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作者报告1例罕见的具有多发性神经病和视神经病临床表现的骨髓单核母细胞白血病病例。病例男,18岁,发热,头痛,进行性面部无力,上睑下垂,复视和视力模糊,1个月后发展为进行性吞咽困难和发音困难,四肢无力住院。查体:体温38℃,脉搏120次/分,呼吸20次/分,血压130/100mmHg。神清,贫血貌,淋巴结和肝脾无肿大。按Snellen 卡片检查视力为20/400,眼底正常,双侧上睑下垂,眼球固定,双瞳孔扩大,对光反射消失,双侧咀嚼肌无力,双侧面肌瘫痪,吞咽和发音困难,咽反射减弱,舌肌和胸锁乳突肌无力,四肢肌力减退,上肢Ⅳ°,下肢Ⅱ°,痛觉和本体感觉存在,腱反射消失,病理反射和脑膜刺激征阴性。实验室检查:血红蛋白6.3g/dl,沉淀细胞容量(packed cell volume)
The authors report a rare case of myelomonocytic leukemia with multiple neuropathies and clinical manifestations of optic neuropathy. Case Male, 18 years old, fever, headache, progressive facial weakness, ptosis, diplopia and blurred vision. One month later, he developed dysphagia and dysphonia, and was unable to hospitalize. Physical examination: body temperature 38 ℃, pulse 120 beats / min, breathing 20 beats / min, blood pressure 130 / 100mmHg. Shen Qing, anemia appearance, lymph nodes and liver and spleen no swelling. According to Snellen card check visual acuity of 20/400, fundus normal, bilateral ptosis, eye fixation, double pupil dilation, disappearance of light reflex, bilateral masticatory muscle weakness, bilateral facial muscle paralysis, difficulty swallowing and pronunciation, pharyngeal reflex Weakness, weakness of tongue and sternocleidomastoid, weakness of limbs, upper limb Ⅳ °, lower limb Ⅱ °, presence of pain and proprioception, disappearance of tendon reflex, pathological reflex and negative meningeal irritation. Laboratory tests: hemoglobin 6.3g / dl, packed cell volume