急性轻型卒中微量脑出血误诊病例的临床特点及影像学表现分析  

Analysis of clinical features and imaging manifestations of misdiagnosed cases of acute minor stroke with microcerebral hemorrhage

作　　者：穆巴拉克·伊力哈 徐霁华[1] 鲁明 Mubalake Yilihamu;Xu Jihua;Lu Ming(Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院神经内科,北京100020

出　　处：《中华脑血管病杂志（电子版）》2024年第5期441-445,共5页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

摘　　要：目的探讨误诊为急性轻型卒中的微量脑出血病例的临床及影像学特点,以期对轻型卒中患者静脉溶栓治疗提供参考。方法本研究为回顾性队列研究,纳入自2023年1月1日至12月31日于北京朝阳医院及医联体医院接受阿替普酶静脉溶栓治疗的缺血性卒中患者194例,分析误诊为轻型卒中并行静脉溶栓治疗或险些行溶栓治疗的微量脑出血病例特征。结果194例患者中,轻型脑卒中患者为89例,其中包括误诊为轻型卒中并行静脉溶栓治疗或险些行溶栓治疗的微量脑出血患者2例,分别为丘脑微量出血及少量硬膜下出血。结论微量脑出血患者临床症状相对较轻,仅表现为轻度偏侧或肢体麻木,无脑出血常见的头痛头晕、恶心呕吐、意识障碍等症状,头颅CT常常显影不清,非常容易漏诊,或误诊为轻型缺血性脑卒中,因此对于轻型卒中拟行静脉溶栓的患者,准确识别微量脑出血至关重要。Objective To investigate the clinical and imaging characteristics of microcerebral hemorrhage cases misdiagnosed as acute minor stroke,thereby offering guidance for the administration of intravenous thrombolysis in minor stroke patients.Methods This retrospective cohort study included 194 patients with ischemic stroke who received intravenous thrombolysis with Alteplase at Beijing Chaoyang Hospital and affiliated hospitals from January 1 to December 31,2023.It retrospectively analyzed the microcerebral hemorrhage cases that were misdiagnosed as minor stroke and underwent intravenous thrombolysis or nearly underwent thrombolysis.Results Among 194 patients,89 were diagnosed with minor stroke,including 2 patients with microcerebral hemorrhage who were misdiagnosed as minor stroke and treated with intravenous thrombolysis or nearly treated with thrombolysis.These cases comprised thalamic microcerebral hemorrhage,and a small amount of subdural hemorrhage,respectively.Conclusion Patients with microcerebral hemorrhage exhibited relatively mild clinical symptoms,showing only mild lateral or limb numbness,without headache,dizziness,nausea and vomiting,and impaired consciousness,which are common in cerebral hemorrhage.Cranial CT scans were often unclear,rendering them susceptible to underdiagnosis or misdiagnosis of minor ischemic stroke.Therefore,it is crucial to accurately identify microcerebral hemorrhage in patients with minor stroke who are ready for intravenous thrombolysis.

关 键 词：轻型卒中 溶栓治疗 阿替普酶 微量脑出血 误诊 

分 类 号：R743.34[医药卫生—神经病学与精神病学]