蛛网膜下腔出血继发癫痫发作38例分析

目的 探讨SAH继发癫痫的临床特点。方法 回顾性分析近10年来经CT及腰穿证实的234例SAH患者中38例继发癫痫发作的临床资料。结果 SAH继发癫痫的发病率为16％，以大发作多见，少数为局限性或精神运动性发作；早发型癫痫发生率为84％，其中以癫痫为首发症状者47％，仅临时用过抗癫痫药；迟发型癫痫发生率为16％，需长期服抗癫痫药。结论 SAH较易继发癫痫．且与出血量及出血部位密切相关；早期发作较易控制，晚期发作较难控制，需长期服用抗癫痫药。     

蛛网膜下腔出血与癫痫

自1984年我科共收治蛛网膜下腔出血(SAH)325例,其中有癫痫发作者85例(26.2％),本文就其病因、临床和预后等方面进行分析。 资料分析 癫痫发作组85例,男42例,女43例,年龄15～     

蛛网膜下腔出血继发性癫痫

本文对294例自发性蛛网膜下腔出血病例进行了回顾性分析,其中33例并发癫痫,发病率为11。2％。并发癫痫组的死亡率为45.4％,显著高于单纯蛛网膜下腔出血组(20.6％)。蛛网膜下腔出血继发性癫痫多数在病程的4周内发生,表现为不同的发作形式,应尽早或预防性应用抗惊厥药,对有二次以上发作的病人有必要坚持规则用药。     

蛛网膜下腔出血继发癫发作38例分析

目的探讨SAH继发癫的临床特点。方法回顾性分析近10年来经CT及腰穿证实的234例SAH患者中38例继发癫发作的临床资料。结果SAH继发癫的发病率为16%,以大发作多见,少数为局限性或精神运动性发作;早发型癫发生率为84%,其中以癫为首发症状者47%,仅临时用过抗癫药;迟发型癫发生率为16%,需长期服抗癫药。结论SAH较易继发癫,且与出血量及出血部位密切相关;早期发作较易控制,晚期发作较难控制,需长期服用抗癫药。     

蛛网膜下腔出血继发急性梗阻性脑积水

本文报告了10例蛛网膜下腔出血继发急性梗阻性脑积水的临床与CT表现。参阅国外有关文献,论述了本病的发病机理,临床表现与脑积水的关系,并对其治疗与预后进行了讨论。     

非典型蛛网膜下腔出血

<正>一般蛛网膜下腔出血(SAH)诊断容易，少数不典型的SAH临床诊断仍很困难，我科诊治二例，报道如下。 例1男性，35岁，3天前饮酒时突然剧烈头痛，呈持续性，呕吐一次。立即到当地医院就诊，做头颅CT检查，提示可疑SAH，转来我院。血压不稳定。查体：血压170/110mmHg，心肺正常。神志清醒，颅神经阴性。四肢肌力，肌张力正常，腱反射对称[++]，病理征未引出。颈部抵抗不明显，克氏征可疑。腰穿；未测压力(压力高)，淡粉红色CSF。     

蛛网膜下腔出血继发正常颅压脑积水

本文报告５例ＳＡＨ继发ＮＰＨ。其主要发病机制是ＣＳＦ循环和吸收障碍所致，与破裂动脉瘤的位置、脑室积血、脑室扩张持续时间及病情程度有关。同时发现脑室扩张后易在动静脉交界处或脑室周围形成小梗塞灶，加重ＮＰＨ的临床表现。     

Neuropsychiatric disturbance after aneurysmal subarachnoid hemorrhage

Although aneurysmal subarachnoid hemorrhage (aSAH) accounts for only 3–5% of all strokes, a high degree of morbidity has been reported in this relatively young subset of patients. Neuropsychiatric disturbance has often been neglected in these reports. We aimed to investigate the pattern and pathological factors of chronic neuropsychiatric disturbance in aSAH patients. This cross-sectional observational four-center study was carried out in Hong Kong. Neuropsychiatric outcome (Neuropsychiatric Inventory Chinese Version [CNPI]) assessments were conducted cross-sectionally 1–4 years after ictus. Pathological factors considered were early brain injury as assessed by admission World Federation of Neurosurgical Societies grade, aneurysm treatment (clipping versus coiling), delayed cerebral infarction, and chronic hydrocephalus. One hundred and three aSAH patients’ spouses or caregivers completed the CNPI. Forty-two (41%) patients were reported to have one or more domain(s) of neuropsychiatric disturbance. Common neuropsychiatric disturbance domains included agitation/aggression, depression, apathy/indifference, irritability/lability, and appetite/eating disturbance. Chronic neuropsychiatric disturbance was associated with presence of chronic hydrocephalus. A subscore consisting of the five commonly affected domains seems to be a suitable tool for aSAH patients and should be further validated and replicated in future studies.     

