神经型布氏杆菌病一例并文献复习

布氏杆菌病是由布氏杆菌引起的一类人畜共患的传染性疾病，世界范围均有感染病例报道，其中以地中海及中东地区较为多见。而在我国其主要流行于内蒙古自治区、吉林省、黑龙江省和新疆维吾尔自治区[1]。根据布氏杆菌病典型症状、     

14例神经型布氏杆菌病患者的护理

总结14例神经型布氏杆菌病患者的护理。神经型布氏杆菌病以神经系统损害为特征,本组患者症状多见头痛呕吐、烦躁抽搐、意识障碍、下肢肌力减弱、共济失调等。着重神经系统症状的护理,减轻神经性疼痛、头痛,做好呕吐、抽搐发作时护理,2例下肢肌力为0的患者指导进行康复干预,做好出院用药及健康指导,防止本病复发。本组患者神经痛、头痛、呕吐、抽搐症状均不同程度缓解,所有患者随访1年均无复发。     

布氏杆菌病52例临床分析

2001年1月至2004年6月的我院传染科共收治布氏杆菌病52例，为了探讨其发病原因，发病年龄、职业及临床特点，以便提出预防措施。现分析如下：     

治疗布氏杆菌病15例临床分析

目的 了解布氏杆菌病临床特点及诊断治疗经验。方法 15例布氏杆菌病行回顾分析。结果 临床治愈12例，好转2例，治愈好转率达90％。结论 布氏杆菌病早期诊断，综合治疗预后良好。     

人感染布氏杆菌病的临床症状

布氏杆菌病是由布鲁氏杆菌引起的一种人兽共患传染病。人以长期发热、多汗、关节痛、睾丸炎、卵巢炎为特征。急性期布氏杆菌病其临床表现颇似重感冒，痛剧者似风湿；慢性期其临床症状类似神经官能症。     

布氏杆菌病误诊1例

患者，男性，37岁。主因发热伴关节疼痛1个半月人院。患者1个半月前受凉后出现畏寒、发热，体温最高达39．8℃，伴明显头痛、乏力，四肢肌肉酸痛，右膝、双踝关节肿痛。人院查体：体温38℃，全身皮肤黏膜无异常，浅表淋巴结无肿大，咽、扁桃体、心肺、腹部、肛门、外生殖器均无异常；右膝、双踝关节轻度肿胀，压痛，双侧“4”字征阴性；双骶髂关节无压痛，右侧足跟腱叩击痛；四肢肌力、肌张力正常，病理征未引出。     

布氏杆菌病20例误诊分析

布氏杆菌病的临床表现变化多端 ,不易早期诊断 ,误诊率较高。我院 1998年 2月～ 2 0 0 1年 11月共诊治35例 ,其中 2 0例在院外或我院首诊时误诊 ,误诊率达5 7% ,现分析误诊原因如下。1　临床资料1 1　一般资料　本组男 14例 ,女 6例 ;年龄 16～ 77岁 ,平均 4 1岁。职业 :牧民 13例 ,干部 4例 ,学生 3例 ;居住地区 :城市 7例 ,牧区 13例。1 2　临床表现　 2 0例均有发热 ,其中伴乏力、多汗、厌食 15例 ,关节痛 9例 ,咽痛 5例 ;咳嗽、咳痰 8例 ,其中伴腓肠肌疼痛 3例 ,胸闷气短、睾丸肿痛、尿频尿痛及恶心呕吐、头痛各 2例。肝大并剑突下压痛 …     

布氏杆菌1例报道并文献复习

1临床资料 患者,男,62岁。因头痛、发热伴恶心呕吐10天入院。患者于入院前10天放羊归来后出现皮肤瘙痒,周身皮肤出现红疹,头痛,恶心、呕吐,发热,体温最高达38.5℃。颈部发硬,无法转动。入院查体：体温37.0℃,血压90/60mmHg,心率57次/分,皮肤可见红疹,咽部无充血,颈部淋巴结未触及,双肺呼吸音清,腹肌无紧张,肝脾未触及,四肢关节无红肿及结节,神清,语利。     

86例布氏杆菌病临床分析

布氏杆菌病（以下简称布病）是由布鲁氏菌引起的一种人畜共患病,人与人之间的主要传染源是染疫的家畜。近年来,随着畜牧业的发展,布病的发病率明显上升。现将收集的86例布病患者的临床资料进行回顾性分析,报告如下。     

