Acute cerebrovascular disorders and myocardial infarction

A retrospective study in 1,314 cases with acute cerebrovascular disease was conducted. The clinical diagnosis included cerebral hemorrhage (CH) 489 cases, cerebral thrombosis (CT) 686 cases, cerebral embolism (CE) 68 cases, and subarachnoid hemorrhage (SAH) 71 cases. Of the 1,314 cases there were 21 patients (1.6%) complicated with acute myocardial infarction during the stage of stroke. The percentage of incidence was 2 cases in CH (0.4%), 13 cases in CT (1.9%), 2 cases in CE (2.9%), and 4 cases in SAH (5%). Based on the detail cases reports the incidence, death rate, diagnosis, and pathogenesis of acute cerebrovascular disease complicated with myocardial infarction were discussed respectively.     

磁共振液体反转恢复序列、梯度回波T2*加权像、质子密度加权像对蛛网膜下腔出血的诊断价值

目的 探讨磁共振液体反转恢复(FLAIR)序列、梯度回波T2*加权像(GRE-T2*WI)、质子密度加权像(PdWI)对蛛网膜下腔出血(SAH)的诊断价值.方法 对50例临床上经症状、体征、CT或腰穿确诊为SAH的患者进行研究.根据头颅磁共振成像(MRI)检查距发病的时间,将50例SAH患者分为急性期SAH组(≤4 d)和亚急性、慢性期SAH组(＞4 d)[1],分析比较MRI的FLAIR、GRE-T2* WI、PdWI不同序列、序列组合和CT对SAH的检出率及其诊断价值,探讨MRI诊断SAH的最佳序列组合.结果 (1)急性期SAH组:26例患者经头颅CT、MRI的FLAIR、GRE-T2* WI、PdWI各序列均诊断为SAH,检出率均达100％,差异无统计学意义;(2)亚急性、慢性期SAH组:24例患者头颅MRI的FLAIR、GRE-T2* WI、PdWI序列检出率均为100％,头颅Cr检出率为62.5％,经统计学分析表明磁共振FLAIR、GRE-T2* WI、PdWI不同序列、序列组合对亚急性、慢性期SAH的诊断优于CT;(3)不典型SAH:其中1例亚急性期SAH患者(发病8d)临床表现不典型,入院当天查头颅CT误诊为脑梗死,于入院第2天行头颅MRI检查明确为少量SAH患者,DWI上显示了少量SAH后迟发性脑血管痉挛所致的急性梗死灶;(4)对MRI诊断SAH进行了序列优化,选用FLAIR和GRE-T2*WI序列组合.结论 (1)磁共振FLAIR、GRE-T2* WI、PdWI各序列、序列组合和CT对急性期SAH均有较高的敏感性;(2)磁共振FLAIR、GRE-T2* WI、PdWI各序列、序列组合对亚急性、慢性期和不典型SAH的诊断明显优于CT,弥补了CT的不足;(3)磁共振FLAIR、GRE-T2*WI是诊断SAH的最佳序列组合.     

MRI Detection of Cerebral Infarction in Subarachnoid Hemorrhage

Objective

To investigate magnetic resonance imaging (MRI) detection of cerebral infarction (CI) in patients presenting with subarachnoid hemorrhage (SAH).

Background

CI is a well-known complication of SAH that is typically detected on computed tomography (CT). MRI has improved sensitivity for acute CI over CT, particularly with multiple, small, or asymptomatic lesions.

Methods

With IRB approval, 400 consecutive SAH patients admitted to our institution from August 2006 to March 2011 were retrospectively reviewed. Traumatic SAH and secondary SAH were excluded. Data were collected on demographics, cause of SAH, Hunt Hess and World Federation of Neurosurgical Societies grades, and neuroimaging results. MRIs were categorized by CI pattern as single cortical (SC), single deep (SD), multiple cortical (MC), multiple deep (MD), and multiple cortical and deep (MCD).

Results

Among 123 (30.8 %) SAH patients who underwent MRIs during their hospitalization, 64 (52 %) demonstrated acute CI. The mean time from hospital admission to MRI was 5.7 days (range 0–29 days). Among the 64 patients with MRI infarcts, MRI CI pattern was as follows: MC in 20 (31 %), MCD in 18 (28 %), SC in 16 (25 %), SD in 3 (5 %), MD in 2 (3 %), and 5 (8 %) did not have images available for review. Most infarcts detected on MRI (39/64 or 61 %) were not visible on CT.

