首诊于眼科的颅内静脉窦血栓形成误诊分析

目的探讨眼科临床工作中颅内静脉窦血栓形成(cranialvenoussinusthrombosis,CVST)误诊的常见原因。方法回顾性分析21例CVST患者的临床资料与误诊情况。结果本组以头痛为首发症状者4例,视物模糊6例,头痛伴视物模糊4例,一过性黑朦2例,视力下降3例,视物变形1例,眼前黑影飘动1例。本组21例眼底检查均表现为视盘水肿。其中首诊时8例误诊为视神经乳头炎,3例误诊为视盘血管炎,2例误诊为视神经网膜炎,2例误诊为屈光不正、弱视,1例误诊为缺血性视神经病变,1例误诊为视盘玻璃膜疣。4例没有明确诊断,只诊为视盘水肿。结论采集病史和体检不够全面以及对CVST的临床特征缺乏深入的认识是眼科临床工作中CVST误诊的主要原因。

Misdiagnose analysis of cranial venous sinus thrombosis in ophthalmology department

Objective To analyze the misdiagnosed causes of cranial venous sinus thrombosis inophthalmologic clinical practice.Methods The clinical data and misdiagnosed information of 21 patients withcranial venous sinus thrombosis were analyzed retrospectively.Results The initial clinical manifestations inthis series mainly included headache in 4 cases,blurred vision in 6 cases,headache companied with blurredvision in 4 cases,transient black dim in 2 cases,vision descent in 3 cases,dysmorphopsia in 1 case and shadowfloat front of eyes in 1 case.Ocular fundus examination of the 21 cases all showed papilloedema.Among the 21cases,8 were misdiagnosed as papillitis,3 were misdiagnosed as optic disc vasculitis,2 were misdiagnosed asneuroretinitis,2 were misdiagnosed as ametropia/amblyopia,1 was misdiagnosed as ischemic optic neuropathyand 1 was misdiagnosed as drusen of the optic disc,4 cases only diagnosed as papilloedema.Conclusions Themain misdiagnosed cause of cranial venous sinus thrombosis in ophthalmologic clinical practice is that someophthalmologists lack profound understanding on the clinical features of the disease and fail to make overallinterrogation or examination for the patients.