蛛网膜下腔出血并发症的预见性护理

回顾分析51例蛛网膜下腔出血急性期CT表现以及出血在颅内的分布情况，总结出其并发症的发生与CT显示的积血阳性及分布区域不同有关。临床上根据其急性期CT表现预测并发症的发生，进行预见性的治疗和护理。     

数字减影血管造影在蛛网膜下腔出血病因诊断中的应用

目的 探讨数字减影血管造影术(DSA)对自发性蛛网膜下腔出血(SAH)病因诊断的价值。方法 对120例经临床和CT诊断为自发性蛛网膜下腔出血的患者经股动脉穿刺插管进行选择性的全脑血管数字减影血管造影术检查，部分病因明确病例进行栓塞治疗。对所有造影结果进行分析。结果 120例血管造影术显示：正常8例(6．7％)，阳性112例(93．3％)，其中颅内动脉瘤79例(70．5％)、血管畸形17例(15．2％)、脑动脉狭窄及闭塞16例(14．3％)，均为自发性蛛网膜下腔出血的主要原因。结论 数字减影血管造影术是蛛网膜下腔出血病因的最直接和最可靠的检查方法，并能为血管内栓塞治疗或外科手术治疗提供可靠解剖形态。     

Cat scratch disease presenting as acute encephalopathy

An unusual case of primary meningo-encephalitis followed by partial complex seizure in a 9-year-old boy was found to be a symptom of cerebral Bartonella henselae infection or cat scratch disease. Despite one clinical relapse at 4 weeks post-presentation, he remained seizure free on carbamazepine for one year. Six months after stopping carbamazepine, however, he developed deja vu phenomena and absence seizures with EEG abnormality. Restarting carbamazepine improved his symptoms.     

蛛网膜下腔出血后脑自我调节机制的持续评价

目的评价蛛网膜下腔出血 (SAH)后血管痉挛对脑自我调节状态的影响。方法动脉血压与平均血流速度 (FV)及收缩期FV之间的相关系数分别称为“Mx”、“Sx” ,当FV >12 0cm/s及Lindegaard率 >3时定义为血管痉挛。 3 2例SAH患者中 ,15例出现血管痉挛。对伴有血管痉挛的患者双侧大脑中动脉行经颅彩色多普勒 (TCD)检测 ,比较Mx和Sx基础值和痉挛期的变化。结果痉挛期Mx(0 46± 0 3 2 )较基础值 (0 2 1± 0 2 4)升高 (P =0 .0 3 )。Sx值分别为 (0 .2 2± 0 .2 6)、(0 .0 5± 0 .2 1) ,痉挛期增高 (P= 0 .0 3 )。Mx与FV(r =0 .5 77,P =0 .0 0 6)、Lindegaard率 (r =0 .672 ,P <0 .0 1)相关。与对侧相比 ,痉挛侧的Mx、Sx增高 (P分别为 0 .0 0 6,0 .0 44 )。结论痉挛期Mx、Sx增高提示脑血管的自我调节机制受损 ,对蛛网膜下腔出血患者的自我调节状态的改变提供了另外的评价方法     

造影剂致急性肾损伤的防治

造影剂引起的急性肾损伤发病率逐年增加,其预后差、并发症多、死亡率高.多学科专家共同努力,积极防治,完全可以改变此症的防治现状.     

炎性抑制与蛛网膜下腔出血后头痛的关系

目的探讨蛛网膜下腔出血(SAH)后头痛的发生是否与蛛网膜下腔炎性改变有关,同时观察地塞米松的免疫抑制作用对头痛的疗效.方法将80例意识清醒、能主诉头痛的SAH患者随机分为4组:单独应用甘露醇治疗组(甘露醇组)、在应用甘露醇基础上行脑脊液置换组(置换组)、地塞米松鞘内注射组(鞘内组)和静脉注射组(静脉组),观察各组患者的止痛效果.结果各组的总有效率分别为:甘露醇组27.27%、置换组66.67%、鞘内组92.36%、静脉组30.00%,鞘内组疗效与其他组疗效的差异有显著性意义,且头痛缓解时间显著延长( P<0.01).结论发生质变的血性脑脊液引起的蛛网膜下腔广泛免疫炎性反应是导致头痛的重要原因,鞘内注射地塞米松治疗SAH后头痛效果显著.     

蛛网膜下腔出血患者焦虑发生情况和相关因素分析

目的 探讨蛛网膜下腔出血患者焦虑发生情况及相关因素分析.方法 采用问卷调查法对73例蛛网膜下腔出血患者焦虑发生情况进行研究,分析焦虑发生与患者性别、年龄、文化程度、医疗费用支付方式、出血次数、临床症状、疾病了解程度及合并疾病的相关性.结果 蛛网膜下腔出血患者焦虑发生率为53.4%.女性患者焦虑发生率明显高于男性患者,重度头痛患者焦虑发生率明显高于轻度头痛患者,出血次数、有无合并疾病与焦虑有明显相关性.结论 正确认识焦虑是开展负性情绪干预的前提,针对蛛网膜下腔出血患者焦虑发生相关因素,积极开展心理疏导,是保障手术顺利进行的重要环节.     