Conclusions

The use of MRI increases the detection of CI in SAH. Unlike CT studies, MRI-detected CI in SAH tends to involve multiple vascular territories. Studies that rely on CT may underestimate the burden of CI after SAH.

     

急性缺血性脑卒中rt-PA静脉溶栓后出血性转化的特殊类型

目的溶栓后出血性转化(hemorrhagic transformation,HT)是重组组织型纤维蛋白溶酶原激活剂(rt-PA)治疗急性缺血性脑卒中的一个重要安全指标。HT有不同的亚型,而不同亚型的预后也不尽相同。我们对急性缺血性脑卒中患者rt-PA静脉溶栓后出现的特殊型HT进行分析。方法对发病3zh内的98例缺血性卒中患者用rt-PA(剂量0．6 mg/kg,最大剂量5 0 mg)进行静脉溶栓治疗,溶栓前后行头颅CT、MRI或数字减影血管造影(DSA)检查判断是否有HT,并判定这种HT与责任病灶的关系。结果溶栓后经CT或MRI检查发现4种特殊的远端HT类型,1例发生蛛网膜下腔出血(SAH),1例梗死部位的对侧出现明显占位效应的脑实质出血,1例出现梗死灶对侧的侧脑室出血,1例出现梗死部位对侧的腔隙性出血。这4例患者所引起的4类HT在临床上均为无症状,预后好。结论对急性缺血性脑卒中的溶栓治疗要坚持动态观和平衡观,对症状性出血性转化的诊断要慎重,充分考虑HT的分型和程度,从而正确判断HT对预后的影响。     

Factors associated with hydrocephalus after subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study

Hydrocephalus is an important complication of subarachnoid hemorrhage (SAH). We analyzed several factors possibly related to hydrocephalus following SAH in 3521 patients from the International Study on the Timing of Aneurysm Surgery. Hydrocephalus was diagnosed on admission computed tomographic (CT) scans in 15% of patients and was thought to be clinically symptomatic in 13.2% of patients. There was a 5.9% overlap between these groups. Using contingency table analysis, we found the following were significantly related to clinical hydrocephalus: increasing age; preexisting hypertension; admission blood pressure measurements; postoperative hypertension; admission CT findings of intraventricular hemorrhage, a diffuse collection of subarachnoid blood, and a thick focal collection of subarachnoid blood; posterior circulation site of aneurysm; focal ischemic deficits; use of antifibrinolytic drugs preoperatively; hyponatremia; admission level of consciousness; and a low score on the Glasgow outcome scale. Using discriminate factor analysis to predict clinical hydrocephalus, the most important variables in order were the following: CT hydrocephalus, intraventricular hemorrhage, admission level of consciousness, presubarachnoid hypertension, increasing age, subarachnoid blood noted on CT scan, posterior circulation aneurysm site, and hypertension postoperatively (canonical correlation = .399). We conclude that the development of hydrocephalus after SAH is multifactorial. Factors that compromise cerebrospinal fluid circulation acutely (eg, intraventricular hemorrhage, hemorrhage from a posterior circulation site of aneurysm, and diffuse spread of subarachnoid blood) contribute to the development of acute hydrocephalus. These same factors, plus the use of antifibrinolytic drugs preoperatively, are also important in the pathogenesis of clinical hydrocephalus, perhaps by promoting subarachnoid fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

术中终板造瘘治疗动脉瘤性蛛网膜下腔出血后脑积水

目的对动脉瘤性蛛网膜下腔出血(SAH)患者进行出血后脑积水测查,同时评价动脉瘤夹闭术中行终板造瘘在脑积水治疗中的作用.方法应用出血后2周的CT或MRI评价SAH后脑积水的发生,18例脑积水患者中7例行动脉瘤夹闭术中终板造瘘,术后随访观察疗效.结果脑积水的总体发生率为13.6% (18/132),7例终板造瘘患者6例术后脑积水得到明显缓解,随访未见相应并发症出现,1例无效.结论动脉瘤夹闭术中行终板造瘘技术相对简单,不会加重患者的经济负担和神经系统损害,对大部分SAH后脑积水疗效肯定.     

