患者女性,33岁。主因头痛、头晕、恶心、呕吐、左眼睑下垂1天入院。既往患高血压病史10年,间断服用降压药物。查体:血压右上肢180/1110mmHg,左上肢150/90mmHg。左限睑下垂,左眼球向下活动受限。右侧颈部可闻血管杂音。化验检查未发现异常。为明确诊断,经左侧股动脉插管依次行主动脉弓、腹主动脉及左右颈动脉造影,结果为多发性大动脉炎,继发性高血压,动眼神经麻痹(系因产生盗血综合征使基底动脉缺血致动眼神经营养障碍)。经对症治疗45天,好转出院。此例患者病程长达10年未能确诊,其原因:对青年高血压患者未追查病因,未详细追问病史及查体,忽略了颈、锁骨上及腹部的血管杂音,未对比检查两侧桡动脉搏动,以致把多发性大动 Patient female, 33 years old. The main cause of headache, dizziness, nausea, vomiting, left eyelid ptosis 1 day admission. Previous 10 years history of hypertension, intermittent use of antihypertensive drugs. Examination: blood pressure right upper limb 180 / 1110mmHg, left upper limb 150 / 90mmHg. Left lid eyelid ptosis, downward movement of the left eye is limited. The right neck can smell vascular murmur. Laboratory tests found no abnormalities. To confirm the diagnosis, the left femoral artery followed by aortic arch, abdominal aorta and left and right carotid angiography, the results of multiple arteritis, secondary hypertension, oculomotor nerve paralysis (due to the production of steal syndrome Basilar ischemia-induced ocular neurotrophic disorder). The symptomatic treatment of 45 days, improved discharged. The patient’s course of up to 10 years failed to diagnose the reason: no trace of etiology of young hypertensive patients, no detailed history and physical examination, ignoring the neck, supraclavicular and abdominal vascular murmur, not on both sides of the radial examination Arterial pulse, resulting in multiple major move