Myocarditis one cases of severe brain.doc

 PAGE \* MERGEFORMAT 7 Myocarditis one cases of severe brain [Keywords:] encephalomyocarditis; treatment Patients, male, 7 years old, Tibetan, from the Plateau. 3 d before admission, after eating fresh apples are not nausea, vomiting two times, non-jet-like, vomit gastric contents, no bloody objects, accompanied by abdominal pain, diarrhea, stool yellow watery stools, no mucus sepsis, 6 times / d, no headache, fever, cough, sputum, no convulsions, breathing difficulties, so that special treatment is not OK, the first two days in children with a sudden loss of consciousness, should not call the emergency room sent to our hospital. 5 d before a fall from a running back the history of the cattle. Admission examination: body temperature 36.6 ℃ , pulse 89 times / min, breathing 42 times / min, blood pressure 92/61 mmHg (1 mmHg = 0.133 kPa), weight 15 kg, the nutritional status of poor, obviously thin, deep coma, pairs of pupil diameter of about 1 mm, light reflex retardation, mouth and nose with a large number of sticky white discharge, no smell of gas exhaled, neck stiffness, throat congestion, and bilateral tonsil Ⅰ degree of swelling, coarse breath sounds lungs, both lungs at the end of smell and a large number of dry rales, cardiac arrhythmia, the first heart sound less blunt, plain abdominal soft, liver and spleen less than ribs, shifting dullness (-), bowel sounds normal, no edema of both lower extremities, tendon reflex, tendon reflexes with a normal knee , bilateral Babinski sign, g’s sign positive, Hoffmann sign negative. Out-patient X-ray: two lung fields clear and prominent pulmonary artery segment, apex blunt upturned, more than normal. Laboratory examination: WBC 0.80 * 109 / L, N 0.811, L 0.83; renal function, electrolytes normal. Admission first visit: (1) bronchial pneumonia; (2) Acute gastroenteritis; (3) coma of unknown origin: brain trauma? Central nervous system infection? (4) food poisoning? (5) The degree of malnutrition Ⅱ . Reported in crit