头颅CT检查阴性的蛛网膜下腔出血误诊临床分析
Clinical Analysis of Misdiagnosis of Subarachnoid Hemorrhage with Nega-tive head CT
王起 1徐晓彤 1杨静1
作者信息
- 1. 100049 北京,航天中心医院神经内科
- 折叠
摘要
目的 探讨头颅CT阴性的蛛网膜下腔出血(SAH)的临床特点、诊治方法和误诊原因、防范措施.方法 对2016 年6 月—2021 年6 月收治的头颅CT检查阴性被误诊为病毒性脑炎的SAH 3 例的临床资料进行回顾性分析.结果 本文3 例分别因发热、头痛4d,突发一过性意识障碍、记忆障碍、发热2d,以及头痛14d、肢体抽搐伴意识丧失3h入院.3 例临床表现均不典型,2 例有发热及精神障碍,1 例为癫痫持续状态,且就诊时头颅CT检查均阴性,皆误诊为病毒性脑炎,后经完善其他影像学和腰椎穿刺脑脊液检查后确诊SAH.后1 例病情稳定,2 例死亡.结论 不典型SAH易误诊,头颅CT检查可无明显异常.对此类患者应尽早行其他影像学和腰椎穿刺脑脊液检查,以减少或避免误诊误治.
Abstract
Objective To investigate the clinical features,diagnosis and treatment methods,causes of misdiagnosis and preventive measures of subarachnoid hemorrhage(SAH)with negative head CT.Methods The clinical data of 3 pa-tients with SAH who were misdiagnosed as viral encephalitis with negative head CT from June 2016 to June 2021 were retro-spectively analyzed.Results Three cases were admitted to hospital due to fever and headache for 4 d,sudden transient dis-turbance of consciousness,memory disturbance and fever for 2 d,and headache for 14 d,limb convulsions with loss of con-sciousness for 3 h,respectively.The clinical manifestations of the three cases were atypical,2 cases had fever and mental dis-orders,and 1 case was in epileptic state.The head CT examination was negative at the time of visit,and all cases were misdi-agnosed as viral encephalitis.SAH was confirmed after other imaging and cerebrospinal fluid examination by lumbar puncture.One patient remained in stable condition and two died.Conclusion Atypical SAH is more likely to be misdiagnosed.CT ex-amination of the head shows no obvious abnormality.For such patients,other imaging and cerebrospinal fluid examination by lumbar puncture should be performed as soon as possible to reduce or avoid misdiagnosis and treatment.
关键词
蛛网膜下腔出血/头痛/误诊/脑炎,病毒性/体层摄影术,螺旋计算机/磁共振成像/磁共振血管造影术/脊椎穿刺Key words
Subarachnoid hemorrhage/Headache/Misdiagnosis/Encephalitis,viral/Tomography,spiral compu-ted/Magnetic resonance imaging/Magnetic resonance angiography/Spinal Puncture引用本文复制引用
出版年
2023
国家科技期刊平台
NSTL
万方数据