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Dołączył: 03 Mar 2011
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 Wysłany: Wto 10:31, 08 Mar 2011 Temat postu: ghd italia sbi vgi coe lnl |
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Posterior reversible encephalopathy syndrome in the clinical and imaging findings (1 case report)
A retired cadres, 316000, China; Hangzhou,[link widoczny dla zalogowanych], Nanjing Military Region, convalescent nursing home area Vertical Division of Labor Office of the sea ground, 310007) [Key words hypoglycemia; infarction, the elderly; consciousness [CLC] R587.3 Document code 【 】 B common hypoglycemia in the elderly is one of a variety of clinical manifestations to neurological symptoms as the main performers often misdiagnosed as cerebrovascular disease. Therefore, the correct understanding of the nervous system of elderly people with low blood sugar symptoms, clinical diagnosis and treatment play an important role. Now our department from January 2001 to April 2008 37 patients were treated between diagnosis and treatment of hypoglycemia in patients with analysis of the situation as follows. 1.1 General Information l clinical data of 37 patients in this group, 31 males and 6 females, aged 62 to 83 years, mean 72 years. Have a clear history of 33 patients with type 2 diabetes, no history of diabetes mellitus in 4. Duration of diabetes 7-24 years. Associated with hypertension in 24 cases, 7 cases of diabetic nephropathy, cardiovascular disease, l2 cases, there is history of cerebral infarction and the remaining obstacles to different degrees of physical activity in 14 cases. 7 cases of oral Xiaoke Pill, l1 cases of oral sulfonylurea hypoglycemic agents, 14 cases of oral sulfonylurea and metformin, and 1 poor efficacy of oral drugs to subcutaneous insulin. I. 2 diagnostic criteria by 1999, China Diabetes Association standards, low blood sugar diagnosis also meet the following three indicators: (1) hypoglycemia; (2) episodes of blood glucose less than 2.8mmol / L; (3) relief of symptoms after glucose supplement or disappear. 1.3 Clinical manifestations of 37 patients with 26 cases of disturbance of consciousness, confusion which 5 patients in the verbal exchanges were not the point, his hands groping action, the specific clinical manifestations and blood glucose in Table l. All patients underwent head CT or head MRI, 6 patients with cerebral malacia, l7 cases of lacunar infarction, cerebral atrophy in 13 cases. Table 137 patients with clinical manifestations of the average blood sugar Note: 'Determination of the average of two blood glucose. 1.4 misdiagnosis of outpatient and emergency patients in 13 cases misdiagnosed as acute cerebral infarction, 1 case of epilepsy, transient ischemic attack (TIA) 1 case. 82-year-old male patient who was diagnosed before 4 episodes, manifested as hemiplegia 1 hour or so,[link widoczny dla zalogowanych], many outside the hospital treatment are misdiagnosed as TIA, the first 5 episodes of blood glucose 2.3mmol / L, 50% glucose intravenously 60Inl after the symptoms disappear. 1.5 Treatment and prognosis of low blood sugar immediately after diagnosis by intravenous injection of 50% glucose 60Inl, followed by 10% 500ml Intravenous glucose output drops, disable all hypoglycemic agents, while giving the oxygen, correction of electrolyte, acid-base imbalances, to improve brain cell function in drug treatment. The results except for 1 patient with low blood sugar level (0.4retool / L) died, the remaining patient's symptoms were gradually reduced or disappeared, blood sugar back to normal. 2 discussion 2. I characteristics of low blood sugar is hypoglycemia diabetes treatment of the most common and most dangerous complication of treatment is not timely, life-threatening. Low blood sugar occurs, the patients showed sympathetic, symptoms of adrenal medulla and central nervous excitement symptoms; the former mainly for hunger, pale, sweating, heart palpitations, anxiety, heart rate,[link widoczny dla zalogowanych], etc.; but long-term diabetic autonomic nerve damage , when the sympathetic symptoms of hypoglycemia may not occur, but only central nervous symptoms ...; card-like complex and diverse central nervous system, symptoms may appear,[link widoczny dla zalogowanych], but the most common disturbance of consciousness, the group coma, drowsiness, Fuzzy total of 26 cases, accounting for 70.3% (26/37). 2.2 low blood sugar mechanism of neurological damage the performance of low blood sugar when the central nervous system central nervous system is essentially the result of a lack of glucose. Central nervous system cells and other tissue cells is different,[link widoczny dla zalogowanych], it does not have glycogen reserves, like other organizations do not ring through the use of free fatty acids as an energy source. When the cerebral cortex is inhibited when the performance of hazy consciousness, orientation and discriminating progressive loss, lethargy, reduced muscle tone, tremor, mental disorders; when cortical inhibition occurs when restless, hyperalgesia, and may have clonic dance-like movements such action or naive. 2.3 misdiagnosis of patients in this group were 15 out-patient, emergency misdiagnosis, 40.5%, misdiagnosed as acute cerebral infarction accounted for 13 cases. Mainly due to: (1) Clinical manifestations and acute cerebrovascular disease very similar to physicians symptoms of low blood sugar central nervous lack of knowledge is the key cause of misdiagnosis; (2) The medical staff was impressed by the brain disease, to focus too much concentrated in the whole brain of patients with focal neurological symptoms and absence of symptoms, the patient ignored the use of hypoglycemic drugs and diet, is also a misdiagnosis; (3) the number of patients showed confusion, aphasia, more difficult to history taking, resulting in misdiagnosis.
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