長期全身性疼痛及近期頭部脹痛：神經內科問題與治療建議-神經內科

長期全身性疼痛及近期頭部脹痛？

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平時每天沒有特殊運動腳踝、小腿前後側肌肉、大腿後側肌肉、屁股肌肉及腰部肌肉會有酸痛情形，以上肌肉也每天都有被電到的痛感（睡前較嚴重），左側都比右側嚴重，心臟有時候會抽痛及悶痛（心律不整），背部肋骨位置會痛，心臟疼痛位置都是面對左側胸部的左上角位置（左鎖骨下，靠近胸骨），疼痛時會影響呼吸造成吸氣。
去年某天凌晨在吃宵夜時突然心臟痛、胸悶、喘不過氣、想吐、左半邊麻且無力，至醫院急診做X光及CT檢查，除肋骨位置有發炎之外沒有找出其他原因，不想吐手有力之後便自行離院。
肋骨發炎的部分醫生說放著讓他自己好但一年了都沒有好，一直疼痛很影響生活。

昨天蹲下起立後感到頭部左側太陽穴位置十分脹痛，伴隨左側顳顎位置微麻，全身肌肉無力，左手無法用力抓握，一天過後頭痛沒有好轉，都會十分脹痛及頭暈，現在脹痛從左側太陽穴順著前額至右側太陽穴一起痛，右側顳顎也有微麻，手較昨天稍微有力，但是出力有點間歇性不連貫，伴隨偶爾心臟位置非常悶痛。

再麻煩醫師為我解惑，以上問題十分影響生活又從來沒有得到解決方法。

去年急診影像檢查報告如下
PA View of the Chest: This study is compared with previous examination dated 2021-10-24. Mild wall thickening of the bilateral bronchi and prominent lung marking. Prominent breast shadows. The cardiac size is within normal limit. The costophrenic angles are sharp. The mediastinum and hila are unremarkable. Air-fluid accumulation in distended stomach. Mild thoracic spine scoliosis(Cobb Angle of Thoracic Curve:13.6 degrees) Thre is no obvious image evidence of displaced fracture. Chest plain film is not sensitive for non-displaced rib fracture and costal cartilage fractures. If local tenderness persistent, suggest chest CT for there evaluation.

CT of the chest with and without IV contrast medium showed: ＞ 註：本檢查報告及判讀範圍依健保規範之開單項目:chest, ，範圍外的額外加掃部位屬於無單號影像，借本單上傳，請開單醫師自行判讀: brain, neck, abdomen, and others. ＞ 已發異常診斷簡訊通報給開單醫師。 ＞ 同時追加須通報之診斷: Thickening of nasopharynx. R/I nasopharyngeal tumor. ＞ 超出本檢查單範圍部位，可能尚有其他影像診斷。如需詳細診斷紀錄，請另開屬於該部位之影像檢查。 ＞ Focal thickened pleura in B6 of LLL (Ser 7, img 28) can’t exclude contusion with blood clot. Also suspected inflammatory change. ＞ Focal reticulonodular infiltration in the LLL (Ser 7, img 32 to 34). R/I tuberculosis, DDx: non-pyogenic inflammation. ＞ No other obvious mass in bilateral pulmonary parenchyma. ＞ No pulmonary embolism. ＞ Satisfactory caliber of the airways. No pleural effusion. No mediastinal LAP. No pericardial effusion. ＞ No aortic lesion. The caliber of aorta was within normal range. No obvious vascular ring. No visible fracture line. ＞ [There is limitation for interpretation of the images. There is some false negative rate for other occlut lesion in this exam. Management may be based on associated survey and clinical evaluation.] Impression:1. Focal thickened pleura in LLL. Suspected blood clot. DDx: inflammatory change. 2. Focal eticulonodular infiltration in the LLL. R/I tuberculosis, DDx: non-pyogenic inflammation. 3. Thickened nasopharynx R/I nasopharyngeal tumor. DDx: inflammatory change. Suggest ENT evalauation. 4. 超出本檢查單範圍部位，可能尚有其他影像診斷。如需詳細診斷紀錄，請另開屬於該部位之影像檢查。[There is limitation for interpretation of the images. There is some false negative rate for other occlut lesion in this exam. Management may be based on associated survey and clinical evaluation.]

Cervical Spine AP and Lateral hyperextension ＆ hyperflexion Views: Grade 1 spondylolisthesis during hyperflexion, C2 on C3. Retrolisthesis during hyperextension, C5 on C6 and C6 on C7.

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小馨，20~29歲女性，詢問日期：2025/09/10