DSA阴性的蛛网膜下腔出血临床分析

目的 探讨DSA阴性的蛛网膜下腔出血(SAH)的病因、临床特点和预后。方法 回顾对比分析30例DSA阴性的SAH及102例DSA阳性的SAH的临床资料。结果 DSA阴性SAH患者年龄偏大，精神症状多见，伴有高血压、高血脂多，而头痛相对较轻，脑神经损害、癫痫发作较少，出血量较小，再出血率、脑积水等并发症较少，死亡率较低，与DSA阳性SAH相比有显著差异。结论 DSA阴性SAH临床表现不典型，症状相对较轻，易误诊，预后较好。DSA阴性主要原因是环中脑池出血(PNSH)、微小动脉瘤，少数可能为假阴性，必要时需行DSA复查。     

首次DSA阴性的自发性蛛网膜下腔出血原因及策略

目的 探讨首次DSA阴性的自发性蛛网膜下腔出血（SAH）患者的发病原因及处理.方法 对29例首次DSA阴性的自发性SAH患者的临床资料进行回顾性分析.结果 29例患者中21例予保守治疗,均治愈出院;经再次DSA,头颅MRI或MRA检查及手术探查后发现阳性结果8例,其中经开颅手术或血管介入治疗后好转6例,伴有脑神经功能损害1例,死亡1例.结论 对于首次DSA阴性的自发性SAH的患者,其病因可能是多方面的,在诊治过程中应予足够重视,有条件应复查头颅MRI或MRA以及再次DSA.     

脑血管造影阴性的自发性蛛网膜下腔出血的诊治探讨

<正>自发性蛛网膜下腔出血(SAH)主要为颅内动脉瘤破裂出 血所致,但有部分病人全脑DSA检查为阴性,不能明确其病因 学诊断,影响其诊治。本研究通过对我科1999年10月～2005 年6月的40例首次DSA检查阴性的病人的检查、诊断及治疗 的回顾性分析,结合影像学资料,探讨其病因学特点及治疗。 临床资料与方法 1．临床资料40例首次DSA检查阴性 病人中,男性26例,女性14例;年龄13～65岁,平均34．8岁。 本组病人发病时均有剧烈头痛,13例出现发病后昏迷,5例有 癫痫发作。21例有脑膜刺激征,合并肢体活动障碍3例。 2．辅助检查本组病人均于发病30min～48小时内行CT     

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     

自发性蛛网膜下腔出血复发的临床探讨

本文收集的１５８例自发性蛛网膜下腔出血（ＳＡＨ）患者中３２例发生再次出血，女性＞男性，有高血压者再发率高。再出血组发病时意识障碍，癫痫样发作，眼底水肿出血等与非复发组有明显差异，死亡率可高达６５．６％。常见病因是动脉瘤和动静脉畸形。再出血多发生在前次起病的１个月内，在动态下发病，再发率有随再发次数增多而减少的倾向。再出血的病残率、死亡率高，所以ＳＡＨ的主要治疗措施应是尽早明确病因，根治病灶     

蛛网膜下腔出血临床表现及病因分析

蛛网膜下腔出血是神经内外科常见疾病,近几年来发病率有增高趋势。蛛网膜下腔出血原因很多,最主要最常见的原因为颅内动脉瘤,动脉硬化,脑动静脉畸形,烟雾病(moyamga),颅脑损伤,脑肿瘤,造血系统疾病,原因不明等。本文重点分析我院1977～1987年收治123例因动脉瘤,动静脉畸形。烟雾病引起的蛛网膜下腔出血。     

原发性蛛网膜下腔出血临床分析

目的 研究原发性蛛网膜下腔出血的临床特征。方法 对127例原发性蛛网膜下腔出血患的临床表现、神经影像学、治疗及预后等资料进行分析。结果 SAH死亡率23．6％，发病时有意识或(及)精神障碍或原发性高血压预后较差。早期头颅CT显示SAH部位在大脑半球表面沟裂、中脑周池、桥池、环池或脑室内预后较差。结论根据早期头颅CT显示SAH部位选用综合治疗措施能够判断预后，降低死亡率。良性SAH与动脉瘤破裂致SAH有明显区别，病情相对较轻，预后良好，DSA绝大部分阴性。适合内科保守治疗。     

