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例1 男,65岁。3天前活动中突然出现头部麻木、全身烧灼感,频繁呕吐。1小时后出现呆笑,语无伦次,定向障碍,随地大小便,狂躁乱奔入院。查体:体温37.8℃,血压20.0/12.7kPa,颈软,克氏征阴性,未引出病理反射。腰穿见血性脑脊液,头颅 CT 证实为 SAH。例2女,42岁。突发头痛伴呕吐1小时入院。查体:神志清楚,心肺正常,颈软,克氏征阴性。腰穿脑脊液无色透明。对症治疗病情无缓解。入院后24小时出现颈强,克氏征阳性,再次腰穿脑脊液为均匀血性,诊断为 SAH。例3 男,54岁。因睡眠中头痛而醒,在当地医院查体无阳性体征,经治疗4天头痛不见缓解,且发现右上肢无力入院。查体:颈软,克氏征阴性,右上肢肌力Ⅳ级。病后第6天行 CT 检查示 SAH 穿破脑实质。讨论 SAH 的典型病例诊断并不难,但确有部分患者因无脑膜刺激征,使临床表现复杂。SAH 患者中无脑膜刺激征的原因与下列几种因素有关:(1)以少见表现为首发症状。SAH 可以某些少见表现为首发症
Example 1 male, 65 years old. 3 days ago suddenly appeared in the head numbness, body burning sensation, frequent vomiting. 1 hour later appeared dumbfounded, incoherent, disordered, anywhere urine, manic run into the hospital. Physical examination: body temperature 37.8 ℃, blood pressure 20.0 / 12.7kPa, neck soft, negative Klebsie, did not lead to pathological reflex. Waist wear see bloody cerebrospinal fluid, head CT confirmed as SAH. Example 2 Female, 42 years old. Sudden headache with vomiting 1 hour admission. Physical examination: conscious, normal heart and lungs, neck soft, Kirschner sign negative. Waist wear cerebrospinal fluid colorless and transparent. Symptomatic treatment of no relief. Twenty-four hours after admission, the neck was strong, positive for Kirschner, and again the lumbar puncture cerebrospinal fluid was homogeneous and bloody. The diagnosis was SAH. Example 3 male, 54 years old. Due to headache and wake up during sleep, physical examination in the local hospital no positive signs, headache after 4 days of treatment did not alleviate, and found the right upper limb weakness hospitalized. Physical examination: neck soft, Kirschner sign negative, right upper limb muscle strength Ⅳ. Six days after the disease CT scan showed SAH puncture brain parenchyma. The typical case of SAH diagnosis is not difficult to diagnose, but indeed some patients due to no meningeal irritation, the clinical manifestations of complexity. The causes of meningeal irritation in SAH patients are related to the following factors: (1) The rare symptom is the first symptom. SAH can be some of the rare first manifestation