蛛网膜下腔出血

患者出现突发剧烈的头痛，头痛在数分钟内达到顶点，并且持续超过1小时，应怀疑蛛网膜下腔出血。常规头颅CT平扫结果正常并不能排除蛛网膜下腔出血，这是因为延缓检查时间会迅速降低CT对诊断的敏感性。当头颅CT平扫正常时，专家建议行腰穿检查。当患者就诊于神经专科时，专科医生应仔细确认发病的时间、年龄、并存疾病，意识水平和任何神经功能缺损。每4小时口服60mg尼莫地平可以减少不良预后，但其他干预措施还很有限。在阻断破裂动脉瘤方面，目前血管内栓塞术已取代了神经外科的动脉瘤夹闭术。多学科随访可以帮助处理蛛网膜下腔出血患者的并发症。     

Subarachnoid haemorrhage in pseudoxanthoma elasticum

A case of pseudoxanthoma elasticum presenting with the rare complication of subarachnoid haemorrhage is described.     

Subarachnoid haemorrhage and the electrocardiogram - a review

Electrocardiographic abnormalities occur in approximately 50% of patients with subarachnoid haemorrhage. The changes can resemble those of myocardial damage, although in most cases post-mortem studies show no macroscopic evidence of injury. Failure to appreciate this can lead to misdiagnosis of organic cardiac disease, cause delay in surgical treatment or even lead to inappropriate therapy. This review deals with the changes that may occur in the electrocardiogram, discusses the explanations put forward, and examines how this may influence future trends in management.     

Subarachnoid haemorrhage in Plasmodium falciparum malaria

A 41 year old man with cerebral malaria was found to have numerous bilateral retinal haemorrhages and very high parasitaemia. Despite intensive treatment his condition deteriorated and he died. Autopsy showed subarachnoid haemorrhage, which has not been previously described in cerebral malaria.     

Subarachnoid haemorrhage: difficulties in diagnosis and treatment.

Aneurysmal subarachnoid haemorrhage is associated with a uniquely severe headache of acute onset. Classical cases are readily identified as such, although this is not always the case. Four cases who were admitted to a district general hospital within a 3-month period are presented, because they demonstrate a variety of presentations, management options, and outcomes.     

Clinics in diagnostic imaging (91). Subarachnoid haemorrhage

Computed tomography (CT) is the initial radiological investigation of patients with an acute neurological event. A 64-year-old woman presenting with generalised weakness and headache for two days was diagnosed on CT to have subarachnoid haemorrhage. Digital subtraction angiography confirmed the cause to be a ruptured posterior communicating artery aneurysm. The patient was treated by neuroradiological intervention using occlusive coils. The CT features of subarachnoid haemorrhage are discussed. Accurate CT interpretation is essential to direct appropriate investigations and management in patients with stroke, particularly as acute cerebral infarction may occasionally mimic subarachnoid haemorrhage. The role of magnetic resonance (MR) imaging in evaluation of cerebral infarct is also discussed.     

Subarachnoid haemorrhage: a cause of left bundle branch block?

We describe what we believe to be the first reported case of documented de novo left bundlebranch block in association with acute subarachnoid haemorrhage.     

自发性蛛网膜下腔出血造影阴性148例临床分析

【目的】提高对自发性蛛网膜下腔出血(SAH)中特殊类型的中脑周围非动脉瘤性蛛网膜下腔出血(PNSH)的认识水平,指导临床诊治。【方法】回顾性分析148例首次造影阴性的自发性SAH病人的临床表现、影像学资料、治疗及预后情况。【结果】本组148例患者Ⅱ级以下133例,除5例患者行腰穿检查确诊为SAH外,其余患者均于发病1~2d内行头颅CT检查确诊。根据CT表现,出血仅位于中脑周围池者,和此部位延及一侧或两侧侧裂池者?延及纵裂池者?并有脑室出血者共122例。全部病人均在发病1~20d内首次行DSA检查,均为阴性。88例复查无阳性发现。139例病人愈后较好;3例有轻度的神经功能障碍;3例行脑室腹腔分流术恢复较好;3例因高龄合并其它脏器并发症家属放弃治疗。百余例患者随访6~36m,均无再出血发生。【结论】PNSH是一种特殊类型的SAH,无严重的脑血管痉挛、脑积水和再出血发生。提高对其的认识,对临床诊疗工作有重要的指导意义。对于非典型的PNSH患者,在除外脑血管痉挛的情况下,要有技术充分的6条血管的脑血管造影,多个角度投照。     

Acute upper gastrointestinal haemorrhage with negative barium-meal x-ray findings: follow-up investigation.

One-hundred and one patients admitted to hospital with acute upper gastrointestinal haemorrhage whose initial barium-meal X-ray examination revealed no abnormality have been followed up 5 to 14 years later. Forty-five were symptom-free, and 8 had dyspepsia, but the barium-meal X-ray findings were still normal. Disease of the lower oesophagus, the stomach or the duodenum was found in 20, 16 of whom had a chronic peptic ulcer and two had gastric carcinoma. There was a poor prognosis for those gastric-ulcer patients whose diagnosis had been missed initially.     

眼底荧光血管造影像质的控制

本文通过对30例眼底荧光血管造影的实验分析,说明最佳视觉清晰度像质的获得与前期的感光胶片的选择、眼底照相机的成像性能、滤光片的组合有关;同时与后期显影配方的选择、时间、温度、搅动显影控制等因素有关。