论文部分内容阅读
患者,男,29岁。以发热、头痛、间歇性抽搐6周,加重3d入院。曾在外院按病毒性脑炎、肝昏迷治疗4周无效。3年前因肝硬化、脾功能亢进,行脾切除手术。无癫痫病史。查体:T38℃,P80次/min,BP14/7kPa。神志清,慢性病容。未见蜘蛛痣,可见肝掌。巩膜无黄染,颈有抵抗感。心、肺阴性。未见腹壁静脉曲张,肝肋下未及,肝相对浊音界缩小,腹部移动性浊音阴性。四肢肌力、肌张力正常。扑翼样震颤阴性,双侧踝阵挛阴性,巴彬斯基征阴性。入院继续按肝昏迷治疗2周,病情无好转,仍发热(T38℃左右),剧烈头痛,伴恶心,呕吐,视物不清,眼球胀痛。脑脊液:蛋白460mg/L,葡萄糖1.82mmol/L,氯化物113mmol/L;细胞数0.014×10~9/L,潘氏试验(±)。肝功:麝浊20U,HbsAgl
Patient, male, 29 years old. To fever, headache, intermittent seizures for 6 weeks, aggravating 3d hospitalization. In the outer court by viral encephalitis, liver coma treatment for 4 weeks is invalid. 3 years ago due to liver cirrhosis, hypersplenism, splenectomy surgery. No history of epilepsy. Physical examination: T38 ℃, P80 times / min, BP14 / 7kPa. Conscious, chronic illness. No spider nevus, visible liver palms. Sclera no yellow dye, the neck has a sense of resistance. Heart, lung-negative. No abdominal varicose veins, hepatic ribs under, liver relative dullness narrowing, abdominal movement dullness negative. Limb muscle strength, muscle tone normal. Flapping wing tremor negative, bilateral ankle clonus negative, Babinski sign negative. Admission to continue hepatic coma treatment for 2 weeks, the disease did not improve, still fever (T38 ℃ or so), severe headache, with nausea, vomiting, blurred vision, eye pain. Cerebrospinal fluid: protein 460mg / L, glucose 1.82mmol / L, chloride 113mmol / L; cell number 0.014 × 10 ~ 9 / L, Pan test (±). Liver function: musk turbidity 20U, HbsAgl