以孤立性眩晕为临床表现的后循环脑梗死误诊原因探析

Cause of Misdiagnosis of Posterior Circulation Ischemic Stroke with Isolated Vertigo as Clinical Manifestation

目的探讨以孤立性眩晕为临床表现的后循环脑梗死的临床特点及误诊原因、防范措施。方法回顾性分析2018年6月—2021年6月收治的曾误诊的以孤立性眩晕为临床表现的后循环脑梗死5例的临床资料。结果本组皆以眩晕为主诉,发病后4例在当地医疗机构就诊,1例在我院急诊就诊。误诊为良性阵发性位置性眩晕和前庭神经炎各2例,Meniere综合征1例。误诊时间1~72 h。5例按照误诊疾病治疗效果不佳,进一步分析病史及床旁头脉冲试验-凝视变向眼震-眼扭转偏斜试验(HINTS)、头颅影像学检查结果等,根据相关诊断标准,确诊后循环脑梗死(4例小脑梗死,1例脑干梗死),给予相应治疗,病情好转出院。随访3个月,预后良好。结论以孤立性眩晕为临床表现的后循环脑梗死易误诊。临床上对于具有多个脑梗死危险因素的孤立性眩晕患者应提高警惕。发散诊断思维、及时行床旁HINTS及重视头颅MRI复查有助于减少或避免此类患者误诊误治。

Objective To explore the clinical characteristic,causes of misdiagnosis and preventive measures of posterior circulation ischemic stroke(PCS)with isolated vertigo as clinical manifestation.Methods Clinical data of 5 PCS patients with isolated vertigo as clinical manifestation that were misdiagnosed from June 2018 to June 2021 was retrospectively analyzed.Results All patients complained of vertigo.After the onset,4 cases were treated in local medical institutions,and 1 case was treated in Emergency Department of our hospital.Of them,2 cases were misdiagnosed as having benign paroxysmal positional vertigo(BPPV),2 as vestibular neuronitis and 1 as Meniere's disease.The duration of misdiagnosis ranged from 1 to 72 h.The therapeutic effect of 5 cases was poor according to the misdiagnosed disease.Further analysis was made on the medical history and the results of bedside head impulse,nystagmus,test of skew(HINTS),skull imaging examination,and according to the relevant diagnostic criteria,diagnosis of PCS was made(4 cerebellar infarction and 1 brainstem infarction).Corresponding treatment was given and the patient was discharged from hospital.They were followed up for 3 months and showed a good prognosis.Conclusion PCS with isolated vertigo as clinical manifestation is more likely to be misdiagnosed.Clinicians should pay special attention to patients presenting with isolated vertigo and multiple cerebrovascular risk factors in clinical practice.Divergent diagnostic thinking,timely bedside HINTS and close attention to cranial MRI reexamination are helpful to reduce or avoid misdiagnosis and mistreatment of those patients.