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患者男,18岁,因患癫痫用卡马西平治疗3个月疗效欠佳,改用丙戊酸钠0.2 g/d治疗40余天。之后,患者突然出现四肢抽搐、意识丧失收入院。经抢救意识恢复,患者述眩晕、复视、恶心、呕吐、耳鸣。检查:构音障碍、眼球震颤、共济失调等症状。入院第4天,患者血氨为117.6μmol/L,血常规、肝、肾功能检测均正常,头颅MRI未见明显异常。停用丙戊酸钠后症状好转,再次服用该药,再次出现头晕。立即停用丙戊酸钠,改用氯硝西泮治疗后症状消失,血氨降至66μmol/L。
Male, 18 years old, due to epilepsy with carbamazepine 3 months of poor efficacy, use sodium valproate 0.2 g / d for more than 40 days. After the sudden emergence of limbs in patients with convulsions, loss of consciousness hospital income. Rescue consciousness restored, the patient described dizziness, diplopia, nausea, vomiting, tinnitus. Check: dysarthria, nystagmus, ataxia and other symptoms. On the fourth day after admission, the blood ammonia level was 117.6μmol / L, and the blood, liver and kidney function tests were normal. No significant abnormality was found in the cranial MRI. After the withdrawal of sodium valproate symptoms improved, take the drug again, again dizziness. Immediate withdrawal of sodium valproate, switch to the use of clonazepam symptoms disappeared, blood ammonia dropped to 66μmol / L.