良性阵发性位置性眩晕53例误诊分析及文献复习

Misdiagnosis Analysis of 53 patients with Benign Paroxysmal Positional Vertigo and Literature Review

目的探讨良性阵发性位置性眩晕(BPPV)的临床特点及误诊原因、防范措施。方法对2018年7月-2021年8月收治的曾误诊的BPPV 53例的临床资料进行回顾性分析。结果本组53例均存在一定程度颈部疼痛,皆出现眩晕,50例眩晕发作时存在心悸,天旋地转、感觉不适,每次发作不超过1 min。均曾因颈部疼痛和眩晕就诊,误诊为颈源性眩晕。误诊时间2~7 d。53例按误诊疾病给予相应治疗效果不佳。后经多学科医师会诊,根据患者症状、体征及影像学检查结果等综合分析并结合相关诊断标准诊断为BPPV。给予手法复位及相应药物治疗1周后,均症状缓解;随访3个月,皆无复发。结论BPPV容易误诊,复位是治疗关键。多学科诊疗能够提高该病确诊率和治疗成功率。

Objective To investigate the clinical characteristics and causes of misdiagnosis,and preventive measures of benign paroxysmal positional vertigo(BPPV).Methods A retrospective analysis was conducted on the clinical data of 500 patients with BPPV that were misdiagnosed between July 2018 and August 2021.Results All 53 cases had some degree of neck pain and vertigo.Of them,50 cases had palpitations,spinning and discomfort during the vertigo,which did lasted for less than 1 min.All had presented with neck pain and vertigo and misdiagnosed as cervicogenic vertigo.The duration of misdiagnosis ranged from 2 to 11 d.All 53 cases were treated accordingly with unfavorable results.After multidisciplinary consultation,the patients were diagnosed with BPPV based on the comprehensive analysis of symptoms,signs,imaging findings and the relevant diagnostic criteria.The symptoms were relieved after 1 week of treatment with manual repositioning and appropriate medication,and no recurrence was observed in 3 months of follow-up.Conclusion BPPV is common and more likely to be missed and misdiagnosed,and repositioning is the key to treatment.Multidisciplinary diagnosis and treatment can improve the diagnosis rate and the success rate of treatment.