中脑周围非动脉瘤性蛛网膜下腔出血患者的临床特点

目的　探讨中脑周围非动脉瘤性蛛网膜下腔出血(PNSH)患者的临床特点、放射学特点、诊断标准和预后。 方法 回顾性分析476例行数字减影全脑血管造影检查(DSA)的蛛网膜下腔出血(SAH)患者的临床和影像学资料,其中97例患者的DSA检查为阴性,患者在SAH后3 d内作头颅CT平扫,根据CT平扫检出了17例患者出血仅限于中脑周围脑池。 结果 17例患者SAH发作时均无意识丧失,无神经系统定位体征。所有患者的Hunt-Hess分级均为Ⅰ级或Ⅱ级。17例PNSH患者的随访期为10~70个月,平均随访44个月。无再出血、脑血管痉挛和脑积水。一般对症治疗,远期生活质量很高。 结论　PNSH临床表现平稳,影像学检查独特,恢复期短,预后良好,无再出血及脑缺血。正确认识、诊断PNSH,可以缩短住院时间,减少重复脑血管造影及开颅手术探查。

Clinical features of perimesencephalic nonaneurysmal subarachnoid hemorrhage

Objective To investigate the clinical and radiological features, diagnostic criteria, and prognosis of perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH) . Methods The authors presented a retrospective analysis of 476 patients presenting subarachchnoid hemorrhage (SAH) with whom digital subtraction angiography (DSA) was primarily taken at West China Hospital from January 1998 to December 2002. From the 97 cases with normal angiogram, 17 cases were found that the blood was confined within perimesencephalic cisterns in the reexamined CT within three days after the SAH onset, and diagnosed as PNSH. The cohort included 9 men and 8 women whose median age was 58 years (range from 38 to 72 years). Long term follow up was evaluated by reviewing the outpatient files and dedicated outpatients review. The mean fellow-up period was 44 months (range 10-70 months). Results There was no loss of consciousness and focal neurological deficit in the cohort of the 17 patients. All patients were classified Hunt and Hess Grade I or II at initial examination. During follow-up period none experienced rebleeding, cerebral artery vasopasm and hydrocephalus, and the quality of life in the long term was excellent after symptomatic care. Conclusion Patients with PNSH have even clinical condition, unique radiological features, short-term convalescence and excellent outcome with no happens of re-bleeding and cerebral ischemia. It is important that the correct diagnosis of PNSH to avoid unnecessary surgical exploration and repetition of angiographic examination.