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男,47岁,农民。因反复抽搐7d伴右侧肢体瘫痪2d入院。病人于入院前7d,无明原因发生阵发性右侧肢体抽搐,发作时病人突然意识丧失倒地,发出尖叫声,随即出现右侧上下肢体阵挛性抽搐,头偏向右侧,双眼向右侧凝视,口中喷出白沫,小便失禁,持续约30s后自行终止,意识转清。2d前,病人在午休起床时突感右侧肢体不能活动,走路不稳,在家观察2d无好转,遂来院诊治。既住体健,否认外伤及头痛史,家族中无类似病史。体检:T 38℃,P 80,R 20,BP130/75 mmHg。神志恍惚,发育正常,营养良好。体检中病人频繁发生右侧肢体阵挛性抽搐,双侧瞳孔等大等贺(阵挛时双眼向右侧凝视,双侧瞳孔散大,光反射消失),双侧鼻唇沟对称,颈软,心肺及腹部正常。右侧上下肢肌力Ⅱ级,肢体浅感觉和腱反射减弱,病理体征未引出。化验:血 WBC 9.4×10~9/L,N 0.74,L 0.16,电解质及肝肾功正常。脑电图示中度异常脑电图改变(左半球)。头部CT颅内未见病变。
Male, 47 years old, farmer. Due to repeated convulsions 7d paralyzed with the right limb 2d admission. Patients 7d before admission, no reason for the occurrence of paroxysmal right limb twitch, the patient suddenly lost consciousness fell to the ground, screams, immediately appear on the right limb clonic twitch, head to the right, both eyes Staring on the right, the mouth spout foam, urinary incontinence, continued for about 30s after the termination of their own consciousness to clear. 2d ago, the patient suddenly felt during the lunch break wake up the right limb can not move, walking unsteady at home observation 2d no improvement, then came to hospital for treatment. Both live health, denied history of trauma and headache, no similar family history. Physical examination: T 38 ° C, P 80, R 20, BP130 / 75 mmHg. Trance, normal development, good nutrition. Physical examination in patients with frequent occurrence of the right limb clonic convulsions, bilateral pupils and other large He (clonic twin eyes staring to the right, bilateral mydriasis, light reflex disappears) bilateral nasolabial fold symmetrical neck soft , Cardiopulmonary and abdominal normal. On the right side of the lower extremity muscle strength Ⅱ level, lower extremity sensory and tendon reflexes, pathological signs did not lead. Laboratory tests: blood WBC 9.4 × 10 ~ 9 / L, N 0.74, L 0.16, normal electrolyte and liver and kidney function. EEG shows moderate abnormal EEG changes (left hemisphere). Head CT no intracranial lesions.