患男,39岁,以左侧肢体无力3h就诊。近10日来作息不规律劳累后感头闷,3h前发现左侧肢体无力,尤以左下肢为甚,无头痛、恶心。既往体健,嗜香烟每日一包多。查:T35℃,P90次/min,R20次/min,BP14/10kPa。神志清晰,双瞳孔直径2.5mm,等大等圆,对光反射灵敏,左侧鼻唇沟略变浅,伸舌略向左偏,左侧面部皮肤感觉迟钝,颈软,心肺无异常.肝脾未触及,左侧上、下肢肌力Ⅳ级,腱反射稍亢,未引出病理反射,左下肢抬腿耐力下降,左手握 Male, 39 years old, with left limb weakness 3h treatment. In the past 10 days to work and rest irregular headache, 3h before found the left limb weakness, especially in the left lower limbs, no headache, nausea. Past physical health, addicted cigarettes a day more than a pack. Check: T35 ℃, P90 times / min, R20 times / min, BP14 / 10kPa. Conscious clarity, double pupil diameter of 2.5mm, such as large round, sensitive to light reflection, the left nasolabial fold slightly shallow, slightly left extensor side of the tongue, left facial skin feeling sluggish, soft neck, no abnormal heart and lung. Spleen not touched, the left upper and lower limb muscle strength Ⅳ grade, tendon reflex a little hyperactivity, did not lead to pathological reflex, left leg leg endurance decreased, left hand grip