震颤性谵妄视频脑电图特征及临床误诊分析OA

Objective To analyze the video electroencephalogram(VEEG)characteristics of patients with delirium tremens(DT),and to explore the causes of misdiagnosis and the key points for clinical differentiation.Methods The clinical data of 6 patients with DT who were initially misdiagnosed as other diseases and admitted to Hengshui People's Hospital from August 2021 to December 2024 were retrospectively analyzed.Results Among the 6 patients,2 were misdiagnosed with complex partial seizures due to fluctuating consciousness and limb tremors,and received Levetiracetam,an antiepileptic agent,but the symptoms did not improve.Two patients were misdiagnosed with metabolic encephalopathy because they presented with confusion and drowsiness,and despite treatment with correction of electrolyte disturbances and fluid resuscitation,the clinical response remained poor.One patient was misdiagnosed as alcoholic hallucinosis due to hallucinations and restlessness,and received antipsychotic treatment,but the tremors and consciousness disorders continued to worsen.One patient was misdiagnosed as hepatic encephalopathy due to fluttering tremors and mild increase in blood ammonia,and the symptoms did not improve after ammonia-lowering treatment.Further long-term VEEG monitoring combined with a history of alcohol withdrawal eventually confirmed the diagnosis of DT.The misdiagnosis lasted 2 to 5 d.After the definitive diagnosis,the patients discontinued antiepileptic and antipsychotic drugs and were treated with Benzodiazepines and high-dose Vitamin B1,and fluid replacement therapy.After 5 to 7 d of treatment,the consciousness disorders,tremors,and autonomic nerve symptoms were basically controlled.Follow-up for 6 months showed that 5 patients experienced no further episodes,and 1 patient developed mild symptoms after a repeated episode of alcohol withdrawal,which was controlled after short-term treatment;all patients did not have obvious cognitive dysfunction and regained their self-care ability.Conclusion The clinical manifestations of DT are diverse and are easily confused with epilepsy,metabolic encephalopathy,and primary mental disorders,leading to misdiagnosis.Clinicians need to improve their ability to identify DT after alcohol withdrawal,and combine detailed collection of drinking and withdrawal history,VEEG and other characteristics,to reduce misdiagnosis.