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患者男性,20岁,1989年11月22日入院。入院前3天病人在劳累、受凉及饮酒后出现左侧腓肠肌疼痛、左下肢麻木、无力,继而累及四肢,进行性加重。次日夜间即不能行走和站立,双臂不能上抬,不能端碗,并出现咀嚼无力。血钾和心电图均正常。当夜出现呼吸困难、胸闷,诊断为格林-巴利综合征、呼吸肌麻痹。患者既往体健,无类似发病史,家族中亦无类似发病者。体格检查:意识清楚,唇轻度发绀,咀嚼肌麻痹,张口无力(张口时齿距2横指),颈无力转动,呼吸动度减弱(约3cm)。四肢肌力1～2级,近端重于远端,肌张力低,腱反射普遍减弱,左膝踝反射消失。其余神经系统检查未见异常。入院后查血常规正常,血钾降低(2.55mmol/L);心电图各导联T波低平。修正诊断为低钾性周期性瘫痪,给予补钾治疗,病情迅速好转,张口齿距达3个半横指,呼吸动度正常,四肢肌力5级,能下床
Male patient, 20 years old, admitted to hospital on November 22, 1989. Three days before admission, the patient showed pain in the left gastrocnemius, left numbness and weakness after exertion, cold and alcohol drinking, and subsequently affected the extremities and exacerbated the exacerbations. The next day that can not walk and stand, his arms can not be raised, can not bowls, and chewing weakness. Potassium and ECG are normal. Breathing difficulties on the night, chest tightness, diagnosis of Guillain-Barre syndrome, respiratory muscle paralysis. Past physical health of patients, no similar history, no similar incidence in the family. Physical examination: Consciousness, mild cyanosis of the lips, masticatory muscle paralysis, impaired mouth (mouth when the two transverse pitch), neck weakness, decreased respiratory motion (about 3cm). Limb muscle strength of 1 to 2, the proximal end is heavier than the distal, low muscle tone, tendon reflex generally weakened, left knee ankle reflex disappeared. The remaining neurological examination showed no abnormalities. Check blood routine after admission, serum potassium decreased (2.55mmol / L); ECG T wave low level. Correct diagnosis of hypokalemic periodic paralysis, given potassium treatment, the condition improved rapidly, mouth distance of up to 3 and a half transverse index, normal breathing, limb muscle strength 5, to get out of bed