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【摘要】 目的 总结老年低血糖昏迷误诊为脑梗死的原因，探讨防范误诊的方法。方法 对我院21例老年低血糖昏迷误诊为脑梗死患者的病史资料进行回顾性分析。结果 21例患者以急性脑梗死收住，确诊为低血糖昏迷后经治疗后意识均转清醒,肢体瘫痪恢复,病理征转阴。结论 对老年糖尿病患者有神经症状者，临床医生的诊断不要仅局限于脑血管意外，鉴别诊断应考虑低血糖昏迷，常规查血糖，并详细询问病史，仔细查体，以减少误诊。�
【关键词】 低血糖；昏迷；老年；误诊；脑梗死��
Clinical analysis in 21 elderly cases with hypoglycemia misdiagnosed as cerebral infarction
XU Nan,XU Yan-cheng.Depatment of Endocrinology, Wuhan University Zhongnan Hospital ,Wuhan 430071,China
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【Abstract】 Objective To study the reason of elderly hypoglycemia misdiagnosed as cerebral infarction and to explore the way of preventing misdiagnosis. Methods The clinical date of 21 patients with diagnosis of hypoglycemia be misdiagnosed as cerebral infarction were reviewed retrospectively.Results 21 patients misdiagnosed as acute cerebral infarction were diagnosed with hypoglycemia finally and sober awareness of all, the restoration of paralyzed limbs, pathological levy negative after treatment.Conclusion Elderly diabetic patients have neurological symptoms, the diagnosis are not only confined to the cerebral vascular accident, should be consider the differential diagnosis of hypoglycemia, the convention to examation of the blood sugar, and the detailed inquiry medical history, the careful physical examination could reduces misdiagnosis.�
【Key words】
Hypoglycemia; Coma; Elderly; Misdiagnosis; Cerebral infarction
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低血糖症(hypoglycemia)是血浆葡萄糖浓度低于2.8 mmol/L，而导致脑细胞缺糖的临床综合征［1］，严重时可引起明显的脑部症状。尤其是老年人可突发意识障碍、肢体瘫痪，甚至抽搐发作等，临床首先考虑到脑血管病。我院2003年12月至2010年12月共收治低血糖昏迷176例,其中21例误诊为脑梗死，现就误诊原因分析如下。�
1 资料与方法�
1.1 一般资料 本组男11例,女10 例,年龄57~72岁，平均64.3岁。糖尿病病史13例,长期吃消渴丸5例,优降糖5 例,胰岛素2例,没经确诊仅凭尿糖(+）~（+ + +)自服糖乐胶囊、胰糖平、苗族糖方、金荞麦胶囊等广告降糖药9例。酗酒者2例。21例患者均误诊急性脑梗死，误诊时间12 h内。临床表现:昏迷21例,伴一侧肢体活动受限15 例,抽搐9例，大汗淋漓5例,精神症状6例。椎体束征阳性20例，肌力3~4级9例,4~5级12例。意识恢复后仍有局灶体征3例,反复抽搐6例。本组均行颅脑CT检查，6例均阴性，9例示基底节区腔隙性脑梗死，6例示陈旧性脑梗死灶。检测血糖水平均低，其中
