初步诊断误诊为周围神经疾病的脑梗死1例临床分析

Clinical Analysis of a Case of Cerebral Infarction Misdiagnosed as Peripheral Nerve Disease

目的观察青年脑梗死患者的临床特征,并探讨其辅助检查及诊疗过程,提高临床识别度.方法报道作者医院2018年3月收治的1例青年脑梗死患者的临床资料,分析其发病特点、辅助检查、诊疗过程.结果患者临床症状以右上肢无力麻木为主要表现,实验室检查未见明显异常,外院考虑周围神经病,但常规肌电图提示未见明显异常,就诊于作者医院门诊,复查常规肌电图示未见肯定神经源性或肌源性损害,进一步行体感诱发电位提示:右上肢SEP示中枢性损害.继而行头颅核磁提示:脑梗死.经治疗症状好转后出院.结论青年脑梗死病例相对少见,易误诊,必要的比较全面的神经电生理检测在初诊及鉴别诊断中发挥了重要作用.

Objective To observe the clinical features of young patients with cerebral infarction, and to explore its auxiliary examination, diagnosis and treatment to improve the clinical recognition. Methods The clinical data of a young cerebral infarction patient admitted to our hospital in March 2018 was reported. The incidence characteristics, auxiliary examination, diagnosis and treatment process were analyzed. Results The main clinical symptoms of the patients were the weakness and numbness of the right upper limb. There was no obvious abnormality in laboratory examination. The external hospital considered peripheral neuropathy, but the routine electromyography showed no obvious abnormality. In our outpatient clinic, no positive neurogenic or myogenic damage was found in routine electromyography. And somatosensory evoked potential (SEP) suggested that SEP of the right upper limb showed central damage. Then head nuclear magnetic prompt: cerebral infarction. He was discharged from hospital after treatment. Conclusion Young patients with cerebral infarction are relatively rare and prone to misdiagnosis. The necessary and more comprehensive neuroelectrophysiological examination plays an important role in the early diagnosis and differential diagnosis .