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目的:提高对蛛网膜下腔出血(SAH)临床特点的认识,减少误诊。方法:回顾分析186例SAH中首诊误诊的32例患者的临床特点,总结分析误诊原因,诊断体会。结果:32例中被误诊为椎基底动脉供血不足8例,高血压性头痛6例,血管性头痛5例,脑出血4例,脑动脉硬化症3例,上呼吸道感染2例,癫痫2例,心衰及急性胃肠炎各1例。结论:提高对SAH不典型临床表现的认识,对有头痛、呕吐、突发眩晕、意识障碍、精神障碍、癫痫发作等症状的患者要考虑有SAH的可能,对可疑SAH的患者要及时作CT及腰穿检查确诊,以减少误诊。
Objective: To improve the understanding of the clinical features of subarachnoid hemorrhage (SAH) and reduce misdiagnosis. Methods: The clinical features of 32 patients with first misdiagnosis in 186 cases of SAH were retrospectively analyzed. The causes of misdiagnosis were summarized and the diagnosis was realized. Results: 32 cases were misdiagnosed as vertebrobasilar insufficiency in 8 cases, hypertensive headache in 6 cases, vascular headache in 5 cases, cerebral hemorrhage in 4 cases, cerebral arteriosclerosis in 3 cases, upper respiratory tract infection in 2 cases, epilepsy in 2 cases , Heart failure and acute gastroenteritis in 1 case. Conclusion: To improve the understanding of atypical clinical manifestations of SAH, SAH may be considered in patients with headache, vomiting, sudden vertigo, disturbance of consciousness, mental disorders, seizures and other symptoms. Patients with suspected SAH should be treated with CT And lumbar puncture examination confirmed to reduce misdiagnosis.