A case of primary subarachnoid hemorrhage due to cerebral amyloid angiopathy]

A 77-year-old man who was suffering from an intracerebral hemorrhage of the left subcortex without hypertension was admitted to our hospital. The only neurological symptom was right arm monoparesis. Brain MRI demonstrated a subarachnoid hemorrhage (SAH) in the left frontal lobe. On the day of admission, conventional cerebral angiography revealed no abnormalities in brain arteries. His symptom was disappeared immediately after admission. He was discharged without neurological deficit on day 25. However, he was rehospitalized in our hospital on the same day because he experienced a right subcortical hemorrhage. The neurological symptoms were consciousness disturbance, aphasia and right hemiparesis. Brain CT disclosed a subcortical hemorrhage in the left temporal lobe. CT stereo-guided drainage was performed. Then, we examined tissue removed from the brain's surface. Histologically, beta-amyloid protein was deposited on the walls of the meningeal and cortical vessels, and it replaced all the layers of those walls. Therefore, a diagnosis of cerebral amyloid angiopathy (CAA) was made. His condition gradually improved, but CT showed an asymptomatic ICH in the right parietal lobe on day 36. On day 47, he had a symptomatic ICH in the left caudate nuclei and right frontal lobe. He died on day 66 because of pneumonia. Intracranial hemorrhages due to CAA have been reported and the majority of the lesions have been lober hemorrhage. To the best of our knowledge, few reports have been published regarding primary SAH caused by CAA. The cause of SAH should be considered as CAA when SAH appears without hypertension or in elderly patients.     

Clinical characteristics of myocardial stunning in acute stroke

Neurogenic stunned myocardium (NSM) after subarachnoid hemorrhage (SAH) is well known, but there is a paucity of data regarding its occurrence following acute stroke. The aim of this study is to investigate the clinical characteristics of NSM in acute non-hemorrhagic stroke. We performed an electronic literature search with Medline and Google Scholar for English-language articles using the terms “ischemic stroke” along with “stunned myocardium” or “Takotsubo cardiomyopathy”. The search resulted in seven case reports/series, but no prospective studies. The mean age of patients with myocardial stunning following ischemic stroke was 72.5 years and 77% of these patients were females. Insular cortex was involved in 38.4% of cases. Mean National Institutes of Health Stroke Scale (NIHSS) score at admission was 12.6 and mean NIHSS at discharge was 10.8. T-wave inversions and ST-segment elevations were noted in 84.6% and 69.2% of patients, respectively. Mean troponin elevation was 0.64 mcg/dL and mean left ventricular ejection fraction (LVEF) was 34.4%. In terms of outcomes, 84.6% of patients had significant improvement in LVEF, mostly within 4 weeks of onset of symptoms. To summarize, NSM was more common in females, with favorable prognosis. Less than half the patients with NSM following stroke had insular involvement. The mean troponin level in NSM after stroke was only half of that seen in SAH. While the lack of prospective studies on NSM in stroke patients precludes drawing further conclusions, more studies are warranted to investigate the risk factors for NSM and the effect on stroke outcomes.     

Imaging of subarachnoid hemorrhage

Even if acute subarachnoid hemorrhage (SAH) accounts for only 5% of strokes, its diagnosis is very important because its clinical consequences can be tragic. Recent technological advances in medical imaging have improved diagnostic and therapeutic management of patients with SAH. Nonenhanced CT of the head is the initial imaging modality in suspected SAH for the detection of ruptured intracranial aneurysms. Digital subtraction angiography (DSA) remains the reference exam. Multidetector row CT angiography may potentially replace DSA in the emergency setting, as it provides image data that allows evaluating aneurysmal morphology, the neck size or the visualization of vessels in the vicinity of the aneurysm. For SAH unrelated to aneurysm rupture (15% of cases), MRI and MRA can be added to the diagnostic work-up in order to exclude other differential diagnoses such as venous thrombosis or angiitis. Finally, transcranial color-coded duplex sonography, CT, or MRI are used in clinical practice in order to detect aggravating factors of SAH like hydrocephalus or vasospasm.     

