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患者女,57岁,因发作性胸背部剧烈疼痛伴双下肢无力26小时,持续性胸背疼痛伴频繁恶心呕吐、腹痛23小时收入院。无大小便障碍,有高血压及冠心病史20余年。检查:Bp25/15kPa。心肺(-)。腹软,上腹部有压痛,无反跳痛。颅神经(-)。上肢肌力肌张力正常,双下肢肌力Ⅳ级,腱反射(++),双侧等叩,双巴彬斯基征(+),双卡道克征(+),胸_(5、6)平面以下痛觉减退。腹部透视未见异常。血清淀粉酶正常。B超示脂肪肝。心电图示心肌缺血改变。腰穿脑脊液压力不高,奎克试验通畅,脑脊液化验正常。胸髓MR扫描未见异常。X线胸片及胸部MR扫描均显示降主动脉夹层动脉瘤。经降低血压及改
Female patient, 57 years old, due to severe chest and back pain accompanied by weakness in both lower extremities 26 hours, persistent chest and back pain with frequent nausea and vomiting, abdominal pain 23 hours income hospital. No urinary incontinence, hypertension and coronary heart disease more than 20 years. Check: Bp25 / 15kPa. Cardiopulmonary (-). Abdomen soft, tenderness on the abdomen, no rebound tenderness. Cranial nerve (-). Upper limb muscle tone normal muscle strength, lower limb muscle strength grade Ⅳ, tendon reflex (++), bilateral tapping, double Babinski levy (+), double card grams grams sign (+), chest _ (5, 6) below the level of pain reduction. Abdominal see no abnormalities. Serum amylase normal. B ultrasound shows fatty liver. ECG shows myocardial ischemia change. Waist wear cerebrospinal fluid pressure is not high, Quik test unobstructed, normal CSF test. Chest MR scan showed no abnormalities. X-ray and chest MR scan showed descending aortic dissection aneurysm. By lowering blood pressure and change