误诊为肌萎缩侧索硬化的神经型布氏杆菌病1例并文献复习

目的 探讨神经型布氏杆菌病(Neurobrucellosis, NB)临床特征,诊断及治疗,反思该病例为何误诊为肌萎缩侧索硬化(amyotrophic lateral sclerosis, ALS),比较二者之间的共同点及临床工作当中如何鉴别。方法 报告1例误诊为ALS的NB患者的临床特点及治疗,结合文献进行归纳总结。结果 患者58岁男性,诊断为NB,治疗2周后症状明显好转,右侧近端肢体肌力Ⅴ^-级,远端肌力Ⅳ^-级,左侧近端肌力Ⅴ^-级,左侧远端肌力Ⅴ^-级,双侧腱反射(+++),双侧Babinski征(+)。转回当地继续抗布氏杆菌治疗。结论 NB误诊为ALS的主要原因在于NB症状体征多不典型,表现多样,颅内感染体征不明显,从而误诊为其他神经系统疾病。     

抗磷脂抗体综合征合并中枢神经系统疾病5例报道及文献复习

目的:探讨抗磷脂抗体综合征(APS)中枢神经系统损害的临床表现及诊治特点。方法:回顾性分析APS合并中枢神经系统疾病患者5例的临床资料,结合文献进行分析。结果:5例抗磷脂抗体(aPL)均阳性,合并脑梗死2例,合并舞蹈病2例,合并癫痫1例,合并僵人综合征1例;治疗予以抗血小板、抗凝、抑制炎症、免疫抑制等,患者症状均得到改善。结论:神经系统受累的APS的诊断主要依据相关临床表现及a PL的检测,未有明确病因的神经系统疾病,可行a PL检测,有助于APS的诊治。     

多发性颅内海绵状血管瘤治疗失当一例并文献复习

目的分析多发性颅内海绵状血管瘤（intracranialcavernousangiomas,ICA）的『临床特点,探讨其诊断与治疗方法。方法回顾分析1例治疗失当的多发性ICA的临床资料,并复习相关文献。结果本例以突发头痛、左侧肢体无力为主要临床表现就诊,3个月前曾于外院针对多发性ICA行1刀治疗,但再次复发。入我院后行急诊手术清除病灶及血肿,术后病理检查证实为颅内ICA。术后患者恢复良好。结论多发性ICA采取放射治疗尚缺少足够证据,应以手术治疗为首选方法,并要尽可能切除病灶,神经导航有助于将手术创伤降至最低。     

先天性无痛症(附3例报告及文献复习)

本文报告3例先天性无痛症，并对国内文献报告的16例进行了分析。重点分析了临床X线表现，并讨论了定义、分类、病因、病理、诊断及鉴别诊断。本病的X线征象主要有：①骨折，②夏科氏关节，③骨关节感染，④骨软骨炎，⑤骺板损伤。此外，笔者认为本病可能合并有中外胚层发育不良。     

Presentation, time to antibiotics, and mortality of patients with bacterial meningitis at an urban county medical center

Our objective was to analyze the presentation, time to antibiotics, treatment, and mortality of patients with bacterial meningitis at a large urban county hospital over a 10-year period. A retrospective chart review of all patients with the diagnosis of bacterial meningitis was done. Information concerning presentation, etiologic organisms, treatment (including time to antibiotics), and outcomes were collected and analyzed. There were 165 charts reviewed with 171 total cases of bacterial meningitis. For adults with community-acquired meningitis, the mortality rate was 14%, for children it was 1.6%. Seventy-six percent of patients received antibiotics in the Emergency Department (ED) with a mean time to antibiotics of 1:08 h ± 13 min. The rest received them as inpatients with a mean time to antibiotics of 6 ± 9 h. The mortality rate for patients with community-acquired disease who received an Emergency Department antibiotic was 7.9%; for patients who received their antibiotics as inpatients the mortality rate was 29%. Our results indicate that the mortality rates from bacterial meningitis at our institution are lower than previously published results. Furthermore, our study supports the concept that the early administration of antibiotics in the ED may reduce mortality and may be an explanation of the lower mortality rates seen here.     

