原发性脑室出血的诊断、病因及预后(附20例病例报告)

目的 :探讨原发性脑室出血 (PIVH)的诊断、病因和预后。方法 :回顾性分析 2 0例 PIVH患者的临床资料、辅助检查、治疗结果。结果 :2 0例中 19例经头颅 CT、 1例经 MRI检查证实为 PIVH,8例行脑血管造影检查 ,病因为脑动静脉畸形者 5例 (2 5 % ) ,脑动静脉畸形伴动脉瘤者 1例 (5 % ) ,Moyamoya病 1例 (5 % ) ,高血压者 5例 (5 5 % ) ,病因不明者 2例 (10 % )。 5例全脑室出血者全部存活 ,15例部分脑室出血者 3例发生再出血 ,其中 2例死亡。结论 :头颅CT可以确诊 PIVH,脑血管造影对于明确出血的病因很有帮助 ,PIVH的病死率与出血量之间关系不大 ,而与再出血之间关系密切     

脑血管造影阴性的蛛网膜下腔出血病因诊断

<正> 近年来急性蛛网膜下腔出血(SAH)的病因学研究不断深入,尽管动脉瘤破裂是该病的最常见原因,但仍有15％的SAH患者首次脑血管造影表现阴性结果。这一部分患者愈后良好,但仍有20％出现脑出血、脑缺血、脑积水等并发症,进一步的放射学检查可有约0～24％的阳性结果发现。本文分析36例,结合文献报告,探讨其病变特点与病因如下。 临床资料 1.一般资料 1999年6月～2002年6月经脑血管造影阴性的SAH36例,约占同期自发性SAH的18％(36/190),其中     

102例自发性脑室出血的临床分析

目的探讨自发性脑室出血的病因。方法回顾性分析2001年1月～2010年6月间收治的102例自发性脑室出血的临床资料。患者按年龄分为4组:1月～3岁者8例,3～40岁12例,40～60岁67例,>60岁15例,除婴幼儿外均行全脑血管造影或CT血管造影。结果主要的出血原因为烟雾病、动脉瘤、高血压和原因不明,不同年龄组的主要出血原因不同,1月～3岁者主要原因是维生素K缺乏,3～40岁组是血管畸形,40～60岁组是烟雾病和动脉瘤,>60岁组是高血压病。结论要明确自发性脑室出血病因应根据病史和行全脑血管造影或CT血管成像检查,不同年龄组的患者自发性脑室出血主要原因不同。     

脑室出血82例临床治疗分析

目的总结脑室出血治疗的体会。方法对2003年6月至2006年6月我院收治的82例脑室出血病人的临床资料进行回顾性分析。此82例病人中，经DSA或CTA检查发现，脑动静脉畸形8例，颅内动脉瘤4例，Moyamoya病2例，余未查明出血原因（有的未做脑DSA或CTA检查）。采用脑室外引流术并尿激酶治疗68例，开颅手术治疗6例（4例颅内动脉瘤和2例脑动静脉畸形），介入治疗6例（均为脑动静脉畸形），保守治疗2例。大部分行双侧脑室穿刺（3例单侧）外引流治疗。发病至手术时间为2。24h。结果82例中，治愈30例，好转37例，长期植物状态3例，死亡12例。结论脑室出血患者意识障碍与脑室积血的量有直接关系，脑室外引流是治疗脑室出血的一种有效方法；脑室出血的病因治疗也非常重要。     

脑室穿刺引流治疗原发性脑室出血

脑室穿刺引流治疗原发性脑室出血杨建芳原发性脑室出血（ＰｒｉｍａｒｙＩｎｔｒａｖｅｎｔｒｉｃｕａｒＨｅｍｏｒｒｈａｇｅ简称ＰＩＶＨ），一直被认为是病情严重、预后不良的疾病［１］，但近年来由于ＣＴ问世及治疗水平的提高，特别是脑室穿刺术技术的开展，已明显降...     

数字减影全脑血管造影384例结果分析

目的探究数字减影全脑血管造影(DSA)的方法、效果及并发症。方法选取我院2009-08—2011-04神经内科行DSA检查的384例患者,对检查结果及DSA并发症情况进行回顾分析。结果 384例患者DSA检查共发现672处异常或病变,226例脑梗死患者共发现490处,52例TIA患者共发现80处,160例VBI患者共发现102处;行DSA患者术后出现并发症17例,并发症率4.4%,其中皮下血肿发生率最高,为47.1%,其并发症经对症处理后均获得缓解;所有患者均获得随访,平均随访(1.6±0.3)a,无并发症后遗症及DSA致病死患者。结论数字减影全脑血管造影能够有效诊断脑梗死、短暂性脑缺血及椎基底动脉供血不足等脑血管疾病,但由于穿刺诊断属于有创操作,医师应在操作中谨慎、仔细,避免由于动脉血管受损导致的并发症,保证患者生存质量。     

原发性脑室出血16例报告

原发性脑室出血１６例报告刘福星，侯健临床资料１、一般资料：本组男１１例，女５例，年龄最小２２岁，最大７５岁，平均５２．５岁，其中４６～６５岁最多，共１１例。有高血压史者１０例，慢性头痛史３例。发病时舒张压超过１４．７ｋＰａ者１２例，正常者２例，余２例...     

