首诊被误诊为精神疾病的器质性木僵的临床特点分析  

Analysis of Clinical Features of Organic Lignocaine Misdiagnosed as a Psychiatric Disorder at the First Diagnosis

作　　者：方雅秀 郑东[1] 张岳峰[1] 谭燕[1] 郭彩凤[1] 陈国华 章慧[1] 周晓明[1] FANG Ya-xiu;ZHENG Dong;ZHANG Yue-feng(Department of Neurology,Brain Hospital Affiliated to Guangzhou Medical University,Guangzhou,Guangdong,510370,China)

机构地区：[1]广州医科大学附属脑科医院神经内科,广东广州510370

出　　处：《黑龙江医学》2023年第9期1053-1056,共4页Heilongjiang Medical Journal

摘　　要：目的:探索首诊被误诊为精神心理疾病的器质性木僵患者的临床特征,以提高临床医生对该症状的认识。方法:选择2017年3月—2020年3月广州医科大学附属脑科医院神经内科收治的82例木僵患者,其中首诊误诊为精神心理疾病53例为误诊组,其余29例诊断正确为非误诊组。分析比较误诊组和非误诊组的人口学和临床特征、实验室检查、神经影像以及神经心理学特征,比较两组患者上述特征存在的差异。结果:82例木僵患者中,首次就诊被误诊为精神病53例(64.63%),诊断正确29例(35.37%)。误诊组53例患者中出现频率最高的木僵的表现形式是重复刻板40例(75.47%),其次是缄默34例(64.15%)和重复语言34例(64.15%),全身僵硬31例(58.49%),凝视26例(49.06%)。两组患者重复刻板、缄默和凝视比较,差异有统计学意义(χ^(2)=4.79、3.95、6.34,P<0.05)。误诊组脑脊液蛋白异常率和脑电图放电率高于非误诊组,差异有统计学意义(χ^(2)=4.74、11.07,P<0.05);而两组患者脑脊液梅毒滴度、自身免疫性脑炎、头颅磁共振成像(MRI)、头颅磁共振成像(MRI)-脑膜病变、头颅MRI-皮层病变、头颅MRI-皮层下病变、头颅MRI-未见明显异常和甲功比较,差异无统计学意义(P>0.05)。结论:本研究强调了腰穿和脑电图检查的重要性,上述检查应该作为木僵患者的重要评估手段之一,尤其是对首次出现、急性起病或者既往有癫痫或认知损害的木僵患者。当出现脑电图异常时,应该进一步完善脑脊液、自体免疫性脑炎、MRI、颅脑磁共振静脉血管成像检查(MRV)、视频脑电图等检查。Objective:To explore the clinical features of patients with organic wood stiffness misdiagnosed as psychiatric disor⁃ders at the first visit in order to improve clinicians’awareness of the condition.Methods:82 patients admitted to the hospital from March 2017 to March 2020 with xylophobia were selected,of which 53 cases were misdiagnosed as psychiatric-psychological disorders in the first diagnosis and the remaining 29 cases were diagnosed correctly.The demographic and clinical characteristics,laboratory tests,neuroimaging,and neuropsychological characteristics of the misdiagnosed and non-misdiagnosed groups were ana⁃lyzed and compared,and the differences in these characteristics between the two groups of patients were compared.Results:Of the 82 patients with xylopathy,53(64.63%)were misdiagnosed as psychosis at the first visit and 29(35.37%)were diagnosed correct⁃ly.The most frequent manifestation of rigidity in the misdiagnosed group of 53 patients was repetitive stereotypy in 40(75.47%),followed by muteness in 34(64.15%)and repetitive speech in 34(64.15%),generalized rigidity in 31(58.49%),and gaze in 26(49.06%).The differences between the two groups comparing repetitive stereotypes,reticence and gaze were statistically significant(χ^(2)=4.79,3.95,6.34,P<0.05).The rates of cerebrospinal fluid protein abnormalities and EEG discharges were higher in the misdiagnosed group than in the non-misdiagnosed group,and the differences were statistically significant(χ^(2)=4.74,11.07,P<0.05).The differences in cerebrospinal fluid syphilis titer,autoimmune encephalitis,cranial MRI,cranial MRI-meningeal lesions,cranial MRI-cortical lesions,cranial MRI-subcortical lesions,cranial MRI-no significant abnormalities and nail function between the two groups were not statistically significant(P>0.05).Conclusion:The study emphasizes the importance of lumbar puncture and EEG,and the above tests should be used as one of the important evaluation tools in patients with xylopathy,especially in pa⁃tients with first presentatio

关 键 词：木僵 脑电图 脑脊液 MRI 误诊 

分 类 号：R651[医药卫生—外科学]