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患者男性,58岁。因进行性步履不稳伴头晕、复视2月入院。2个月前无诱因渐感双下肢沉重、力弱,走路欠稳以右侧显著,并伴头晕复视。近1月来复视消失,双上肢活动笨拙,言语缓慢含糊,步行左右摇摆,被迫卧床休息,腰穿检查正常,病前无胸痛咳血病史。检查:意识清,吟诗样语言,眼底正常,无偏盲复视,双眼向左右注视时均出现水平性眼球震颤,快相向注视侧。肌张力低下,指鼻、跟、膝,胫试验不稳准,反击试验(+),Romberg氏征(+),双手轮替运动笨拙,腱反射对称性低下,双侧Babinski氏征(一)。 痰找瘤细胞4次均(-),双肺正侧位及断层为左
Male patient, 58 years old. Unstable due to progressive walking with dizziness, diplopia admitted in February. Two months ago, there was no incentive for both lower extremity heavy legs weak, weak walking to the right significantly, and with dizziness diplopia. Nearly a month to double disappear, clumsiness in both upper extremities, slow and vague language, walking swaying around, forced to bed rest, lumbar puncture to check the normal, no history of chest pain and hemoptysis. Check: Consciousness, Yin poetry language, fundus normal, non-hemianopic diplopia, both eyes to the left and right when there are horizontal nystagmus, fast side to the gaze. (+), Romberg’s sign (+), clumsiness of hands rotation, low symmetry of tendon reflex, bilateral Babinski’s sign (a) . Phlegm looking for tumor cells 4 times (-), both lung posterior lateral and the fault is left