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目的:探讨急性闭角型青光眼患者被误诊为患有偏头痛的原因。方法:对2例急性闭角型青光眼误诊为患有偏头痛的患者的临床资料进行回顾性分析。结果:急性闭角型青光眼发作时,可导致患者的眼压急剧升高,使其眼内的三叉神经末梢受到刺激,同时反射到该神经的眼支分布区,如脑血管、脑膜血管、静脉窦等处。这些组织都为痛觉敏感组织,受刺激后引起P物质、降钙素基因相关肽(CGRP)和其他神经肽释放增加,引起血管扩张,使患者出现搏动性头痛。结论:神经内科医师在临床工作中,遇到以头痛、恶心、呕吐等为主要症状的病人时(尤其老年患者)且排除其患有脑出血,在考虑偏头疼诊断时,应想到其患有急性闭角型青光眼急性发作的可能。应仔细询问患者的病史、发病特点、伴随症状,并仔细检查其眼部或及时请眼科医生前来会诊,做出及时准确的诊断及治疗,防止误诊、误治。
Objective: To investigate the causes of misdiagnosis of migraine in patients with acute angle-closure glaucoma. Methods: The clinical data of 2 patients with acute angle-closure glaucoma misdiagnosed as migraine were retrospectively analyzed. Results: The onset of acute angle-closure glaucoma can lead to the sharp increase of intraocular pressure and irritation of the trigeminal nerve endings in the eye, which is reflected to the distribution of eye branches of the nerve such as cerebrovascular, meningeal vessels and veins Sinus and other places. These tissues are all pain-sensing tissues that are stimulated to cause increased release of substance P, calcitonin gene-related peptide (CGRP) and other neuropeptides, causing vasodilation and giving patients a pulsating headache. CONCLUSIONS: In clinical practice, neurologists encounter headaches, nausea and vomiting as the main symptoms (especially in elderly patients) and exclude them from having intracerebral hemorrhage. When considering the diagnosis of migraine, they should think of Acute angle-closure glaucoma may be acute attack. Should be carefully asked about the patient’s medical history, the incidence of symptoms, accompanied by symptoms, and carefully check their eyes or timely ophthalmologist came to consultation, make timely and accurate diagnosis and treatment to prevent misdiagnosis and mistreatment.