Analysis of the causes of misdiagnosis in posterior circulation cerebral infarction

WANG Xuanxuan; LI Chengxia; WU Jihua

doi:10.3969/j.issn.1002-3429.2025.24.002

Abstract：Objective To analyze the misdiagnosis causes and preventive measures of posterior circulation cerebral infarction(PCCI)as schizophrenia,vestibular neuritis,or Meniere's disease.Methods Clinical data of 3 patients with PCCI that had been misdiagnosed and then treated from June 2020 to June 2023 were retrospectively analyzed.Results One patient presented with visual hallucinations and speech-behavioral disorders for 7 d.The patient was initially diagnosed with schizophrenia,and treated accordingly,but the symptoms were not improved.After admission,according to the clinical symptoms,specialized examination and cranial magnetic resonance imaging(MRI),cerebellar infarction was diagnosed.The misdiagnosis lasted 7 d.One patient presented with paroxysmal vertigo with nausea,vomiting and tinnitus for 6 h.According to the clinical symptoms and specialized examination,it was considered as Meniere's disease.On the second day after symptomatic treatment,the vertigo showed progressive aggravation.The second physical examination and transcranial MRI T2 Flair sequence showed the high-signal shadow in the right cerebellar nodule,suggesting the ischemic lesion in the right cerebellar nodule(the right posterior inferior cerebellar artery supply area),which was diagnosed as acute cerebellar infarction.The misdiagnosis lasted 2 d.One patient was treated for sudden headache,dizziness and fever for 2 d.According to the clinical symptoms and signs,elevated white blood cell count,neutrophil count and lymphocyte count,and the cranial CT scan showing no obvious abnormality,vestibular neuritis was initially considered.At 3 d after treatment with anti-inflammatory,analgesic drugs and vestibular function improvement,the patient still experienced persistent pulsatile pain in the posterior occipital region,with rebound nystagmus and gaze-evoked nystagmus.Additional T2-weighted cranial MRI revealed ischemic foci in the left cerebellar vermis,paravermis,and cerebellar base(the blood supply area of the left posterior inferior cerebellar artery),confirming the diagnosis of acute cerebellar infarction.The misdiagnosis lasted 5 d.After the diagnosis,all the 3 patients were given Aspirin for antiplatelet aggregation,Atorvastatin to stabilize plaque,Ginkgo Biloba Ketone Ester dispersible tablets to improve cerebral circulation,Vitamin B12 for nerve nutrition and other symptomatic treatment,and they were discharged after improvement.Two patients were followed up for 6 months with good prognosis and no sequelae,except one patient who had residual mild hemiparesis on one side.Conclusion The complex anatomy and physiological structure of the posterior circulation lead to diverse and intricate symptoms and signs of PCCI,which is prone to misdiagnosis.In clinical practice,patients suspected of PCCI should undergo neuroimaging examinations such as cranial CT or MRI to reduce the early misdiagnosis rate of this disease.