原发性脑室出血10例临床分析

近年来，由于应用灭鼠方法不当及鼠药泛滥，造成很多氟乙酰胺中毒患者，尤以农村地区为重。儿童由于识别能力差，常常造成误服，给临床诊治造成困难，为提高对该病的认识，我们分析1997-07～2003-07共32例儿童中毒者的神经系统表现，报告如下。     

缺血性脑卒中患者的数字减影脑血管造影的研究

目的探讨缺血性脑卒中患者全脑血管造影的特点。方法对243例缺血性脑卒中患者进行全脑血管造影检查,回顾性分析脑动脉颅内动脉狭窄、颅外动脉狭窄的发生率及其分布情况。结果在243例缺血性脑卒中180例（74.07%）存在脑动脉狭窄或闭塞,前循环动脉狭窄或闭塞82例（45.46%）,后循环52例（28.89%）,前后循环均有46例（25.56%）。颅内动脉狭窄或闭塞48例（26.67%）,颅外动脉86例（47.78%）,颅内、外动脉均有46例（25.56%）。180例中共发现狭窄血管356支,单支血管病变82例,多支血管病变98例。颅外血管狭窄以颈内动脉颅外段最多,颅内血管狭窄以椎动脉颅内段和大脑中动脉为多。结论脑血管造影可以准确地评价缺血性脑卒中患者脑动脉狭窄的分布情况及其程度,为临床提供了诊治依据。     

影响原发性脑室出血预后因素的研究

目的 :探讨影响原发性脑室出血预后的因素。方法 :分别从年龄、脑室积血程度、脑室内积血 CT值和GCS(Glasgow coma scale)四个方面对 36例原发性脑室出血患者死亡率的影响进行分析。结果 :通过χ2 检验和L ogistic回归分析 ,CT值≥ 6 5 Hu组死亡率显著高于 CT值 <6 5 Hu组 (P<0 .0 1) ;GCS≤ 7组死亡率高于 GCS>7组(χ2 检验 P<0 .0 5 ,L ogistic回归分析 P>0 .0 5 ) ;全脑室积血组死亡率高于部分脑室积血组 (L ogistic回归分析 P<0 .0 5 ,χ2 检验 P>0 .0 5 ) ;而不同年龄组死亡率则无影响。结论 :急性期脑室内积血的 CT值高低是影响原发性脑室出血预后的主要因素 ,其次可能是脑室内积血程度和病情轻重     

烟雾病致脑室出血的脑血管影像学特点

目的探讨烟雾病致脑室出血的脑血管影像学特点。方法回顾性分析64例烟雾病致脑室出血患者的临床资料。结果本组患者DSA检查示,双侧病变58例、单侧病变6例,合并动脉瘤4例;均见烟雾状血管。其中双侧大脑前动脉闭塞4例(6.3%),双侧大脑中动脉闭塞2例(3.1%),脉络膜前动脉远端闭塞41例(64.0%),后交通动脉远端闭塞11例(17.2%),单侧颈内动脉分叉处或大脑前动脉A1段、大脑中动脉M1段闭塞共6例(9.4%)。脉络膜前动脉异常扩张和延长108支(84.4%),后交通动脉异常扩张或延长26支(20.3%)。结论脉络膜前动脉和/或后交通动脉扩张、延长是烟雾病致脑室出血的脑血管影像学特点,并且这也可能是烟雾病致脑室出血的主要病因。     

蛛网膜下腔出血脑血管造影假阴性原因分析

目的 探讨蛛网膜下腔出血(SAH)脑血管造影假阴性发生的可能原因,提高SAH病因诊断的准确性.方法 回顾性分析452例SAH患者的脑血管造影结果初次阴性52例,复查造影25例,发现6例有异常病变:4例前交通动脉瘤,1例C<,2>段动脉瘤,1例脑血管畸形.结果 结合文献对这6例初次脑血管造影假阴性的原因进行分析,总结发生假阴性的原因.结论 SAH造影时应采用高分辨率的造影机;二维造影时要多角度投射,避开血管间的重叠;必要时采用三维血管重建;提高阅片医生的能力;初次阴性病例可配合CTA、MRA检查且必须强调全面细致复查造影.     

