求助，吞咽困难查因
<p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">患者因“吞咽困难、饮水呛咳三天”入院，患者三天前与他人生气后开始出现吞咽困难，自诉食物进口腔后部后感觉丧失，无法作吞咽动作，且饮水呛咳现象明显。同时患者感全身乏力，行走需搀扶，家属觉其说话带有鼻音。三天来患者几乎未有进食进水，咳痰较多，多位白色泡沫痰及唾液。入院前一日患者开始出现发热，自测体温</span><chmetcnv wst="on" tcsc="0" numbertype="1" negative="False" hasspace="False" sourcevalue="38.1" unitname="℃"></chmetcnv><span lang="EN-US"><font face="Times New Roman">38.1</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">℃</span><chmetcnv></chmetcnv><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">，在当地医院静脉输液治疗（磷霉素），效果不佳。门诊查脑干</span><span lang="EN-US"><font face="Times New Roman">MRI</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">：</span><span lang="EN-US"><font face="Times New Roman">1</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">、脑干未见明显异常征象。</span><span lang="EN-US"><font face="Times New Roman">2</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">、轻度脑白质变性。胸片：左下肺感染。血常规：</span><span lang="EN-US"><font face="Times New Roman">WBC</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">：</span><span lang="EN-US"><font face="Times New Roman">12.43*10^9/L</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">，</span><span lang="EN-US"><font face="Times New Roman">N:84.90%</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">。患者病程中，无明显的头昏头晕，无视物旋转，无恶心呕吐，无明显的偏侧肢体乏力麻木，症状没有晨轻暮重的特点，无明显的胸闷气急，无呼吸困难。精神萎靡，食欲、夜眠差，小便正常，未解大便。自诉既往</span><span lang="EN-US"><font face="Times New Roman">40</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">年前有过“脊髓灰质炎”病史，具体情况表述不清。个人史、家族史无特殊。查体：</span><span lang="EN-US"><font face="Times New Roman">T</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">：</span><chmetcnv wst="on" tcsc="0" numbertype="1" negative="False" hasspace="True" sourcevalue="36.3" unitname="℃"></chmetcnv><span lang="EN-US"><font face="Times New Roman">36.3 </font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">℃</span><chmetcnv></chmetcnv><span lang="EN-US"><font face="Times New Roman">P</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">：</span><span lang="EN-US"><font face="Times New Roman">72</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">次</span><span lang="EN-US"><font face="Times New Roman">/</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">分</span><span lang="EN-US"><font face="Times New Roman">R</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">：</span><span lang="EN-US"><font face="Times New Roman">20</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">次</span><span lang="EN-US"><font face="Times New Roman">/</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">分</span><span lang="EN-US"><font face="Times New Roman">BP</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">：</span><span lang="EN-US"><font face="Times New Roman">110/70mmHg</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">神志清，精神萎，体型偏瘦，查体合作。全身皮肤黏膜无黄染，浅表淋巴结未扪及，耳鼻通畅，唇不绀，伸舌居中，咽不红，扁桃体不肿大。颈软，右下肺可闻及少量湿罗音。余肺野未闻及明显的干湿罗音。心律齐，各瓣膜听诊区未闻及明显的病理性杂音。腹平软，无压痛反跳痛，肝脾肋下未及，移动性浊音（</span><span lang="EN-US"><font face="Times New Roman">-</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">），双下肢无浮肿。专科检查：意识清楚，精神萎靡，表情淡漠，语言流利，检查合作。双眼球居中，双侧眼球活动佳，无眼震，双侧瞳孔等大同圆，</span><span lang="EN-US"><font face="Times New Roman">D</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">＝</span><chmetcnv wst="on" tcsc="0" numbertype="1" negative="False" hasspace="True" sourcevalue="3" unitname="mm"></chmetcnv><span lang="EN-US"><font face="Times New Roman">3 mm</font></span><chmetcnv></chmetcnv><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">，双侧对光反射及调节反射灵敏。张口下颌无偏斜，闭目有力，鼻唇沟对称，示齿口角不偏。发音呈后鼻音，双侧软腭对称，但右侧抬举较左侧好，双侧咽反射迟钝，伸舌居中。肌力：双下肢远近端</span><span lang="EN-US"><font face="Times New Roman">IV</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">级，双上肢远近端</span><span lang="EN-US"><font face="Times New Roman">IV</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">级，肌张力正常。共济运动不合作。无不自主运动。浅深感觉正常，四肢腱反射对称。双侧病理征可疑阳性，脑膜刺激征阴性。入院后予以腰穿检查，脑脊液蛋白、葡萄糖、氯均在正常范围。脑脊液常规正常，未找到抗酸杆菌，墨汁染色阴性。脑电图、</span><span lang="EN-US"><font face="Times New Roman">Sep</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">、</span><span lang="EN-US"><font face="Times New Roman">Vep</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">均正常。入院后曾分别予以阿昔洛韦、弥可保、低分子肝素、地塞米松、黛力新治疗，效果不佳。目前患者口腔内分泌物较前稍有所减少，但仍不能吞咽不能进食。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';"></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'mso-hansi-font-family:';">该病人该如何诊断啊？脑血管病？癔症？肌肉疾病？感染性疾病？迷茫中，恳请各位高手指点迷津！</span></p> 神经症可能性较大
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