以眼痛为首发症状动脉瘤性蛛网膜下腔出血的误诊原因分析  

Misdiagnosed Causes Analysis of Aneurysmal Subarachnoid Hemorrhage with Eye Pain as the Initial Symptom

作　　者：岑礼燕 李洁嫦 CEN Li-yan;LI Jie-chang(Department of Neurology,Kaiping Central Hospital,Kaiping,Guangdong 529300,China)

机构地区：[1]开平市中心医院神经内科,广东开平529300

出　　处：《临床误诊误治》2021年第8期14-16,21,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨以眼痛为首发症状动脉瘤性蛛网膜下腔出血的误诊原因及预防措施。方法对2018年1月—2020年1月误诊的以眼痛为首发症状动脉瘤性蛛网膜下腔出血5例的临床资料进行回顾性分析。结果本组误诊5例,误诊率为27.8%。4例因眼痛伴视物不清收入眼科,其中3例诊断为急性青光眼、1例诊断痛性眼肌麻痹综合征;另1例因眼痛伴流泪畏光收入神经内科,既往有偏头痛病史,诊断偏头痛发作。5例行腰椎穿刺脑脊液检查及全脑数字减影血管造影后确诊为动脉瘤性蛛网膜下腔出血,给予手术及内科治疗后2例死亡,2例有肢体瘫痪,1例无后遗症。结论以眼痛为首发症状动脉瘤性蛛网膜下腔出血在临床上极易误诊,加强非专科医师对不典型表现蛛网膜下腔出血相关知识的学习,保持高度警惕性,是避免误诊的关键。Objective To investigate misdiagnosed causes and preventive measures of aneurysmal subarachnoid hemorrhage(SAH)with eye pain as the initial symptom.Methods Clinical data of 5 patients with aneurysmal SAH with eye pain as the initial symptom misdiagnosed between January 2018 and January 2020 was retrospectively analyzed.Results In the study,5 patients were misdiagnosed,and the misdiagnosis rate was 27.8%.Four patients were admitted to Department of Ophthalmology because of ophthalmalgia associated by blurred vision,in whom 3 patients were diagnosed as having acute glaucoma and 1 as having painful ophthalmoplegia syndrome.Another 1 patient was admitted to Department of Neurology because of eye pain associated by tears and photophobia and a history of migraine,and the patient was diagnosed as having migraine attack.The 5 patients were confirmed as having aneurysmal SAH after lumbar puncture cerebrospinal fluid test and whole brain digital subtraction angiography.After operation and medical treatment,2 patients died,2 patients had limb paralysis,and 1 patient had no sequelae.Conclusion Aneurysmal SAH with eye pain as the initial symptom is more likely to be misdiagnosed in clinical practice.The key to avoiding misdiagnosis is to improve atypical SAH-related knowledge and maintain sharp vigilance.

关 键 词：蛛网膜下腔出血 动脉瘤 眼痛 误诊 青光眼 痛性眼肌麻痹综合征 偏头痛 

分 类 号：R743.35[医药卫生—神经病学与精神病学]