原发性脑室内出血47例前瞻性临床研究

目的 研究并明确原发性脑室内出血(PIVH)的病因、临床特征、危险因素和预后.方法 前瞻性地制订严格的纳入标准,连续收集2008年9月至2010年10月在我院诊治的PIVH患者,对其临床资料、辅助检查、治疗方式及预后进行分析.结果 共纳入47例患者,男27例,女20例,比例为1.35∶1,平均年龄(52.6±126)岁.GCS评分10.8±2.6;Graeb评分5.8±26;合并梗阻性脑积水者22例(47%);确诊Moyamoya病12例(26%),动静脉畸形10例(21%)和动脉瘤5例(11%),病因不详20例(43%).单纯开颅手术12例(26%),开颅联合脑-硬膜-血管-肌肉血管融合术(EDAMS)6例(13%),单纯EDAMS治疗5例(11%),EDAMS联合吻合手术1例(2%),脑室外引流3例(6%),γ-刀治疗8例(17%),介入治疗2例(4%o),保守治疗10例(21%).患者均随访6个月,住院死亡7例(15%),6个月末mRS评分＜3分者31例(66%),≥3分者9例(19%),出院后无死亡病例.结论 PIVH临床少见,发病年龄相对较小;Moyamoya病、动静脉畸形和动脉瘤是排前三位的病因,高血压是最主要的危险影响因素;通过合理治疗,PIVH可获得较好的预后;年龄、高血压、糖尿病、吸烟史及入院时GCS评分可不同程度预测住院死亡率.

Abstract：

Objective To define the clinical features, risk factors, etiology and prognosis of primary intraventricular hemorrhage (PIVH).Methods We prospectively formulated strict inclusive criteria and consecutively collected patients with diagnosis and treatment for PIVH in our hospital from September 2008 to October 2010.The clinical information, laboratory examinations, treatment and prognosis were analyzed.Results 47patients(27 males and 20 females, a ratio of 1.35: 1, with an average age of 52.6 ± 12.6 years old) were internalized in the study.The initial symptoms were headache in 24 cases, and disturbance of consciousness in 23 cases.The GCS score was 10.8 ± 2.6 and Graeb score was 5.8 ± 2.6.Combined obstructive hydrocephalus was found in 22 cases (47%).The diagnosis of moyamoya disease was confirmed in 12 patients (26%), while vascular malformations in 10 (21%) and aneurysm in 5( 11% ).The other 20 patients had unknown etiology (43%).Craniotomy was performed in 12 cases (26%), craniotomy combined EDAMS in 6(13%), EDAMS in 5(11% ), EDAMS combined with anastomosis in 1(2% ), ventricular drainage in 3(6% ), γ-knife in 8( 17% ), interventional therapy in 2(4% ), and conservative treatment in 10 patients (21%).All patients were followed - up for 6 months.7 cases of hospital mortality (15%) were found.31 patients (66%) got less than 3 points of mRS score at the end of the 6th month, and 9 patients ( 19% ) had greater than or equal to 3 points.After discharge there was no death.Conclusion PIVH is relatively rare in clinical practice.The age of onset for PIVH is relatively small.Moyamoya disease, AVM and aneurysm are ranked the top three causes, and hypertension is the most important risk factor.Through reasonable treatment, patients with PIVH could get better prognosis.Age, hypertension, diabetes, smoking history and admission GCS score could predict hospital mortality in varying degrees.     

Intraventricular thrombolysis with rt-PA in patients with intraventricular hemorrhage

Dunatov S, Antoncic I, Bralic M, Jurjevic A. Intraventricular thrombolysis with rt‐PA in patients with intraventricular hemorrhage.
Acta Neurol Scand: 2011: 124: 343–348.
© 2011 John Wiley & Sons A/S. Objectives – To evaluate safety, clinical feasibility, and outcome of intraventricular (IVen) administration of recombinant tissue plasminogen activator (rt‐PA) in patients with intraventricular hemorrhage (IVH). Materials and methods – Forty‐eight patients with IVH who received IVen rt‐PA were compared with 49 age‐, sex‐, Glasgow Coma Scale score‐, and Intracerebral Hemorrhage score‐matched control patients. Patients with IVH of aneurysmal or arteriovenous malformation origin were excluded. External ventricular drainage was inserted as soon as baseline CT was performed and rt‐PA was administered within 12 ± 1 h after the ictal onset. Results – The outcome after 3 months was evaluated using the modified Rankin Scale (mRS). In addition, Glasgow Outcome Scale (GOS) and mortality were assessed. A good outcome, defined as mRS 0–3, was detected in 27% of patients from the control group vs 58% of patients in the IVen group; P = 0.003. GOS as other outcome scale yielded a significant difference between groups: 20% in the control group, vs 54% in the IVen group; P = 0.001. A statistically significant decrease in mortality was observed in the IVen group: 30% in the control vs 10% in IVen group; P = 0.003. No one patient died because of a complication which could be directly attributed to the IVen thrombolytic therapy. Conclusions – IVen administration of rt‐PA seems to be safe in cases of IVH. This pilot study shows that it may be associated with better outcomes. Further studies and clinical randomized trials are needed to establish indications and IVen administration protocols.     

