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患者女,45岁,农民。刺激性咳嗽1年余伴头痛、呕吐15天入院。诉近1年来干咳、周期性痰多,无咯血,纳差,盗汗,曾不规则服用抗生素,40天前咳嗽加重、痰多伴发热。胸片示左下肺大片致密影。诊断为左下肺炎,予青、链霉素肌注。10余天后因症状无明显缓解,自行放弃治疗。15天前始无诱因出现头右顶部持续性胀痛,输液后加重伴呕吐,同时左侧肢体进行性乏力,站立、行走困难,有复视。胸片复查提示左下肺炎。头颅CT检查示右顶枕部大片低密度阴影,其内见稍高密度的圆形结节灶,直径约1cm。增强后见顶枕低密度区有一3cm×5cm的环状强化薄壁,其下方有2个直径1.5cm的小厚壁环状强化影。诊断为转移癌,胶质瘤不能除外。门诊以肺癌脑转移收治入院。体检:体温37.8℃。神志清,精神软,营养差。双瞳孔等大,对光反射可,右眼视力稍差,双耳听力正常,面部对称,有颈抵抗,左肺可闻及干湿性啰音。上下肢肌力左侧Ⅳ级,右侧Ⅴ级。
Female patient, 45 years old, farmer. Irritating cough for more than 1 year with headache, vomiting 15 days admitted to hospital. The last 1 years of dry cough, periodic sputum, no hemoptysis, anorexia, night sweats, had irregularly taking antibiotics, cough aggravated 40 days ago, sputum accompanied by fever. Chest radiograph shows a large shadow of the left lower lung. Diagnosis of the lower left pneumonia, to the green, streptomycin intramuscular injection. More than 10 days due to no significant relief of symptoms, to give up their own treatment. 15 days ago there are no incentives at the top of the right head persistent pain, aggravated with infusion of vomiting, while the left limb was weak, standing, walking difficulties, diplopia. Chest radiography prompted left pneumonia. Head CT examination revealed a large low-density shadow of the top right occipital, which see a slightly higher density of circular nodules, a diameter of about 1cm. After the enhancement see the top pillow low density area has a 3cm × 5cm ring enhanced thin wall, below the 2 diameter 1.5cm small thickening of the ring enhancement. Diagnosis of metastatic cancer, glioma can not be excluded. Outpatient admitted to hospital with lung cancer metastasis. Physical examination: body temperature 37.8 ℃. Conscious, soft-hearted, poor nutrition. Double pupil and other large, light reflexes may be, the lesser right vision, binaural hearing, facial symmetry, cervical resistance, left lung can be heard and wet and dry rales. Left and right lower extremity muscle strength Ⅳ grade, right Ⅴ grade.