误诊为梅尼埃病的后循环脑梗死12例临床反思  

Clinical Reflection of 12 Patients with Posterior Circulation Cerebral Infarction Misdiagnosed as Meniere's Disease

作　　者：陈超 党宝齐 CHEN Chao;DANG Baoqi(Department of Acupuncture and Moxibustion,the Third People's Hospital of Zhangjiagang City,Zhangjiagang,Jiangsu 215611,China;Department of Rehabilitation,Zhangjiagang Hospital of Traditional Chinese Medicine,Zhangjiagang,Jiangsu 215600,China)

机构地区：[1]张家港市第三人民医院针灸科,江苏张家港215611 [2]张家港市中医医院康复科,江苏张家港215600

出　　处：《临床误诊误治》2025年第8期29-33,共5页Clinical Misdiagnosis & Mistherapy

基　　金：2022年度苏州市科技发展计划指导性项目(SKYXD2022064)。

摘　　要：目的探讨后循环脑梗死(PCCI)的临床特点、误诊为梅尼埃病(MD)的原因及防范误诊措施。方法回顾分析2022年6月至2024年6月收治的12例初诊误诊为MD的PCCI患者临床资料。结果12例均以眩晕为主诉就诊,伴恶心呕吐6例、步态不稳6例、耳鸣9例、头痛3例、肢体无力3例、平衡障碍6例、偏身感觉障碍3例、听力损害6例,均无家族眩晕史。头颅CT平扫均无明显异常。均初诊为MD,予对症治疗无明显改善,遂就诊我院。入院后经详细问诊,全面神经系统查体,行床旁头脉冲-眼震-眼偏斜试验、头颅磁共振检查,最终确诊为PCCI,误诊时间为3~10d。12例确诊后予阿司匹林、银杏酮酯分散片、巴曲酶、维生素B12等治疗,症状好转出院,随访3个月症状消失,无后遗症。结论PCCI常无典型表现,症状复杂多样,且早期CT诊断阳性率较低,易误诊MD。加强对本病的鉴别诊断能力,熟悉眩晕性疾病病因诊断流程,合理选择相关影像学检查,必要时多次复查,可及早确诊,减少误诊的发生。Objective To investigate the clinical characteristics of posterior circulation cerebral infarction(PCCI),the causes of misdiagnosis as Meniere's disease(MD)and preventive measures of misdiagnosis.Methods The clinical data of 12 patients with PCCI initially misdiagnosed as MD that were admitted from June 2022 to June 2024 were retrospectively analyzed.Results The chief complaint of the 12 patients was vertigo,accompanied by nausea and vomiting in 6 patients,gait instability in 6 patients,tinnitus in 9 patients,headache in 3 patients,limb weakness in 3 patients,balance disorder in 6 patients,hemisensory disturbance in 3 patients,and hearing impairment in 6 patients.There was no family history of dizziness.CT scan of the head showed no obvious abnormality.All patients were initially diagnosed as MD,and there was no obvious improvement after symptomatic treatment,so they present to our hospital.After admission,PCCI was confirmed by detailed inquiry,comprehensive nervous system examination,bedside head impulse,nystagmus,test of skew(HINTS)and skull magnetic resonance examination.The misdiagnosis lasted 3-10 d.After diagnosis,12 patients were treated with Aspirin,Ginkgo Ester dispersive tablets,Batroxase,and Vitamin B 12,symptoms were improved and they were discharged from hospital.After 3 months of follow-up,symptoms disappeared without sequelae.Conclusion PCCI often has no typical manifestations,but complex and diverse symptoms,and the positive rate of early CT diagnosis is low,which generally lead to misdiagnosis of MD.Strengthening the ability of differential diagnosis of this disease,being familiar with the diagnosis process of causes of vertigo disease,reasonable selection of relevant imaging examinations,and repeated reexamination when necessary are needed to confirm the diagnosis early and reduce the occurrence of misdiagnosis.

关 键 词：后循环脑梗死 误诊 梅尼埃病 头脉冲-眼震-眼偏斜试验 磁共振检查 鉴别诊断 

分 类 号：R743.33[医药卫生—神经病学与精神病学]