神经内科重症监护病房中癫痫与非癫痫性发作的误诊。
Misdiagnosis of epileptic and non-epileptic seizures in a neurological intensive care unit.
机构信息
University of Muenster, Department of Neurology, Muenster, Germany.
出版信息
Acta Neurol Scand. 2010 Sep;122(3):189-95. doi: 10.1111/j.1600-0404.2009.01287.x. Epub 2009 Dec 10.
OBJECTIVE
The etiological misinterpretation of paroxysmal neurological symptoms frequently causes a delayed treatment or an inappropriate utilization of ICU-capacities.
METHODS
In this study, the data of 208 patients admitted to a neurological ICU because of acute transient neurological deficits, loss of consciousness or unclear motor phenomena were retrospectively analyzed. The initial emergency room diagnosis was compared to the final diagnosis and the rate of misdiagnosis was related to the patients' history and diagnostic data.
RESULTS
In 13.9%, the emergency room diagnosis of epileptic seizures turned out to be incorrect, whereas in 15.6%, the final diagnosis of epileptic seizures was missed in the emergency room. Factors that were significantly correlated to missing the seizure diagnosis were (i) no prior history of epilepsy, (ii) old age, (iii) multi-morbidity, (iv) pathologic CT-scans demonstrating cerebrovascular lesions, (v) seizure description by non-professionals, (vi) predominantly negative seizure phenomena (aphasia, loss of consciousness, paresis), (vii) lack of tongue-bite lesions.
目的
阵发性神经系统症状的病因误解常常导致治疗延误或 ICU 资源利用不当。
方法
本研究回顾性分析了 208 例因急性短暂性神经功能障碍、意识丧失或不明运动现象而入住神经科 ICU 的患者的数据。将急诊室的初始诊断与最终诊断进行比较，并将误诊率与患者的病史和诊断数据相关联。
结果
13.9%的患者急诊室癫痫发作的诊断不正确，而 15.6%的患者在急诊室漏诊了癫痫发作。与漏诊癫痫相关的因素有：（i）无癫痫既往史，（ii）年龄较大，（iii）多病共存，（iv）CT 扫描显示脑血管病变，（v）非专业人员描述的癫痫发作，（vi）主要为阴性癫痫发作现象（失语、意识丧失、瘫痪），（vii）无舌咬伤病变。
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