前庭性偏头痛57例误诊临床剖析
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摘要
目的分析前庭性偏头痛的临床特点及误诊原因,提高诊断率。方法对2016年9月—2018年1月我院收治并误诊为其他疾病的前庭性偏头痛57例的临床资料进行回顾性分析。结果本组均在外院首诊并误诊,误诊时间10～70 d,平均25.75 d,误诊为良性阵发性位置性眩晕36例,梅尼埃病13例,后循环缺血8例。57例均出现5～12次中度到重度的前庭症状发作,且均存在日常活动后头痛症状加重的情况。后完善相关检查,结合临床资料,均确诊为前庭性偏头痛,予盐酸氟桂利嗪口服及改变生活作息治疗1个月,其中44例症状明显减轻,发作次数明显减少;6例症状消失;5例症状无明显改善;2例失访。随访3个月,34例症状未复发;11例出现1次偏头痛症状发作,但较轻微,持续时间均未超过1 h,无前庭症状;3例出现1次偏头痛及前庭症状发作,持续时间均<24 h;1例症状无明显改善;8例失访。结论前庭性偏头痛临床表现缺乏特异性,且个体差异较大,临床医师应加强对该病的认识和警惕,以避免或减少误诊。
Objective To analyze the clinical features and causes of misdiagnosis of vestibular migraine(VM) in order to improve the diagnosis rate. Methods Clinical data of 57 patients with VM misdiagnosed as other diseases who were admitted to and treated in Neurology Department of our hospital from September 2016 to January 2018 were retrospectively analyzed. Results All 57 cases were initially diagnosed and misdiagnosed in other hospitals, and the duration of misdiagnosis was 10-70 d, with an average of 25.75 d. Of all patients, 36 cases were misdiagnosed as benign paroxysmal positioning vertigo, 13 cases as meniere disease,and 8 cases as posterior circulation ischemia. All the 57 patients presented with moderate to severe vestibular symptoms for 5 to 12 times, and all of them had aggravated headache symptoms after daily activities. After completion of relevant examinations combined with clinical data, all patients were diagnosed with VM.All patients received oral flunarizine hydrochloride capsules daily for 1 month and required to live and rest regularly for 1 month. In 44 patients, the episodes of vertigo were significantly reduced after treatment, and the number of occurrences was significantly reduced. Six cases of vertigo disappeared, 5 cases had no significant improvement in symptoms and 2 cases were lost to follow-up. The patients were followed up for 3 months.Of them, 34 cases had no recurrence of symptoms. Eleven cases had one mild migraine episode, the duration of which did not exceed 1 h, and there was no vestibular symptom.Three cases presented with one episode of migraine and vestibular symptoms for <24 h. There was no significant improvement in 1 case and 8 cases were lost to follow-up. Conclusion The clinical manifestations of VM are non-specific and vary greatly among individuals. Clinicians should strengthen the awareness and vigilance of this disease to avoid or reduce misdiagnosis.
Objective To analyze the clinical features and causes of misdiagnosis of vestibular migraine(VM) in order to improve the diagnosis rate. Methods Clinical data of 57 patients with VM misdiagnosed as other diseases who were admitted to and treated in Neurology Department of our hospital from September 2016 to January 2018 were retrospectively analyzed. Results All 57 cases were initially diagnosed and misdiagnosed in other hospitals, and the duration of misdiagnosis was 10-70 d, with an average of 25.75 d. Of all patients, 36 cases were misdiagnosed as benign paroxysmal positioning vertigo, 13 cases as meniere disease,and 8 cases as posterior circulation ischemia. All the 57 patients presented with moderate to severe vestibular symptoms for 5 to 12 times, and all of them had aggravated headache symptoms after daily activities. After completion of relevant examinations combined with clinical data, all patients were diagnosed with VM.All patients received oral flunarizine hydrochloride capsules daily for 1 month and required to live and rest regularly for 1 month. In 44 patients, the episodes of vertigo were significantly reduced after treatment, and the number of occurrences was significantly reduced. Six cases of vertigo disappeared, 5 cases had no significant improvement in symptoms and 2 cases were lost to follow-up. The patients were followed up for 3 months.Of them, 34 cases had no recurrence of symptoms. Eleven cases had one mild migraine episode, the duration of which did not exceed 1 h, and there was no vestibular symptom.Three cases presented with one episode of migraine and vestibular symptoms for <24 h. There was no significant improvement in 1 case and 8 cases were lost to follow-up. Conclusion The clinical manifestations of VM are non-specific and vary greatly among individuals. Clinicians should strengthen the awareness and vigilance of this disease to avoid or reduce misdiagnosis.
