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1.因突然血压升高,头晕头痛误诊为高血压脑病:男,58岁,因突然头晕头痛2小时入院。有高血压病史5年。查体:Bp29.3/17.3kPa。颈软,心肺及神经系统检查无阳性体征,初诊高血压脑病。用降压药等对症治疗无效,次日出现烦躁不安、脑膜刺激征,腰穿为血性脑脊液。确诊为SAH。分析:老年人SAH多由高血压、动脉硬化引起,出血速度相对较慢,出血量较少;老年人痛阈增高,对疼痛刺激不敏感;且多伴有脑萎缩,脑室蛛网膜下腔扩大,可缓冲脑水肿继发的颅内压增高。另外,SAH老年患者的脑膜刺激症状可在发
1. due to sudden high blood pressure, dizziness, headache misdiagnosed as hypertensive encephalopathy: male, 58 years old, due to sudden dizziness and headache 2 hours admission. Have a history of hypertension for 5 years. Physical examination: Bp29.3 / 17.3kPa. Neck soft, cardiopulmonary and nervous system examination without positive signs, newly diagnosed hypertensive encephalopathy. With antihypertensive drugs and other symptomatic treatment ineffective, the next day irritability, meningeal irritation, waist wear bloody cerebrospinal fluid. Confirmed as SAH. Analysis: The elderly SAH mostly caused by hypertension, arteriosclerosis, bleeding speed is relatively slow, less bleeding; elderly pain threshold increased, not sensitive to pain stimulation; and more with brain atrophy, ventricular subarachnoid expansion , Can buffer cerebral edema secondary to increased intracranial pressure. In addition, SAH elderly patients with meningeal irritation in the hair