血管性认知障碍患者继发癫痫误诊临床分析  

Clinical Analysis of Misdiagnosis of Secondary Epilepsy in Patients with Vascular Cognitive Impairment

作　　者：段瑞生[1] 刘娜[2] 尹楠 褚红珊 高雅[1] 安金[1] 高世瑜 DUAN Ruisheng;LIU Na;YIN Nan;CHU Hongshan;GAO Ya;AN Jin;GAO Shiyu(Department of Neurology,Hebei Key Laboratory of Cerebral Network and Cognitive Disorder,Hebei General Hospital,Shijiazhuang 050000,China;Department of Surgery,Shijiazhuang Medical College,Shijiazhuang 050599,China)

机构地区：[1]河北省人民医院神经内科、河北省脑网络与认知障碍疾病重点实验室,石家庄050000 [2]石家庄医学高等专科学校外科教研室,石家庄050599

出　　处：《临床误诊误治》2024年第21期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生健康委员会项目(20170363)。

摘　　要：目的探讨血管性认知障碍(VCI)继发癫痫的误诊原因及防范措施。方法回顾性分析2023年7至12月收治的曾误诊的VCI继发癫痫5例的临床资料。结果2例反应迟钝患者初步诊断为脑梗死、VCI,给予相应治疗效果不佳;1例言语不清患者曾于外院行动态脑电图检查未见痫样放电,诊断为脑梗死、VCI,经治疗症状再次加重,诊断为脑梗死;1例间断头晕患者伴有基底动脉明显狭窄,诊断为椎-基底动脉系统短暂性脑缺血发作、VCI;1例头晕患者诊断为耳石症、VCI,给予相应治疗效果不佳。5例均经反复询问病史、了解发病特点,予动态脑电图检查发现痫样放电,明确诊断为癫痫。误诊时间5 d~6个月。确诊后予以口服丙戊酸钠后症状消失,2周后复查脑电图未见痫样放电。结论VCI继发癫痫因患者病史表述不清楚、临床表现不典型等易误诊,接诊医生遇及疑似癫痫VCI患者时要细致、反复询问病史,并加强对特殊临床表现癫痫的认识,重视动态脑电图对特殊类型癫痫诊断价值,以减少本病误诊。Objective To investigate the causes of misdiagnosis and preventive measures of epilepsy secondary to vascular cognitive impairment(VCI).Methods The clinical data of 5 patients with misdiagnosed epilepsy secondary to VCI treated from July 2023 to December 2023 were retrospectively analyzed.Results Two unresponsive patients were initially diagnosed with cerebral infarction and VCI,and the corresponding treatment was not effective.A patient with slurred speech was diagnosed with cerebral infarction and VCI after ambulatory electroencephalography(EEG)examination in another hospital without epileptic discharge.After treatment,the symptoms worsened again and the patient was diagnosed as cerebral infarction.One patient with intermittent dizziness and significant basilar artery stenosis was diagnosed with vertebrobasilar transient ischemic attack and VCI.One patient with dizziness was diagnosed with otoliths and VCI,and the corresponding treatment was not effective.All the 5 patients were diagnosed with epilepsy after repeated inquiry about medical history and understanding of the characteristics of the disease,and epileptic discharge was found by ambulatory EEG.Misdiagnosis lasted 5 d to 6 months.After diagnosis,the symptoms disappeared after oral administration of Sodium Valproate,and no epileptic discharge was found in EEG reexamination 2 weeks afterwards.Conclusion Patients with epilepsy secondary to VCI are prone to misdiagnosis due to unclear medical history and atypical clinical manifestations.When treating patients with suspected epilepsy secondary to VCI,doctors should carefully and repeatedly inquire about the medical history,strengthen their understanding of special clinical manifestations of epilepsy,and pay attention to the diagnostic value of ambulatory EEG for special types of epilepsy,so as to reduce misdiagnosis of this disease.

关 键 词：癫痫 认知障碍 痴呆 血管性 误诊 脑梗死 脑缺血发作 短暂性 耳石症 脑电图 

分 类 号：R742.1[医药卫生—神经病学与精神病学]