医疗诊断信息求助: 请帮助科大784校友张戈找出病因

juanminwang

亲爱的校友,
科大784校友张戈现正躺在美国的Florida的Tampa医院一个多星期（到今天是第九天）:
生活不能自理，吃喝拉撒全在床上由亲人(妻子，儿子和妹妹)或医务人员协助。刚开始一个星期不知道是什么病，后来认为是脑膜炎，但过了一个星期医生又说不是脑膜炎，不知道是什么病。有些医生甚至在这种情况下建议回家养着（不知道什么病又生活不能自理），在家属和部分医生地坚持下还留在医院。但由于医院方面没有能力诊断出具体病因，特求助各位校友（特别是本人有经验的校友，或与名医院，名医生能有联系的校友），帮忙找出病因或提供有用信息。具体的症状如下（到今天2011年4月23日为止由妻子提供）：


My husband has been sick for 16 days now with a debilitating illness. It
started with flu-like symptoms – fever, nausea, vomiting, muscle aches
(concentrated to the back). He volunteered to go to the emergency room twice to
diagnose his condition to no avail. Five to six days into the illness, he
complained about double-vision, and he appeared to be disoriented and confused.
A week in, he began having trouble urinating, had trouble standing, had become
very weak, and he became delusional.
We took him into the emergency room and the doctors performed a series of
tests. His lumbar puncture hinted at a viral infection – elevated protein
levels, and lymphocytes in his spinal fluid. However, all other tests – MRI and
CT scans of his head and abdomen, EEG, vitals, blood – are all normal. His
fever disappeared two weeks into his illness, and he is relatively clear-headed
when we talk to him. He suffers from long-term memory loss – he has trouble
recalling even the big events in his life. He still has trouble urinating, he
has drooped eyelids, he doesn’t talk much, he still feels dizzy, he falls
asleep instantly and is hard to wake, and he is so weak he doesn’t have
strength to sit up. The doctors tested for a lot of potential viruses but found
none. They stopped acyclovir and antibiotics and started him on steroids to
treat him for an autoimmune encephalitis condition. Any ideas as to what he
has? Our family is extremely worried.
He does do a lot of yard work, and we live in Florida where there are a lot of
insects including mosquitoes and ticks. This spring, he had very bad allergies
that lasted for four months.


如有任何有用信息或诊断，请回邮件或打电话给我（510）6736733
Email: ShaoZhen <shaozhen@hotmail.com

万分感谢！
兰慧彬（834G）

我不是医学专业的,只是一个普通人, 但我看了病人的状况后感觉要么是中毒(蛇类或虫类)或是严重的过敏症状? 我不懂, 不能给你们帮助,很抱歉! 我听说在佛罗里达有个梅约中心很有名.   我唯一能做的是祝福和祈祷.愿他能早日恢复健康! 主保佑

知足

不懂医，帮不上忙，顶一下。希望专家们关注一下，给些建议。为校友祈福，愿他能早日恢复健康!

BlueSky

引用第2楼知足于2011-04-25 12:54发表的  :
不懂医，帮不上忙，顶一下。希望专家们关注一下，给些建议。为校友祈福，愿他能早日恢复健康!

中午已电话和email联系了。

知足

谢谢热心的BlueSky。专家们不了解详情，也许发表没把握的意见有顾虑，现转贴一些网友的评论，懂行的看看有没有道理：
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听说过渐冻人综合征吗？学名脊髓侧索硬化症。看样子患者像是由普通感冒诱发的亚急性发病过程。

链接：http://www.sle999.com/changshi/2005/1-14/15920.htm

另一网友回复：不像肌萎缩侧索硬化症， 因为这个校友发病和病情进展太快了。
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光看提供的info 不足已作出判断，大致上还是主要考虑病毒脑炎，自身免疫脑病，包括ALS，MS，lupus，Jacob.
佛州的医生好像都想到了。先看看有没疗效， 可边治疗边诊断。
不过也有不运气的时候，上月俺这有一年轻人的肺肾综合症（GOODPASTURE）就被肺科的误诊了, 误治了一个月，导致病人死亡。
他该找个当地好的neurologist会诊，get 2nd opinion.
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被毒虫之类的咬过？某种生物毒素？但如果是这种情况当地应该常见？　　医生也会比较有经验？
　
惭愧， 确实帮不上什么忙 生物毒素可能性很小，乱猜的。有些医院技术条件可能不够好，或者不是最好，不能提供最理想的医疗条件，但一般有经验的医生都会比较清楚业内技术力量最强的医疗研究机构是哪几家 家族病史？  各种应该做的检查有没有做全？