Initial hyperglycemia as an indicator of severity of the ictus in poor-grade patients with spontaneous subarachnoid hemorrhage

An association between hyperglycemia and outcome in spontaneous subarachnoid hemorrhage (SAH) has been sporadically reported. Our hypothesis was that hyperglycemia is a sign of central metabolic disturbance linked with specific appearances on computerized tomography (CT) scans reflecting different degrees of corresponding brain injury. The admission plasma glucose level, initial CT findings, and outcome after 6 months were analysed in a cohort of 99 patients with SAH in Hunt & Hess Grade IV or V. The CT scans were quantitatively assessed for subarachnoid blood, intracerebral hematoma, intraventricular hemorrhage, hydrocephalus, midline shift and compression of the perimesencephalic cisterns. These findings were combined to determine a three-point CT severity score. All patients showed elevated (>5.8 mmol/l) plasma glucose levels on admission. Mortality among 33 patients with glucose concentration below 9.0 mmol/l was 33.3%, 71.1% for the 45 patients with glucose level between 9.0 and 13.0 mmol/l, and 95.2% for the 21 patients with concentration above 13.0 mmol/l (P<0.0001). Glucose level was higher in Grade V than in Grade IV patients (mean+/-SD) (11.8+/-3.2 vs 9.8+/-2.9 mmol/l; P=0.0012). Patients with mild CT findings (n=10) had the lowest glucose level (8.9+/-1.8 mmol/l; P=0.0082), whereas patients with severe findings (n=56) had the highest glucose (11.4+/-3.5 mmol/l; P=0.011). Despite association with clinical grade and extent of CT findings, logistic multiple regression revealed the admission plasma glucose level to be an independent prognosticator of outcome. The prognostic potential of the initial plasma glucose level may be beneficial in management protocols of poor-grade SAH patients.     

Predictors of cerebral microbleeds in acute ischemic stroke and TIA patients

BACKGROUND: Cerebral microbleeds (CMB) detected on gradient-echo T2*-weighted MRI have been associated with cognitive impairment and the potential for increased risk of intracranial hemorrhage. We evaluated risk factors for these microangiopathic lesions in a cohort of stroke and transient ischemic attack patients. METHODS: Presence and number of CMB in consecutive acute stroke patients admitted to a university hospital stroke service over an 18-month period were rated. Multivariate models were generated to determine the contribution of 21 demographic and clinical variables to the frequency and number of CMB. RESULTS: Of 164 patients (mean age 71 years, 52% female), 57 (35%) had CMB evident on gradient-echo T2*-weighted MRI. CMB were more commonly noted among patients with small vessel disease ischemic stroke mechanism (47%) than large vessel atherothromboembolic (12%) or cardioembolic (18%, p = 0.0001). In univariate analysis, patients with CMB were older, (p = 0.008), more likely to have been on >1 antihypertensive prior to admission (p = 0.024) than those without CMB. In multivariate logistic regression analyses, presumed small vessel stroke subtype, history of atrial fibrillation, being on >1 antihypertensive prior to admission, and smoking were independent factors increasing the risk of CMB. Logistic regression analysis by number of CMB showed almost similar findings. CONCLUSIONS: CMB are more frequently noted in hospitalized stroke and transient ischemic attack patients with small vessel ischemia, as well as those with important modifiable vascular risk factors like atrial fibrillation and smoking.     

脑卒中后不同时段发生抑郁患者的头颅磁共振波谱分析

目的：应用磁共振波谱（MRS）技术探讨脑卒中后不同时段发生脑卒中后抑郁（PSD）脑N-天冬氨酸盐/肌苷（NAA/Cr）和胆碱/肌酐（Cho/Cr）的代谢改变。方法：急性脑卒中住院病例223例,脑卒中后72h予汉密顿抑郁量表（24项版）评分,≥8分者（PSD患者）根据病例编号,采用随机数字表法分为干预组（第1组）和对照组（第2组）;〈8分者1个月时再次评分,≥8分者再分为干预组（第3组）和对照组（第4组）;〈8分者2个月时再评分,≥8分者再分为干预组（第5组）和对照组（第6组）;〈8分者3个月再评分,≥8分组（第7组）、〈8分组（第8组）。干预组（1、3、5、7组）给予帕罗西汀20mg·d-1治疗。分别在72h、3个月对PSD患者行MRS（双侧颞叶海马、丘脑）检测。结果：①在NAA/Cr比值中：72h和3个月时,第4、6组颞叶海马、丘脑ROINAA/Cr比值低于第2组（P〈0.05）;而与第7组相比,P〈0.01;第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;各组患者各ROINAA/Cr比值72h与3个月比较,均差异无统计学意义。Cho/Cr比值中：第4、6组海马和丘脑ROICho/Cr比值高于第2、7组,且以海马更为显著（P〈0.01）;而第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;第4、6组右侧丘脑ROICho/Cr比值3个月较72h时增高。②3个月时第4、6组右颞叶ROICho/Cr高于第5组（P〈0.05）。③第7组72h、3个月时右海马ROICho/Cr比值高于第8组（P〈0.05）。结论：MRS在PSD早期诊断中价值有限,但对病程1和2个月时PSD的发生有较为肯定的预示意义;针对该人群进行早期干预对改善脑代谢具有积极意义。     

