青年脑梗死误诊为单纯部分性发作癫痫临床分析

Clinical Analysis of Cerebral Infarction in Young Adults Misdiagnosed as Simple Partial Seizure of Epilepsy

目的探讨青年脑梗死诊治要点及误诊为单纯部分性发作癫痫的原因、防范措施。方法对2021年2月—2022年10月收治的曾误诊为单纯部分性发作癫痫的青年脑梗死7例的临床资料进行回顾性分析。结果本组7例年龄23~38岁,主要表现为多次发作一过性或短暂性右肢乏力,伴右面部发麻;右肢肌力均减低,右鼻唇沟变浅和腱反射减弱各3例,舌右伸偏斜、共济失调和Babinski征阳性各2例。7例均于外院综合门诊误诊为单纯部分性发作癫痫,误诊时间2~3 d。入我院后均经头颅MRI及磁共振血管造影(MRA)检查确诊脑梗死,予相应治疗后病情好转出院。出院后随访6个月,7例均未复发,2例遗留轻微肢体功能障碍。结论青年脑梗死早期症状不典型,易误诊。基层医院临床医生应提高对该病警惕性,加强对其认识,对有脑部体征且伴有脑梗死易患因素青年患者,不要因年龄小而轻易否定脑梗死诊断,必要时及时转诊并行MRI、MRA等影像学检查,以及早确诊并治疗。

Objective To investigate the key points of diagnosis and treatment of cerebral infarction in young adults,causes of misdiagnosis as simple partial seizure of epilepsy and preventive measures.Methods Clinical data of 7 young adults with cerebral infarction misdiagnosed as simple partial seizure of epilepsy treated from February 2021 to October 2022 were retrospectively analyzed.Results Seven patients were aged 23-38 years.They mainly presented with multiple episodes of transient or temporary right limb weakness accompanied by right facial numbness.There was decreased muscle strength of the right limb,shallower right nasolabial sulcus and weakened tendon reflex in 3 patients respectively,right tongue extension deviation,ataxia,and positive Babinski sign in 2 patients respectively.All 7 cases were misdiagnosed as simple partial seizure of epilepsy in the comprehensive outpatient department of other hospitals,the duration of misdiagnosis was.After admission to our hospital,cerebral infarction was confirmed by head MRI and MRI angiography(MRA).After corresponding treatment,7 patients were discharged with improved condition.At 6-month follow-up after discharge,there was no recurrence and 2 patients had minor limb dysfunction.Conclusion The early symptoms of cerebral infarction in young adults are not typical,so early misdiagnosis often occurs.The receiving doctors in primary hospitals should enhance their vigilance and improve their understanding of the disease.For young patients with brain signs and risk factors of cerebral infarction,they should not easily deny the diagnosis of cerebral infarction due to their young age,and timely MRI,MRA and other imaging examinations should be performed when necessary to avoid misdiagnosis.