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目的探讨蛛网膜下腔出血(SAH)的临床症状及误诊情况。方法回顾分析误诊的30例SAH病例的临床临床表现、误诊情况及转归。结果本组30例中,昏迷5例(16.7%),头剧痛8例(27.0%),隐痛4例(13.3%),恶心呕吐11例(37.0%),眩晕5例(16.7%),精神障碍3例(10.0%),发作性抽搐2例(6.7%),嗜睡1例(3.3%),以头痛、恶心呕吐多见;30例患者误诊为急性胃肠炎3例(10.0%),梅尼埃病4例,椎基底动脉供血不足5例(16.7%),颈椎病4例(13.3%),晕厥3例(10.0%),高血压脑病4例(13.3%),自主神经功能紊乱2例(6.7%),癫痫发作2例(6.7%),脑炎1例(3.3%),老年精神病2例(6.7%)。延误诊断1 d者16例(53.3%)2,d者9例(30.0%)3,d者4例(13.3%),其中1例(3.3%)误诊时间长达19 d。30例患者经头颅CT或腰穿检查确诊为蛛网膜下腔出血。结论老年人SAH临床表现不典型,复杂多样,易导致误诊。对于高度怀疑而且头颅CT检查阴性的患者,根据情况行腰穿脑脊液检查,必要时行数字减影血管造影(DSA)检查,以早期明确诊断。
Objective To investigate the clinical symptoms and misdiagnosis of subarachnoid hemorrhage (SAH). Methods The clinical manifestations, misdiagnosis and outcome of 30 cases of misdiagnosed SAH were retrospectively analyzed. Results Among the 30 cases, coma was found in 5 cases (16.7%), head pain in 8 cases (27.0%), pain in 4 cases (13.3%), nausea and vomiting in 11 cases (37.0%), dizziness in 5 cases 3 cases (10.0%) were mental disorders, episodes of seizures were in 2 cases (6.7%) and drowsiness was in 1 case (3.3%), headache and nausea and vomiting were common in 30 cases. 4 cases of Meniere’s disease, 5 cases of vertebrobasilar insufficiency (16.7%), 4 cases of cervical spondylosis (13.3%), 3 cases of syncope (10.0%), 4 cases of hypertensive encephalopathy (13.3%), autonomic nervous function 2 cases (6.7%) of disorder, 2 cases of seizures (6.7%), 1 case of encephalitis (3.3%) and 2 cases of senile mental illness (6.7%). Delayed diagnosis of d in 16 cases (53.3%) 2, d in 9 cases (30.0%) 3, d in 4 cases (13.3%), of which 1 case (3.3%) misdiagnosis time as long as 19 days. Thirty patients were diagnosed with subarachnoid hemorrhage by head CT or lumbar puncture. Conclusion The clinical manifestations of SAH in the elderly are not typical, complex and diverse, easily lead to misdiagnosis. For patients who are highly suspected and have a negative CT scan, lumbar and cerebrospinal fluid tests are performed on a case-by-case basis and, if necessary, digital subtraction angiography (DSA) is performed to confirm the diagnosis early.