Classification of acute encephalopathy in respiratory syncytial virus infection

Infection with respiratory syncytial virus (RSV) is known to be associated with central nervous system symptoms such as convulsions. We investigated cytokines, nitrogen oxide (NO) _x , and the viral genome in cerebrospinal fluid (CSF) obtained from children with RSV infection-related convulsions or central nervous symptoms and compared the data with type of encephalopathy. Of nine patients enrolled (six boys and three girls; aged 10 days–3 years), one metabolic error, five excitotoxicity, one cytokine storm, and two hypoxia cases were found. The patients presented with unilateral convulsions, generalized convulsions, and convulsions following cardiopulmonary arrest, apnea, and nuchal rigidity. In all patients, a rapid check for RSV of nasal fluid was positive. The RSV genome (subgroup A) was detected in the CSF of five of the nine patients; two patients with hypoxic encephalopathy were negative for the RSV genome. The CSF interleukin (IL)-6 levels were high only in patients with the excitotoxicity and cytokine storm type of encephalopathy. NO _x levels were high in all the subject cases. In the excitotoxicity type, NO _x levels were significantly higher than those in the control and other groups. NO _x level may become an important parameter for the diagnosis and classification of acute encephalopathy in RSV. Strategies to treat each type of encephalopathy, targeting cytokines and free radicals, should be established.     

动脉瘤性蛛网膜下腔出血早期病因治疗与保守治疗效果的对照研究

目的探讨动脉瘤性蛛网膜下腔出血(SAH)后早期病因治疗与保守治疗对疗效及预后的影响。方法将84例动脉瘤性SAH患者按治疗方案的不同选择,随机分为两组,病因治疗组(A组,42例)：在急性出血期先对破裂的动脉瘤进行血管内栓塞,然后立即将SAH引流出；常规保守治疗组(B组,42例)。对照分析A、B两组的临床资料及疗效。结果A、B两组临床资料比较差异无统计学意义,具有可比性(P＞0．05)。A组GOS预后良好率明显高于B组,两组比较差异有统计学意义(χ~2=9．22,P＜0．01)；B组重残率高于A组,两组比较差异有统计学意义(χ~2=3．94,P＜0．05)；B组死亡率亦高于A组,两组比较差异有统计学意义(χ~2=3．90,P＜0．05)。结论动脉瘤性SAH后在急性出血期先对颅内动脉瘤进行血管内栓塞,然后立即将SAH引流出的治疗方法对提高该病的治愈率、改善预后和降低死亡率具有重要的意义。     

动脉瘤性蛛网膜下腔出血早期认知功能减退的临床研究

目的观察动脉瘤性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)患者早期认知功能减退的发生率并探讨其发生的危险因素。方法回顾性分析2016年1月至2020年8月在福建省立医院就诊的195例动脉瘤性SAH并急诊行血管内介入栓塞治疗患者的临床资料,按照术后2周简易精神状态检查(Mini-Mental State Examination,MMSE)评定结果,分为认知功能减退组(n=40)与认知功能正常组(n=155),比较两组患者性别、年龄、高血压、糖尿病、吸烟、血脂、尿酸、肌酐、抽搐表现、心肌损伤、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、格拉斯哥昏迷量表(Glasgow coma scale,GCS)、Hunt-Hess分级、术前出血巴罗神经学研究所(Barrow Neurological Institute,BNI)评分、蛛网膜下腔出血早期脑水肿评分(Subarachnoid hemorrhage early brain edema scale,SEBES)、术前脑积水、术前改良Rankin评分(modified Rankin scale,mRS)、动脉瘤位置、动脉瘤大小、介入栓塞手术方式、是否脑脊液引流、合并甲状腺机能低下、脑血管痉挛、迟发性脑梗死等指标并进行比较,应用单因素、多因素Logistic 回归分析蛛网膜下腔出血出现早期认知功能下降的危险性因素。结果单因素分析显示:认知功能减退组患者年龄、尿酸、肌酐水平高于认知功能正常组,差异有统计学意义(P<0.05)。与认知功能正常组相比,认知功能减退组在合并hs-CRP升高、抽搐、肌钙蛋白升高等临床表现、脑功能损伤评分高(Hunt-Hess分级≥3级、GCS评分≥8分、术前出血BNI评分≥3分、早期脑水肿SEBES评分≥3分)、出现围手术期并发症(术前脑积水、术前mRS评分>3分、脑血管痉挛、合并迟发性脑梗死)方面可能性更高,差异有统计学意义(P<0.05)。多因素分析示高龄(OR=7.990,95%CI:1.021~1.121,P=0.005)、高尿酸(OR=4.059,95%CI:1.000~1.011,P=0.044)、早期脑水肿SEBES评分高(OR=7.072,95%CI:2.344~277.908,P=0.008)、术后超声经颅多普勒超声(transcranial Doppler,TCD)提示脑血管痉挛(OR=8.064,95%CI:2.100~57.244,P=0.005)、合并迟发性脑梗死(OR=5.118,95%CI:1.173~9.238,P=0.024)是动脉瘤性SAH行介入栓塞术后发生早期认知功能下降的独立危险因素。结论建议对aSAH合并高龄、高尿酸、脑水肿严重、继发脑血管痉挛及迟发性脑梗死的患者进行动态的神经心理学评估,早期识别认知功能减退并积极干预。     

