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目的探讨慢性苯妥英钠中毒性脑病的临床特点,分析误诊原因并提出防范措施。方法对1例在外院多次误诊的慢性苯妥英钠中毒性脑病的临床资料进行回顾性分析并复习相关文献。结果本例因反复发作性头晕伴视物模糊2年余,加重伴饮水呛咳、言语不清1个月,再次加重伴烦躁、幻视3 d入院。曾在外院多次就诊,诊断为椎动脉供血不足及多发性硬化,经相关治疗后症状逐渐加重并出现精神行为异常,入我院后经追问病史得知患者有癫痫病史9年并长期不规律口服苯妥英钠,查脑电图示弥漫性慢波,苯妥英钠血药浓度>40 mg/L,诊断为慢性苯妥英钠中毒性脑病,立即停用苯妥英钠,改用奥卡西平抗癫痫,同时加强补液、利尿促进药物排泄,2周后头晕及精神症状消失且苯妥英钠血药浓度降至0.5 mg/L,1个月后复查脑电图正常。结论临床接诊以发作性头晕就诊的苯妥英钠不规律口服者应想到中毒性脑病可能,对此类患者应监测血药浓度,做到早发现、早治疗,避免误诊误治。
Objective To investigate the clinical features of chronic phenytoin toxic encephalopathy, analyze the causes of misdiagnosis and put forward preventive measures. Methods A retrospective analysis and review of the clinical data of 1 case of chronic phenytoin toxic encephalopathy misdiagnosed outside the hospital were performed. Results of this case because of repeated episodes of dizziness with blurred vision more than 2 years, aggravating with drinking water cough, ill-defined 1 month, aggravated again with irritability, visual field visualization 3 d admission. Have seen multiple visits to the hospital, diagnosis of vertebral artery insufficiency and multiple sclerosis, after treatment, the symptoms gradually aggravated and mental disorders, into our hospital after the medical history of patients with epilepsy history of 9 years and long-term irregular Oral phenytoin, check EEG diffuse slow wave, phenytoin plasma concentration> 40 mg / L, diagnosed as chronic phenytoin toxic encephalopathy, immediately stop phenytoin sodium, switch to oxcarbazepine antiepileptic, while strengthening Rehydration, diuretic promote drug excretion, 2 weeks after the disappearance of dizziness and psychiatric symptoms and phenytoin sodium plasma concentration decreased to 0.5 mg / L, 1 month after the review of normal EEG. Conclusions Clinical admissions to patients with episodic dizziness treatment of irregular oral phenytoin should think of toxic encephalopathy may be for such patients should monitor blood concentration, early detection and early treatment to avoid misdiagnosis and mistreatment.