神经白塞病误诊2例报告并文献复习

目的：探讨神经白塞病（NBD）的诊治方法及误诊的原因。方法：对神经白塞病2例进行回顾性分析。结果：2例男性患者均有中枢神经系统损害的症状、体征及影像学表现，均曾被误诊，经详细询问病史及体格检查后才得以正确诊断。结论：对于中枢神经系统损害的患者，如果难以用常见神经系统疾病来解释，尤其是男性患者，应注意到本病的可能，病史询问不详细、体格检查不充分、缺乏对该病的认识是造成误诊的主要原因。     

脂质沉积性肌病2例报告并文献复习

目的：探讨脂质沉积性肌病（LSM）的临床和肌肉病理特点。方法：分析2例脂质沉积性肌病患者的临床特点、实验室检查、肌活检资料,并复习相关文献。结果：LSM的主要临床特点为四肢近端肌无力和对运动不耐受,肌萎缩多不明显,血清肌酶轻中度升高,肌电图多呈肌源性损害;肌肉病理显示肌纤维空泡变性,脂滴明显增多,电镜也证实肌纤维内脂滴堆积。结论：LSM是一种少见的肌病类型,以肢体近端肌无力和对运动不耐受为主要表现,临床上多长期误诊,确诊依靠肌肉病理检查。     

Clinical Characteristics and Treatment Outcome of Central Nervous System Nocardiosis: A Systematic Review of Reported Cases

BackgroundThe clinical spectrum of systemic nocardiosis encompasses pulmonary and disseminated disease. Central nervous system (CNS) involvement is an important feature of disseminated disease with significant mortality and high relapse rate, especially in those with suppressed cell-mediated immunity. This systematic review aimed to evaluate the epidemiology, clinical features, diagnosis, therapeutic interventions, and outcome in patients with CNS nocardiosis.MethodsA literature search was performed in major databases (PubMed, Google Scholar, and Scopus) by using distinct keywords: “CNS disease,” “Nocardia,” “meningitis,” “brain abscess,” “disseminated disease,” and “Cotrimoxazole.” We included all patients ≥18 years with CNS nocardiosis reported between January 2000 and December 2020.ResultsA total of 129 papers were included in the final analysis. The mean age of patients was 55 ± 16 years, and the majority were male (70.8%). Nocardia farcinica was the commonest species (39.6%), followed by Nocardia nova (5.9%). Thirty-four percent of the patients were found to be immunocompetent. Corticosteroid use was the most common predisposing factor (55.8%). Among neuroimaging findings, brain abscess was most common (86.9%), followed by leptomeningeal enhancement (12.1%). The overall case-fatality rate in CNS disease was 22.8%. On multivariate analysis, patients who underwent surgery (OR 2.4, 95% CI 0.99–4.11, p value 0.046) had better survival than those treated with antimicrobial therapy alone. Immunodeficient state (OR 0.32, 95% CI 0.15–0.90, p value 0.019) was independently associated with poor outcome.ConclusionCNS nocardiosis carries significant mortality, especially in immunodeficient patients. We advocate the use of surgery combined with antimicrobials to improve clinical outcome.     

非外伤性横纹肌溶解症的临床特点

目的了解非外伤性横纹肌溶解症(RM)的临床特点和发病机制。方法对11例非外伤性RM的病因和临床表现进行回顾性分析。结果本组病因包括药物性3例,一氧化碳中毒2例,高强度运动2例,高强度农业劳动1例,其他3例。临床表现为肌无力、肌痛、肌肿胀、茶色尿、肾功能衰竭,实验室检验包括肌酸激酶增高,各种电解质紊乱。结论药物是引起非外伤性RM的主要原因,诊断主要依据临床表现和血清肌酸激酶显著升高。急性肾功能衰竭是其严重和导致死亡的主要并发症。     

老年人蛛网膜下腔出血临床分析

目的总结老年人蛛网膜下腔出血(SAH)的临床特征、并发症和预后。方法回顾性分析132例老年人SAH的临床资料。结果56.8%患者以头痛为主要症状,43.2%出现头晕或眩晕,40.1%出现意识障碍,脑膜刺激征阴性比例为70.5%。病因以动脉瘤最常见。伴高血压者死亡率高。结论老年人SAH临床表现多样化,体征不明显,半数预后好,但死亡率高。     

复合妊娠3例分析并文献复习

目的：提高对宫内外复合妊娠(HP)的临床认识，减少漏诊误诊。方法：分析报道3例复合妊娠．并复习献，总结该病的临床表现、诊断、治疗等特点。结果：HP临床表现多样，缺乏特异性，容易漏诊误诊。结论：提高对HP的认识可减少漏诊或误诊。对要求保留宫内妊娠，正确及时的治疗可带来良好的结局。