Hepatococcal electrolyte blood glucose is normal。
On the day of the admission, the waist wear is as follows:
Appearance clear,Internal pressure 250Water column brain fluid IgGap;gt;108g。
Give treatment10sky,Dehydration reduction,Mannitol、Glycero,Castulovi anti-virus 025 q12h,Dexamethasone5g2sky,Cephalon 2g qd,Patient symptoms improve,No fever,Headache is obviously reduced。
10The day after the day, the following:
Review the waist:Appearance clear,Intracranial pressure 265Water column。
From the patient’s medical history、Investigate、Cerebrospinal fluid and treatment,Consider viral meningitis,But there is also a place that does not meet,Is the number of cerebrospinal fluid cells,Sugar and chloride,And the total amount of protein is also relatively high.,Combined with blood andCRPAs a result, it is suggested tuberculous meningitis.,However, there is no targeted treatment of blood and cerebrospinal fluid without targeted treatment.。The landlord said a wave of three fold,Basically is not viral meningitis,Because the disease is self-limiting disease,Never have a variety of improvements。So comprehensive analysis,Patient consideration:1Tasteasteen meningitis,Reason is high heat,Chill,Blood routine white cells are not high,Osophilia0,The cerebrospinal fluid is also more in line with the cold changes.,Exceptions of ceplature the therapeutic effect is also good,Indirect support。2Autologous immunogene mesh inflammation,Cerebrospinal fluidIgGhigh,And the patient has rapidly improved blood and cerebrospinal fluid indicators after hormones.。3Be careful to pay attention to whether there is a tumor,Since there is no information on the head image, it is not good.。It is recommended to provide blood culture、Cerebrospinal fluid bacteria culture、Cerebrospinal fluid ink
fever1week,headache、Dizziness3Tianjinyuan。Highest395℃,Chill,headache,Accompany dizziness,Vomit2Second-rate。
Inside:Swallow,Double lateral tonsil,Soft,Slightly resistant,Double-side pupil, etc.,Auscultation is no abnormal,Abdomen soft,No tenderness and anti-jump,Liver and spleen,Double lower limbs without edema,Pathology。
Past history:Issue,No surgery history,No history of blood transfusion,No sensitive history。
Personal history:History of smoking3year,daily3branch,No drinking history,No other bad habits。
consider,1,Tuberculosis?2Autoimmune brain?
an examination,Tuberculosis,Cerebrospinal tuberculosis culture,Tspot,Autoimmune antibody,BrainMR。
treatment,In the original treatment,Economic capability home Cancel
Reply to praise5collect1More6 building
Daren a bit of rain spring wind、Ximen is happy
Benitis of intracranial infection,Pathogenesis needs to be considered:bacteria,Virus,tuberculosis,Fungus。Anti-bacterial antiviral seems to be effective,But since the blade mentioned“A wave of three fold”,Then you have to focus on the cause of bacteria and viruses.。
Gamble,Second hypertrophic meningitis。
Not typical tuberculous meningitis、Second hypertrophic meningitis、Viral meningitis has no specific difference from cerebrospinal fluid.。Smear ink dyed to find thorough bacteria, although it is simple,But the positive rate is not too high,Only only65about。Centrifugation after washing、Cultivation can improve a little positive rate,But is the simplest and rude antigen detection of pneumophilia hybrid,High-quality,Can also be used as an efficacy judgment indicator,AlmostPCTThe meaning of bacterial infection。
Looking forward to the results of cultivating and pneumophilic capsular antigen detection
Summary of medical history:
1male,20age,Issue,This acute attack;
2fever1week,headache、Dizziness3sky;Maximum body temperature395℃。Fever,Behindhae、Vomit,Treated in local hospitals。
3Inside:Swallow,Double lateral tonsil,Slightly resistant,Double-side pupil, etc.,Auscultation is no abnormal,Abdomen soft,No tenderness and anti-jump,Liver and spleen,Double lower limbs without edema,Pathology;
4Inspection:Blood routine:WBbsp;679109L N 893 E L;Blood:30h;No abnormal blood transfusion routine;liver、Renal function、blood sugar、Normal electrolyte;
Cerebrospinal fluid examination:
Cerebrospinal fluid pressure increase;
Cerebrospinal fluid routine:Nuclear cell 309106L Multi-core 30Single-core 70;
Cerebrospinal fluidization:protein 14832gL,Normal range of sugar,chloride 1194oL。
Initial brain spine smear?Blood culture?SkullCTorMRChest imaging?
From the above information,The patient diagnosed the central nervous system infection inflammation can be established。
to be continued
SMain identification diagnosis of infection: