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患者,男,57岁。因感冒后双下肢麻木无力10余天入院。既往有糖尿病史,无肝病史。体检:一般内科查体无异常。神经系统检查:双上肢肌力V级,双下肢Ⅲ级,四肢腱反射低,病理征(一),四肢呈手套袜套样感觉障碍。化验:血糖13.2mmol/L,肝功正常。腰穿压力正常,脑脊液细胞数0,蛋白1.15g/L,寡克隆带阳性。给予胰岛素及皮质激素治疗1个月,双下肢肌力恢复至V~-级,但出现双下肢浮肿,食欲差,复查肝功异常,B超示肝大,腹水,肝CT示右肝癌,肝内转移伴腹水,后转肿瘤医院治疗。 讨论 患者感冒后发病,双下肢无力伴末梢型感觉障碍,脑脊液蛋白—细胞呈分离现象。符合格林—巴利综合征的诊断标准。患者激素治疗1个月肢体无力好转,但出现肝功异常,经CT诊断为肝癌。由于条件所限没有化验血清和脑脊液抗—Hu抗体。因此不
Patient, male, 57 years old. Her numbness in both lower extremities was admitted to hospital for more than 10 days due to a cold. There was a history of diabetes and no history of liver disease. Physical examination: General medical examination without exception. Nervous system examination: upper limb muscle strength V, lower limb III, lower extremities tendon reflex, pathological signs (a), limbs were socks-like sensory disturbances. Laboratory tests: Blood glucose 13.2mmol/L, normal liver function. Lumbar puncture pressure was normal, CSF cell number was 0, protein was 1.15 g/L, and oligoclonal band was positive. After 1 month of insulin and corticosteroid treatment, the muscle strength of both lower extremities returned to V~-grade, but edema of both lower extremities occurred, appetite was poor, liver function abnormalities were examined, B ultrasound showed hepatomegaly, ascites, liver CT showed right liver cancer, and intrahepatic Transfer with ascites, and then transfer to cancer hospital. Discussion After the onset of cold in patients, weakness in the lower extremities was associated with peripheral sensory disturbances, and cerebrospinal fluid protein-cell separation was observed. In line with the diagnostic criteria of Guillain-Barre syndrome. One month of hormone therapy in patients with hormone therapy improved, but abnormal liver function, CT diagnosis of liver cancer. Due to limited conditions, serum and cerebrospinal fluid anti-Hu antibodies were not tested. So not