后循环梗死误诊为前庭外周性疾病13例分析  

Analysis of 13 cases of posterior circulation infarction misdiagnosed as peripheral vestibular disease

作　　者：严小艳[1] 王晓倩 韩玉梁[1] 赵津京[1] 王凯[1] Yan Xiaoyan;Wang Xiaoqian;Han Yuliang;Zhao Jinjing;Wang Kai(Department of Neurology,The 305 Hospital of PLA,Beijing 100017,China)

机构地区：[1]解放军第305医院神经内科,北京100017

出　　处：《北京医学》2020年第9期832-835,共4页Beijing Medical Journal

基　　金：首都特色应用研究与成果推广(Z171100001017175)。

摘　　要：目的探讨以眩晕为主要临床表现的后循环梗死的误诊原因和降低误诊的措施。方法选择2014年6月至2019年12月解放军第305医院初诊为前庭外周性疾病最终确诊为后循环梗死的病例13例,回顾性分析其临床资料。结果13例患者首诊均以眩晕为首发症状,5例伴有共济失调,2例伴有听力损害;无其他神经系统体征。其中5例为进展性卒中。脑血管病风险因素评估结果提示,69.2%(9/13)的患者具有≥3个以上危险因素;所有患者眩晕床旁查体结果提示前庭中枢性损害;所有患者早期头颅CT结果为阴性,头颅MRI证实为后循环梗死。结论要重视以眩晕为唯一或主要临床表现的患者首诊,对存在脑血管病风险因素的患者需警惕后循环梗死的可能,眩晕床旁查体和早期头颅MRI检查十分必要,有助于减少误诊。Objective To investigate the cause of misdiagnosis of posterior circulation infarction misdiagnosed as peripheral vestibular disease and the measures to reduce misdiagnosis.Methods The clinical data of 13 cases with posterior circulation infarction misdiagnosed as peripheral vestibular diseases were retrospectively analyzed.Results Thirty-three patients were diagnosed with vertigo as the first symptom,five with ataxia,two with hearing impairment,and no other neurological signs.Five of them developed progressive stroke.The results of cerebrovascular risk factors assessment showed that 69.2%(9/13)of the patients had more than three risk factors,vertigo bedside physical examination suggested all the patients had central vestibular damage.The early cranial CT results of all the patients were negative at the early stage,it was finally confirmed as posterior circulation infarction by MRI.Conclusions Attention should be paid to the patients with vertigo as the only or main clinical manifestation.For the patients with cerebrovascular disease risk factors,it is necessary to pay attention to the possibility of posterior circulation infarction.Physical examination and early cranial MRI examination are necessary to reduce misdiagnosis.

关 键 词：后循环梗死 眩晕 误诊 

分 类 号：R743.3[医药卫生—神经病学与精神病学]