临床上如何鉴别癫痫与晕厥.doc

How to identify clinical epilepsy and syncope（临床上如何鉴别癫痫与晕厥）The differential diagnosis of syncope and epilepsy is quite difficult. According to statistics, about l / 3 of patients with syncope misdiagnosed as epilepsy. Syncope and epilepsy misdiagnosed due to both the Department of common clinical, and accompanied by many of the same episodic manifestations: loss of consciousness, pupil dilation, clonic beating tonic convulsions, incontinence, increased saliva secretion accompanied by vomiting fatigue after the onset of syncope and epilepsy are likely to occur.晕厥与癫痫的鉴别诊断是相当困难的。据统计大约l3的晕厥患者被误诊为癫痫。晕厥和癫痫极易误诊的原因是两者都系临床上常见，且伴有许多相同的发作性表现：意识丧失、瞳孔扩大、阵挛性跳动、强直性惊厥、大小便失禁、唾液分泌增多，伴有呕吐的发作后疲劳在晕厥和癫痫中都可能出现。How to identify clinical epilepsy and syncope临床上如何鉴别癫痫与晕厥1, the main clinical symptoms of syncope is loss of consciousness, and therefore subject to epileptic generalized tonic-clonic or tonic-clonic seizures, complex partial seizures identify absence seizures and only a disturbance of consciousness. In general, the following points to support the diagnosis of syncope.1、晕厥的主要临床症状是意识丧失，因而须与癫痫的全身性强直阵挛或强直阵挛发作、失神发作和仅有意识障碍的复杂部分发作鉴别。一般说来，以下几点支持晕厥的诊断。Seizures often induced by anxiety or pain.发作常由焦虑或疼痛诱导。Are standing or sitting.都在站立或坐位时发生。Accompanied by pale, sweating.伴有面色苍白、大汗。Tonic-clonic activity and the tongue bitten or after the onset of confusion, drowsiness and headache. Bradycardia support syncope attack, although some episodes may also have heart rate, but rarely cause bradycardia.无强直一阵挛活动和舌咬伤或发作后意识模糊、昏睡及头痛。发作时心率减慢支持晕厥，虽然部分发作也可有心率减慢，但很少引起心动过缓。2, EEG syncope and epilepsy to identify great value, tonic-clonic seizures in patients in the tonic phase showed amplitude gradually enhanced diffuse 10Hz wave the clonic phase for diffuse slow gradually slows, miscellaneousflocks of spikes, absence seizures can be seen in the regularity and symmetry 3Hz spike and slow wave, irregular the l 2.5Hz sharp - slow wave and spike - slow wave the intermittent period 80% of patients with abnormal EEG. Syncope slow-wave EEG intermittent majority of normal, such as it is still not confirmed, especially difficult to distinguish convulsive syncope and epilepsy, and 24-hour ambulatory EEG monitoring or video EEG in identifying special helpful.2、脑电图对晕厥和癫痫鉴别有很大的价值，强直阵挛发作的患者在强直期表现为振幅逐渐增强的弥漫性10Hz波，阵挛期为逐渐变慢的弥漫性慢波，杂以成群的棘波，失神发作可见到规律和对称的3Hz棘一慢波，不规则l25Hz尖-慢波和多棘-慢波，间歇期80%患者的脑电图异常。而晕厥患者主要为慢波，间歇期脑电图多数正常，如仍不能确诊者，尤其是很难区别惊厥性晕厥和癫痫时，24小时动态脑电图监测或视频脑电图在鉴别中特别有帮助。3, the primary symptoms of the disease also contribute to the differential between the two. Idiopathic orthostatic hypotension, syncope also impotence, sweating, sphincter dysfunction, pyramidal tract signs repeatedly lying orthostatic blood pressure systolic difference of 6.6 was measured.3、原发疾病的症状也有助于两者的鉴别。特发性直立性低血压除晕厥外还有阳萎、出汗、括约肌功能障碍、锥体束征等，连续多次测定卧立位血压收缩期相差66。4, syncope with absence seizures identify of the latter does not fall, the attack nor pale, sweat, and blood pressure changes, the onset and termination faster than syncope episodes state.4、晕厥与失神发作的鉴别主要是后者不跌倒，发作时也无面色苍白、大汗和血压改变，发作和终止都比晕厥快，没有明显的发作后状态。kPa or more to support the diagnosis. Ventricular fibrillation, tachycardia, atrial fibrillation, aortic valve stenosis is often the cause of cardiogenic syncope; hypoglycemia is also a common cause of syncope, blood glucose checks can be diagnosed; severe anemia and more in the case of hard syncope.kPa以上者支持诊断。心室纤颤、心动过速、心房纤颤、主动脉办狭窄常是心源性晕厥的病因；低血糖也常引起晕厥，血糖检查可以确诊；严重贫血多在用力的情况下出现晕厥。5, syncope is a transient reduction of cerebral blood flow in the brain diffuse ischemic syndrome, the clinical symptoms of the missing rather than irritation, loss of consciousness is often pale, cold sweats, seizuresrapidly falls, decreased muscle tone, limb rigidity, tongue bite, incontinence are relatively rare. Epilepsy is the result of abnormal activity of the neurons, the major clinical manifestations of irritation, rigidity, myoclonus, falls, tongue bite, incontinence than syncope are much more common twitch duration of longer than convulsive syncope.5、晕厥是脑血流一过性的降低导致脑部广泛性缺血的综合征，其临床症状主要是“缺失”而非刺激症状，故意识丧失前常有面色苍白、出冷汗，发作中迅速跌倒，肌张力降低，而肢体强直、舌咬伤、大小便失禁都比较少见。癫痫是神经元异常活动的结果，临床主要表现为刺激症状，故强直、阵挛、跌伤、舌咬伤、大小便失禁比晕厥常见得多，抽搐持续的时间也比惊厥性晕厥长。6, prodromal symptoms, such as abdominal discomfort, fear, facial flushing, dizzines