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例1:女,36岁,因左侧肢体活动不灵10天,加重件言语减少,表情淡漠4天入院。入院前10~+天感全身酸痛、畏寒、腹泻,2天后出现左侧肢体无力,行走跛行,入院前4天感头昏,出现语言减少,表情淡漠,右上下肢不随意伸屈运动。入院前10小时不语、小便失禁。查体:内科检查无特殊。神经系统检查:神清、表情淡漠、缄默。颅神经检查阴性。四肢肌力:左上肢Ⅳ级,左下肢Ⅲ级,右上下肢5级。四肢肌张力增高,有不自主重复动作,腱反射活跃,双侧踝阵挛阳性,右侧夏达克氏征阳性,左侧戈登氏征可疑。浅、深感觉正常。腰穿:脑脊液压力、常规、生化均正常。双眼视诱发电位正常。脑电图示:轻-中度异常。头颅CT扫描正常。SPECT显示:左侧颞叶和顶叶血流灌注减低约9%。诊断:散发性脑炎。
Example 1: Female, 36 years old, due to left limb movement is not working for 10 days, aggravating the words to reduce the expression indifferent 4 days admission. 10 ~ + days before admission feeling body aches, chills, diarrhea, left limb weakness after 2 days, walking claudication, 4 days before admission dizziness, language loss, apathy, right upper extremity involuntary flexion exercise. 10 hours before admission, no words, incontinence. Physical examination: no special medical examination. Nervous system examination: God clear expression indifference, silence. Negative cranial nerve examination. Limb muscle strength: left upper limb Ⅳ, left lower extremity Ⅲ, right upper extremity 5. Limb muscle tension increased involuntary repetitive movements, tendon reflexes, bilateral ankle clonus positive, right Shakeduck’s syndrome positive, left Gordon’s syndrome suspicious. Shallow, deep feeling normal. Waist wear: cerebrospinal fluid pressure, routine, biochemical are normal. Binocular evoked potentials were normal. EEG shows: light - moderate abnormalities. Head CT scan is normal. SPECT showed a 9% reduction in left temporal and parietal flow perfusion. Diagnosis: sporadic encephalitis.