摘要
目的探讨脑胶质瘤的临床特点及误诊原因、防范措施。方法对2017年4月-2021年1月收治的曾误诊的脑胶质瘤13例的临床资料进行回顾性分析。结果本组皆出现头痛及恶心、呕吐症状,出现感觉和运动障碍、受累肢体乏力8例,表情淡漠7例;口角歪斜8例,触及浅表淋巴结增大5例。5例血白细胞升高;5例脑脊液检查示颅内压升高。于右侧基底核区发现肿物10例(76.92%),左侧顶叶发现肿物2例(15.38%),左侧颞叶海马区发现肿物1例(7.69%)。病初误诊为急性播散性脑脊髓炎5例,急性脑梗死8例,误诊时间2~5个月,按误诊疾病予相应治疗病情缓解不明显,后经脑组织病理学检查诊断为脑胶质瘤。5例给予手术联合术后辅助放化疗症状缓解,随访1年无复发;8例给予手术及放化疗,随访1年,病情稳定4例,因病情恶化死亡和失访各2例。结论脑胶质瘤临床表现多样,当影像学表现为弥漫性和多发性病变时极易误诊。低年资临床医生接诊此类患者时,若按初诊疾病治疗效果不佳,应考虑到脑胶质瘤,尽早行脑组织病理学检查。
Objective To explore the clinical characteristics,causes of misdiagnosis and preventive measures of brain glioma.Methods The clinical data of 13 patients with brain glioma misdiagnosed from April 2017 to January 2021 were retrospectively analyzed.Results In this group,there was headache,nausea and vomiting symptoms in all cases,sensory and motor disorders,fatigue of affected limbs in 8 cases,and apathy in 7 cases.Distortion of commissure was found in 8 cases,and the enlarged superficial lymph nodes were palpable in 5 cases.Five cases had elevated white blood cells,and cerebrospinal fluid examination showed elevated intracranial pressure in 5 cases.Ten cases(76.92%)of tumors were found in the right basal nucleus,2 cases(15.38%)in the left parietal lobe and 1 case(7.69%)in the left temporal lobe and the hippocampus.At the beginning of the disease,5 cases were misdiagnosed as acute disseminated encephalomyelitis,8 cases as acute cerebral infarction,and the misdiagnosis took 2 to 5 months.According to the misdiagnosed disease,the remission of the disease was not obvious after the corresponding treatment,and then the diagnosis of brain glioma was made by brain histopathological examination.Five cases were treated with surgery combined with postoperative adjuvant radiotherapy and chemotherapy to relieve symptoms,and no recurrence was found at 1-year follow-up.Eight cases were treated with surgery,radiotherapy and chemotherapy,and followed up for 1 year,4 cases were stable,2 cases died and 2 cases were lost to follow-up due to deterioration of the disease.Conclusion The clinical manifestations of brain glioma are diverse,and it is more likely to be misdiagnosed when the imaging findings are diffuse and multiple lesions.When junior clinicians receive such patients,if the therapeutic effect is far from satisfactory according to the initially diagnosed disease,the brain glioma should be considered and the brain histopathological examination should be carried out as soon as possible.
作者
王坤
武江
田姗子
柳爱军
刘波
WANG Kun;WU Jiang;TIAN Shan-zi;LIU Ai-jun;LIU Bo(Department of Neurosurgery,Cangzhou People's Hospital,Cangzhou,Hebei 061000,China;Department of Electrocardiogram,Cangzhou People's Hospital,Cangzhou,Hebei 061000,China;Department of Neurosurgery,Hebei General Hospital,Shijiazhuang 050000,China)
出处
《临床误诊误治》
CAS
2023年第2期30-33,共4页
Clinical Misdiagnosis & Mistherapy
基金
河北省科技支撑计划项目(152777145)。
关键词
脑胶质瘤
误诊
脑脊髓炎
急性播散性
脑梗死
病理学检查
Glioma
Misdiagnosis
Encephalomyelitis,acute disseminated
Brain infarction
Physical examination
