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结核性脑膜炎(简称结脑)脑脊液蛋白质增高合并激素性肌病临床上极少见,现报告1例如下。患者吴××,女,25岁,因头痛、呕吐10天,神志不清1天入院。查体:浅昏迷,体温38.8℃,脉搏80次,血压13.3/9.33 kPa,呼吸18次。颈项强直,布氏征(+),心率80次,律齐,无杂音,左下肺呼吸音减低,两肺无干湿罗音。腹部(-)。四肢肌力正常,克氏征(+)。脑脊液:压力2.16 kPa,黄色有絮状物,WBC 4.4×10~6/L,N0.90,L0.10,蛋白35g/L,,糖11.1mmol/L,氯化物110 mmol/L。奎氏试验(+)。色氨酸试验(+)。血沉41 mm/h。胸片示:左侧少量胸腔积液伴胸膜肥厚。诊断:结脑,左侧结核性胸腔积液。给链霉素、雷米封、利福平、吡嗪酰胺及综合治疗,3天后神志转清,1周后体温正常。患者仍有头痛,且有左眼斜视,脑脊液蛋白在50 g/L左右,脑脊液静置10分钟即出现胶冻状凝块。故给雷米封50 mg、地塞米松3 mg,椎管内注射,隔天1次。
Tuberculous meningitis (referred to as knot brain) cerebrospinal fluid protein in patients with hormone myopathy is extremely rare, is reported in 1 case as follows. Patient Wu × ×, female, 25 years old, due to headache, vomiting for 10 days, confusion 1 day admitted to hospital. Examination: shallow coma, body temperature 38.8 ℃, pulse 80 times, blood pressure 13.3 / 9.33 kPa, breathing 18 times. Neck stiffness, Brinell sign (+), heart rate 80 times, law Qi, no noise, reduced left lung breath sounds, both lungs without dry rales. abdomen(-). Normal limb muscle strength, Kirschner sign (+). Cerebrospinal fluid: pressure 2.16 kPa, yellow floc, WBC 4.4 × 10 ~ 6 / L, N0.90, L0.10, protein 35g / L, sugar 11.1mmol / L, chloride 110 mmol / L. Qui ’s test (+). Tryptophan test (+). ESR 41 mm / h. Chest X-ray showed: a small amount of pleural effusion on the left with pleural thickening. Diagnosis: knot brain, left tuberculous pleural effusion. To streptomycin, Remy sealed, rifampicin, pyrazinamide and comprehensive treatment, 3 days after the consciousness clear, normal body temperature after 1 week. Patients still have headaches, and left-eye strabismus, cerebrospinal fluid protein in about 50 g / L, the cerebrospinal fluid standing for 10 minutes that jelly-like clots. So to Remy sealed 50 mg, dexamethasone 3 mg, spinal canal injection, every other day.