儿童弥漫性轴索损伤误漏诊原因分析及防范措施儿童弥漫性轴索损伤误漏诊原因分析及防范措施  

Analysis and Preventive Measures for Misdiagnosis and Missed Diagnosis of Diffuse Axonal Injury in Children

作　　者：王学成 朱磊 张敏 李政委 霍晓利 WANG Xuecheng;ZHU Lei;ZHANG Min;LI Zhengwei;HUO Xiaoli(Department of Intensive Care Medicine,Xuzhou Children's Hospital,Xuzhou,Jiangsu 221000,China;Department of Neurosurgery,Xuzhou Children's Hospital,Xuzhou,Jiangsu 221000,China;Department of Cardiac Function,Xuzhou Central Hospital,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州市儿童医院重症医学科,江苏徐州221000 [2]徐州市儿童医院神经外科,江苏徐州221000 [3]徐州市中心医院心功能科,江苏徐州221000

出　　处：《临床误诊误治》2025年第6期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：徐州市卫生健康委科技项目(XWKYSL20220489)。

摘　　要：目的分析儿童弥漫性轴索损伤(DAI)临床误漏诊原因,总结其特点。方法回顾性分析2023年5月至2024年5月收治的2例儿童DAI临床资料,总结误漏诊原因及防范措施。结果1例患儿因车祸后意识障碍入院,头颅CT检查未见明显异常,初诊为脑挫裂伤,给予脱水及对症支持等治疗2 d后病情无改善,后行MRI检查发现DAI影像学改变,遂确诊为DAI。误诊时间2 d。确诊后给予甘露醇脱水降颅压、营养神经药物治疗,患儿意识逐渐恢复,随访6个月恢复正常生活。1例患儿因跌倒后头痛、呕吐伴短暂意识丧失入院,CT检查显示右侧轻微硬膜下血肿,初诊为硬膜下血肿,按硬膜下血肿予对症处理7 d后症状加重;后行头颅MRI增强扫描发现胼胝体及半卵圆中心区域有弥漫性损伤,确诊为DAI合并硬膜下血肿。漏诊时间8 d。确诊后予脱水降颅压、营养神经药物及高压氧治疗,同时行早期康复干预,患儿1个月后可独立行走,随访6个月无明显后遗症。结论DAI因影像学表现隐匿及症状复杂,容易误诊为其他颅脑疾病或漏诊;对于外伤后出现意识障碍患儿,应高度重视头颅MRI检查,并结合病史及临床表现尽早明确诊断,及时采取针对性治疗以改善预后。Objective To analyze the causes of clinical misdiagnosis and missed diagnosis of diffuse axonal injury(DAI)in children,and to summarize its characteristics.Methods Retrospective analysis was performed on clinical data of two children with DAI admitted from May 2023 to May 2024,and the causes of misdiagnosis,missed diagnosis and preventive measures were summarized.Results One child was admitted to the hospital due to consciousness disorders after a car accident.No obvious abnormalities were found on the head CT scan,and initial diagnosis was cerebral contusion and laceration.After 2 days of treatment including dehydration and symptomatic support,the condition did not improve.Afterwards,MRI examination revealed changes in DAI imaging,and the diagnosis was confirmed as DAI.The misdiagnosis lasted 2 d.After diagnosis,the child was given mannitol dehydration to reduce intracranial pressure and nutritional nerve medication treatment.Their consciousness gradually recovered and they were followed up for 6 months to resume normal life.One child was admitted to the hospital due to headache,vomiting,and temporary loss of consciousness after a fall.CT examination showed mild subdural hematoma on the right side,and the initial diagnosis was subdural hematoma.Symptomatic treatment was given for subdural hematoma for 7 days,and the symptoms worsened.Subsequent head MRI enhanced scan revealed diffuse damage to the corpus callosum and the central area of the semiovale,confirming the diagnosis of DAI with subdural hematoma.The missed diagnosis lasted 8 days.After diagnosis,dehydration to reduce intracranial pressure,nutritional nerve drugs,and hyperbaric oxygen therapy were given,along with early rehabilitation intervention.The child was able to walk independently after one month and was followed up for six months without significant sequelae.Conclusion DAI is prone to misdiagnosis as other cranial diseases and missed diagnosis due to its hidden imaging features and complex symptoms.For children with consciousness disorders after

关 键 词：弥漫性轴索损伤 儿童 误诊 漏诊 脑损伤 血肿 硬膜下 磁共振成像 鉴别诊断 

分 类 号：R726.511.5[医药卫生—儿科]