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男,46岁,于1991年9月22日7点40分因昏迷而入院。该患于当日凌晨3点左右睡眠中被家人发现意识不清,鼾声呼吸,推之不醒,呼之不应,急来我院就诊。平素健康。入院后查:T:36.5C,P:54次/分。R:16次/分。Bp:20/14kPa。意识不清,呼吸深大,右侧瞳孔扩大约7ram,对光反射消失。眼底视乳头水肿明显,压眶及角膜反射存在。无鼻唇沟变浅及口角歪斜,项强二横指,左颈总动脉搏动弱于右侧。双肺呼吸音清晰。心音纯,节律不整,心率54次/分。四肢肌力、肌张力及腱反射均减弱,无明显肢体瘫,未引出病理反射,急查心电:窦性心动过缓,前间壁心肌梗塞(损伤期),较频发室性期前收缩,心肌缺血。腰穿化验脑脊液为无色透明,白细胞2×10~6/L。初诊为脑栓塞,急性心梗,脑小天幕疝。经10余天降颅压扩张脑血管,营养心肌及细胞活化剂等对症治疗病情明显好转,瞳孔恢复正常,意识转清,能正确回答问话。为了
Male, 46 years old, was hospitalized at 7:19 on September 22, 1991 for coma. The affected patient was found in the sleep around 3 am that day, unconsciousness, snore breathing, push not wake up, call should not, urgent to our hospital. Usually healthy. After admission check: T: 36.5C, P: 54 beats / min. R: 16 times / min. Bp: 20 / 14kPa. Consciousness, deep breathing, the right pupil to expand about 7ram, the light reflection disappears. Fundus papilledema obvious, pressure orbital and corneal reflex exist. No nasolabial fissure and mouth skew skew, Xiangqiang two transverse means, left common carotid artery pulse weaker than the right. Breath sounds clear lungs. Pure heart sound, irregular rhythm, heart rate 54 beats / min. Limb muscle strength, muscle tone and tendon reflex were weakened, no significant limb paralysis, did not lead to pathological reflex, emergency ECG: sinus bradycardia, anterior myocardial infarction (injury), more frequent ventricular contraction ,Myocardial ischemia. Waist wear test cerebrospinal fluid is colorless and transparent, white blood cells 2 × 10 ~ 6 / L. Newly diagnosed as cerebral embolism, acute myocardial infarction, cerebellar hernia. After more than 10 days decreased intracranial pressure to dilate cerebrovascular, nutritional heart muscle and cell activators and other symptomatic treatment significantly improved the condition, the pupil returned to normal consciousness cleared, the correct answer to questions. in order to