头颅CT检查阴性的蛛网膜下腔出血误诊临床分析  

Clinical Analysis of Misdiagnosis of Subarachnoid Hemorrhage with Negative head CT

作　　者：王起[1] 徐晓彤 杨静[1] WANG Qi;XU Xiaotong;YANG Jing(Department of Neurology,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院神经内科,北京100049

出　　处：《临床误诊误治》2023年第7期23-27,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的 探讨头颅CT阴性的蛛网膜下腔出血(SAH)的临床特点、诊治方法和误诊原因、防范措施。方法 对2016年6月—2021年6月收治的头颅CT检查阴性被误诊为病毒性脑炎的SAH 3例的临床资料进行回顾性分析。结果 本文3例分别因发热、头痛4 d,突发一过性意识障碍、记忆障碍、发热2 d,以及头痛14 d、肢体抽搐伴意识丧失3 h入院。3例临床表现均不典型,2例有发热及精神障碍,1例为癫痫持续状态,且就诊时头颅CT检查均阴性,皆误诊为病毒性脑炎,后经完善其他影像学和腰椎穿刺脑脊液检查后确诊SAH。后1例病情稳定,2例死亡。结论 不典型SAH易误诊,头颅CT检查可无明显异常。对此类患者应尽早行其他影像学和腰椎穿刺脑脊液检查,以减少或避免误诊误治。Objective To investigate the clinical features,diagnosis and treatment methods,causes of misdiagnosis and preventive measures of subarachnoid hemorrhage(SAH) with negative head CT.Methods The clinical data of 3 patients with SAH who were misdiagnosed as viral encephalitis with negative head CT from June 2016 to June 2021 were retrospectively analyzed.Results Three cases were admitted to hospital due to fever and headache for 4 d,sudden transient disturbance of consciousness,memory disturbance and fever for 2 d,and headache for 14 d,limb convulsions with loss of consciousness for 3 h,respectively.The clinical manifestations of the three cases were atypical,2 cases had fever and mental disorders,and 1 case was in epileptic state.The head CT examination was negative at the time of visit,and all cases were misdiagnosed as viral encephalitis.SAH was confirmed after other imaging and cerebrospinal fluid examination by lumbar puncture.One patient remained in stable condition and two died.Conclusion Atypical SAH is more likely to be misdiagnosed.CT examination of the head shows no obvious abnormality.For such patients,other imaging and cerebrospinal fluid examination by lumbar puncture should be performed as soon as possible to reduce or avoid misdiagnosis and treatment.

关 键 词：蛛网膜下腔出血 头痛 误诊 脑炎 病毒性 体层摄影术 螺旋计算机 磁共振成像 磁共振血管造影术 脊椎穿刺 

分 类 号：R743.35[医药卫生—神经病学与精神病学]