癫痫与晕厥误诊病例分析

Analysis of misdiagnosed cases: epilepsy and syncope

目的 探讨癫痫与晕厥诊断及鉴别诊断的方法,最大限度减少误诊发生.方法 回顾性分析2008年4月-2012年9月北京大学人民医院神经内科和心内科6例误诊病例的临床资料,查阅并复习关于癫痫与晕厥诊断及鉴别诊断的相关文献.结果 在癫痫与晕厥的临床特征中,发作时是否有姿势性张力和意识丧失,以及发作后意识模糊持续时间的长短对二者的诊断与鉴别诊断具有重要的意义.癫痫发作时脑电图(EEG)可见高度节律性异常放电,而晕厥期间EEG表现为脑电活动频率变慢和低平.结论 临床表现为胸闷、心律失常等植物神经性症状时,不应局限于心脏本身,应考虑到支配心脏电活动的不同水平的神经系统功能或结构的异常;相反,抽搐不一定是源于大脑的异常电活动所致的癫痫发作,可能由晕厥引发.

Objective To explore how to differentiate the epilepsy and syncope in order to minimize the misdiagnosis.Methods Retrospectively analyzed the medical record of 6 cases which were misdiagnosed as epilepsy or syncope during April 2008 to September 2012 and reviewed the literatures about the differential diagnosis.Results Among the clinical characteristics,the ictal positional tone and loss of consciousness as well as the duration of postictal confusion are very important to the differential diagnosis.The ictal EEG shows highly rhythmic abnormal discharges when epileptic seizures oecur.However,the ietal EEG would become slower and flatler during syncope.Conclusions When the automomic disorder and signs such as chest distress,arrhythmia.appear,the causes should not be limited in the cardiac diseases,the functional or structural abnormalities of the nervous system innervating the heart should also be considered;on the contrary,convulsions might not only due to the abnormal electrical activity in the brain,but syncope.