiet and no convulsions in the sleep state. Have eyes with phenytoin sodium, carbamazepine, phenobarbital and zolanzepam no significant effect, slightly relieved symptoms of calcium. Physical examination: surgical scar visible in the neck. Facial nerve tapping sign and beam arm test were negative. Muscle strength and normal muscle tension, nose and knee with tibia test is not allowed, the active movement of the body muscle gross muscle clonus, affecting the proximal limbs, the other limbs and trunk muscles. To move closer to the goal of the most obvious, after the exercise stopped with clonus disappear, with sweating and limb pain. Walking due to lower limb myoclonus bounce-like gait. Laboratory tests: blood, urine, they routine, serum potassium, sodium, chloride, calcium, phosphorus, alkaline phosphatase, cerebrospinal fluid routine and biochemical, EMG, EEG, MRI were normal. After taking acetamide test (0.75g / day, 3 times), the symptoms eased. After clonidine plus stability (6mg / day, 3 times), 2 days after myoclonus disappeared. After discharge from the hospital to continue taking medication, 3 months after the onset of asymptomatic seizures and have resumed work. Discussion Lance-Adams syndrome after cerebral hypoxia complications. Heart and respiratory arrest caused by any reason can be triggered, but more with anesthesia