Stroke in women of reproductive age: comparison between stroke related and unrelated to pregnancy

Pregnancy may increase the risk of stroke. However, few studies have compared strokes in women of reproductive age that occur in pregnancy or the puerperium (pregnancy-related stroke, PRS) with those unrelated to pregnancy. This study assesses risk factors and etiologies of stroke in these women based on relationship to pregnancy. From 1984 to 2002, all female patients 15 through 40 years of age with a first-ever stroke at National Taiwan University Hospital were included in this study. PRS was defined as patients who had stroke occurrence during pregnancy or within 6 weeks postpartum. Stroke was categorized as cerebral infarction (CI), cerebral hemorrhage (CH), or subarachnoid hemorrhage (SAH) and divided into subtype according to etiology. Risk factors and etiologies were compared for patients with PRS and stroke unrelated to pregnancy. We identified 49 patients with PRS, and 353 patients with stroke unrelated to pregnancy. There was no statistically significant difference in distribution of CI subtypes. Cerebral venous thrombosis (CVT) was more common in PRS than stroke unrelated to pregnancy (39% vs. 7%, P<0.001), and 73% of these cases occurred postpartum. Preeclampsia-eclampsia was an important cause of peripartum CH (37%), but not CI (4%). Among PRS cases, postpartum cerebral venous thrombosis and preeclampsia-eclampsia were the major causes of CI and CH, respectively.     

Locked-in syndrome due to bilateral cerebral peduncular infarctions with occlusion of persistent primitive trigeminal artery]

A 61-year-old woman with diabetes mellitus was admitted to our hospital with right hemiparesis and dysarthria. Brain MRI showed bilateral cerebral peduncular infarctions. Three days after admission, she was unable to generate any voluntary movements, except for those of the eye, suggesting locked-in syndrome (LIS). She could not speak, but showed good comprehension by blinking in response to verbal commands. Brain CT 5 days later revealed subarachnoid hemorrhage (SAH) around quadrigeminal and ambient cistern. Cerebral angiogram on the following day revealed no aneurysm, occlusion of right persistent primitive trigeminal artery (PPTA) and a little flow of the bilateral vertebral arteries. Eye movements were impossible in all directions on the 11th day and MRI showed new infarctions of the midbrain and the ventral portion of the pons. However, an EEG on the 20th day was almost normal. We speculated that low blood flow in the basilar artery from the PPTA caused bilateral cerebral peduncular infarctions, and that weakness of the PPTA caused SAH.     

Diagnosis of perimesencephalic nonaneurysmal subarachnoid hemorrhage with computed tomography

Objective: In 4% to 31% of patients with acute subarachnoid hemorrhage (SAH), no underlying cause is identified. Blood is restricted to the perimesencephalic cisterns in about two thirds of these patients. These patients are identified as having perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH), a syndrome based on the interpretation of computed tomography (CT) findings on admission, with an excellent prognosis, far better than other patients with SAH with or without an aneurysm. However, the diagnosis is subject to interrater variability, and differentiation between PNSAH and ruptured supratentorial aneurysm by means of CT has not been investigated. Therefore we investigated the validity of prediction of PNSAH with CT scan. Methods: A total of 303 consecutive patients, admitted within 72 hours after the initial bleeding with symptoms and signs of spontaneous SAH, which was confirmed by CT or spectrophotometric analysis of the cerebrospinal fluid (CSF) in whom either a selective 4-vessel angiogram (n = 293) or postmortem examination (n = 10) was performed, were studied. Results: We found an interrater agreement for the diagnosis perimesencephalic nonaneurysmal subarachnoid hemorrhage of 93% and a κ value of 0.65. Sensitivity was 30% for observer 1 and 46% for observer 2. The positive predictive value was 73% for observer 1 and 76% for observer 2. Among those diagnosed as having PNSAH, we found vertebrobasilar artery aneurysms in 19% (both raters) and internal carotid artery aneurysms in 5% (observer 1) and 8% (observer 2). Conclusion: We conclude that PNSAH can be distinguished on CT in the majority of patients; however, the angiographical management in PNSAH should not differ from other SAHs.     

