CAJ | 학술논문

目的：探讨老年脑干脑炎的发病原因及误诊原因、防范措施。方法回顾性分析2010年1月—2013年12月北京航天中心医院及朝阳医院收治的5例老年脑干脑炎误诊病例的临床资料。结果本组均存在脑卒中危险因素；1例存在前驱感染表现,4例无明确前驱感染；症状主要为头晕及肢体力弱,体征主要有球麻痹、中枢性面瘫、三叉神经受累、锥体束征等；2例出现呼吸衰竭。本组就诊初期均误诊为脑干梗死,后经头颅MRI检查确诊脑干脑炎。给予糖皮质激素等治疗3周~1个月,1例痊愈、4例明显好转出院；出院后随访1年无复发。结论老年脑干脑炎临床表现缺乏特异性,易误诊。提高对其认识及重视鉴别诊断等可减少或避免老年脑干脑炎误诊误治。
목적：탐토노년뇌간뇌염적발병원인급오진원인、방범조시。방법회고성분석2010년1월—2013년12월북경항천중심의원급조양의원수치적5례노년뇌간뇌염오진병례적림상자료。결과본조균존재뇌졸중위험인소；1례존재전구감염표현,4례무명학전구감염；증상주요위두훈급지체력약,체정주요유구마비、중추성면탄、삼차신경수루、추체속정등；2례출현호흡쇠갈。본조취진초기균오진위뇌간경사,후경두로MRI검사학진뇌간뇌염。급여당피질격소등치료3주~1개월,1례전유、4례명현호전출원；출원후수방1년무복발。결론노년뇌간뇌염림상표현결핍특이성,역오진。제고대기인식급중시감별진단등가감소혹피면노년뇌간뇌염오진오치。
Objective To analyze causes of misdiagnosis of senile brainstem encephalitis as brainstem infarction and to discuss the measures to avoid misdiagnosis and mistreatment. Methods We collected clinical data of 5 cases of senile brainstem encephalitis who were hospitalized in Aerospace Center Hospital and Chaoyang Hospital of Beijing during January 2010 and December 2013, and the causes of misdiagnosis were analyzed. Results All of the 5 cases had the risk factors for stroke, 1 of the 5 cases had definite manifestation of previous infection. The major complains were dizziness and weakness. Commen signs included ball paralysis, central facial paralysis, trigeminal nerve injury, pyramidal tract signs. 2 of the 5 cases had respiratory failure. All of the 5 cases had been misdiagnosed as brainstem infarction during their first visit. And brainstem encephalitis was confirmed after brain MRI scanning. All the patients underwent glucocorticoid treatment for 3 weeks to 1 month. 1 patient recovered, 4 patients improved obviously, and no recurrence occurred after they were followed up for 1 year after discharge. Conclusion The clinical manifestations of senile brainstem encephalitis are lack of specificity and tend to be misdiagnosed. To improve the awareness of senile brainstem encephalitis and to pay more attention to the differential diagnosis may reduce or avoid misdiagnosis and mistreatment of brain stem encephalitis.