Neuroinflammation responses after subarachnoid hemorrhage: A review

Subarachnoid hemorrhage (SAH) is an important cause of stroke mortality and morbidity, especially in the young stroke population. Recent evidences indicate that neuroinflammation plays a critical role in both early brain injury and the delayed brain deterioration after SAH, including cellular and molecular components. Cerebral vasospasm (CV) can lead to death after SAH and independently correlated with poor outcome. Neuroinflammation is evidenced to contribute to the etiology of vasospasm. Besides, systemic inflammatory response syndrome (SIRS) commonly occurs in the SAH patients, with the presence of non-infectious fever and systematic complications. In this review, we summarize the evidences that indicate the prominent role of inflammation in the pathophysiology of SAH. That may provide the potential implications on diagnostic and therapeutic strategies.     

颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病

目的探讨颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病临床特点。方法回顾分析14例颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病患者的临床资料、血清心肌酶谱[包括肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、氨基末端B型利尿钠肽前体(NT-pro BNP)]水平、心电图和超声心动图表现。结果 14例患者入院时(初次检查)血清心肌酶谱[CK(591.93±248.78)IU/L、CK-MB(27.07±7.66)IU/L、NT-pro BNP(8685.36±3963.44)IU/L]水平即升高,2周复查时下降[CK(137.79±29.93)IU/L、CK-MB(14.36±5.58)IU/L、NT-pro BNP(577.14±203.37)IU/L],治疗前后差异具有统计学意义(t=7.090,P=0.000;t=4.897,P=0.000;t=7.778,P=0.000)。入院时心电图表现为ST段抬高或压低、T波倒置、QT间期延长,超声心动图呈节段性左室壁运动异常,左心室射血分数(36.07±6.15)%,2周复查时升至(56.43±3.18)%(t=13.381,P=0.000),1个月后恢复正常。结论颅内动脉瘤性蛛网膜下隙出血可诱发Takotsubo心肌病,患病率约4.58%,患者预后良好。超声心动图对早期筛查至关重要,急性期可通过冠状动脉造影术明确诊断。     

Hypertensive intracerebral hematoma after aneurysmal subarachnoid hemorrhage

We report a patient with sequential intracerebral hematoma in bilateral basal ganglia after an aneurysmal subarachnoid hemorrhage. A 55-year-old woman presented with sudden loss of consciousness without a past history of hypertension. Subarachnoid hemorrhage secondary to a ruptured anterior communicating artery aneurysm was seen on initial CT and an intracerebral hematoma was observed in both basal ganglia 3 hours later on a follow-up CT scan. We suggest that delayed intracerebral hematoma may occur due to increased intracranial pressure caused by aneurysmal rupture and discuss the possible mechanisms of this occurrence.     

Lactate and free fatty acids after subarachnoid hemorrhage

The hypothesis that lactate and free fatty acids (FFA) are elevated in the first minutes after subarachnoid hemorrhage (SAH) is tested. Adult rats were subjected to an endovascular SAH through the right internal carotid artery while under anesthesia. The brains were frozen in-situ at 15, 30, 60 min, and 24 h post-hemorrhage. Regional measures of tissue lactic acid and FFA were made in the hippocampi, ipsilateral cortex, contralateral cortex, and cerebellum. Lactic acid levels were significantly elevated from sham animals in each region within the first hour (p<0.0001 cerebellum, right, and contralateral cortex, p<0.01 hippocampus), but did not change significantly over the first hour. At 24 h post-hemorrhage, there was no significant difference in the lactic acid levels from controls. Similarly, total FFA were significantly higher in each region as compared to sham operated controls within the first hour (p<0.001 cerebellum, p<0.05 hippocampus, p<0.05 contralateral cortex, p<0.0001 ipsilateral cortex). By 24 h, there was no significant difference in FFA levels from shams. The data indicate that aerobic metabolism fails and cellular damage with degradation of cell membranes occurs in the first minutes after SAH, and lasts for at least 1 h. However, this process is stabilized within 24 h in our model. Although the largest effect was seen in the ipsilateral cortex, all areas of the brain were effected.     

蛛网膜下腔出血后脑血管痉挛发病机制的研究新进展

蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后,患者常伴有脑血管痉挛(cerebral vasospasm,CVS),出血后4～14d为高峰期.CVS导致脑组织局部缺血,进而引起神经功能障碍.近年来有大量文献资料和实验数据表明SAH后CVS的发生率约30％～80％,约46％的患者出现临床症状,是导致SAH患者死亡或致残的主要并发症[1].其病因机制复杂,研究表明多种因素与CVS的发生有关.本文就SAH后CVS发病机制的研究进展综述如下.     

