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患者,男,10岁,住院号84201。因反复发作性畏寒、发热及头痛4年。近10天再次发作入院。患者4年前跌倒时右眼内毗偏下方被竹筷戳伤,数日后发现流清水样鼻涕,持续性存在,无咽痛、鼻咽搔痒,无喷嚏、鼻塞,每当停止流清水样鼻涕或转为混浊脓性时,患者即出现畏寒,发热、头痛及精神萎靡,有时恶心呕吐。发作时用青霉素,磺胺药治疗效果佳。先后共发作10余次,曾被当地医院诊为“流脑”。检查:T38℃,P100次/分,R20次/分,Bp90/70mmHg,神志清楚,精神萎靡,面色灰白,皮肤(-),右眼内毗偏下方可见星芒状瘢痕,范围约0.8cm,上颌窦压痛(-),筛窦压痛(±),咽不红,扁桃体不大,心肺(-),腹部(-),神经系统:除颈部抵抗及克匿格氏征、布氏征阳性外,无其他定
Patient, male, 10 years old, hospital number 84201. Due to recurrent chills, fever and headache for 4 years. Nearly 10 days episodes of hospitalization again. Patient was stabbed with bamboo chopsticks at the bottom of his right eye four years ago when he fell down. A few days later he was found to have runny nose and persistent presence of no sore throat, itching of nasopharynx, no sneezing, nasal congestion, When it turns cloudy or purulent, the patient develops chills, fever, headache, and apathetic, sometimes nausea and vomiting. Attack with penicillin, sulfa drug treatment effect is good. Has a total of more than 10 episodes, has been diagnosed as a local hospital “meningitis.” Check: T38 ℃, P100 beats / min, R20 beats / min, Bp90 / 70mmHg, conscious, apathetic, pale gray skin (-) Maxillary sinus tenderness (-), ethmoid sinus tenderness (±), pharynx not red, tonsil not, cardiorespiratory (-), abdomen (-), nervous system: except for neck resistance and Kendig’s sign, Outside, no other set