Cerebral vasospasm associated with intraventricular hemorrhage

Background and Purpose: Cerebral vasospasm remains a major complication associated with aneurysmal subarachnoid hemorrhage. Although several case reports have demonstrated that intraventricular hemorrhage (IVH) related to a ruptured arteriovenous malformation can result in vasospasm in the absence of subarachnoid hemorrhage, to our knowledge, this is the first case report of cerebral vasospasm associated with primary IVH. Case Report: A 44-year-old female was admitted with cerebellar infarction secondary to left posteroinferior cerebellar artery occlusion. Her hospital stay was complicated by primary IVH. Three days after her IVH, she became disoriented and developed a peculiar interest in counting numbers. This behavioral change was associated with an increase in cerebral blood flow velocity in the anterior circulation. Middle cerebral artery M1 velocity almost doubled from 65 to 130 cm/second. Her symptoms resolved with initiation of hypervolemia, hypertension, and hemodilution (triple H) therapy. Conclusions: Cerebral vasospasm may contribute to the comorbidities of IVH. Routine transcranial Doppler may be warranted for screening of cerebral vasospasm in IVH patients.     

CT angiography demonstration of the development of intraventricular hemorrhage during aneurysm rupture

The authors present the 3D reconstructed CT angiography image of extravasation from a rebleeding aneurysm. Direct hemorrhage of a bleeding aneurysm into the lateral ventricle was detected by CT angiography. This image clearly visualized that extravasated contrast medium spurting from a rupturing anterior communicating artery aneurysm, penetrated the ventricle wall and passed through the lateral ventricle to reach the temporal horn. This case provides a real-time demonstration of the way how an intraventricular hemorrhage develops during rupture of an anterior communicating artery aneurysm.     

自发性脑出血破入脑室对患者预后的影响

目的分析自发性脑出血伴发脑室出血的概率以及脑室出血的解剖部位并对脑出血病人的预后进行评估。方法作者回顾性分析了长沙市第四医院脑血管疾病中心7年来收治的自发性脑出血病人的CT结果和临床病例资料,对病人进行遴选,统计破入脑室的概率以及出血的解剖位置和破入脑室的关系和病人的预后情况。结果共统计了307例自发性脑出血的患者,其中39.7%伴有脑室出血。通过统计得出丘脑和尾状核的出血最容易破入脑室(分别为52.7%和100%)。在病人发病后第三个月时对患者进行随访和mRS预后评分,分值越高提示预后越差。伴有脑室出血的病人的平均mRS评分是不伴有脑室出血的病人的近2倍。结论很多自发性脑出血的病人都伴有脑室出血,这种出血发生概率和脑出血的量和部位密切相关。脑出血的病人如果合并脑室出血通常提示患者预后不良。     

外伤性脑室内出血31例临床分析

目的分析总结外伤性脑室内出血的诊断和治疗特点。方法对过去10年来31例外伤性脑室内出血的的病因学、影像学、诊断和治疗特点进行分析。结果多数为车祸致伤，重型颅脑伤占26例。原发TIVH17例，继发TIVH14例。脑室出血量按Graeb法分类：1～4分(轻度)12例，5～8分(中度)10例．9M2分(重度)9例。28例合并其他颅脑损伤。伤后6个月GOS评分：死亡14例，植物状态1例，重残2例，中残5例，良好9例。结论闭合性颅脑损伤后TTVH的发生率较低，反映了脑损伤的严重程度。     

纤溶酶元激活剂在重度脑室内出血治疗中的应用

目的 总结纤溶酶元激活剂尿激酶和重组链激酶在脑室内出血治疗中的效果。方法 对30例重度脑室内出血病人行单侧或双侧侧脑室外引流，经引流管注入纤溶剂进行纤溶治疗。结果 30例中，29例引流效果良好。术后第4d脑室积血减少50%以上，术后第7d18例积血基本消失，8例积血减少80%。3例术后术后发生再出血。死亡2例。结论 早期脑室外引流及纤溶治疗重度脑室内出血效果良好。