A 35-year-old unmarried man living alone was brought to the emergency department with acute abdominal pain mainly in the epigastric region. He could not provide any detailed history regarding his presenting complaint but had no fever or other constitutional symptoms. He was known to have diabetes mellitus, but we had no information on any other medical history. Following admission to hospital, his Glasgow Coma Scale score deteriorated rapidly over 24–48 hours from 14/15 to 4/15, and he was intubated and ventilated. His pupils were symmetrical at 4 mm in diameter and were slowly reactive. Deep tendon reflexes were globally diminished with reduced muscle tone, and plantar responses were down going. The remaining neurological examination including cranial nerve function and optic fundi was normal, and there was no neck stiffness. His blood pressure on admission was 190/100 mmHg with a pulse rate of 90 beats per minute. The random plasma glucose level was 19.8 mmol/L and his arterial blood gases showed a high anion gap metabolic acidosis (pH 6.7). Serum electrolytes showed a normal level of serum sodium of 135 mmol/L, but a raised serum potassium level of 5.7 mmol/L. Serum calcium and magnesium levels were normal. Ketone bodies were present in the urine but not in the serum. His renal function was gradually deteriorating with a raised serum creatinine level of 308 μmol/L. CT scan of the head on admission was normal. Cerebrospinal fluid contained 1.48 g/L of protein, 3.7 mmol/L of glucose (paired plasma glucose of 7.9 mmol/L), 0 polymorphs, 4 lymphocytes and red blood cells (1750×106 cells/L). Electroencephalogram showed generalised slow delta activity throughout the record suggesting encephalopathy or encephalitis. Urine toxicology screen was negative for cocaine, methamphetamine, morphine, tetrahydrocannabinoids, amphetamine, barbiturates, benzodiazepine, methadone and tricyclic antidepressants. ### Question 1: What clinical syndrome best describes this presentation? He was previously well and presented acutely with epigastric pain but soon became unconscious with very …

中文翻译：

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成人急性白质脑病

一名 35 岁独居未婚男子因急性腹痛被送往急诊室，主要在上腹部。他无法提供任何关于其主诉的详细病史，但没有发烧或其他全身症状。已知他患有糖尿病，但我们没有任何其他病史的信息。入院后，他的格拉斯哥昏迷量表评分从 14/15 到 4/15 在 24-48 小时内迅速恶化，他被插管和通气。他的瞳孔是对称的，直径为 4 毫米，反应缓慢。随着肌张力降低，深腱反射整体减弱，足底反应下降。其余神经系统检查包括颅神经功能和视眼底均正常，颈部无僵硬。入院时他的血压为 190/100 mmHg，脉搏为 90 次 / 分钟。随机血浆葡萄糖水平为 19.8 mmol/L，动脉血气显示高阴离子间隙代谢性酸中毒（pH 6.7）。血清电解质显示正常的血清钠水平为 135 mmol/L，但升高的血清钾水平为 5.7 mmol/L。血清钙和镁水平正常。酮体存在于尿液中，但不存在于血清中。他的肾功能逐渐恶化，血清肌酐水平升高至 308 μmol/L。入院时头部CT扫描正常。脑脊液含蛋白质1.48 g/L，葡萄糖3.7 mmol/L（配对血浆葡萄糖7.9 mmol/L），多形体0个，淋巴细胞和红细胞4个（1750×106个细胞/L）。脑电图在整个记录中显示全身缓慢的 delta 活动，提示脑病或脑炎。尿液毒理学筛查对可卡因、甲基苯丙胺、吗啡、四氢大麻素、苯丙胺、巴比妥类药物、苯二氮卓类药物、美沙酮和三环类抗抑郁药呈阴性反应。### 问题 1：什么临床综合征最能描述这种表现？他以前身体很好，急性上腹疼痛，但很快就失去知觉，非常…… 哪种临床综合征最能描述这种表现？他以前身体很好，急性上腹疼痛，但很快就失去知觉，非常…… 哪种临床综合征最能描述这种表现？他以前身体很好，急性上腹疼痛，但很快就失去知觉，非常……