表现不典型的脑桥梗死临床误诊分析

Analysis of Clinical Misdiagnosis of Pontine Infarction with Atypical Mani⁃festations

目的分析脑桥梗死早期不典型表现及发生误诊的原因,并进一步总结防范误诊措施。方法回顾分析2021年1月至2023年12月收治的脑桥梗死误诊12例病例资料。结果12例中男8例,女4例;年龄49~75岁;均于发病24 h内就诊;有高血压病史10例,有高脂血症史6例,有颈椎病史4例。8例出现例病灶对侧中枢性面舌瘫及肢体瘫合并偏身感觉障碍,11例轻度共济失调,12例眼球震颤,5例构音障碍,8例伴头晕,6例恶心呕吐,8例肌力检查异常,7例瘫痪侧Babinski's征阳性,4例耳鸣,3例一过性复视。12例行头颅CT检查均未见新发梗死灶,因中枢性面瘫、肢瘫及偏身感觉障碍误诊大脑半球梗死8例,因眩晕、耳鸣、无神经系统定位体征误诊椎基底动脉供血不足4例。发病24 h后行头颅磁共振检查发现脑桥梗死灶,遂确诊脑桥梗死。误诊时间24~36 h。12例确诊后予抗血小板聚集、改善微循环等治疗,治疗1个月后患者病情明显好转。结论部分脑桥梗死早期临床表现不典型,无明确定位体征,加之早期CT检查敏感性、特异性低,使得早期误漏诊情况时有发生。仔细询问相关病史及易患因素,认真神经系统查体,熟知脑桥解剖结构及病变特征,当CT检查未发现脑部责任梗死灶时应及时行磁共振检查或多次检查,以防早期误漏诊。

Objective To analyze the atypical manifestations of early pontine infarction and the causes of misdiagno-sis,and to further summarize the preventive measures for misdiagnosis.Methods The case data of 12 patients with misdiag-nosed pontine infarction admitted from January 2021 to December 2023 were retrospectively analyzed.Results Among the 12 patients,8 were males and 4 were females aged 49-75 years.All patients were treated within 24 h after onset.There were 10 patients with history of hypertension,6 patients with history of hyperlipidemia,and 4 patients with history of cervical spine.There were 8 patients with contralateral central faciolingual palsy and limb palsy combined with hemisensory disturbance,11 with mild ataxia,12 with nystagmus,5 with dysarthria,8 with dizziness,6 with nausea and vomiting,8 with abnormal muscle strength during examination,7 with Babinski's sign positive on the paralyzed side,4 with tinnitus,and 3 with transient diplo-pia.No new infarcts were found in head CT examinations in 12 patients.Eight patients were misdiagnosed with cerebral hemi-sphere infarction due to central facial paralysis,limb paralysis and hemisensory disorder,and 4 patients were misdiagnosed with insufficient vertebra basilar artery blood supply due to vertigo,tinnitus and no neurological signs.Brain MRI examination revealed pontine infarction within 24 h after the onset of the disease,and then confirmed the diagnosis of pontine infarction.Misdiagnosis lasted from 24 to 36 h.After diagnosis,12 patients were treated with anti-platelet aggregation and improvement of microcirculation,and their condition was significantly improved at 1 month after treatment.Conclusion The early clinical manifestations of partial pontine infarction are not typical,with no definite localization sign,and the sensitivity and specificity of early CT examination are low,which often leads to the early misdiagnosis and missed diagnosis.Careful inquiry about rele-vant medical history and risk factors,careful examination of the nervous system,and being familiar with the anatomical struc-ture and pathological characteristics of the pontine brain,and prompt MRI or multiple examinations when no responsible cere-bral infarction is found by CT examination are necessary to prevent early misdiagnosis and missed diagnosis.