三叉神经痛三例临床误诊分析
Clinical Analysis of Misdiagnosis of Trigeminal Neuralgia
庞金磊 1孙海燕 1郭向飞 1霍岩松 1何明伟1
作者信息
- 1. 100029 北京,首都医科大学附属北京安贞医院麻醉中心疼痛科
- 折叠
摘要
目的 分析三叉神经痛的临床特点及误诊原因,以减少误诊,提高诊断准确率.方法 回顾性分析2021 年1 月至2022 年12 月诊治的3 例三叉神经痛误诊患者的临床资料.结果 1 例女性患者右侧面部间断性剧烈疼痛半年,初步诊断为牙髓炎,多次接受牙科治疗但均无效,后经详细的病史采集和神经系统检查,发现其疼痛呈电击样,并结合神经系统检查和影像学检查结果,确诊为三叉神经痛.1 例男性患者因左侧面部疼痛伴头痛 2 个月就诊,初步诊断为偏头痛,接受非甾体抗炎药和抗抑郁药治疗无效后经神经系统和影像学检查确诊为三叉神经痛.1 例女性患者因左侧面部反复发作的电击样疼痛就诊,初步诊断为面肌痉挛,随后接受肉毒素局部注射等相关治疗,但效果不明显,后经神经系统和影像学检查确诊为三叉神经痛.误诊时间分别为6、2、3 个月.确诊后均予卡马西平治疗,预后良好.结论 三叉神经痛初期误诊率较高,需提高临床医师对该病的认识,加强病史采集,必要时行相关的影像学等检查以提高诊断准确性.
Abstract
Objective To analyze the clinical characteristics and causes of misdiagnosis of trigeminal neuralgia(TN),so as to reduce misdiagnosis and improve diagnostic accuracy.Methods The clinical data of 3 misdiagnosed patients with TN from January 2021 to December 2022 were retrospectively analyzed.Results A female patient suffered from intermit-tent severe pain on the right side of the face for six months.The patient was initially diagnosed as pulpitis,and the patient re-ceived several dental treatments,which,however,failed.After collection of detailed medical history and neurological exami-nation,it was found that the pain was electric shock,and combined with the neurological examination and imaging examination results,it was confirmed as TN.A male patient presented with left facial pain with headache for 2 months.The initial diagno-sis of migraine was confirmed as TN after Nonsteroidal anti-inflammatory drugs and Antidepressants failed to respond to treat-ment.A female patient presented with recurrent electric shock pain on the left side of her face.The initial diagnosis was hemi-facial spasm,followed by local Botulinum toxin injection and other related treatments,but the effect was not obvious;the diag-nosis was later confirmed as TN by neurologic and imaging examination.The duration of misdiagnosis was 6,2,and 3 months,respectively.All patients were treated with Carbamazepine after diagnosis and the prognosis was good.Conclusion The early misdiagnosis rate of TN is high.It is necessary to improve the understanding of clinicians,strengthen the collec-tion of medical history,and combine imaging and other medical technical examinations when necessary to improve the diagnos-tic accuracy.
关键词
三叉神经痛/误诊/牙髓炎/偏头痛/面肌痉挛/疼痛/诊断/卡马西平Key words
Trigeminal neuralgia/Misdiagnosis/Pulpitis/Migraine/Facial spasm/Pain/Diagnosis/Carbamazepine引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据