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1.以癫痫样发作为突出表现1例:该例68岁,以反复意识丧失、抽搐4天来院。4天前于大便时突然晕倒,不省人事,口唇紫绀,四肢抽动,数秒钟自行缓解,发作间期感心慌、胸闷,诊为“癫痫”,予相应药物治疗无效,反复发作3次。查:神志清,BP10/6kPa,心率36次/分、律整,心音低钝,心电图示下壁心肌梗塞、Ⅲ度房室传导阻滞。该例误诊原因在于只偏重于表面现象,故突发晕厥的老年人,都应及时常规心电图检查。 2.以脑血管病变为首发症状者4例:如1例男性患者,72岁,因头晕、右侧肢体活动不便、失语4小时急诊。往有高血压病史。查体BP14/10kPa。言语不清,双侧瞳孔等大,露齿口角歪斜,颈软,心率76次/分,右肢肌力Ⅲ级,肌张力低,病理反射弱阳性。以“急性脑血管意外”相应治疗,次日症状明显缓解,查心电图示前壁急性心肌梗塞。
1 to epilepsy as a prominent manifestation of 1 cases: the case of 68 years old, with repeated loss of consciousness, convulsions 4 days to hospital. Suddenly fainted 4 days ago in the stool, unconsciousness, cyanosis of the lips, limbs twitching, a few seconds to ease themselves, seizures during a sense of panic, chest tightness, diagnosed as “epilepsy” to the appropriate drug treatment is invalid, recurrent 3 times. Check: delirious, BP10 / 6kPa, heart rate 36 beats / min, the whole law, low heart sound blunt, ECG lower wall myocardial infarction, Ⅲ degree atrioventricular block. The reason for this misdiagnosis is that only the emphasis on the surface phenomenon, so syncope of the elderly sudden, should be routine ECG. 2. Cerebral vascular disease as the first symptom in 4 cases: such as 1 case of male patients, aged 72, due to dizziness, right limb activity inconvenience, aphasia 4 hours emergency. To have a history of hypertension. Physical examination BP14 / 10kPa. Speech is unclear, bilateral pupils and other large, tooth mouth angle skew, neck soft, heart rate 76 beats / min, right limb muscle strength class III, low muscle tone, pathological reflex weak positive. To “acute cerebrovascular accident,” the corresponding treatment, symptoms were significantly alleviated the next day, check ECG showed anterior myocardial infarction.