老年小量脑出血患者误诊脑梗死临床分析  

Clinical Analysis of Misdiagnosed Cerebral Infarction in Elderly Patients with Small Amount of Cerebral Hemorrhage

作　　者：莫建兵[1] 姚庚奇 蒲景礼 杨周[1] MO Jianbing;YAO Gengqi;PU Jingli;YANG Zhou(Department of Neurosurgery,the People's Hospital of Lezhi County,Lezhi,Sichuan 641500,China)

机构地区：[1]乐至县人民医院神经外科,四川乐至641500

出　　处：《临床误诊误治》2024年第10期23-26,共4页Clinical Misdiagnosis & Mistherapy

基　　金：2023年度资阳市第二批科技计划(应用基础研究)项目(zykjjsc20-yyjc-2023-38)。

摘　　要：目的总结老年小量脑出血误诊脑梗死的原因及其防范措施。方法分析2021年1月至2023年1月收治的早期误诊为脑梗死的老年小量脑出血10例病案资料。结果本组男7例,女3例;年龄61~72岁;均有高血压史;急性发病,静态(睡眠、休息)发病3例,动态发病7例;发病时10例血压均升高;9例出现头晕,2例轻微头痛,6例言语不利,3例轻微中枢性面、舌瘫,偏瘫7例,未出现意识障碍或呕吐症状。于当地乡镇卫生院或诊所初步诊断为脑梗死。给予对症治疗,临床症状无明显好转或加重,遂转我院。全面分析病情后行头颅CT检查发现基底节区出血5例,丘脑出血4例,颞叶出血1例,中线结构居中,侧脑室受压变窄4例;出血量2.9~7.3 mL,平均5.1 mL。均确诊为小量脑出血。误诊时间4~5 d。确诊后10例给予控制血压、脱水、维持水电解质平衡,以及营养脑神经、活血化瘀等药物治疗,3~4周后症状体征基本恢复正常,复查头颅CT示血肿均已明显吸收,预后良好。结论老年小量脑出血因老年人生理病理特点,导致早期无典型颅内压升高、脑膜刺激征表现,加之出血量少,无显著占位效应,使得未行CT等影像学检查前易考虑为脑梗死。加强接诊医生对老年小量脑出血的认识,提高警惕性,重视血压升高表现及发病时状态,及早行CT等影像学检查,可提高本病早期确诊率。Objective To analyze the causes and preventive measures of misdiagnosis of cerebral infarction in senile patients with small amount of cerebral hemorrhage.Methods The medical records of 10 elderly patients with small amount of cerebral hemorrhage who were early misdiagnosed as cerebral infarction were selected from January 2021 to January 2023.Results There were 7 males and 3 females in this group who were aged 61-72 years.All had a history of hypertension and acute attack,including static(while sleeping or at rest)disease in 3 patients and dynamic disease in 7 patients.Blood pressure was elevated in all 10 patients.There was dizziness in 9 patients,mild headache in 2 patients,speech impairment in 6 patients,mild central facial and lingual paralysis in 3 patients,and hemiplegia in 7 patients,and none of them had disturbance of consciousness or vomiting.The initial diagnosis was cerebral infarction in the local township health center or clinic.After symptomatic treatment,the clinical symptoms did not significantly improve or worsen,and then they were transferred to our hospital.After comprehensive analysis of the condition,CT examination of the head showed basal ganglia hemorrhage in 5 patients,thalamic hemorrhage in 4 patients,temporal lobe hemorrhage in 1 patient,and the middle line structure and narrowing of the lateral ventricle due to compression in 4 patients.The blood loss was 2.9-7.3 mL,with an average of 5.1 mL.All patients were diagnosed as small amount of cerebral hemorrhage,and the duration of misdiagnosis was 4-5 d.After diagnosis,10 patients were treated with drugs such as controlling blood pressure and dehydration,maintaining water and electrolyte balance,nourishing the brain and nerves,promoting blood circulation and removing stasis.After 3 to 4 weeks,the symptoms and signs basically returned to normal,and the head CT examination showed that hematoma had been obviously absorbed,showing favorable prognosis.Conclusion Due to the physiological and pathological characteristics of the elderly,small amou

关 键 词：小量脑出血 老年人 误诊 脑梗死 体层摄影术 螺旋计算机 意识障碍 颅内压 脑膜刺激征 

分 类 号：R743.34[医药卫生—神经病学与精神病学]