患者女,62岁。因发热,右耳痛伴流脓三天,失语二小时入院。代诉三天前发热右耳痛、耳漏自服泰利必妥片后症状无好转,晨起剧烈头痛、呕吐数次,继失语,小便失禁,急诊检查血压22/10kPa,血糖26mmol/L,酮体(-),WBC,26.8×10~9/L,N85％。以“右急性化脓性中耳炎,化脓性脑膜炎,糖尿病”入院。检查T39℃,嗜睡状态,失语、烦躁不安,不合作,肌力Ⅱ～Ⅲ级,皮下无出血点及瘀斑,双瞳孔等大,直径为2.5mm,对光反射迟钝。右鼓膜充血、穿孔且有脓痂覆盖,肺部未闻及罗音,心率104次/分,听诊无病理性杂音,肝脾无肿大,左巴彬斯基征(+),戈尔登(+),欧贲汉姆征(+),住院期间反复抽搐呈癫痫样发作。脑脊液生化测定总蛋白2.8g/L,糖10.3mmol/L,氯化物107.2mmol/L,培养无菌生长。头颅及颞骨CT检查:右急性化脓性中耳炎伴岩部破坏、颅内积气。诊断:1.右急 Female patient, 62 years old. Due to fever, right ear pain with suppurative three days, aphasia two hours admitted. Appear three days ago, fever, right ear pain, ear cream self-service telbivudine tablets no improvement in symptoms, early morning severe headache, vomiting several times, following aphasia, urinary incontinence, emergency blood pressure 22 / 10kPa, blood glucose 26mmol / Body (-), WBC, 26.8 × 10 ~ 9 / L, N85%. To “right acute suppurative otitis media, purulent meningitis, diabetes” admission. Check T39 ℃, drowsiness, aphasia, irritability, uncooperative, muscular strength Ⅱ ~ Ⅲ level, no subcutaneous bleeding spots and ecchymosis, double pupil and other large, diameter 2.5mm, slow light reflex. Right tympanic membrane congestion, perforation and pus scab coverage, the lungs have not heard and rales, heart rate 104 beats / min, auscultation without pathological murmurs, hepatosplenomegaly, Zababinsky sign (+), Gordon (+), European Beam Han sign (+), repeated seizures during hospitalization was epileptic seizures. Cerebrospinal fluid biochemical determination of total protein 2.8g / L, sugar 10.3mmol / L, chloride 107.2mmol / L, cultured sterile growth. Head and temporal bone CT examination: Right acute suppurative otitis media with rock damage, intracranial gas. Diagnosis: 1. right urgency