Early Magnetic Resonance Imaging Decreases Hospital Length of Stay in Patients with Ischemic Stroke

Background

Imaging modalities are important part of stroke evaluation. Noncontrast head computed tomography (CT) is the initial imaging modality in acute stroke and although important to rule out acute hemorrhage and making a decision on thrombolytic treatment, ischemic changes may not be visible on CT for up to 24 hours. Magnetic resonance imaging (MRI) brain is an invaluable tool to confirm an ischemic stroke and facilitates stroke evaluation. Objective of this study was to investigate the correlation between time to MRI and length of hospital stay.

Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data

ObjectiveSeveral studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. MethodsWe respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. “Off-hour hospital presentation” was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox''s proportional hazard model. ResultsIn subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106–1.400; HR, 1.402; 95% CI, 1.124–1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. ConclusionThis study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.     

大脑中动脉动脉瘤破裂致蛛网膜下腔出血的新CT分型及其临床价值(附121例报告)

目的探讨大脑中动脉动脉瘤(MCAA)破裂后蛛网膜下腔出血(SAH)的CT分型方法及其临床价值。方法 1997年12月至2011年9月开颅夹闭破裂MCAA 121例。依据其SAH CT的特点分为两型,Ⅰ型为脑池出血型,70例;Ⅱ型为脑池出血伴脑实质或脑室出血型,51例。分析这种分型与术前Hunt-Hess分级及患者预后的关系。结果出院时按GOS评估预后,CT分型为Ⅰ型的70例患者中,治愈65例(92.9%),生活自理3例(4.3%),死亡2例(2.9%);51例Ⅱ型患者中,治愈36例(70.6%),生活自理9例(17.6%),重残4例(7.8%),死亡2例(3.3%);两者治愈率差异显著(P<0.01)。CT分型Ⅰ型患者中术前Hunt-Hess分级Ⅰ~Ⅲ级比例(97.1%,68/70)明显高于CT分型Ⅱ型患者(54.1%,28/51;P<0.01)。结论 MCAA破裂后SAH的CT分型与术前Hunt-Hess分级呈正相关,与病人的预后呈负相关。     

动态测定出血性脑血管病患者血浆神经肽Y的临床意义

目的:动态观察脑出血(CH)及蛛网膜下腔出血(SAH)患者血浆神经肽Y(NPY)的水平变化,探讨NPY与出血性脑血管病发生、发展的关系。方法:采用放射免疫法测定了46例脑出血,30例SAH患者及28例健康人血浆NPY的含量。结果:CH和SAH患者血浆NPY水平均明显高于对照组(P<0.001)。发病24小时内即显著升高,4～7天达高峰,8～15天开始下降,15天后CH组仍维持较高水平。重型CH患者NPY水平显著高于轻型和中型。大面积出血组高于小面积出血组。SAH患者伴迟发性缺血性障碍(DID)组明显高于不伴DID组。结论:NPY可能在CH及SAH的发生及病理生理过程中起重要作用。     

Primary intracerebral and subarachnoid hemorrhage. An approach to diagnosis and therapy.

The diagnosis of primary intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) has become easier with the advent of modern imaging techniques. The incidence of ICH has declined, while SAH has remained relatively constant. The prognosis for both disorders remains dismal and the mortality rate is substantially higher than that observed with ischemic stroke. Early imaging with CT or MRI is important for rapid and accurate diagnosis. General medical management in a skilled nursing facility should be available for patients who are not moribund. Therapy for ICH is predominantly supportive and effective medical and surgical intervention remains elusive. For SAH, calcium channel blockers may reduce cerebral ischemic complications related to vasospasm, but effective medical therapy to prevent rebleeding has not been established. Early surgery after SAH should be considered in clinically stable patients. Many challenges remain regarding the prevention and treatment of both these cerebral hemorrhage subtypes.