最大的可能性是某种病毒感染引发的一系列免疫系统症状。如果是自身免疫性的问题，基本上也确实无药可治，只能依靠自身免疫力逐渐恢复，但前提是医院把该做的一切检查都做了.....现在有很多检查是过去我们都没有听说过的基因检测之类的。
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想象是急性脱髓鞘疾病。临床表现多样化，整个神经系统都有可能受损伤，会时好时坏，尚无特效办法，但多数人用激素治疗。希望能进入长期缓
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觉得中毒的可能性比较大，试一下排毒，就是不吃任何食物，只喝新鲜果菜汁，排毒的效果快和好，不要大补。
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干YARDWORK时, 有没有动过水仙?
水仙，其毒性为全草有毒，鳞茎毒性较大。误食后有呕吐、腹痛、脉搏频微、出冷汗、下痢、呼吸不规律、体温上升、昏睡、虚脱等，严重者发生痉挛、麻痹而死。鳞茎的浸剂对豚鼠、兔和猫的子宫都有很强的兴奋作用，能使鸽呕吐。小鼠腹腔注射水仙总生物碱LD50为182mg／kg；狗肌肉注射16mg／kg，出现活动减少、不食，部分死亡。 水仙的花、枝、叶都有毒，所以要警防小孩子无意间的吞食。
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我不是这方面的专家，就发表一下不是专家的意见。我觉得当地医院医生的诊断和治疗思路是对的。

看了这个病人的简短病例，个人认为考虑病毒性脑炎和自身免疫性脑炎（autoimmune encephalitis）是对的。病毒性脑炎里唯一可治疗的是 Herpes Encephalitis. 这个病人一用 Acyclovir 治疗过，但治疗无效，另外根据描述这个病毒的诊断好像也已被排除。

病毒性脑膜炎和自身免疫性脑膜炎，临床表现很难区分。现在医生越来越认识到自身免疫性脑膜炎这类疾病，原来认为是病毒性脑炎的很多病例，其实是 autoimmune encephalitis。诊断 autoimmune encephalitis 需要查很多自身抗体，如 Anti-N-methyl-D-aspartate receptor (NMDAR)，  LGI1 antibodies  LGI1 antibodies， AMPA receptor antibodies， Anti-CASPR-2 等等，可能有些抗体一般的化验室还不能做。个人觉得值得考虑 Anti-NMDA receptor encephalitis，值得去查 Anti-N-methyl-D-aspartate receptor。

另外还要考虑肿瘤引起的 脑炎（Paraneoplastic encephalitis）。小细胞肺癌，淋巴癌，睾丸癌等较常见。很多时候，脑炎表现在这些癌还没被发现前。 如果怀疑癌症的话，可以做一下胸部，腹部和盆腔 的 CT 和睾丸的超声波。治疗这类脑炎的同时，还要治疗肿瘤。

Paraneoplastic and autoimmune encephalitis 是可以治疗的，治疗及时的话，有些病人得病情会有改善。治疗这些脑炎的一线用药是免疫抑制药 steroid, intravenous immune globulin and plasma exchange. 对上面的治疗无效的话，二线用药是 Cyclophosphamide or rituximab. 另外如果有肿瘤的话，一定要治疗肿瘤。
祝病人早日病情改善
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sounds like Guillain-Barre Syndrom.
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check this West Nile Virus Symptoms
Signs and symptoms of the West Nile virus infection range from no symptoms at all to a rapidly fatal brain infection. In areas where the virus is common, people are more likely to show no symptoms of the infection or have only a mild, flulike illness rather than a severe brain infection. Even in an area of outbreak, the likelihood of a person developing illness after infection with West Nile virus is about 1 in every 140-300 people.

•West Nile virus infection typically begins with the abrupt onset of fever, chills, muscle aches, headache, and overall feeling of illness. Headache is particularly common and may be severe. The person may have sensitivity to light with pain behind the eyes.
•Most people fully recover. In others, particularly the elderly, the disease can progress to cause encephalitis or meningitis.
•In the 59 people hospitalized during the initial New York outbreak, signs and symptoms included fever (90%), muscle weakness (54%), headache (46%), altered mental status (44%), rash (22%), stiff neck (19%), joint aches (17%), sensitivity to light (15%), and body aches (14%).

会不会是一种带特种virus的蚊，虫叮咬后引发的经血液扩散性的virus 感染？影响脑神经，导致半瘫至全瘫。面部神经当然也受牵连（眼皮下垂等），因lumbar puncture hinted at a viral infection – elevated protein levels。
不像是ALS, ALS发展没这么快，ALS 从发生重肌无力到生命终结一般是2--5年。
不宜耽搁，应找专家diagnose, 进行对症的treatment. virus 有多种， 用药也不同。
尽供参考，祝康愈。