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患者女性,18岁,入院前3天因受凉后感畏寒、发热、头痛,同时出现呕吐胃内容物5次,非喷射性。入院前1天出现右眼不能睁开。查体:T 38.4℃,神志清楚,双下肢皮肤可见散在瘀点及瘀斑,双眼可完全闭合,用力睁眼时,左侧眼裂仅3mm,左侧为15mm。用双手拇指压迫患者额肌时,右侧上睑仅能轻微上提。双瞳孔各4mm,等圆,双眼球各方向运动无障碍。颈强直,克氏征、布氏征均阳性,无锥体征。血常规:Hb 124g/L,RBC4.09×10~12/L,WBC 12.6×10~9/L,N0.84,L0.13,M 0.03。脑脊液检查:压力2.45kPa,混浊、RBC1～2个/HP、WBC 500个/HP,涂片发现革兰氏染色阴性肾形双球菌。诊断流行性脑脊髓膜炎(普通型)并发右侧上睑下垂。给予青霉素G钾80万U肌肉注射,每8小时1次,肯霉素G钠640万U静脉滴注,每日1次,同时用磺胺嘧啶钠4g静
Patient Female, 18 years old, 3 days before admission due to chills, fever, headache, vomiting stomach contents 5 times, non-jet sex. 1 day before admission, the right eye can not open. Physical examination: T 38.4 ℃, clear consciousness, visible in both lower extremity skin scattered petechiae and ecchymosis, eyes can be completely closed, forced eyes open, the left eye crack only 3mm, the left is 15mm. When pressing the patient’s frontal muscles with both thumbs, the right upper eyelid can only be slightly raised. Double pupil of the 4mm, so round, eye movement in all directions without obstacles. Neck stiffness, Kirschner sign, Clinton sign were positive, no cones sign. Blood: Hb 124g / L, RBC4.09 × 10-12 / L, WBC 12.6 × 10 ~ 9 / L, N0.84, L0.13, M 0.03. Cerebrospinal fluid examination: pressure 2.45kPa, turbid, RBC1 ~ 2 / HP, WBC 500 / HP smear found negative Neisseria meningitidis. Diagnosis of meningococcal meningitis (common type) complicated with right ptosis. Given penicillin G potassium 800000 U intramuscular injection, once every 8 hours, Kencomycin G sodium 6.4 million U intravenous infusion, once daily, while with sodium sulfadiazine 4g static