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患女,66岁,于1990年4月9日午饭后在院内聊天时突然从坐椅上滑下,当时意识清楚,但吐字不清,1h 后送入医院。途中呕吐4～5次,为胃内容物,呈喷射性,伴左侧肢体活动失灵。既往有慢性风心病史10余年,无高血压病史。查体:T37.8℃,P96次/min,BP18.7/12.04kPa。营养中等,卧位,二尖瓣面容,查体欠合作,颈静脉充盈,两肺呼吸音粗糙,未闻干湿罗音。心前区无隆起,心界向左下扩大,P96次/min,心律不齐,S_1亢进,P_2>A_2,心尖区可闻及隆隆样舒张期杂音,无传导。腹软,肝、脾不大,双下肢无浮肿。神经系统检查:嗜睡、语言含糊不清,两侧额纹对称,眼球活动尚灵活,双瞳孔等大等圆约4mm,光反射存在,左侧鼻唇沟变浅,口角向右歪斜,伸舌偏左,示齿左侧欠佳,听力正常,左侧上下肢肌力0°,右侧V°,,腹壁反
Affected woman, 66 years old, on April 9, 1990 after lunch in the hospital chatting suddenly slipped from the chair, was aware, but articulation unclear, 1h after the hospital. Vomiting on the way 4 to 5 times for the stomach contents, was jet, with left limb activity failure. Past history of chronic heart disease more than 10 years, no history of hypertension. Physical examination: T37.8 ℃, P96 times / min, BP18.7/12.04kPa. Medium nutrition, supine position, mitral valve surface, physical examination owed cooperation, filling the jugular vein, rough breathing sounds of both lungs, no smell of wet and dry rales. There was no uplift in the precordial area, the heart bound to the lower left expanded, P96 times / min, arrhythmia, S_1 hyperthyroidism, P_2> A_2, apex area can be heard and rumbling like diastolic murmur, no conduction. Abdominal soft, liver, spleen is not large, no swelling of both lower extremities. Nervous system examination: drowsiness, vague language, bilateral frontal symmetry, eye movements are still flexible, double pupil and other large round about 4mm, there is light reflex, the left nasolabial fissure shallow, diagonal skew to the right, tongue extension Left side, showing poor left tooth on the left, normal hearing, left upper limb muscle strength 0 °, right V °, abdominal wall anti