误诊为脑卒中的老年曼陀罗中毒一例

Datura stramonium poisoning misdiagnosed with stroke: report of one elderly patient

曼陀罗为草本茄科植物,全株有毒,其主要成分是莨菪碱、阿托品及东莨菪碱等生物碱,中毒后轻者主要表现为口、咽喉发干,吞咽困难,瞳孔散大、谵语幻觉、心率增快等,严重者可发生昏迷、抽搐甚至呼吸、循环衰竭而死亡。该文报道1例曼陀罗中毒的老年患者,因突发意识不清入院,由于患者有高血压病史,且行头颅CT显示右侧颞叶局部密度稍低,考虑到老年危重病患者的重点疾病多为脑血管和循环系统疾病,故初诊医师按脑卒中给予治疗,但疗效不明显,后经接班医师继续追问病史,明确患者发病前2 h曾因关节痛而饮用曼陀罗籽浸泡的药酒,不排除曼陀罗中毒的可能而予以新斯的明0.5 mg肌内注射,患者病情逐渐好转,最后明确诊断为曼陀罗中毒。因此,对于以意识障碍为首发症状就诊而且有高血压病史的曼陀罗中毒老年患者,应详细询问病史、完善各项检查以避免将其误诊为急性脑血管意外。

Datura stramonium is a category of freely branching herb and all parts of the plant are poi-sonous,which contain essential components of hyoscyamine,atropine and tropane alkaloids.Mild Datura stra-monium intoxication typically leads to mouth and throat dryness,dysphagia,mydriasis,delirious speech,hal-lucination and tachycardia,etc.Severe patients may present with coma,spasm and even death induced by res-piration and circulatory failure.We reported one elderly patient intoxicated by Datura stramonium.The patient was admitted to hospital with a sudden disturbance of consciousness.The patient had a medical history of hy-pertension.Head CT scan revealed relatively low density of the right temporal lobe.Considering the high risk of cerebral vascular and circulatory system diseases for the aged population,the patient was primarily diagnosed with stroke and received corresponding therapy.However,no significant efficacy was achieved.After further inquiry of medical history,it was comfirmed that the patient had taken medicinal wine soaked with Datura stra-monium seed to release arthralgia two hours before onset.Considering the possibility of Datura stramonium in-toxication,the patient was administered with 0.5 mg of neostigmine via intramuscular injection and relevant symptoms were gradually mitigated.The patient was eventually diagnosed with Datura stramonium poisoning. Consequently,the possibility of Datura stramonium poisoning should be considered for elderly patients with ini-tial symptoms of consciousness disorder and a medical history of hypertension.Explicit inquiry of medical histo-ry and different necessary examinations should be fully performed to avoid the misdiagnosis of acute cerebrovas-cular events.