延誤診斷之致命性「蜘蛛膜下腔出血」－個案報告及文選回顧

Delayed Diagnosis of Fatal Subarachnoid Hemorrhage: A Case Report and Literature Review

張家禎(Betty Chia-Chen Chang) ； 鍾嫈嫈(Jin-Jin Tjung) ； 鄭世榮(Shih-Jung Cheng) ； 黃榮貴(Jon-Kway Huang) ； 鄭碩仁(Sho-Jen Cheng) ； 鄒孟婷(Meng-Ting Tsou)

《台灣家庭醫學雜誌》 22卷1期 (2012/03) Pp. 34-40

https://doi.org/10.7023/TJFM.201203.0034

摘要

「蜘蛛膜下腔出血」是一個少見但致命的疾病。然而，「蜘蛛膜下腔出血」的病人常常只會以頭痛的症狀來求診，因而很容易被誤診而使得病人無法獲得適時適當的治療。一位沒有慢性病史的五十六歲女性。因為頭痛至基層醫療院所接受治療，但之後卻被診斷為致命性的「蜘蛛膜下腔出血」。病人的神經學症狀頭痛發生幾天後才出現，經及時轉診及緊急處理後，病人病情恢復的相當好。頭痛是基層醫療很常見的症狀。頭痛的原因中，會致命的「蜘蛛膜下腔出血」發生率不高而容易被誤診或被延遲診斷。因此家庭醫學科醫師必需對「蜘蛛膜下腔出血」的診斷具有更高的警覺性，並且能夠將它與其他良性的頭痛做鑑別診斷。

並列摘要

Subarachnoid hemorrhage (SAH) is a rare but fatal condition. Because headache may be the only complaint in a patient with SAH, the chance of a delayed or missed diagnosis in such a patient is quite high. We report the case of a 56-year-old woman without any systemic disease who presented to primary care with a headache but was later found to have a subarachnoid hemorrhage. The headache was initially perceived as benign but ptosis and diplopia appeared a few days later. The correct diagnosis was followed by prompt transcatheter arterial embolization, and the patient recovered without any sequelae. Headache is a very common complaint in primary care. Because of the low percentage of SAH in patients with headache, the diagnosis may be delayed or missed entirely. It is therefore important for primary care physicians to be aware of this possibility and to be able to distinguish it from benign headaches.

並列關鍵字

delayed diagnosis ； headache ； intracranial aneurysm ； primary health care ； subarachnoid hemorrhage

參考文獻

Bederson, JB,Connolly, ES, Jr.,Batjer, HH(2009).Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association.Stroke.40,994-1025.

De Rooij, NK,Linn, FH,van der, Plas JA(2007).Incidence of subarachnoid hemorrhage: a systematic review with emphasis on region, age, gender and time trends.J Neurol Neurosurg Psychiatry.78,1365-72.

Dhopesh, V,Anwar, R,Herring, C(1979).A retrospective assessment of emergency department patients with complaint of headache.Headache.19,37-42.

Edlow, JA,Caplan, LR(2000).Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage.NEJM.342,29-36.

Feigin, VL,Paraq, V,Lawes, CM(2005).Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the Asia-Pacific region: an overview of 26 cohorts involving 306,620 participants.Stroke.36,1360-5.