108例自发性蛛网膜下腔出血临床分析

目的 探讨自发性蛛网膜下腔出血(SAH)的起病状态、病因、临床特点及治疗方法.方法 对108例SAH患者的临床资料进行回顾性分析.结果 108例静态起病65例(60.2%),DSA 检查56例,发现颅内动脉瘤50例(89.2%).临床表现多样,以头痛(75例,占69.4%)、头晕(18例,占16.7%)、呕吐(93例,占86.1%)常见.介入治疗22例,手术治疗29例,保守治疗57例,再出血死亡13例. 结论 SAH起病状态不一,病因多为颅内动脉瘤,临床表现多样,DSA检查能直接明确病因,选择合理、恰当治疗方案.     

首次DSA阴性蛛网膜下腔出血44例临床分析

目的探讨蛛网膜下腔出血(subarachnoid hemorrhage,SAH)患者首次数字减影血管造影(digital subtractionangiography,DSA)呈阴性的原因及诊疗策略。方法对近年来44例首次DSA呈阴性的SAH病人的临床资料进行回顾性分析,并在出血后2～3周进行DSA复查,分析其阴性结果及原因。结果 DSA阴性组在性别、年龄、Hunt-Hess分级及Fish-er分级、高血压诱因与DSA阳性组比较差异均有统计学意义(P<0.05);对首次DSA阴性患者2～3周后行DSA复查,6例诊断为动脉瘤或血管畸形,脑周围非动脉瘤性蛛网膜下腔出血(PNSAH)患者14例中,复查DSA亦无阳性发现,20例患者原因不明。结论对首次DSA检查结果呈阴性的SAH病人,中脑周围非动脉瘤性蛛网膜下腔出血临床过程及预后相对良性,可不必重复造影。其余患者均应在2～3周后行DSA或CTA、MRA复查,甚至手术探查,预后相对于动脉瘤性蛛网膜下腔出血亦良好。     

全脑血管造影阴性的蛛网膜下腔出血的病因探讨

目的 探讨全脑血管造影阴性的多膜下腔出血（ＳＡＨ）的病因学特点及临床处理方法。方法 对１９９３￣１９９８年５０例全脑血管造影阴性患的诊断、治疗进行回顾性分析。结果 ５０例患中８例获明确诊断,通过重复全脑血管造影检查发现１例右颈内动脉Ｃ１－２段动脉瘤;ＭＲＩ检查发现３例隐匿性血管畸形,其中２例经手术证实;手术探查发现２例动脉瘤,１例动脉壶腹,１例中服静脉畸形。结论 首次脑血管造影检查阴性的ＳＡＨ     

Coagulation Profile after Spontaneous Intracerebral Hemorrhage: A Cohort Study

Background

Intracerebral hemorrhage (ICH) causes death or disability and the incidence increases with age. Knowledge of acute hemostatic function in patients with ICH without anticoagulant and antiplatelet therapy is sparse. Increased knowledge of the coagulation profile in the acute phase of ICH could improve acute treatment and recovery. We investigated coagulation at admission and changes in coagulation during the first 24hours after symptom onset.

Computed Tomographic Angiography as the Primary Diagnostic Study in Spontaneous Subarachnoid Hemorrhage

PURPOSE: To evaluate the utility of computed tomographic angiography (CTA) as the primary diagnostic investigation in patients with spontaneous subarachnoid hemorrhage (SAH), and to correlate the results with intraoperative findings in those with ruptured aneurysms. MATERIALS AND METHODS: A retrospective review of 243 patients with spontaneous SAH was performed. The patients selected were those with acute SAH confirmed by noncontrast head computed tomography or by cerebrospinal fluid findings from a lumbar puncture. Patients subsequently underwent preoperative three-dimensional CTA as the sole or primary diagnostic study. The results of the CTA were correlated with the intraoperative findings in those patients undergoing emergent surgical clipping of acutely ruptured intracranial aneurysms. RESULTS: CTA correctly detected the ruptured aneurysm in 170 of the 171 cases, which required surgical clipping. Our data demonstrates that CTA has a 99.4% detection rate in acutely ruptured aneurysms as compared to intraoperative findings [confidence interval 97.8-99.9%]. CONCLUSION: CTA can provide prompt and accurate diagnostic and anatomic information in the setting of SAH with an excellent detection rate in acute ruptured aneurysms. These findings suggest an increased role for CTA in the evaluation of cerebral aneurysms.     

