容易误诊漏诊的硬脑膜动静脉瘘9例分析  

Dural arteriovenous fistula with easily inaccurate or missed diagnosis:analysis of 9 cases

作　　者：廖焕权[1] 王鸿轩[2] 陈红兵[1] 杨智云[3] 王莹[1] 贺涓涓[1] 尚文锦[1] 洪华[1] 

机构地区：[1]中山大学附属第一医院神经内科,广东广州510080 [2]中山大学附属第二医院神经内科,广东广州510120 [3]中山大学附属第一医院放射科科,广东广州510080

出　　处：《中风与神经疾病杂志》2011年第4期330-332,共3页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金资助项目(30971028);广东省自然科学基金资助项目(06021232);广东省科技计划项目(2007B031502003);广州市科技计划项目(2009Z1-E021);中山大学附属第一医院优秀青年人才支持计划项目(18700112)

摘　　要：目的提高对容易误诊漏诊的硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的诊断水平。方法回顾性总结9例DAVF的临床资料,结合文献进行分析。结果 9例主要临床表现及误诊情况分别为:视朦或视力下降4例,无颅内高压症状,误诊为视神经炎、颅内结核感染或特发性颅内压增高;记忆力下降1例,误诊为病毒性脑炎;双下肢无力1例,误诊为急性脊髓炎、神经鞘瘤;反复头痛1例,误诊为偏头痛、特发性颅内压增高;反复抽搐1例,误诊为正常颅内压脑积水;饮水呛咳、吞咽困难1例,误诊为脑梗死。3例满足于静脉窦血栓的诊断而忽略了DAVF。所有病例影像学均漏诊,但如仔细观察仍可发现细微的血管形态改变,提示动静脉畸形。结论 DAVF临床表现缺乏特异性,加上临床及放射科医师对本病认识不足,诊断思路狭窄,造成本病误诊、漏诊率高。Objective To improve the diagnostic capability of dural arteriovenous fistula（DAVF） which easily leads to inaccurate or missed diagnosis.Methods The clinical information of 9 cases of DAVF was summarized retrospectively,and analyzed with a literature review.Results The main clinical manifestations and misdiagnosis of 9 cases were： 4 cases presenting with only amaurosis fugax or vision loss without symptoms of increased intracranial pressure were misdiagnosed as optic neuritis,intracranial tuberculosis infection and idiopathic intracranial hypertension;1 case presenting with memory decline was misdiagnosed as viral encephalitis;1 case presenting with bilateral lower limbs weakness was misdiagnosed as acute myelitis and neurilemmoma;1 case presenting with recurrent headache was misdiagnosed as migraine and idiopathic intracranial hypertension;1 case presenting with repeating seizures was misdiagnosed as normal intracranial pressure hydrocephalus;1 case presenting with choking water and swallowing difficulty was misdiagnosed as cerebral infarction.3 cases were satisfied with the diagnosis of venous sinus thrombosis while ignoring DAVF.Images in all cases were missed diagnosed.However,read carefully,subtle changes of vascular morphology suggesting arteriovenous malformation could still be found.Conclusions The lack of specificity of the clinical manifestations of DAVF,and clinician and radiologist with inadequate knowledge and narrow thinking about the disease,may lead to missed or inaccurate diagnosis.

关 键 词：硬脑膜动静脉瘘 误诊 漏诊 

分 类 号：R742[医药卫生—神经病学与精神病学]