脑胶质瘤术后放射性脑病五例误诊分析

Misdiagnosed Analysis of 5 Patients with Radiation Encephalopathy after Glioma Surgery

目的探讨脑胶质瘤术后放射性脑病误诊原因及防范措施,提高诊治水平。方法对2013年1月—2015年8月西安交通大学医学院附属3201医院收治的曾误诊的脑胶质瘤术后放射性脑病5例的临床资料进行回顾性分析。结果本组分别因头痛、呕吐,头晕、癫痫反复发作,言语不能、左侧肢体障碍、左上肢肌力1级、左下肢肌力2级,头昏伴左眼视力下降及左侧肢体无力、肌力4级入院,经头颅CT和(或)MRI检查等均误诊为脑胶质瘤术后复发,误诊时间5~15 d。5例均予手术治疗,术后病理检查确诊为脑胶质瘤术后放射性脑病,确诊后予相应治疗临床症状均得到缓解,术后10~15 d出院。结论放射性脑病复杂多样的临床表现常导致患者发病时症状不典型,故接诊医生应全面了解放射性脑病相关知识,接诊类似本文患者时详细询问病史、全面体格检查,并及时进行相关医技检查,尽早明确或筛除放射性脑病诊断,减少或避免误诊发生。

Objective To investigate misdiagnosed causes and precautionary measures of radiation cncephalopathy af- ter glioma surgery to improve diagnosis and treatment levels. Methods Clinical data of 5 patients with radiation encephalopathy after glioma surgery admitted during January 2013 and August 2015 was retrospectively analyzed. Results Patients were admitted for headache, vomiting, dizziness, recurrent attacks of epilepsy, logagnosia, left limb disorder, degree I left upper limb muscle strength, degree Ⅱ left lower limb, dizzy associated by left eye blurred vision, left limbs weakness and degree IV myodynamia. All patients were misdiagnosed as having postoperative recurrence of glioma recurrence by head CT and （or） MRI examination, and misdiagnosed time was 5-15 d. All the 5 patients underwent surgery, and radiation encephalopathy after glioma surgery was confirmed by postoperative pathological results. Clinical symptoms were relieved after corresponding treat- ment, and patients were discharged 10-15d after surgery. Conclusion Patients with radiation enccphalopathy show atypical induced by complex manifestations, and clinicians should comprehensively understand the related knowledge, carefully ask disease history and perform comprehensive examination so as to confirm radiation encephalopathy as early as possible to avoid misdiagnosis occurrence.