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急性脑梗死相关误诊原因分析及防范对策OA

Analysis of misdiagnosis causes of acute cerebral infarction and preventive measures

中文摘要英文摘要

目的 分析急性脑梗死相关误诊的原因,探讨减少误诊的防范对策.方法 回顾性分析2024年5月—2025年2月收治的2例急性脑梗死相关误诊病例的临床资料.结果 1例22岁女性患者因意识不清伴肢体抽搐就诊,初诊考虑中毒、感染等病因,予相应治疗后效果不佳,后经完善血管评估确诊为左椎动脉夹层继发基底动脉闭塞.误诊时间15 h.确诊后行血管内治疗,血管成功再通,但预后不良.1例82岁男性患者因卒中样症状就诊,初诊为缺血性脑卒中并行全脑血管造影术,后经多模态磁共振成像确诊为脑脓肿.误诊时间3 d.确诊后经抗感染治疗后病情稳定,随访预后良好.结论 急性脑梗死相关误诊涉及真性脑梗死漏诊和卒中模拟病的误判两个方面,提高医务人员的诊断警惕性、优化影像学征象识别能力、规范诊疗流程是降低本病误诊率的重要措施.

Objective To analyze the causes of misdiagnosis related to acute cerebral infarction(ACI)and to investigate preventive measures to reduce such misdiagnoses.Methods A retrospective analysis was conducted on the clinical data of 2 patients with ACI-related misdiagnosis admitted from May 2024 to February 2025.Results A 22-year-old female patient presented with disturbance of consciousness and limb convulsions.Initially,the diagnosis was considered to be poisoning or infection,and corresponding treatments were given but with poor effect.Subsequently,after comprehensive vascular assessment,a diagnosis of left vertebral artery dissection with secondary basilar artery occlusion was confirmed.The misdiagnosis lasted 15 h.After diagnosis,endovascular treatment was performed,and the blood vessels were successfully recanalized,but the prognosis was poor.An 82-year-old male patient presented with stroke-like symptoms.Initially,he was diagnosed with ischemic stroke and underwent whole-brain angiography.Subsequently,it was confirmed as a brain abscess through multimodal magnetic resonance imaging.The misdiagnosis period was 3 d.After diagnosis,he was treated with anti-infection therapy and the condition stabilized.The follow-up prognosis was good.Conclusion The misdiagnosis related to ACI involves two aspects:missed diagnosis of true cerebral infarction and misjudgment of stroke mimics.Enhancing the diagnostic vigilance of medical staff,optimizing the identification of imaging signs,and standardizing the diagnosis and treatment process are important measures to reduce the misdiagnosis rate of this disease.

向智滔;陈仰昆;周宝玉

广东医科大学第一临床医学院,广东 湛江 524023||南方医科大学第十附属医院(东莞市人民医院),广东 东莞 523059广东医科大学第一临床医学院,广东 湛江 524023||南方医科大学第十附属医院(东莞市人民医院),广东 东莞 523059南方医科大学第十附属医院(东莞市人民医院),广东 东莞 523059

急性脑梗死误诊椎动脉夹层基底动脉闭塞脑脓肿卒中模拟病鉴别诊断多模态磁共振成像

acute cerebral infarctionmisdiagnosisvertebral artery dissectionbasilar artery occlusionbrain abscessstroke mimicsdifferential diagnosismultimodal magnetic resonance imaging

《临床误诊误治》 2026 (6)

1-7,7

国家卫生健康委医药卫生科技发展研究中心项目(WKZX2023CZ0223)

10.3969/j.issn.1002-3429.2026.06.001

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