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患者女,13岁。半年前无明显诱因出现间断呕吐,呕吐物为胃内容物,伴视物不清;近半个月来呕吐症状加重,伴有明显头痛。体检:神志清楚,双侧瞳孔不等大,右侧直径6 mm,左侧直径3 mm,右侧直接及间接对光反射消失,左侧直接及间接对光反射存在,复视存在,右侧视力减退。脑膜刺激征阴性,右侧肌力5级,左侧肌力3~4级。实验室检查:血浆皮质醇26.46 ug/d L,中枢神经特异蛋白(S100β):0.19 ug/l。
Female patient, 13 years old. Six months ago there was no obvious incentive to intermittent vomiting, vomit for the stomach contents, with blurred vision; vomiting in the past two months increased, accompanied by obvious headache. Physical examination: Consciousness, bilateral pupils ranging from large, right 6 mm in diameter, left 3 mm in diameter, the right side of the direct and indirect light reflex disappeared, the left side of the direct and indirect presence of light reflex, diplopia exist, the right side Vision loss. Negative meningeal irritation, the right side of the muscle 5, 3 to 4 left muscle strength. Laboratory tests: plasma cortisol 26.46 ug / d L, central nervous system specific protein (S100β): 0.19 ug / l.