我们在这里描述了模仿中风的蘑菇中毒的典型案例。一名64岁的男性因车祸被转介到急诊室(ED)。他被发现发汗,低血压,心动过缓,在演讲中有点困惑。体格检查中未观察到外伤迹象。患者右四肢无力和双侧严重肌病。实验室检查正常,除了白细胞增多,轻度高血糖,轻度高氮血症和中度低钾血症。临床图片,除了瞳孔缩小,因此暗示中风,这也被认为是车祸的原因。病人的妻子,后来被带到急诊室,据报道,丈夫4年前中风,右偏瘫残留.她还提到病人出现出汗和意识模糊的迹象,汽车是故意开进沟里的.在其他细节中,她提到丈夫在开车前两个小时吃了她亲自收集的蘑菇。两毫克阿托品,因此,在怀疑胆碱能毒物的情况下,静脉补液和钾,并迅速获得完全缓解。在病人吃的蘑菇混合物中,一位真菌学家发现了蜜环菌(一种可食用的蘑菇),尤其是次胞,一种含有毒蕈碱的蘑菇,很容易与蜜环菌混淆。观察和口服补液后,病人出院了。
We describe here a paradigmatic
case of mushroom poisoning mimicking a stroke. A 64-year old male was referred to the emergency department (ED) for a car accident. He was found diaphoretic, hypotensive, bradycardic, and slightly confused at presentation. No signs of trauma were observed on physical examination. The patient had weakness of the right limbs and bilateral severe myosis. The lab tests were normal, except for leukocytosis, mild hyperglycemia, mild hyperazotemia and moderate hypokalemia. The clinical picture, with the exception of
miosis, was thereby suggestive for a stroke, which was also considered the cause of the car accident. The patients\' wife, who was brought later to the ED, reported that the husband had suffered a stroke 4 years earlier, with residual right hemiparesis. She also referred that the patient showed signs of diaphoresis and confusion, and the car was intentionally driven into the ditch. Among other details, she referred that the husband ate mushrooms that she had personally collected 2 hours before taking the drive. Two mg of atropine, intravenous rehydration and potassium were hence administered in the suspicion of a cholinergic toxydrome, and complete clinical remission was rapidly obtained. Among the mixture of mushrooms eaten by the patient, a mycologist identified Armillaria Mellea (an edible mushroom) and notably Inocybe Fastigiata, a toxic muscarine-containing mushroom, easily confounded with Armillaria. After observation and oral rehydration, the patient was discharged.