引文
[1]Dieterich M,Obermann M,Celebisoy N.Vestibular migraine:the most frequent entity of episodic vertigo[J].J Neurol,2016,263(S1):S82-S89.
[2]Dieterich M,Brandt T.Episodic vertigo related to migraine(90 cases):vestibular migraine[J].JNeurol,1999,246(10):883-892.
[3]茅利玉,朱佳浩,高峰,等.临床易误诊的复发性眩晕-前庭性偏头痛[J].浙江医学,2014,36(13):1190-1193.
[4]Lempert T,Olesen J,Furman J,et al.Vestibular migraine:diagnostic criteria:consensus document of the Bárány Society and the International Headache Society[J].Nervenarzt,2013,84(4):511-516.
[5]鲁明,樊东升.前庭性偏头痛-从诊断到治疗[J].中国疼痛医学杂志,2017,23(12):927-930.
[6]Stolte B,Holle D,Naegel S,et al.Vestibular migraine[J].Cephalalgia,2015,35(3):262-270.
[7]Furman J M,Marcus D A,Balaban C D.Vestibular migraine:clinical aspects and pathophysiology[J].Lancet Neurol,2013,12(7):706-715.
[8]周丽丽,王文昭,杨月嫦,等.前庭性偏头痛的研究现状[J].临床耳鼻咽喉头颈外科杂志,2016,30(24):1983-1986.
[9]Dimitri P S,Wall C 3rd,Oas J G,et al.Application of multivariate statistics to vestibular testing:discriminating between Menière's disease and migraine associated dizziness[J].J Vestib Res,2001,11(1):53-65.
[10]任同力,戴春富,王武庆.前庭型偏头痛102例临床特征分析[J].中国眼耳鼻喉科杂志,2014,14(3):146-150.
[11]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):173-177.
[12]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.梅尼埃病诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):167-172.
[13]邹世桢,李进让,田师宇.前庭神经炎五例临床误诊分析[J].临床误诊误治,2017,30(10):10-13.
[14]Jeong S H,Kim H J,Kim J S.Vestibular neuritis[J].Semin Neurol,2013,33(3):185-194.
[15]冯芹.突发眩晕23例首诊误诊分析[J].临床误诊误治,2006,19(10):73.
[16]何及,樊东升,孙宇.颈性眩晕[J].中国实用内科杂志,2011,31(6):414-415.
[2]Dieterich M,Brandt T.Episodic vertigo related to migraine(90 cases):vestibular migraine[J].JNeurol,1999,246(10):883-892.
[3]茅利玉,朱佳浩,高峰,等.临床易误诊的复发性眩晕-前庭性偏头痛[J].浙江医学,2014,36(13):1190-1193.
[4]Lempert T,Olesen J,Furman J,et al.Vestibular migraine:diagnostic criteria:consensus document of the Bárány Society and the International Headache Society[J].Nervenarzt,2013,84(4):511-516.
[5]鲁明,樊东升.前庭性偏头痛-从诊断到治疗[J].中国疼痛医学杂志,2017,23(12):927-930.
[6]Stolte B,Holle D,Naegel S,et al.Vestibular migraine[J].Cephalalgia,2015,35(3):262-270.
[7]Furman J M,Marcus D A,Balaban C D.Vestibular migraine:clinical aspects and pathophysiology[J].Lancet Neurol,2013,12(7):706-715.
[8]周丽丽,王文昭,杨月嫦,等.前庭性偏头痛的研究现状[J].临床耳鼻咽喉头颈外科杂志,2016,30(24):1983-1986.
[9]Dimitri P S,Wall C 3rd,Oas J G,et al.Application of multivariate statistics to vestibular testing:discriminating between Menière's disease and migraine associated dizziness[J].J Vestib Res,2001,11(1):53-65.
[10]任同力,戴春富,王武庆.前庭型偏头痛102例临床特征分析[J].中国眼耳鼻喉科杂志,2014,14(3):146-150.
[11]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):173-177.
[12]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.梅尼埃病诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):167-172.
[13]邹世桢,李进让,田师宇.前庭神经炎五例临床误诊分析[J].临床误诊误治,2017,30(10):10-13.
[14]Jeong S H,Kim H J,Kim J S.Vestibular neuritis[J].Semin Neurol,2013,33(3):185-194.
[15]冯芹.突发眩晕23例首诊误诊分析[J].临床误诊误治,2006,19(10):73.
[16]何及,樊东升,孙宇.颈性眩晕[J].中国实用内科杂志,2011,31(6):414-415.