老年性出血性脑血管病42例误诊分析

Analysis of Misdiagnosis of 42 Cases of Senile Hemorrhagic Cerebral Vascular Disease

【目的】探讨老年性出血性脑血管病误诊原因，为临床诊断提供指导。【方法】收集本院2009年5月至2012年4月42例老年性脑出血误诊病例资料，分析误诊原因及诊治结果。【结果142例误诊病例中，6例误诊为癫痫，5例误诊为消化性溃疡出血，2例误诊为心律失常，6例误诊为高血压脑病，3例误诊为紧张性头痛，2例误诊为急性酒精中毒，4例误诊为一氧化碳中毒，4例误诊为老年性痴呆，6例误诊为椎基底动脉供血不足，2例误诊为短暂性脑缺血性发作，2例误诊为急性上呼吸道感染。30例行腰穿检查，24例为血性脑脊液，CT检查发现42例均存在出血性改变。【结论】老年性出血性脑血管病易被误诊为癫痫、消化性溃疡性出血、高血压脑病等症，行头颅cT检查可有效确诊。

[Objective]To explore the causes of misdiagnosis of senile hemorrhagic cerebral vascular dis- ease in order to provide the guideline of clinical diagnosis. [Methods] The data of 42 cases of senile cerebral hemorrhage in our hospital from May 2009 to April 2012 were collected. The cause of misdiag.nosis and the re- suits of diagnosis and treatment were analyzed. [Results] Among 42 misdiagnosis patients, 6 patients were misdiagnosed as epilepsy, and 5 patients were misdiagnosed as peptic ulcer hemorrhage, and 2 patients were misdiagnosed as arrhythmia, and 6 patients were misdiagnosed as hypertensive encephalopathy, and 3 patients were misdiagnosed as tension headache, and 2 patients were misdiagnosed as acute alcohol poisoning, and 4 pa- tients were misdiagnosed as carbon oxide poisoning, and 4 patients were misdiagnosed as senile dementia, and 6 patients were misdiagnosed as vertebro basilar artery insufficiency, and 2 patients were misdiagnosed as tran- sient cerebral ischemia, and 2 patients were misdiagnosed as acute upper respiratory infection. Lumbar punc- ture of 30 patients showed 24 eases of hemorrhagic cerebrospinal fluid. CT examination revealed 42 cases of hemorrhagic change. [Conclusion] Senile hemorrhagic cerebrovascular disease is easy to be misdiagnosed as epilepsy, peptic ulcer hemorrhage and hypertensive encephalopathy. But head CT examination can diagnose it effectively.