CAJ | 학술논문

目的：探讨颈动脉夹层（ cervical artery dissection, CeAD)的诊治现状,分析临床表现不典型CeAD的误漏诊原因及防范措施。方法对我院收治的2例曾误漏诊的临床表现不典型的CeAD临床资料进行回顾性分析。结果本组因颈部扭伤48 h,突发左侧肢体强直、僵硬伴左眼失明3 h及突发左侧肢体力弱伴头痛6 h入院各1例,发病初期曾分别诊断为颈椎病和脑出血,1例漏诊,入我院后均经头颈螺旋CT动脉造影（ CTA)检查确诊为CeAD,分别给予抗凝、抗血小板及营养神经等治疗及仅给予营养神经治疗,均病情好转出院。结论 CeAD临床表现复杂多变且缺乏特异性,首诊易误漏诊。加强对该病认识、仔细问诊和查体及发散诊断思维有利于提高CeAD早期诊断率,改善患者预后。
목적：탐토경동맥협층（ cervical artery dissection, CeAD)적진치현상,분석림상표현불전형CeAD적오루진원인급방범조시。방법대아원수치적2례증오루진적림상표현불전형적CeAD림상자료진행회고성분석。결과본조인경부뉴상48 h,돌발좌측지체강직、강경반좌안실명3 h급돌발좌측지체력약반두통6 h입원각1례,발병초기증분별진단위경추병화뇌출혈,1례루진,입아원후균경두경라선CT동맥조영（ CTA)검사학진위CeAD,분별급여항응、항혈소판급영양신경등치료급부급여영양신경치료,균병정호전출원。결론 CeAD림상표현복잡다변차결핍특이성,수진역오루진。가강대해병인식、자세문진화사체급발산진단사유유리우제고CeAD조기진단솔,개선환자예후。
Objective To discuss the current treatment method of cervical artery dissection ( CeAD) and to analyze the cause of misdiagnosis and missed diagnosis and preventive measures for atypical CeAD. Methods Clinical data of two pa-tients misdiagnosed and missed diagnosis with atypical CeAD were retrospectively analyzed in our hospital. Results One pa-tient suffered stiffness in the left limbs and blind in the left eye for 3 hours due to sudden neck sprain for 48 hours. The other presented with weakness in the left limbs and a headache for 6 hours. In the early stage, patients had been initially misdiag-nosed with cervical spondylosis and cervical hemorrhage respectively, and one patient missed diagnosis. Both were diagnosed with CeAD by computer tomographic angiography ( CTA) upon admission. One patient was treated with anticoagulation, anti-platelet theray and neurophic treatment. The other received only neurophic treatment. Both the patients turned for the better and were discharged. Conclusion Clinical manifestation of CeAD is complex, changeable, and lacks specificity, prone to misdiagnosis and missed diagnosis for the first visit. Improving awareness for CeAD, careful inquiry and physical examination, and divergent diagnostic thinking may contribute to increasing early diagnostic rate of CeAD and improving prognosis of CeAD patients.