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例1,男,59岁,农民。主因双下肢乏力半年,不能行走5天入院。10年前有慢性肝炎史。近半年来感双下肢无力伴食欲明显下降,且记忆力减退,口齿不清。无力逐渐进展,步行时足尖着地,膝关节屈曲,步速缓慢,无肌肉萎缩及大小便功能障碍。5天前双下肢不能行走。查体:神清,语利,颅神经(-),双上肢肌力Ⅴ级,双下肢Ⅰ级,近端肌力弱于远端,膝腱反射亢进,踝阵挛阳性,双巴氏征阳性。感觉系统正常,轻度双足内翻。脊髓造影,头CT、脑脊液检查均正常。肝功能GPT轻度升高,A/G倒置。肝胆B超示:肝硬化腹水。眼科未发现K—F环。肌电图示:神经元性损害。诊断为肝性脊髓病,予以保肝及神经营养性剂治疗,症状无明显好转,随访2年死亡。 例2,男性,52岁,因双下肢截瘫3个月入院。病初为双下肢乏力强直感,走路费力,曾在当地医院按“脑梗塞”治疗无好转并出现双下肢痉挛性瘫痪,无发
Example 1, male, 59 years old, farmer. Mainly due to weakness of both lower extremities for six months, can not walk 5 days admission. 10 years ago, a history of chronic hepatitis. Over the past six months, feeling both lower limb weakness with an obvious loss of appetite, and memory loss, speechless. Inability to gradually progress, walking pointed foot, knee flexion, slow pace, no muscle atrophy and urinary dysfunction. 5 days ago can not walk the lower limbs. Examination: Shenqing, language profit, cranial nerves (-), upper limb muscle strength Ⅴ level, lower limb Ⅰ grade, lower than the distal muscular strength, knee tendon hyperreflexia, ankle clonus positive, double Pakistan’s sign Positive. Feel normal system, mild bipedal varus. Myelography, head CT, cerebrospinal fluid were normal. Liver function GPT mildly elevated, A / G inversion. Hepatobiliary B ultrasound shows: cirrhosis and ascites. Ophthalmology did not find K-F ring. Electromyography: Neuronal damage. Diagnosis of hepatic myelopathy, to be liver and neurotrophic agent treatment, no significant improvement in symptoms, followed up for 2 years of death. Example 2, male, 52 years old, paraplegic due to double lower extremity 3 months admission. The beginning of the disease as a double lower extremity tonic feeling, walking hard, had a local hospital according to “cerebral infarction” treatment without improvement and there are double lower extremity spastic paralysis, no hair