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目的探讨老年患者部分性癫痫发作与短暂性脑缺血发作(TIA)的诊断与鉴别诊断。方法对76例年龄≥65岁初诊为TIA患者的全脑数字减影血管造影(DSA),头颅磁共振血管成像(MRA)及24h动态脑电图回顾性分析。结果 76例患者中,20例脑电图异常,占26.32%。20例脑电图患者中,11例监测到临床发作,其中8例有癫痫波发放,另9例无临床发作。脑电图正常56例(73.68%)。最终确诊部分性癫痫发作8例,占10.53%。头颅MRA或DSA显示颅内外大血管异常67例(88.16%)。结论老年人部分性癫痫发作与TIA有时在临床上表现相似,容易造成部分性癫痫发作的误诊、漏诊,对不能排除部分性癫痫发作患者应进行视频脑电图及MRA或DSA等检查明确诊断。
Objective To investigate the diagnosis and differential diagnosis of partial seizure and transient ischemic attack (TIA) in elderly patients. Methods Retrospective analysis was performed on digital brain shadow subtraction angiography (DSA), cranial magnetic resonance angiography (MRA) and dynamic EEG in 76 patients aged 65 years or older with initial diagnosis of TIA. Results Among 76 patients, 20 cases had abnormal EEG, accounting for 26.32%. Of the 20 EEG patients, 11 had clinical seizures monitored, of whom 8 had epileptic waves and the other 9 had no clinical seizure. EEG normal 56 cases (73.68%). The final diagnosis of partial seizures in 8 cases, accounting for 10.53%. Head MRA or DSA showed intracranial extravascular abnormalities in 67 cases (88.16%). Conclusion Partial seizures in the elderly are sometimes clinically similar to TIA, which may lead to misdiagnosis and missed diagnosis of partial seizures. Video electroencephalography and MRA or DSA should be used to confirm the diagnosis of partial seizures.