作者：赵龙1，2 ，朱茜 2，3 ，李峥 1，2 ，李舜 1，2 ，王远传 1，2 ，唐晓平 1，2

单位：

1.637000 四川省南充市，川北医学院附属医院神经外科　；2.637000 四川省南充市，川北医学院附属医院神经外科研究室；3.637000 四川省南充市，川北医学院附属医院护理部；通信作者：唐晓平，E-mail：txping1971@163.com

关键词：

颅内动脉瘤；诊断；误诊；疾病特征；体层摄影术，螺旋计算机；磁共振血管造影术；磁共振成像

关键词（英文）：

Intracranial aneurysm；Diagnosis；Diagnostic errors；Disease attributes；Tomography，spiralcomputed；Magnetic resonance angiography；Magnetic resonance imaging

中图分类号：

R 743.9

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.007

基金项目：

四川省科技厅重点项目（2015SZ0114）；南充市市校战略合作项目（18SXHZ0286）

摘要：

背景　正常人群颅内动脉瘤发生率较高（发生率为 3%~7%），而部分颅内动脉瘤患者临床及影像学表现不典型，极易误导临床诊治。目的　分析临床及影像学表现不典型的颅内动脉瘤患者误诊情况，以提高此类患者诊断效率。方法　川北医学院附属医院 2013—2018 年共收治诊断明确的颅内动脉瘤患者 1 138 例，选取其中首诊误诊患者 25 例作为研究对象。回顾性分析 25 例误诊患者一般资料、入院情况、首诊误诊情况，并结合相关文献分析临床及影像学表现不典型的颅内动脉瘤特点、诊断策略及治疗策略。结果　25 例患者中男 12 例，女 13 例；年龄 41~71 岁，平均年龄（56.5±7.2）岁；门诊入院 3 例，急诊入院 15 例，院外转入 10 例（3 例先转入门诊）。1 例首诊误诊为短暂性脑缺血发作，行颅脑 CT 血管造影（CTA）检查发现右侧后交通动脉瘤并行动脉瘤夹闭术，术后恢复良好。3 例首诊误诊为颅脑创伤，行颅脑 CTA 或数字减影血管造影（DSA）确诊为前循环动脉瘤并行开颅手术夹闭动脉瘤，术后恢复良好。4 例首诊误诊为颅内肿瘤，其中 1 例术中发现颅内动脉瘤破裂并大出血，行动脉瘤夹闭术，术后出现后组颅神经功能障碍及轻偏瘫；1 例明确诊断后放弃治疗；2 例术前发现颅内动脉瘤，行动脉瘤夹闭术，术后恢复良好。17例首诊误诊为高血压脑出血，除 1 例因动脉瘤再次破裂、病情迅速加重而放弃手术外，其余 16 例均行动脉瘤夹闭术，术后 2 例因并发症而死亡，其余 14 例患者中术后改良 Rankin 量表（mRS）评分为 5 分者 2 例、4 分者 3 例、3 分者 3 例、2分者6例。结论　颅内动脉瘤发生率较高，且部分颅内动脉瘤患者临床及影像学表现不典型，极易导致漏诊、误诊（如短暂性脑缺血发作、颅脑创伤、颅内肿瘤、高血压脑出血等），临床医师及影像学医师应加强对此类患者的认识，提高诊断效率，并在条件允许的情况下建议患者积极行手术治疗。

英文摘要：

Background　Incidence of intracranial aneurysm is relatively high in general population（is about 3%to 7%），however there are a few intracranial aneurysm patients with atypical clinical manifestations and imaging findings，which is easily misleading clinical diagnosis and treatment. Objective　To analyze the misdiagnosis of intracranial aneurysmwith atypical clinical manifestations and imaging findings，and to improve its diagnostic efficiency. Methods　A total of 1 138patients were definitely diagnosed in the Affiliated Hospital of North Sichuan Medical College from 2013 to 2018，of them 25cases with misdiagnosis were selected as the objects. General information，condition of hospitalization and misdiagnosis at thefirst diagnosis were retrospectively analyzed in the 25 patients，meanwhile characteristics，diagnostic and therapeutic strategyof intracranial aneurysm with atypical clinical manifestations and imaging findings were summarized by combining with pertinentliteratures. Results　Of the 25 patients，12 cases were males，the other 13 cases were females；the average age was（56.5±7.2）years old，which ranged from 41 to 71 years old；3 cases firstly admitted in the Department of Outpatient Service，15 casesfirstly admitted in the Department of Medical Emergency，10 cases firstly admitted in other hospitals（including 3 cases firstlyadmitted in the Department of Outpatient Service）. Only 1 case firstly misdiagnosed as transient ischemic attack，who confirmedas right posterior communicating aneurysm by craniocerebral CTA and underwent intracranial aneurysmal clipped operation，withgood postoperative prognosis. A total of 3 cases firstly misdiagnosed as craniocerebral trauma，who confirmed as right posteriorcommunicating aneurysm by craniocerebral CTA or DSA and underwent intracranial aneurysmal clipped operation，with goodpostoperative prognosis. A total of 4 cases firstly misdiagnosed as intracranial tumors，thereinto 1 case found ruptured intracranialaneurysm complicated with massive haemorrhage during operation and underwent intracranial aneurysmal clipped operation，with postoperative cranial nerve dysfunction and hemiparesis；1 case abandoned treatment after confirmation of intracranialaneurysm；2 cases confirmed as intracranial aneurysm before operation and underwent intracranial aneurysmal clippedoperation，with good postoperative prognosis. A total of 17 cases firstly misdiagnosed as hypertensive cerebral hemorrhage，thereinto 1 case abandoned operation due to once again ruptured intracranial aneurysm and rapid progression of illness；all of theother 16 cases underwent intracranial aneurysmal clipped operation，but 2 cases died because of complications，however mRSscore was five in cases，four in 3 cases， three in 3 cases，and two in 6 cases. Conclusion　Incidence of intracranial aneurysmis relatively high，however clinical manifestations and imaging findings may be atypical in some patients with intracranialaneurysm，which is very easily lead to missed diagnosis and misdiagnosis（such as transient ischemic attack，intracranialtumors， intracranial tumors and hypertensive cerebral hemorrhage），thus clinicians and imaging doctors should enhance theawareness to such patients and improve the diagnostic efficiency，moreover suggest the active surgical treatment if conditions permit.

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