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患者,女,53岁。因突发剧烈头痛、颈痛及呕吐3天而就诊。无脑外伤、发热、腰椎穿刺等病史,既往体健。查体:T 36.4℃,BP100/70 mmHg,神清,颅神经正常,心肺腹正常,四肢肌力肌张力正常,感觉系检查正常,颈强(+)。Kernig征(-)。头颅CT平扫无异常。入院后初诊蛛网膜下腔出血(SAH),给予脱水降颅压治疗。患者头痛颈强及呕吐无改善。第3天发现患者在平卧时反感头晕,无其它不适,但搬动患者成坐位或立位时立即出现剧烈头痛、颈痛伴恶心呕吐,并不敢睁眼。故行腰穿,脑脊液压力为60mmH_2O,外观淡黄稍混浊,蛋白1.0 g/L,细胞数8个/mm~3。依据病史、体征及腰穿结果,结合头颅CT阴性,纠正诊断为自发性低
Patient, female, 53 years old. Due to sudden severe headache, neck pain and vomiting for 3 days and treatment. No brain injury, fever, lumbar puncture and other medical history, previous physical health. Examination: T 36.4 ℃, BP100 / 70 mmHg, Shen Qing, normal cranial nerves, normal heart and lung abdomen, muscle tone muscle tone of the normal limbs, sensory examination was normal, neck strong (+). Kernig sign (-). Head CT scan without exception. After initial admission to subarachnoid hemorrhage (SAH), given dehydration and intracranial pressure treatment. Patients with neck pain and vomiting no improvement. On the third day, the patient found that the patient had discomfort and dizziness when supine. There was no other discomfort, but the patient had severe headache and neck pain with nausea and vomiting immediately after sitting or standing, and did not dare to open his eyes. Therefore, the line of lumbar puncture, cerebrospinal fluid pressure 60mmH_2O, the appearance of light yellow slightly cloudy, protein 1.0 g / L, the number of cells 8 / mm ~ 3. Based on history, signs and lumbar puncture results, combined with head CT negative, correct diagnosis of spontaneous low