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患者,女,12岁。于1998年3月注射乙脑疫苗,部位在左上肢皮下。常规用量,用1支药物分注给5人,注射完后约10min,即感左上肢麻木、疼痛,双下肢瘫痪、无力行走。另4人均无不良反应。当地医院未明确诊断给消炎及维生素类药物处置,未见好转而转入第四军医大学诊治。查体:T37℃,左侧肢体痛觉减弱,左肢体肌力Ⅲ级,左巴彬斯基可疑,余无阳性体征。经做颅脑CT、MRT测左腋神经传导速度、血生化、血沉、B超等均正常。给予药物、语言暗示治疗。体温、感觉正常,左侧肌力恢复至Ⅴ～Ⅵ级行走自如。最后确诊为:癔病瘫痪,来本院疗养。 体会 患儿为一女性未成年人,癔病瘫痪较为少见。注射疫苗后10min出现左侧肢体感觉及双下肢运动异常,易联想到变态反应性疾病。经密切观察和完整检查后药物、语言暗示治疗,病情恢复。容易造成错觉上小病大治和医疗上纠分。
Patient, female, 12 years old. In March 1998 injection of Japanese encephalitis vaccine, the site in the left upper limb subcutaneous. Conventional dosage, with a drug dispensing to 5 people, about 10min after injection, that is, left upper limb numbness, pain, paralysis of both lower extremities, unable to walk. The other 4 were no adverse reactions. The local hospital did not give a clear diagnosis of anti-inflammatory and vitamin drugs, did not improve and transferred to the Fourth Military Medical University diagnosis and treatment. Physical examination: T37 ℃, left limb pain decreased, left limb muscle strength Ⅲ grade, left Babinski suspicious, I no positive signs. After doing brain CT, MRT measured left axillary nerve conduction velocity, blood biochemical, ESR, B-ultrasound were normal. Give medicine, language implies treatment. Body temperature, feeling normal, left muscle strength recovered to Ⅴ ~ Ⅵ walking freely. Finally diagnosed as: hysteria paralysis, to hospital recuperation. Experience children with a female minors, hysteria paralysis is relatively rare. 10min after injection of the left limb appeared sensory and motor extremities abnormalities, easy to think of allergic diseases. After close observation and complete examination of drugs, language implies treatment, recovery. Easily lead to delusions on the great cure and medical treatment of the disease.