摘要
目的 探讨脑胶质瘤临床误诊的原因,并分析其疾病特点和防范误诊措施.方法 回顾分析2022 年1月至2023 年1 月收治的3 例误诊为其他疾病的脑胶质瘤患者的临床资料.结果 1 例女性患者因反复头痛和呕吐就诊,初诊为偏头痛,接受常规止痛药物治疗2 周后,症状未见缓解,遂行头颅磁共振检查示左侧颞叶占位性病变,后经手术病理结果确诊为胶质母细胞瘤.1 例男性患者因癫痫发作就诊,有癫痫病史,长期服用抗癫痫药物控制病情,此次发作较为严重,初步诊断为癫痫发作,进一步行头颅CT检查示右侧额叶肿块,后经手术病理检查确诊为星形细胞瘤.1 例男性患者因左侧肢体无力和言语不清就诊,初诊为缺血性脑卒中,接受溶栓治疗后症状无明显缓解,头颅CT检查发现右侧顶叶占位性病变,后经手术病理检查确诊为间变性星形细胞瘤.误诊时间6～20 d.术后均给予放化疗,随访情况良好,未见复发转移.结论 脑胶质瘤误诊临床较为常见,主要是由于症状和影像学特征的非特异性及接诊医生临床经验不足导致的,通过提高医务人员对本病的认知、完善诊断流程等可以有效减少误诊,提高诊断准确性,从而改善患者预后.
Abstract
Objective To investigate the causes of clinical misdiagnosis of brain glioma,and to analyze its disease characteristics and preventive measures.Methods The clinical data of 3 patients with brain glioma who were misdiagnosed with other diseases from January 2022 to January 2023 were retrospectively analyzed.Results A female patient was diag-nosed with migraine due to recurrent headache and vomiting.At 2 weeks after conventional analgesic therapy,the symptoms were not relieved.A head magnetic resonance imaging(MRI)examination was performed and revealed space-occupying le-sions in the left temporal lobe,and glioblastoma was confirmed by surgical pathology.A male patient with a history of epilepsy presented with epilepsy and had been taking anti-epileptic drugs for a long time to control the condition.The seizure was more serious and was initially diagnosed as epileptic seizure.Further CT examination of the head showed a mass in the right frontal lobe,which was later confirmed as astrocytoma by operation and pathological examination.A male patient presented with left limb weakness and slurred speech and was initially diagnosed as stroke.After receiving thrombolytic therapy,the symptoms were not significantly relieved.Head CT examination revealed space-occupying lesions in the right parietal lobe,which were later confirmed as anastrocytoma by operation and pathological examination.Misdiagnosis lasted from 6 to 20 d.All patients were given radiotherapy and chemotherapy after operation.The follow-up was favorable and no recurrence or metastasis was ob-served.Conclusion Misdiagnosis of brain glioma is common in clinical practice,which is mainly caused by the non-specific symptoms and imaging features and the lack of clinical experience of the receiving doctors.Improving the cognition of medical staff and improving the diagnostic process can effectively reduce misdiagnosis and improve the diagnostic accuracy,so as to improve the prognosis of patients.
基金项目
2021年秦皇岛市科学技术研究与发展计划自筹经费项目(20210A119)
维普
万方数据