中脑周围非动脉瘤性蛛网膜下腔出血的诊治

目的本探讨中脑周围非动脉瘤性蛛网膜下腔出血(PNSAH)的临床发病特点、影像学特点以及诊治。方法回顾性分析我科连续收治的92例脑血管造影(CAG)阴性SAH，发现PNSAH21例。所有患均进行CT、全脑血管造影、MR检查，16例行CT血管造影(CTA)检查。结果所有患无意识障碍，Hunt Hess分级1～2级，CT上SAH位于中脑周围的脑池内，Fisher分级梗阻2～3级。CAG、CTA和MR均无阳性发现。采用对症治疗，无再出血、症状性脑血管痉挛和脑积水等并发症，GOS均为优。结论PNSAH是一种预后佳且并发症低的良性SAH。首次CAG和CTA检查均正常的典型患，1月后可只行CTA省肯略CAG复查。

Perimesencephalic nonaneurysmal subarachnoid hemorrhage: diagnosis and treatment

Objective To investigate the features of clinical occurrence, imaging, diagnosis and treatment of Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH). Methods We carried out a retrospective analysis of 92 consecutive patients with SAH and negative cerebral angiography (CAG). We identified 21 cases with the PNSAH. All the patients received computed tomography (CT), CAG, and magnetic resonance (MR). Sixteen patients also underwent CT angiography (CTA). Results All patients were conscious, whose Hunt and Hess scale were Grade I to II. All the CT scan revealed SAH located in the perimesencephlic cistern and that Fisher Grade were 2 to 3. The CAG, CTA, and MR imaging failed to show any positive finding. Patients treated with medical therapy didn't be found any complications such as rebleeding, symptomatic vasospasm, and hydrocephalus. The Glasgow outcome scales (GOS) were good in all patients. Conclusion The PNSAH is a distinct clinical entity, with a good prognosis, low rate of complications and benign nature history. If the PNSAH patients with a typical CT pattern were normal in first CAG and CTA, they only needed repeated 3D-CTA and no CAG checking a month later.