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A(实习医生):本例临床特点为发病急骤,有表情淡漠、嗜睡、呆视,颈项轻度抵抗等症状,首先应考虑中枢神经系统疾患,如病毒性脑炎、脑膜炎。B(实习医生):发病前有发热、流涕、咳嗽等呼吸道感染史,以后出现神经系统症状,周围血象不高,同意为病毒性脑炎的诊断,但发生的脑症状中,却无抽搐及其它颅神经症状,病程中无发热,脑脊液正常,这些又不支持病毒性脑炎的诊断。家住农村,未接种过卡介苗,结核性脑膜炎(简称结脑)早期,脑膜刺激征也可以不明显,故应想到结脑。而患儿出现脑症状已达20小时,脑脊液无变化,起病急的结脑还是极少
A (Intern): The clinical features of this case are sudden onset, indifferent expression, drowsiness, faintness of eyes, mild neck reaction and other symptoms. First, central nervous system disorders such as viral encephalitis and meningitis should be considered. B (interns): Before the onset of fever, runny nose, cough and other respiratory tract infections, later neurological symptoms, peripheral blood is not high, agreed to the diagnosis of viral encephalitis, but the occurrence of brain symptoms, but no convulsions And other cranial nerve symptoms, no fever during the course of disease, normal cerebrospinal fluid, which does not support the diagnosis of viral encephalitis. Live in rural areas, have not been vaccinated BCG, tuberculous meningitis (referred to as knot brain) early, meningeal irritation may not obvious, it should think of knot brain. Children with brain symptoms have been up to 20 hours, no change in cerebrospinal fluid, acute onset of knot brain or very little