The predicted value of arteriography in nontraumatic intracerebral hemorrhage

We retrospectively assessed the diagnostic value of cerebral arteriography for the search of an etiology in 102 patients with nontraumatic intracerebral hemorrhages evaluated between 1980 and 1985. Arteriography was diagnostic in 22 of 50 non-hypertensive patients and in only 6 of 47 hypertensive patients. Five patients with a bleeding diathesis had normal arteriography. From the total group, we found 12 saccular aneurysms, 9 arteriovenous malformations, 3 cases of moya-moya and 3 instances of superior sagittal sinus thrombosis. One patient had metastatic choriocarcinoma. Sites of hemorrhage among all patients with diagnostic arteriograms were: lobar 19, intraventricular 5, thalamic 2, caudate 1, and corpus callosum 1. Lobar hemorrhages in the non-hypertensive group and intraventricular hemorrhages in hypertensive individuals had the highest yield of arteriographic abnormalities. We believe cerebral arteriography is indicated in non-hypertensive patients with lobar hemorrhages. Most hypertensive patients, in particular those with putaminal hemorrhages, do not require arteriography.     

Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis

BACKGROUND AND PURPOSE: The frequency of intracerebral hemorrhages (ICHs) in people aged 31 years (odds ratio, 3.48), and those with ICH that resulted from arteriovenous malformations were aged <20 years (odds ratio, 2.80). The final outcome was considered favorable in 60%. CONCLUSIONS: ICHs in young people are mainly lobar in location and result from vascular malformation. Hypertension causes most cases in which the ICH is located in the basal ganglia. Mortality and morbidity in the acute phase are low and are related to hypertension as the cause of ICH.     

Onyx治疗中～大型与巨大型脑动脉瘤和动静脉畸形

目的:介绍Onyx治疗脑动脉瘤和动静脉畸形。方法;采用Onyx栓塞4例颅内中～大型动脉瘤和1例巨大型动脉瘤,以及3例巨大型脑动静脉畸形。结果:5例脑动脉瘤中3例获得100％栓塞,2例95％以上栓塞,载瘤动脉均保持通畅。临床恢复良好,仅1例颈内动脉海绵窦段动脉瘤患者术后动眼神经麻痹症状略有加重。3例巨大脑动静脉畸形一次栓塞35％～40％左右。结论:Onyx栓塞中～大型和巨大型宽颈动脉瘤、栓塞脑动静脉畸形有独特的优越性,但长期疗效有待随访。     

Retinal hemorrhages. Its significance in 100 patients with acute encephalopathy of unknown cause

A total of 94 patients had subarachnoid hemorrhage and it was strongly suspected in the remaining six patients. Acute encephalopathy associated with independent ocular hemorrhage due to hypoxia, multiple emboli, or bleeding tendencies was not a diagnostic problem during this study. Aneurysms occurred in 64 patients (combined with vascular malformations in four), isolated vascular malformations in four; "spontaneous" hematomas in 13, evidence of cryptic head trauma in six, hemorrhage from a glioblastoma in one, and no cause was identified in six patients. Retinal hemorrhages were more prominent ipsilateral to the site of intracranial bleeding. No single aneurysm location predominated and multiple aneurysms were common. The high mortality of 56% supports previous conclusions that retinal hemorrhages tend to accompany severe intracranial bleeding.     

颅内动脉瘤破裂导致脑内血肿的诊断与治疗

目的探讨颅内动脉瘤破裂导致脑内血肿的诊断和治疗原则。方法本组男15例，女12例，年龄18～67岁，平均51岁。27例脑内血肿均经脑血管造影（DSA）或CT脑血管造影（CTA）检查确诊，其中前交通动脉瘤7例，后交通动脉瘤10例，大脑中动脉瘤9例，后交通动脉瘤合并大脑中动脉瘤1例。本研究对其临床表现、影像学特点及处理原则分别进行了分析。结果27例患者中有24例行开颅动脉瘤夹闭及血肿清除术，2例行股动脉穿刺血管内弹簧圈栓塞治疗，1例行DSA检查确诊动脉瘤后术前准备时再出血，抢救无效死亡。根据GOS分级，本组Ⅰ级3例，Ⅱ级1例，Ⅲ级3例，Ⅳ级7例，Ⅴ级13例。结论某些特殊部位的白发性脑内血肿，有可能是颅内动脉瘤破裂出血所致，需尽早行DSA或CTA检查明确诊断，治疗以手术为首选，术中夹闭动脉瘤并将血肿清除。     

Nontraumatic cerebral hemorrhage in the young: A study of 107 cases.

Background: Reports on intracerebral hemorrhage (ICH) in the young are rare, and information on the cause and prognosis of ICH in this age-group is sparse. Methods: All cases of ICH admitted to three major hospitals in Saudi Arabia over a 15-year period were retrospectively reviewed. Patients aged between 6 months and 45 years at stroke onset were studied. Pooling of our data with those published from other centers was used for final analysis. Results: One hundred seven cases (69 male, 38 female), including 12 children younger than 10, were analyzed. The causes of hemorrhage were as follows: arteriovenous malformations (AVMs), 23%; systemic hypertension, 20%; blood dyscrasias, 16%; berry aneurysms, 8%; other causes, 7%. No cause was found in 26%. Sixty-two percent of the ICHs were lobar and 3% multiple. Early death rate was high (27%). Twelve percent of the patients were lost to follow-up, and only 26% returned to a state of complete autonomy. Conclusion: The pooling of the causative data from our cases and the 253 others reported in the literature showed that even before 45 years of age systemic hypertension is the leading cause of ICH. It accounts for approximately 30% of the cases, with AVMs (20%) being next. The pooled overall early mortality rate is approximately 20%, and only one third of the patients return to independent living.     

