麻痹性痴呆误诊的原因分析  

A causal analysis on 14 cases of patients misdiagnosed with General Paresis of Insane

作　　者：张校明[1] 钟晓波[1] 黄亚琳[1] 陈蒂丝[1] 董再全[1] 胡峻梅[1] 

机构地区：[1]四川大学华西基础医学与法医学院司医精神病学教研室,610041

出　　处：《神经疾病与精神卫生》2009年第2期131-133,共3页Journal of Neuroscience and Mental Health

摘　　要：目的探讨麻痹性痴呆易被误诊的可能原因，提高临床诊断率。方法回顾性分析14例曾被误诊的麻痹性痴呆患者的临床资料。结果以不典型的精神症状群首发而被误诊为功能性精神障碍10例，其中误诊例次率最高的是精神分裂症占47．3％，其次是躁狂症占31．6％；以进行性加重的痴呆为主要首发症状而被误诊为阿尔兹海默病的2例及血管性痴呆1例；以酒依赖伴有痴呆样症状为主被误诊为酒精所致精神障碍的1例。〈40岁的占总数的28．5％。否认或故意隐瞒治疗史9例，根本不知情5例。误诊时处于发病早期无神经系统的阳性体征8例；处中晚期有神经系统阳性体征且呈不同程度表现的共6例，其中仅1例伴有特异性阿-罗氏瞳孔特征。14例辅助检查均不够完善，均未及时进行相关梅毒血清学检查。结论麻痹性痴呆易被误诊的首要原因是首发精神症状不典型，其次是冶游史易被隐瞒、早期神经系统阳性体征不明显或中晚期缺乏阿-罗氏瞳孔特异性体征、辅助检查不够完善和及时。Objective To explore possible causes for patients misdiagnosed with general paresis of insane （GPI） and improve the efficiency of correct clinical diagnosis. Methods Retrospectively analyzed the clinical data from 14 cases of patients misdiagnosed with general paresis of insane. Results 10 cases with initial atypical psychological symptoms were misdiagnosed as functional mental disorder in which the majority of patients were misdiagnosed as schizophrenia which accounts for 47.3%, and mania accounts for 31.6% ; Of three cases with multiple infarct dementia （MID） as a primary initial symptom, two were misdiagnosed as Alzheimer＇s disease, and one was misdiagnosed as vascular dementia; One case with a main symptom of alcohol dependence and dementia was misdiagnosed as mental disorder due to the use of alcohol. Patients under the age of 40 account for 28.5% of the total number. Nine cases of patients denied or deliberately hid their history of unclean coitus, while five cases of patients simply have no knowledge of their disease. In eight cases, misdiagnosis was made at an early stage with no positive signs of the nervous system; While in six other cases, misdiagnosis was made at the middle--advanced stage with positive signs of differentiated degrees of the nervous system, and there was only one case with specific characteristics of Argyll--Robertson＇s pupil. Accessory examinations in the fourteen cases were inade- quate in that they failed to carry out syphilis serological examinations in a timely manner. Conclusions Causes for the frequent misdiagnosis of general paresis of insane were： First, the initial symptoms of the disease are atypical psychological symptoms; Second, onset age tends to be younger, the history of unclean coitus is easily hidden, positive signs of the nervous system are not obvious at the early stage or lack specific characteristics of Argyll--Robertson＇s pupil at the middle--advanced stage, as well as the imperfect accessory examinations that are always delayed.

关 键 词：麻痹性痴呆 误诊原因 梅毒 

分 类 号：R749.1[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]