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目的 分析脊髓硬脊膜动静脉瘘(SDAVF)的误诊原因与防范措施。方法 回顾性分析2020年1月至2023年12月收治曾误诊的脊髓硬脊膜动静脉瘘患者3例的临床资料。结果 3例分别表现为单侧上肢感觉障碍、单侧下肢麻木无力、进行性加重的双下肢麻木无力伴腰部疼痛。误诊为短暂性脑缺血发作的1例给予相关治疗后症状无改善，予颈椎磁共振血管造影检查确诊；误诊为脊髓炎的1例经糖皮质激素治疗后症状加重，行手术探查确诊；误诊为腰椎间盘突出的1例行脊髓数字减影血管造影检查确诊。误诊时间6 d～3个月。确诊后2例给予手术治疗后好转；1例拒绝手术治疗，失访。结论 SDAVF罕见的起病形式、阴性的磁共振结果、异常脑脊液检查结果、假阴性的脊髓数字减影血管造影及多种疾病症状叠加均是导致误诊的重要原因，临床对疑似患者应提高警惕，详细询问病史，完善相关检查，避免误诊。
Abstract：Objective To analyze the causes of misdiagnosis and preventive measures of spinal dural arteriovenous fistula(SDAVF). Methods The clinical data of 3 patients with misdiagnosed SDAVF admitted from January 2020 to December 2023 were retrospectively analyzed. Results Three patients presented with unilateral upper limb sensory disturbance, unilateral lower limb numbness and weakness, and progressive aggravation of lower limb numbness and weakness with lumbar pain. One patient was misdiagnosed as transient ischemic attack, which was not improved after treatment, and was confirmed by cervical magnetic resonance angiography. The symptoms of 1 patient misdiagnosed as myelitis worsened after glucocorticoid treatment, and the diagnosis was confirmed by surgical exploration. One patient misdiagnosed as lumbar disc herniation was diagnosed by spinal digital subtraction angiography. The misdiagnosis lasted 6 d to 3 months. After diagnosis, 2 patients had improved condition after surgical treatment, and 1 patient declined surgical treatment and was lost to follow-up. Conclusion The rare onset of SDAVF, negative magnetic resonance results, abnormal results of cerebrospinal fluid examination, false negative digital subtraction angiography of spinal cord and the superposition of various disease symptoms are all important factors leading to misdiagnosis. Clinical vigilance should be raised for suspected patients, detailed medical history should be inquired, and relevant examinations should be performed to avoid misdiagnosis.
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基本信息:
DOI：
中图分类号:R744.1
引用信息:
[1]钟丹,邓珊.不典型脊髓硬脊膜动静脉瘘误诊原因探讨[J].临床误诊误治,2024,37(18):16-20+31.
基金信息:
柳州市科技计划项目(2024YB0101A010)