自发性脑出血后神经功能与脑血流动态变化相关研究

研究66例SICH患者急性期、亚急性期、恢复期SPECT脑血流显像和神经功能,发现:(1)临床神经功能与rCBF的变化密切相关;(2)失语组与无失语组者Broca区和Wernicke区rCBF亦存在显著差异,失语的恢复与rCBF的恢复相一致;(3)CDD现象与出血量及出血部位有关,出血量大和/或优势半球出血易引起CDD。提示积极改善脑出血患者亚急性期和恢复期脑血流量,有助于临床神经功能的恢复。     

低分子肝素预防脑出血后深静脉血栓有效性和安全性研究

目的 评估自发性脑出血（spontaneous intracerebral hemorrhage,sICH）患者早期皮下注射低分子肝素 （low molecular weight heparin,LMWH）预防深静脉血栓形成（deep vein thrombosis,DVT）的有效性。 方法 共104例急性sICH患者纳入研究,其中LMWH组51例,对照组53例。LMWH组在入院后第4天开始, 连续7 d皮下注射低分子肝素0.4 ml/d;对照组相对应给予下肢间断充气加压（intermittent pneumatic compression,IPC）措施。两组患者均于入院当天及LMWH治疗第7天检测溶血磷脂酸（lysophosphatidic acid,LPA）水平及抗凝血因子Ⅹa活性,并观察患者有无出血征象。 结果 治疗期间所有患者均未出现颅内血肿扩大及再出血事件,与对照组比较,治疗后LMWH组LPA 水平（11.74±5.30）ng/ml明显低于对照组（26.81±5.12）ng/ml,比较差异具有统计学意义（P＜0.05）。 治疗后LMWH组抗凝血因子Xa活性（25.96±7.97）ng/ml明显较对照组（8.06±1.32）ng/ml增高,比较 差异具有统计学意义（P＜0.05）。 结论 急性sICH住院患者为DVT的高发人群,sICH患者在急性期皮下注射低剂量LMWH预防DVT是有效 和安全的。     

Association Factors for CT Angiography Spot Sign and Hematoma Growth in Korean Patients with Acute Spontaneous Intracerebral Hemorrhage : A Single-Center Cohort Study

Objective

This study was conducted to clarify the association factors and clinical significance of the CT angiography (CTA) spot sign and hematoma growth in Korean patients with acute intracerebral hemorrhage (ICH).

Methods

We retrospectively collected the data of 287 consecutive patients presenting with acute ICH who arrived within 12 hours of ictus. Baseline clinical and radiological characteristics as well as the mortality rate within one month were assessed. A binary logistic regression was conducted to obtain association factors for the CTA spot sign and hematoma growth.

Results

We identified a CTA spot sign in 40 patients (13.9%) and hematoma growth in 78 patients (27.2%). An elapsed time to CT scan of less than 3 hours (OR, 5.14; 95% CI, 1.76-15.02; p=0.003) was associated with the spot sign. A CTA spot sign (OR, 5.70; 95% CI, 2.70-12.01; p<0.001), elevated alanine transaminase (GPT) level >40 IU (OR, 2.01; 95% CI, 1.01-4.01; p=0.047), and an international normalized ratio ≥1.8 or warfarin medication (OR, 5.64; 95% CI, 1.29-24.57; p=0.021) were independent predictors for hematoma growth. Antiplatelet agent medication (OR, 4.92; 95% CI, 1.31-18.50; p=0.019) was significantly associated with hematoma growth within 6 hours of ictus.

Conclusion

As previous other populations, CTA spot sign was a strong predictor for hematoma growth especially in hyper-acute stage of ICH in Korea. Antithrombotics medication might also be associated with hyper-acute hematoma growth. In our population, elevated GPT was newly identified as a predictor for hematoma growth and its effect for hematoma growth is necessary to be confirmed through a further research.