中英临床推理肺癌病人逐渐瘫痪韩

SECTION1第一部分

A54-year-oldmanpresentedwithpainintheleftchestfor3days.Hismedicalhistorywasremarkableforhyperlipidemiamanagedwithdietandstatin.Hedeniedtobaccosmokingandconsumptionofalcohol.Physicalexaminationwasunrevealing.Thepatientwasdiagnosedwithanadenocarcinomaofthelungharboringanepidermalgrowthfactorreceptor(EGFR)mutationthatmetastasizedtoT2-T4levels.HewastreatedwithradiotherapyanddexamethasonefollowedbyGefitinib.

54岁男性主因左侧胸痛3天入院。其病史有显著的高脂血症，正在接受饮食和他汀治疗。病人否认吸烟饮酒史。体格检查未见明显异常。病人被诊断为表皮生长因子受体（EGFR）突变阳性的肺腺癌，并且转移至T2-T4水平。我们对他采用了放疗和地塞米松治疗，继之给予口服吉非替尼。

Inthesubsequentweeks,thepatientdevelopedflaccidparaparesiswithMedicalResearchCouncil(MRC)gradedstrengthof3/5inmostmusclesofthelowerlimbsandnormalpower(MRCof5/5)intheupperlimbs.Deeptendonreflexesweresymmetricalandgrade1+inthelowerlimbsand2+intheupperlimbs.Plantarresponseswereflexor.SensoryexaminationrevealedimpairedpinprickcaudaltotheT4level.Cranialnerveexaminationwasunremarkable.ThepatientwasdiagnosedwithaT2-T4pathologicfracturecausingspinalcord







































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