论文部分内容阅读
患者男性,22岁。入院前一月患“感冒”,经扑热息痛、复方新诺明等药物治疗,感冒症状消失。但一周后出现步态不稳,走路时左右摇摆,并有跌倒。病程中有头痛、头晕,但无恶心呕吐,无意识丧失及记忆力减退。患者平素健康。体检:体温35.7℃,血压120/70mmHg。一般状况可,神经系统:意识清,讲话缓慢,无呐吃,计算力正常,回答问题准确。自觉视力好,瞳孔正常,眼球运动不受限,无眼震颤,眼底正常。四肢肌力肌张力正常。无不自主运动,双上肢明显意向性震颤,双下肢无明显震颤。指鼻及对指试验不准,轮替试验笨拙,跟膝胫试验尚准。步态欠稳,轻度左右摇晃,不能走直线,昂白反征(±)。生理反射存
Male patient, 22 years old. One month prior to admission suffering from “cold”, paracetamol, cotrimoxazole and other drug treatment, symptoms of the cold disappeared. However, a week later, the gait was unstable and swayed when walking and had a fall. Headache, dizziness, but no nausea, vomiting, loss of unconsciousness, and loss of memory. Patients usually healthy. Physical examination: body temperature 35.7 ℃, blood pressure 120 / 70mmHg. The general situation can be, the nervous system: awareness, speech slow, no na eat, calculate the power of normal, accurate answer to the question. Conscious vision, pupil normal, eye movement is not limited, no nystagmus, fundus normal. Limb muscle strength Normal muscle tone. All involuntary movements, both upper extremity obvious intention tremor, double tremor no obvious tremor. Finger nose and fingers are not allowed to test, clumsy rotation test, with the knee shin test is still accurate. Gait is not stable, mild shaking around, can not go straight, white anti-levy (±). Physiological reflection deposit