中英鹰眼征莱姆病蜱虫森林脑炎TBE
SECTION1第一部分01
A49-year-oldmanwithnosignificantmedicalhistorywasseenbyaneurologicconsultantineasternBavaria,Germany,afterhedevelopedweaknessofbotharms.Afewdaysearlierhehadbeenreferredtotheinternalmedicinedepartmentwithflu-likesymptomslastingfor2weeks,whichimprovedonlytransientlywithtrimethoprim/sulfamethoxazoleforsuspectedurinarytractinfection.Theneurologicexaminationrevealedanalertandorientedpatientwhowasfebrile(39.8°C,.6°F)butwithoutmeningealsignsorheadache.Hehadnormalcranialnervesandweaknessoftheshouldergirdleandbothproximalarms.Hehadnosensorydeficits,washyporeflexic,andhadflexorplantarresponses.Gaitwasunsteady.Bladderfunctionwasreportedlynormal.Thepatientwasapassionatemushroomhunterandhadnosickcontacts.
49岁男性患者，既往体健，因出现双上肢乏力于德国拜仁东部神经科就诊。几天前，患者因持续2周的流感样症状于内科门诊就诊，怀疑为尿路感染，予甲氧苄啶/磺胺甲恶唑治疗，症状暂时缓解。神经系统体格检查：体温39.8°C（.6°F），神志清，定向力正常，无脑膜刺激征或头痛，颅神经检查阴性。肩胛带肌和双侧上肢近端肌力下降，无感觉障碍，腱反射减弱，屈跖反射正常，步态不稳。膀胱功能正常。患者是一个工作积极的采菇人，没有疾病的接触史。
Questionsforconsideration:
1.Whereisthemostlikelyclinicallocalizationofthepatient’ssymptoms?
2.Whatadditionaltestingwouldyoure鍛煎拰娴╃壒鐧界櫆椋庝笓绉戝尰闄?娌荤枟鐧界櫆椋庢晥鏋滃浣?
