台北市中医师公会中医药研究论丛

公会简介

理事长的话

公会沿革

公会章程

212.14 复视－神经急症之鉴别诊断思维与病例分享

TJ TCM.21(2) : 151-168, 2018

DOI : 10.6516/TJTCM.201809_21(2).0014

复视－神经急症之鉴别诊断思维与病例分享

The Differential Diagnosis for Diplopia to Identify/Exclude Possible Emergency

Neurological Diseases: Demonstrations from Two Clinical Cases

李昌狄1　徐培珊1　陈建霖1,2　黄建荣1　游明谦1,2*

1 佛教慈济医疗财团法人台北慈济医院中医部，台北，台湾

2 慈济大学学士後中医学系，花莲，台湾

【摘要】

复视之表现涵盖各种严重眼科疾病与神经系统重症的可能，需要临床医师快速鉴别诊断并应有足够的认识与警觉。本文整理中西医之文献，以厘清复视的西医鉴别诊断思路与中医辨证处方用药原则，并以二例原因不同之复视病例作佐证。第一个病例为有肝癌病史之67 岁男性突发复视及头晕，经转诊急诊後，证实其复视为严重中枢神经疾病之初期表现，提示临床应审慎诊察不可轻忽；第二个病例为头痛主诉之48 岁男性，最终诊断为疑似第六对脑神经之病毒感染，其诊治过程呈现出临床应有之鉴别诊断思考及如何安排检验与检查来协助诊断，该病例在高剂量类固醇治疗无效後，以水煎剂麻黄汤之加减使症状迅速获得改善。本文透过文献整理与病案分析，提供中医师於临床上做初步诊断、适当转介及正确治疗之依据。

【关键词】复视、鉴别诊断、中医辨证

Chang-Ti Lee1Pei-Shan Hsu1Chien-Lin Chen1,2

Chien-Jung Huang1Min-Chien Yu1,2

1Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical

Foundation, Taipei, Taiwan

2School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan

【Summary】

Diplopia is a possible clinical presentation of some severe ophthalmologic or neurologic diseases. Clinicians should have enough knowledge and awareness to make differential diagnosis as soon as possible when approaching a patient with diplopia. We organized the information about diplopia from Chinese and Western medicine literature to clarify the thinking process of making differential diagnosis and the principles of Traditional Chinese Medicine’s (TCM) pattern identification and treatment. We used two different cases with diplopia to present the differential diagnosis and treatment processes by pattern identification. The first case was a 67-year old male with hepatocellular carcinoma who had acute diplopia with dizziness. The fact that the final diagnosis was ischemic stroke in this case after transferred to Emergency Room immediately suggests that diplopia may be a manifestation of emergency neurology. The second case was a 48-year old male with headache and exacerbate diplopia. We demonstrated here a complete diagnostic process for diplopia evaluation in this case. Virus infection of cranial

nerve VI was suspected. High-dose corticosteroid was used, but in vain, then modified Ma-Huang-Tang traditional decoction was applied to cure diplopia due to precise pattern identification. By organizing literature information and clinical case analysis, we hope this article can help clinicians with diagnosis, referral and treatment.

【Keywords】Diplopia, Differential diagnosis, Pattern identification

	台北市中医师公会　官网：http://www.tpcma.org.tw　地址：台北市中正区青岛西路11号3楼 E-mail：tp.cma@msa.hinet.net　电话：(02)2314-3456(代表号)　传真：(02)2314-8181	线上浏览人数
		总浏览人数:7704131 2013.12.9 网页更新