脑静脉窦血栓形成误诊原因分析

摘要

目的 探讨脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的误诊原因,并提出减少误诊的对策.方法 对我院2003年2月-2012年2月收治7例误诊的CVST的临床资料进行回顾性分析.结果 本组7例因意识障碍、癫痫误诊为病毒性脑炎3例；因头痛、呕吐伴局灶性神经功能缺失误诊为脑梗死2例,脑出血1例；因胸闷、呕吐误诊为冠心病1例.误诊时间1 ～30 d.均经CT静脉造影(CTV)检查确诊,予脱水、抗凝、溶栓等治疗,6例好转,1例死亡.结论 CVST早期临床表现无特异性,临床医生应提高对本病的认识,对疑诊患者及时行头颅CT及CTV等检查,可降低误诊率.%Objective To explore the misdiagnosis cause of cerebral venous sinus thrombosis (CVST) in order to reduce misdiagnosis. Methods Clinical data of 7 misdiagnosed patients with CVST during February 2003 and February 2012 were retrospectively analyzed. Results 3 patients out of the 7 patients with disturbance of consciousness and epilepsy were misdiagnosed as having virus encephalitis; 3 patients with headaches and vomitting combined with focal nerves afunction were misdiagnosed as having cerebral infarct (2 patients) and cerebral hemorrhage (1 patient) ; One patient with dyspnea and vomiting was misdiagnosed as having coronary artery disease. The duration of the misdiagnosis period was 1-30 days. The 7 patients were finally diagnosed by CTV and CT, and given dehydration, anticoagulation and thrombolytic therapies. 6 patients improved and 1 patient died. Conclusion Clinicians should raise awareness of CVST of the early unconspicuous symptoms of CVST. The brain CT scanning and CTV features are valuable for diagnosing CVST and reducing misdiagnosis rate.