Clinical analysis of etiology of spontaneous subarachnoid hemorrhage diagnosed by computed tomography

In 575 cases with subarachnoid hemorrhage (SAH) diagnosed by computed tomography (CT) scan, four vessel cerebral angiography was performed several times at more than two-week intervals to investigate a source of the hemorrhage. The first four-vessel study on admission revealed 530 cases (92.2%) of ruptured cerebral aneurysms, four (0.7%) of ruptured arteriovenous malformation, 25 (4.3%) of unknown etiology. Repeated four vessel study showed eight (32.0%) aneurysms among 25 cases whose first studies were negative. Six of the eight cases had aneurysms in the vertebro-basilar system. In 11 cases, repeated four-vessel study failed to detect the hemorrhagic source; and no generalized diseases were noted. One of them had recurrence of SAH 19 months after the onset of the initial one. The patient was underwent operation, which showed thrombosed ruptured aneurysm. Our present investigation demonstrated that ruptured aneurysm was responsible for 94.8% of all 575 cases of SAH detected by CT scans and 10 cases (1.7%) were diagnosed as cases of SAH of unknown etiology.     

The relationship of arterial hypertension to intracranial saccular aneurysms: Histometric assessment of the role of hemodynamic stress in terms of arterial medial hypertrophy

In order to elucidate hemodynamic characteristics of the circle of Willis in patients with saccular aneurysms and the causative relationship linking saccular aneurysms and hypertension, branches of the circle of Willis from 21 patients with ruptured aneurysms and of seven normotensive and eight hypertensive controls were histometrically investigated. The 21 aneurysm cases consisted of 12 single, four multiple and five single giant aneurysms. Among these 21 patients, 11 had no clinical history of systemic hypertension. Histometric analysis revealed that the average thickness of the media of the resistance vessels in the circle of Willis in all 21 patients was significantly greater than that of the normotensive control group (P < 0.001), and that the mean thickness of the whole aneurysm group was almost equal to that of the hypertensive control group (t= 0.102). Moreover, the difference between 11 aneurysm patients without clinical history of hypertension and 10 aneurysm patients with clinical history of hypertension was insignificant (t= 1.293). Based on these data, we conclude that an increased local hemodynamic stress with hypertensive alterations of the arterial wall is prerequisite for the development of cerebral saccular aneurysm even in patients without a history of systemic arterial hypertension.     

A comparative study of the cerebrovascular complications of cocaine: alkaloidal versus hydrochloride--a review

Cocaine, especially in its alkaloidal or "crack" form, has been increasingly associated with cerebrovascular disease. Before the crack epidemic, cocaine hydrochloride (HCl) was also implicated as a cause of stroke. However, less is known about the differences in stroke subtypes, age at stroke onset, or presence of underlying structural cerebrovascular disease with different forms of cocaine use. We compared 26 patients (previously reported) from our four institutions plus 16 cases reported in the literature of stroke associated with alkaloidal cocaine to 63 (57 reported in the literature and six not previously reported from our four institutions) cases of stroke associated with cocaine HCl. Ischemic and hemorrhagic strokes are equally likely after alkaloidal cocaine use, whereas cocaine HCl is more likely (approximately 80% of the time) to cause hemorrhagic stroke, with approximately half the intracranial hemorrhages occurring from ruptured cerebral saccular aneurysms or vascular malformations. The presence of an underlying cerebral aneurysm was more common among patients with cocaine HCl-associated strokes than alkaloidal cocaine-associated strokes. Cerebral infarction was significantly more common among the alkaloidal cocaine users than in all the cocaine HCl users, and this was also true when alkaloidal cocaine users were compared with parenteral cocaine HCl (intravenous and intramuscular) users. Only hemorrhagic stroke has been reported with intravenous cocaine HCl use. We conclude that the pathogenesis of cocaine-related stroke is heterogeneous, and depends, in part, on the form of cocaine used.     

Stroke in Saudi Arabian young adults: a study of 120 cases

One hundred and twenty cases of stroke occurring in Saudi Arabian subjects aged 15 to 45 years are reviewed. These constituted 12.7% of a group of 946 stroke patients. Males outnumbered females (76/44). The frequency of intracranial hemorrhage, including subarachnoid hemorrhage, was slightly lower than cerebral infarction (41.5 vs 58.5%). The causes of large cerebral infarction were as follows: atherosclerosis 17 (28%), cardiac embolism 12 (19.5%), uncommon and uncertain causes 21 (34.5%). Some unusual causes were encountered such as dissecting arterial aneurysm due to popular healing manoeuvres or to traditional dance, retrograde embolism from a thoracic outlet syndrome or embolism from a fibroelastoma of the mitral valve chorda. Lacunar cerebral infarction was diagnosed in nine cases. Hypertension (25.5%) and arteriovenous malformations (20.5%) were the main causes of cerebral hemorrhage; all subarachnoid hemorrhages except one were due to berry aneurysms. The cause was undetermined in 16% of cerebral infarction and 26% of intracranial hemorrhage. The high frequency of stroke in young Saudi Arabian adults is probably a reflection of the demographic structure of the predominantly young Saudi society. The observed causes were relatively similar to those in industrial societies. Contrary to other developing countries infectious disease no longer seems to be an important cause of stroke. Drug abuse, which is becoming an important cause in Western societies, was encountered in only two of our cases.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.     

脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.