临床误诊误治

目的 探讨后循环脑梗死（POCI）的临床特点、误诊原因及预防措施。方法 分析2021年5月至2023年6月收治的4例POCI患者误诊为梅尼埃病的临床资料。结果 本组4例均以眩晕（持续性眩晕3例，阵发性眩晕1例）为主诉就诊，伴恶心呕吐2例，步态不稳2例，耳鸣3例，头痛1例，听力损害3例。4例患者均误诊为梅尼埃病，误诊时间3～6(4.34±1.06)d。本组4例患者接受对症治疗后，临床症状无改善，停药后眩晕仍反复出现且加重，入院后经详细询问病史，进一步完善相关检查（头脉冲-眼震-眼偏斜试验、头颅磁共振血管成像），结合疾病的特点及检查结果，最终确诊为POCI，梗死部位：脑桥2例，小脑1例，枕叶1例。确诊后给予规范化对症治疗，患者病情转归良好，出院后随访3个月，无后遗症发生。结论 POCI症状复杂多样，且早期影像学检查阳性率低，易误诊为梅尼埃病。初诊医师应提高对POCI的鉴别能力，熟悉眩晕性疾病诊断流程，完善相关检查，做到早确诊早治疗，减少POCI误诊的发生。

Objective To explore the clinical features, causes of misdiagnosis and preventive measures of posterior circulation cerebral infarction(POCI). Methods The clinical data of 4 patients with POCI who were misdiagnosed as having Meniere's disease from May 2021 to June 2023 were analyzed. Results All 4 patients in this group presented with vertigo as the chief complaint(3 patients with continuous vertigo and 1 patient with paroxysmal vertigo), accompanied by nausea and vomiting in 2 patients, unsteady gait in 2 patients, tinnitus in 3 patients, headache in 1 patient, and hearing impairment in 3 patients. All 4 patients were misdiagnosed as Meniere's disease, and the misdiagnosis lasted 3-6(4.34±1.06) d. After receiving symptomatic treatment, the clinical symptoms of the 4 patients in this group did not improve. After drug withdrawal, vertigo still recurred and worsened. After admission, based on detailed inquiry of the medical history and further completion of relevant examinations(head pulse-nystagmuseye deviation test, head magnetic resonance angiography), combined with the characteristics of the disease and the examination results, it was finally diagnosed as POCI. Infarction site included pons in 2 patients, cerebellum in 1 patient and occipital lobe in 1 patient. After diagnosis, standardized symptomatic treatment was given, and the patient had a good outcome. During the 3-month follow-up after discharge, no sequelae occurred. Conclusion The symptoms of POCI are complex and diverse, and the positive rate of early imaging examinations is low, making it more likely to be misdiagnosed as Meniere's disease. Physicians conducting the initial diagnosis should enhance their ability to differentiate POCI, be familiar with the diagnostic process of vertigo diseases, complete relevant examinations, and achieve early diagnosis and early treatment, so as to reduce the occurrence of misdiagnosis of POCI.