以神经系统症状首发的获得性免疫缺陷综合征七例误诊原因分析

Analysis of 7 Misdiagnosed Cases of Acquired Immune Deficiency Syndrome with Neurological Symptoms at Onset

目的探讨以神经系统症状首发的获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)的发病机制、误诊原因及防范措施。方法回顾性分析我院2007年1月—2013年12月误诊的以神经系统症状首发的AIDS 7例的临床资料。结果本组6例以头痛、头晕就诊,伴记忆力减退2例,伴腹胀、厌食1例;1例以左上肢麻木就诊。均否认毒品接触史、冶游史及输血史。7例首诊考虑后循环缺血5例,躯体化障碍和脑梗死各1例,给予相应治疗,症状均无缓解,进一步行人类免疫缺陷病毒(human immunodeficiency virus,HIV)抗体定量检查及蛋白印迹确认试验阳性,确诊AIDS,转疾病预防控制中心治疗。结论以神经系统症状首发的AIDS易误诊。耐心细致病史询问、发散诊断思维和及时进行特异性医技检查可减少或避免其误诊误治。

Objective To investigate the first symptom of AIDS in nervous system,and analyze the misdiagnosis cause,and enhance awareness of AIDS. Methods Retrospective analysis of 7 misdiagnosed acquired immune deficiency syndrome（AIDs） cases with neurological symptoms at onset admitted to our hospital during January 2007 and December 2013 was made.Results There were cases of headaches and dizziness in 6 patients,with memory disorder in 2 patients,with abdominal distension anorexia in 1 patient; Body lack of power in 1 patient. All the patients denied drug exposure history,amusement history and blood transfusion history. In the 7 cases,5 cases were misdiagnosed as posterior circulation ischemia,1 case was misdiagnosed as somatization disorder,and 1 case of left upper limb weakness patient was misdiagnosed as cerebral infarction. After corresponding treatment there was no sings of relief in symptoms. HIV antibody test result was positive,and validation test later confirmed AIDS,and then the patients were transferred to the center for disease control and prevention for treatment. Conclusion AIDS patients with a manifestation of neurological symptoms as the first symptom tend to be misdiagnosed. An inquiry of detailed medical history,creative thinking and special medical examination may help to reduce misdiagnosis and mistreatment rates.