【作者】 明淑萍；

【导师】 张晓琴；

【作者基本信息】 武汉大学 ， 神经病学， 2004， 硕士

【摘要】 患者，男，60岁，因肢体无力进行性加重3天，伴麻木1天，于2001年1月6日入院： 患者于入院前3天因劳累后感头晕、流涕、打喷嚏，并觉双上肢无力，活动不灵活，但尚能做家务活；自认为是劳累后所致，未加注意。入院前1天患者觉双上肢无力加重，并同时感双下肢无力，行走困难，伴双手指及双足趾端麻木感。无头痛、呕吐、发热、吞咽困难、胸闷、呼吸急促等症。饮食可，大小便正常。门诊以“肌无力原因待查”收入院。 既往史：无类似发作史；否认高血压、糖尿病史。 入院查体：T：36．6℃，R：20次／分，P：80次／分，BP：130／80mmHg（17．3／10．7kPa），抬入病房，全身浅表淋巴结无肿大，咽部充血，甲状腺无肿大，心肺腹检查无异常。 神经系统检查：神志清楚，言语流利；双侧眼裂对称，无眼睑下垂，双瞳孔等大等圆，直径3mm，光反射存在，眼球各方向运动自如，眼底检查视乳头清晰。双侧鼻唇沟对称，音叉试验听力正常，未见眼震；伸舌居中，双侧软腭活动好，咽反射存在，耸肩及转颈有力；颈软，颈部动脉搏动对称；四肢肌肉无萎缩，双上肢肌力Ⅲ级，双下肢肌力Ⅱ级：腹壁反射（+）、双侧肱二头肌反射、桡反射、膝反射、踝反射均消失，四肢肌张力减低。全身深、浅感觉及共济运动检查未见明显异常；病理反射及脑膜刺激征均未引出。植物神经系统检查未见异常。 辅助检查 1．实验室检查：血常规、尿常规、大便常规均正常，肝。肾功能正常，空腹血糖6．02mmol／L，血K⁺：3．90mmol／L，血清肌酶及甲状腺功能检查正常。血沉值在正常范围。 2．影像学检查：双肺X线片无异常；头颅CT检查未见异常。 3．心电图检查：正常窦性心律。 4．肌电图检查示：F波潜伏期延长、出现率减低（65％）；运动神经传导速度减慢，感觉神经传导速度正常。 5．脑脊液检查：压力100mmH₂O，无色清亮，蛋白0.40g/L,细胞数4个/mm³糖4．2mmol／L.氯化物121mmol／L。于第入院第10天脑脊液检查压力110mmH₂O.无色清亮，蛋白0。83g／L，细胞数2个／mm³，糖3.8mmol／L，氯化物125mmol／L。 6．新斯的明试验结果阴性。 7．腓肠神经活检：神经纤维轻度肿胀，部分髓鞘斑片状脱失，少量炎性细胞浸润。 入院后给予激素、抗生素、VitBl、VitBl2营养神经等对症支持治疗．患者病情无改善。入院第二同患者四肢肌力降至O级，并出现憋气，呼吸困难，心慌，意识模糊等症状，立即气管插管后气管切丌，呼吸机辅助呼吸。更多还原

【Abstract】 A 60-year-old male patient was admitted to the hospital beacause of progressive weakness of extremities for 3 days and accompany with numbness for 1 day.About 2 days prior to his admission the patient felt dizziness snivel sneeze and experience weakness of bilateral upper extremities.Movement is not agility.He considered that was conduced by tied,so he had not pay attention to it.From this morning the patient feel the weakness of bilateral upper extremities exacerbation, and felt weakness of bilateral lower extremities.He was difficult to walk,and felt numbness of his fingers and toes.Without headache, vomiting, fever, felt oppressed dysphagia or shortness of breath.Past history: He had not similar attacks, had not hypertension and diabetea.Examination on admissim: T:36.6℃, P80 per min, R20 per min, P:15.0/9.3kpa. Common conditions were well, superfacial lymph nodes were impalpable. Posterior pharyngeal wall was congested.Thyroid was normal and trachea was in the center position.Examinations of lung,heart and abdomen were regular.Neurological examination: He was conscious mind and specking was clear Palpebral fissures symmetrical without blepharoptosis.Pupils were round,symmetrical, dia 3.0 mm and reactive to light is normal and no nystagmus. The jundi showed no papilledema. The nasolabial groove was similarity . The fasciculatious of the tongue is in the midline. There was no atrophy of the tongue. The movement of soft palate were well.The gag reflex was intect .He shrugged his shoulders and turned his neck. The pulsation of the carotid arteries were symmetry. Muscles of all extremities had not atrophy. The upper extremities muscle force were III grade.and the lower extremities muscle force were II grade.The muscular tension were diminished. Abdominal refle（+）,the bilaterally reflexes of biceps reflex, patellar reflex and ankle jerk extinction. His sensation were normal and no ataxia.There was no pathologic reflexes meningeal irriation and antagonistic system was normal. Assisted examination1.Laboratory examination:Routine examination of the blood urine and stool were normal. Liver and kindney serum founctions were regular. Fasting blood sugar:6.02 mmol L,K⁺ 3.90mmol/L. serum myokinase, hyroid function and blood sedimentation rate were normal.2. Image analysis: Lung x-ray slide; brain CT scan was normal.3. Electrocardiogram examination was normal.4.Electromyogram: F-wave latent period alongation and frequency of occurrence reduce, motor nerver condution velocity reduce,sensory nerver condution velocity was normal.5. Examination of cerebrospinal fluid: The CSF was clear, pressure 100 mm H2O ,cell count 4 X 109/ L ,protein0.4 g/ L ,glucose 4.2 mmol/ L , CL+ 121mmol/L.Lumbar examition was operation after 12 days, the CSF was clear, pressure:110 mmH2O,cell count2 X 109/ L ,protein0.83 g/ L ,glucose 3.8 mmol/ L , CL+125mmol/L6. Prostigmine Test result was Negative.7.Sural nerve Biopsy: Nerve fiber slightiy swelling, segment myelin losed a small inflammatory infiltrateAfter related examination were taken, the patient received treatment with corticosteroid antibiotics VitB₁ and VitBj2. After patient was admitted 2 days,his extremities muscle force were descend to 0,and feel dyspnea palpitation obtundation , operate tracheostomy and intraacheal tube with ventilator was used.更多还原