原发性胼胝体变性二例误诊原因分析

Cause Analysis of 2 Misdiagnosed Patients with Primary Marchiafava-Bignami Disease

目的探讨原发性胼胝体变性的临床特点、诊疗方法及误诊原因、防范措施。方法对曾误诊的2例原发性胼胝体变性的临床资料进行回顾性分析,并复习相关文献。结果 2例均为中年男性,皆有长期大量饮酒史,分别因视物模糊、视物成双1个月及头晕、反应迟钝2月余,加重伴记忆力差、步态不稳10余天入院,均曾误诊为脑梗死,给予相应治疗,病情无缓解。入我院后经MRI等检查,诊断慢性酒精中毒性脑病、原发性胼胝体变性等,给予大剂量维生素B族及适量糖皮质激素等治疗,患者均病情缓解出院。结论原发性胼胝体变性常见病因为慢性酒精中毒,临床表现缺乏特异性,应注意与脑梗死相鉴别。该病MRI独特改变有助于诊断。

Objective To investigate clinical features,diagnosis and treatment methods,misdiagnosed causes andpreventive measures of primary MarchiafavaBignami disease （MBD） . Methods Clinical data of 2 patients with primaryMBD was retrospectively analyzed,and related literatures were reviewed. Results The 2 patients were middleaged male witha long term history of heavy alcohol consumption,and were admitted for blurred vision and diplopia for 1 month and dizzinessand torpid reaction for 2 months accompanied by memory impairment and gait ataxia for more than 10 days respectively. The 2patients were misdiagnosed as having cerebral infarction,but the conditions were not relieved after corresponding treatments.After admission in our hospital,chronic encephalopathia alcoholic and primary MBD was confirmed by examination such asmagnetic resonance imaging （MRI） ,and then the 2 patients were relieved and discharged after treatments of highdose of vitamin B group and appropriate amount of glucocorticoid in early stage of disease. Conclusion The etiological factor of primarymarchiafavabignami disease is chronic alcoholism,and its clinical manifestations are lack of specific,and therefore cliniciansshould pay attention to differential diagnosis with cerebral infarction. The special MRI changes contribute the diagnosis.