背景:我们报告了一例持续12个月的临床攻击,具有严重且未解决的临床特征,涉及多个医学学科。
方法:一名53岁的白人男性,除了中度肾功能损害外,他以前都很健康,在1年内因神经系统疾病复发而住院12次,心血管,胃肠道症状和体征,没有任何明显的病因。有两次,他心脏骤停,成功复苏。在第一次心脏骤停之后,插入心脏除颤器。在我们医院的第12次入院期间,在综合多学科评估后怀疑乌头碱中毒,并通过血清和尿液分析证实。稍后,乌头碱也在头发中被检测到,表明在症状期内暴露。做出诊断后,没有进一步的发作。他的心脏除颤器后来被移除,他又回去工作了.以前的癫痫诊断也被放弃了。犯罪意图被怀疑,他的妻子因谋杀未遂被判11年监禁。对乌头碱中毒的可能性进行标准化评估,作为11次入院的原因,建立了“乌头碱评分”。分数是基于神经学的,心血管,胃肠,和文献报道的其他临床特征。我们还提出了使用头发分析来确认临床特征解决后评估的可疑中毒病例的案例。
结论:本报告说明了秘密中毒病例带来的医学挑战。在没有明显原因的情况下,出现来自多个器官系统的症状和体征的患者中,应该总是怀疑中毒。为了解决这类案件,需要深入了解特定有毒物质的影响。我们提出了一个“乌头碱评分”,可能对疑似乌头碱中毒的病例有用。
BACKGROUND: We report a
case of a clinical challenge lasting for 12 months, with severe and unresolved clinical features involving several medical disciplines.
METHODS: A 53-year-old Caucasian male, who had been previously healthy apart from a moderate renal impairment, was hospitalized 12 times during a 1-year period for a recurrent complex of neurological, cardiovascular, and gastrointestinal symptoms and signs, without any apparent etiology. On two occasions, he suffered a cardiac arrest and was successfully resuscitated. Following the first cardiac arrest, a cardiac defibrillator was inserted. During the 12th admission to our hospital, aconitine poisoning was suspected after a comprehensive multidisciplinary evaluation and confirmed by serum and urine analyses. Later, aconitine was also detected in a hair segment, indicating exposure within the symptomatic period. After the diagnosis was made, no further episodes occurred. His cardiac defibrillator was later removed, and he returned to work. A former diagnosis of epilepsy was also abandoned. Criminal intent was suspected, and his wife was sentenced to 11 years in prison for attempted murder. To make standardized assessments of the probability for aconitine poisoning as the cause of the eleven prior admissions, an \"aconitine score\" was established. The score is based on neurological, cardiovascular, gastrointestinal, and other clinical features reported in the literature. We also make a
case for the use of hair analysis to confirm suspected poisoning cases evaluated after the resolution of clinical features.
CONCLUSIONS: This report illustrates the medical challenge raised by cases of covert poisoning. In patients presenting with symptoms and signs from several organ systems without apparent cause, poisoning should always be suspected. To solve such cases, insight into the effects of specific toxic agents is needed. We present an \"aconitine score\" that may be useful in cases of suspected aconitine poisoning.