Relative changes in flow velocities in vasospasm after subarachnoid hemorrhage

Introduction: Transcranial Dopplers (TCDs) have been used to monitor cerebral blood flow velocities in subarachnoid hemorrhage (SAH). The purpose of our two-part study was to compare the reliability of relative increases in flow velocities with conventionally used absolute flow velocity indices and to correct for hyperemia-induced flow velocity change. Methods: Part 1: Charts of 50 patients admitted to Hahnemann University Hospital with aneurismal SAH were reviewed. Mean middle cerebral artery maximum flow velocities (MCA-MFV) were reviewed for initial flow velocities (IFVs) and maximal flow velocities (MFVs) that were reached during hospital course. Correlating flow velocities (SFVs) were noted in patients who developed symptomatic vasospasm. MFV/IFV and SFV/IFV ratios were calculated to evaluate relative changes in flow velocity. Part 2: Correction for hyperemia was derived from Lindegaards Ratio using extracranial internal carotid artery (ICA) flow velocity ratio (corrected MCA-MFV/observed MCA-MFV=EC-ICAFV (day1)/observed EC-ICAFV). Results: Part 1: All 10 patients who developed symptomatic vasospasm exhibited a twofold increase (SFV/IFV: >2) in flow velocities prior to developing symptomatic vasospasm, and 5 patients had a threefold increase (SFV/IFV: >3). Of the 40 patients who did not develop symptomatic vasospasm, 33 patients did not have a twofold increase in their flow velocities at any time. The positive predictive value for MFV/IFV greater than 3 (n=6) and SFV/IFV greater than 3 (n=5) was 100%. The negative predictive value for MFV/IFV less than 2 (n=33) was 100%. Data using relative changes (twofold increase) in flow velocity was more sensitive (100 to 90%), specific (83 to 70%), and predictive (positive predictive value [PPV]: 59 to 45%; negative predictive value [NPV]: 100 to 97%) for symptomatic vasospasm than absolute flow velocity indices using MCA-MFV greater than 120—even in combination with Lindegaards Ratio (MCA/ICA greater than 3). Part 2: Correction for hyperemia by modifying Lindegaard’s Index in the 32 patients where data was available improved the PPV of absolute flow velocities from 44 to 62%. In this population, the application of this equation while evaluating relative change in flow velocities improved PPV of twofold increase from 57 to 73%. Conclusion: Relative changes in flow velocities in patients with aneurysmal SAH correlated better with clinically significant vasospasm than absolute flow velocity indices. Correction for hyperemia improved predictive value of TCD in vasospasm.     

中脑周围非动脉瘤性蛛网膜下腔出血

目的　提高对中脑周围非动脉瘤性蛛网膜下腔出血 (PNSH)的认识水平以指导临床诊治。方法　回顾性分析 2 4例PNSH病人的临床表现、影像学资料、治疗及预后情况。结果　本组 2 4例病人发病 1～ 14d内DSA检查均阴性 ,经治疗全部治愈出院 ,平均病程 2 9d。随访 3个月至 5年 ,无严重的脑血管痉挛、脑积水和再出血发生。结论　PNSH是一种特殊类型的SAH ,提高对其认识 ,对临床治疗工作有重要的指导意义。     

Cerebral infarction secondary to vasospasm after perimesencephalic subarachnoid hemorrhage

Perimesencephalic subarachnoid hemorrhage (pSAH) has been described as a distinct form of subarachnoid hemorrhage (SAH) associated with good outcomes. We report a 48-year-old female who developed cerebral infarction due to severe diffuse vasospasm following pSAH. The patient presented with non-aneurysmal pSAH and was discharged home on day 5. However, one week later she developed an acute onset of right hemiparesis. A brain MRI showed acute infarctions on diffusion weighted imaging and her cerebral angiogram showed diffuse vasospasm. The patient received intra-arterial diltiazem and hypervolemic-hypertensive-hemodilution therapy with resulting resolution of the vasospasm and hemiparesis. While not as common as in SAH, there is a potential for the occurrence of cerebral infarction due to vasospasm after pSAH.     

无蛛网膜下腔出血的破裂脑动脉瘤

目的 总结无蛛网膜下腔出血(SAH)的破裂脑动脉瘤的诊治经验.方法 对15例在起病后2 d内首次CT或MRI上表现为脑内出血(ICH),和(或)脑室内出血(IVH)、硬脑膜下血肿(SDH)和壁间出血(IMH)而无SAH的破裂脑动脉瘤患者的临床表现、影像学检查结果 、治疗方法 和预后进行回顾性分析.结果 本组首次CT或MRI检查表现为ICH者3例、IVH合并ICH者6例、SDH者1例、IVH者1例、IMH者3例和等高混合密度者1例.其中动脉瘤位于大脑中动脉6例、前交通动脉4例、后交通动脉3例、大脑前动脉1例和小脑后下动脉1例.开颅手术夹闭动脉瘤13例,血管内栓塞2例.出院时GOS评分:恢复良好8例、中残3例、重残3例和植物生存1例.本组15例占同期破裂脑动脉瘤的3.8%.结论 破裂脑动脉瘤首次CT扫描可表现为单纯ICH,和(或)IVH、SDH、IMH而无SAH,与CT扫描时间、动脉瘤的部位和指向以及出血量有关.早期控制颅内高压、及时诊断和有效处理破裂动脉瘤,是改善预后的关键.