误诊为耐药性癫痫的胰岛素瘤4例临床报告

Report of 4 cases of insulinoma misdiagnosed as incurable epilepsy

目的了解胰岛素瘤非痫性发作的临床特征及与耐药性癫痫的鉴别。方法回顾性研究4例发作间期EEG和头部MRI正常,抗癫痫药物治疗无效而误诊为耐药性癫痫,经术后病理证实为胰岛素瘤非痫性发作病例,分析其临床特征和误诊原因,探索其鉴别要点。结果胰岛素瘤非痫性发作多出现在空腹或进食前,发作前后有交感神经兴奋症状,临床表现多样化是重要的鉴别要点;早期常规血糖检查诊断价值有限。结论胰岛素瘤所致的非痫性发作极易误诊为耐药性癫痫,发作期血糖、血清胰岛素和胰岛素释放指数等实验室检查可为诊断提供依据;B超和CT是重要的影像学检查手段,影像学检查阴性而其它检查支持胰岛素瘤时需行病理学检查,明确诊断是胰岛素瘤所致非痫性发作治疗的关键。

Objective To improve the understanding of clinical feature of seizure caused by insulinoma and to distinguish the diagnosis between insulinoma and incurable Epilepsy. Methods Reviewing retrospectively clinical data of four cases whose normal interictal EEG and MRI of brain,definitely diagnosed as insulinoma with pathology,and were misdiagnosed as refractory epilepsy. Analyzing clinical feature of non-seizure attack caused by insulinoma and investigating the factors for misdiagnosis and the principle of distinction. Results Non-seizure attack of insulinoma often happened with empty stomach or before foodintaking. Vagus nerve often be exciting before and after attack. The symptom of non-seizure attack was complex. In early period of insulinoma,normal serum sugar is limited and ictal serum sugar,serum insulin and insulin releasing exponent could be clue of diagnosis. Abdomen type-B ultrasonic and CT are important imaging examination. It is necessary to perform pathology diagnosis when imaging examination is normal. Conclusion It is difficult to differentiate the diagnosis between non-seizure attack caused by insulinoma and refractory epilepsy. The prognosis of 4 cases were good and the symptoms disappeared after insulinoma insection. The correct diagnosis of insulinoma is critical for good prognosis.