內科網路繼續教育試題解析-BN1021100 | 隱球菌腦膜炎csf
另外，老年病患頭痛比率不高，有可能是因為腦壓昇高或水腦的比率不高的關係。
由於隱球菌腦膜炎常造成腦壓過高，因此利用腰椎穿刺抽取腦脊髓液進行檢查並測量腦壓，是非常 ...☆網路內科繼續教育☆有效期間：民國102年11月01日至102年11月30日止 CaseDiscussion[PresentationofCase] A79-year-oldwomanpresentedtothegeriatricsclinicwithdysuriaandgeneralweaknessfor1week.Shehadamedicalhistoryofhypertension,aorticregurgitation,osteoporosiswithL4vertebralcompressionfracture,anddepression.Shekeptregularfollow-upatourgeriatricsoutpatientdepartment(OPD). Shehadbeeninherusualstateofhealthuntil1-2monthsbeforethisadmission,whenincreasingdrowsinessanddeclineofphysicalfunctionwerenotedbythefamilymembers.Twoweeksbeforethisadmission,shedevelopednumbnesssensationoverthefourextremitiesandpainfromthebilateralbuttockstothethighOneweekpriortothisadmission,shepresentedtoourgeriatricsOPDwithdysuria,nocturia,productivecough,generalmalaise,andpoorappetite.Shedidnotreportedheadaches,rhinorrhea,sorethroat,dyspnea,abdominalpain,orgrosshematuria.Sheappearedinacuteillnessandhadrepeatednauseaandvomitingatthattime.Adiagnosisofacutedeliriumfromurinarytractinfectionwasmadeandshewasadmittedtoourgeriatricward.Onarrival,thebloodpressurewas138/88mmHg,thepulserate105beatsperminute,therespirations18breathsperminute,andthetemperature37.7℃.Onexamination,nopercussiontendernessatthecostovertebralanglewasnoted.Neurologicalexaminationshoweddrowsyconsciousnesswithmusclepowerapproximately3/5atthefourlimbs.Wewerenotabletoperformgaitassessmentduetogeneralweakness.Easychokingwasalsonotedoncranialnerveexamination.Theurineoutputalsodecreasedtonearlyzeroonthesameday,andtheurinalysisrevealedmildpyuria(WBC10-20/HPF)andatestfornitritewasnegative.Otherlaboratoryresultswereshownbelow:[LaboratoryStudy]1.BiochemistryData 4/144/174/204/234/264/274/295/06Alb(g/dL)2.73.0 2.7T-BIL(mg/dL)0.450.62 0.71AST(U/L)811481277163 77127ALT(U/L)7090806042 5167ALP(U/L)63 252GGT(U/L)183206 330UN(mg/dL)75.493.169.971.878.770.659.553.6CRE(mg/dL)2.02.42.22.62.62.01.72.4Na(mmol/L)131140134134133134137131K(mmol/L)4.23.14.03.32.53.13.53.7CRP(
由於隱球菌腦膜炎常造成腦壓過高，因此利用腰椎穿刺抽取腦脊髓液進行檢查並測量腦壓，是非常 ...☆網路內科繼續教育☆有效期間：民國102年11月01日至102年11月30日止 CaseDiscussion[PresentationofCase] A79-year-oldwomanpresentedtothegeriatricsclinicwithdysuriaandgeneralweaknessfor1week.Shehadamedicalhistoryofhypertension,aorticregurgitation,osteoporosiswithL4vertebralcompressionfracture,anddepression.Shekeptregularfollow-upatourgeriatricsoutpatientdepartment(OPD). Shehadbeeninherusualstateofhealthuntil1-2monthsbeforethisadmission,whenincreasingdrowsinessanddeclineofphysicalfunctionwerenotedbythefamilymembers.Twoweeksbeforethisadmission,shedevelopednumbnesssensationoverthefourextremitiesandpainfromthebilateralbuttockstothethighOneweekpriortothisadmission,shepresentedtoourgeriatricsOPDwithdysuria,nocturia,productivecough,generalmalaise,andpoorappetite.Shedidnotreportedheadaches,rhinorrhea,sorethroat,dyspnea,abdominalpain,orgrosshematuria.Sheappearedinacuteillnessandhadrepeatednauseaandvomitingatthattime.Adiagnosisofacutedeliriumfromurinarytractinfectionwasmadeandshewasadmittedtoourgeriatricward.Onarrival,thebloodpressurewas138/88mmHg,thepulserate105beatsperminute,therespirations18breathsperminute,andthetemperature37.7℃.Onexamination,nopercussiontendernessatthecostovertebralanglewasnoted.Neurologicalexaminationshoweddrowsyconsciousnesswithmusclepowerapproximately3/5atthefourlimbs.Wewerenotabletoperformgaitassessmentduetogeneralweakness.Easychokingwasalsonotedoncranialnerveexamination.Theurineoutputalsodecreasedtonearlyzeroonthesameday,andtheurinalysisrevealedmildpyuria(WBC10-20/HPF)andatestfornitritewasnegative.Otherlaboratoryresultswereshownbelow:[LaboratoryStudy]1.BiochemistryData 4/144/174/204/234/264/274/295/06Alb(g/dL)2.73.0 2.7T-BIL(mg/dL)0.450.62 0.71AST(U/L)811481277163 77127ALT(U/L)7090806042 5167ALP(U/L)63 252GGT(U/L)183206 330UN(mg/dL)75.493.169.971.878.770.659.553.6CRE(mg/dL)2.02.42.22.62.62.01.72.4Na(mmol/L)131140134134133134137131K(mmol/L)4.23.14.03.32.53.13.53.7CRP(