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作者报导阿狄森氏恶性贫血伴有向上凝视麻痹一例,女性,47岁,由于复视和酒醉感四周而就诊。除两月前有轻微头痛和注意力不集中外,无其它不适。体温、血压正常,面苍白。双眼底轻度早期原发性视神经萎缩,眼球水平快速跟随及聚合运动正常,无复视,垂直快速跟随运动完全不能,向下凝视轻度障碍,水平和垂直的头眼运动均存在,且贝耳氏现象消失。没有聚合痉挛及退缩性眼震,瞳孔对光反射正常,没有眼睑挛缩,眼球位于中间位。其它颅神经正常。双上肢远端轻度无力,伴有腱反射活跃和霍夫曼氏征阳性。双下肢轻度无力,踝反射消失,巴彬斯基氏征阴性,双侧腹壁反射消失;步态不稳,昂伯氏征阳性;整个右侧的振动觉,轻触觉和本体感觉受损。无小脑体征。排尿正常。Hb为9.2g/dl,红细胞指数提示巨细胞性贫血,骨髓显示普遍的功能抑制和幼巨红细胞的出现。血清B_(12)降低到178ρg/ml(正常值400—1100ρg/ml),而血清和红细胞的叶酸盐水平正常。血沉50mm/小时。其它实验室检查正常。腰穿压力及CSF 正常。头颅、
The authors report a case of Addison’s pernicious anemia associated with upward gaze paralysis, a 47-year-old woman who was seen for diplopia and a drunkenness. No other discomfort except mild headache and inattention two months ago. Body temperature, normal blood pressure, pale face. Early binocular mild primary optic atrophy, rapid eyeball follow-up and polymerization normal movement, no diplopia, vertical rapid follow-up exercise completely unable to stare down mild disorders, horizontal and vertical head movement are present, and the shellfish Ear phenomenon disappeared. There is no polymerization spasm and retch nystagmus, pupil light reflex normal, there is no eyelid contracture, the eye is located in the middle. Other cranial nerves normal. Mild distal weakness of both upper extremities with active tendon reflex and Hoffmann’s sign positive. Both lower extremity mild weakness, ankle reflex, Babinski’s sign negative, bilateral abdominal reflex disappeared; unsteady gait, Ambert positive sign; the entire right vibration, touch and body sensory impaired. No cerebellar signs. Urination is normal. Hb was 9.2 g / dl, red blood cell index prompted giant cell anemia, bone marrow showed universal dysfunction and the appearance of juvenile giant red blood cells. Serum B_ (12) decreased to 178 pg / ml (normal 400-1100 pg / ml), while serum and erythrocyte folate levels were normal. ESR 50mm / hour. Other laboratory tests are normal. Lumbar pressure and normal CSF. Head,