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一例21岁女性患者,因发作性不省人事、抽搐、反应迟钝半个月入院。一年前患者曾因不规则发热、四肢关节红、肿、疼痛,伴失眠多梦、记忆力减退在某院按风湿性关节炎治疗效果不佳。近两个月来,出现持续性头痛阵发性加重,并伴有呕吐、心慌、言语减少。半个月前突然不省人事、四肢抽动、双眼上翻,并伴有尿失禁,一次历时约20分钟,发作后反应迟钝。体温38℃,血压120/80。患者神志清,表情淡漠,反应迟钝,无语。面部潮红,双颊部可见点状红色丘疹。左耳后有两个1×1.5厘米的黑色结痂,脱发明显。双肺散在干性罗音,心率134次/分,律整。肝上界在第5肋间,肋下2厘米,质韧,有触痛。脾肋下未及。双膝关节肿胀,压痛。左腘窝处有一1.5×2厘米边缘不整的隆起,中央
A 21-year-old female patient admitted to hospital for half a month due to episodic unconsciousness, convulsions, and unresponsiveness. A year ago, patients had irregular fever, limbs and joints, swelling, pain, with insomnia and more dreams, memory loss in a hospital by rheumatoid arthritis treatment ineffective. In the past two months, persistent headache accompanied by paroxysmal agitation, accompanied by vomiting, palpitation, speech reduction. Half a month ago suddenly unconscious, limbs twitching, eyes up, accompanied by incontinence, a duration of about 20 minutes after the onset of unresponsive. Body temperature 38 ℃, blood pressure 120/80. Patients conscious, apathetic, unresponsive, speechless. Facial flushing, visible cheek red pustule papules. Left after two 1 × 1.5 cm black scab, hair loss significantly. Shuangluan scattered dry rales, heart rate 134 beats / min, law and order. The upper limit of the liver in the 5th intercostal space, ribs 2 cm, tough quality, tenderness. Spleen under the ribs. Double knee swelling, tenderness. The left popliteal fossa has a 1.5 × 2 cm edge irregular bulge, central