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40岁男性,伴有头痛及精神状态改变。

40-year-old Male with a Headache and Altered Mental Status.

作者信息

Rubenstein Rebecca J, Alblaihed Leen, Dezman Zachary D W, Bontempo Laura J

机构信息

University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland.

University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.

出版信息

Clin Pract Cases Emerg Med. 2020 Nov;4(4):499-504. doi: 10.5811/cpcem.2020.10.49546.

DOI:10.5811/cpcem.2020.10.49546
PMID:33217256
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7676804/
Abstract

A 40-year-old man presents to the emergency department with headache, nausea and paresthesias, with subsequent fever and mental status change. Magnetic resonance imaging showed increased fluid-attenuation inversion recovery signal involving multiple areas of the brain, including the pons. This case takes the reader through the differential diagnosis of rhombencephalitis (inflammation of the hindbrain) with discussion of the unanticipated ultimate diagnosis and its treatment.

摘要

一名40岁男性因头痛、恶心和感觉异常就诊于急诊科,随后出现发热和精神状态改变。磁共振成像显示脑桥等多个脑区的液体衰减反转恢复序列信号增强。本病例引导读者对菱脑炎(后脑炎症)进行鉴别诊断,并讨论意外的最终诊断及其治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f6e7/7676804/3909bb29f9a3/cpcem-04-499-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f6e7/7676804/3909bb29f9a3/cpcem-04-499-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f6e7/7676804/3909bb29f9a3/cpcem-04-499-g001.jpg

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1
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Clin Pract Cases Emerg Med. 2020 Nov;4(4):499-504. doi: 10.5811/cpcem.2020.10.49546.
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本文引用的文献

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West Nile Virus: An Update on Pathobiology, Epidemiology, Diagnostics, Control and "One Health" Implications.西尼罗河病毒:病理生物学、流行病学、诊断、防控及“同一健康”影响的最新进展
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Clinical Mimickers of Amyotrophic Lateral Sclerosis-Conditions We Cannot Afford to Miss.
肌萎缩侧索硬化症的临床模仿者——我们不能错过的病症
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Imaging in Lyme neuroborreliosis.莱姆病神经螺旋体病的影像学检查
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Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States.蜱传斑疹伤寒立克次体病的诊断和治疗:落矶山斑点热和其他斑点热群立克次体病、埃立克体病和无形体病 - 美国。
MMWR Recomm Rep. 2016 May 13;65(2):1-44. doi: 10.15585/mmwr.rr6502a1.
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Rhombencephalitis / brainstem encephalitis.菱形脑炎/脑干脑炎。
Curr Neurol Neurosci Rep. 2011 Dec;11(6):543-52. doi: 10.1007/s11910-011-0228-5.
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Viral encephalitis: causes, differential diagnosis, and management.病毒性脑炎:病因、鉴别诊断及治疗
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Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis.尤因埃立克体,一种新确认的人类埃立克体病病原体。
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Clinical and neuroradiographic manifestations of eastern equine encephalitis.东部马脑炎的临床和神经影像学表现
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Exposure to deer blood may be a cause of human granulocytic ehrlichiosis.接触鹿血可能是人类粒细胞埃立克体病的一个病因。
Clin Infect Dis. 1996 Jul;23(1):198. doi: 10.1093/clinids/23.1.198.