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患者 男性,29岁.以发热、头痛、间歇性抽搐6周,加重3天入院.曾在外院按病毒性脑炎、肝昏迷治疗4周无效.3年前因肝硬变、脾功能亢进,行脾切除手术.无癫痫病史.查体:T38℃,P 80次/分,BP14/7kPa(105/52.5mmHg).神志清,慢性病容.未见蜘蛛痣,可见肝掌.巩膜无黄染,颈有抵抗感.心、肺检查未见异常.未见腹壁静脉曲张,肝肋下未触及,肝相对浊音界缩小,腹部无移动性浊音.四肢肌力、肌张力正常.扑翼样震颤阴性,双侧踝阵挛阴性,巴彬斯基征阴性.入院继续按肝昏迷治疗2周,病情无好转.仍发热(T38℃左右),剧烈头痛,伴恶心,呕吐,视物不清,眼球胀痛.腰穿脑脊液检验:蛋白460mg/L,葡萄糖1.82mmol/L,氯化物113mmol/L;细胞数0.014×10~9/L,潘
Male patient, aged 29. With fever, headache, intermittent seizures for 6 weeks, increased 3 days admitted to the hospital outside the hospital by viral encephalitis, liver coma treatment for 4 weeks is invalid. 3 years ago due to liver cirrhosis, hypersplenism, Splenectomy surgery. No history of epilepsy. Physical examination: T38 ℃, P 80 beats / min, BP14 / 7kPa (105 / 52.5mmHg) .Spiritual clear, chronic disease .No spider nevus, , The neck has a sense of resistance. Heart, lung examination showed no abnormal. No abdominal varicose veins, hepatic ribs untouched, the liver is relatively dull boundaries shrink, abdominal dullness without mobility. Limb muscle strength, muscle tone normal. Negative, bilateral ankle clonus negative, Babinski syndrome was negative.Admission continued to be treated by hepatic coma for 2 weeks, the condition did not improve.The still fever (T38 ℃ or so), severe headache, with nausea, vomiting, blurred vision, Eyeball pain.Lumbar cerebrospinal fluid test: protein 460mg / L, glucose 1.82mmol / L, chloride 113mmol / L; cell number 0.014 × 10 ~ 9 / L, Pan