多层CT血管造影在自发性蛛网膜下腔出血病因诊断中的应用

目的评价多层螺旋CT对自发性蛛网膜下腔出血病因诊断中的价值。方法11例MSCT平扫确诊为SAH患者均行64层螺旋CT脑血管造影,其中8例MSCT检查后进行DSA检查,3例进行手术治疗。结果MSCT造影显示11例自发性SAH中,9例为动脉瘤出血,1例脑动静脉畸形。11例病例均经DSA或手术证实。结论多层CT血管造影对自发性蛛网膜下腔出血的病因诊断准确性高,无创伤性,快速,简便。可作为一种首选的检查方法。     

Reversible cerebral vasoconstriction syndrome presenting as subarachnoid hemorrhage: A rare cause of postpartum seizure

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cerebrovascular disorder affecting large- and medium-sized arteries, occurring most commonly in young women. Thunderclap headache is the usual primary symptom; seizure is uncommon. During the postpartum period, seizure is a significant concern. The main causes of postpartum seizures are posterior reversible encephalopathy syndrome and cortical venous thrombosis; RCVS-related postpartum seizure is rare. Despite its rarity, its course may be fulminant, resulting in permanent disability or death if the diagnosis is delayed and treatment is not started promptly. We report an unusual case of RCVS presenting as a subarachnoid hemorrhage in a 31-year-old woman admitted for postpartum seizure.     

蛛网膜下腔出血患者症状性脑血管痉挛的预测与研究

目的研究蛛网膜下腔出血患者中症状性脑血管痉挛的预测.方法76例蛛网膜下腔出血患者均行脑血管造影、TCD检查、Fisher量表评分,同时对性别、年龄、吸烟、高血压等因素进行分析,研究上述因素是否可对临床症状性脑血管痉挛进行预测.结果脑血管造影及TCD检查时有脑血管痉挛、Fisher分型Ⅲ型、高龄患者临床脑血管痉挛的发生率显著高于对照组,而性别、吸烟、高血压不是脑血管痉挛的危险因素.结论脑血管造影、TCD检查、Fisher量表可以进对临床症状性脑血管痉挛进行预测.     

血糖范围和蛛网膜下腔出血患者预后关系的研究

目的探讨蛛网膜下腔出血(SAH)患者血糖范围与预后的关系。方法选择2003～2006年我院SAH患者62例,在入院第1、3、5、7、10、14天分别检测静脉血糖,以病情的轻重、转归和存活患者的生存质量分组,观察血糖值与它们的关系。结果将血糖控制在4.6～7.8mmol/L时对改善预后是有效的。结论蛛网膜下腔出血患者血糖范围与患者的预后有关。     

Simultaneous occurrence of subarachnoid hemorrhage and cerebral venous sinus thrombosis: A systematic review of cases

Although the leading causes of subarachnoid hemorrhage (SAH) are aneurysm rupture and arteriovenous malformations, cerebral venous sinus thrombosis (CVST) can, in rare cases, be associated with SAH. This phenomenon is an uncommon presentation, with less than a hundred cases reported based on our review of the literature. The purpose of this review is to highlight what is known regarding these cases, how they are managed and to highlight the need for further studies that will serve as a basis for the development of a standard management guideline across board. The following databases were searched: PubMed and Ovid Embase. A complementary search of Google Scholar and AJOL was done. Gray literature search was also conducted on the Google search engine for any additional relevant papers. We were able to extract data regarding 33 cases from 29 identified studies. The mean age was 46.6 ± 14.08. 17 (51.5%) of the cases were female, and the female‐to‐male ratio is 1.1:1. Headache was by far the commonest symptom, occurring in 82% of cases followed by seizures in 42% of cases. Four patients (12%) had loss of consciousness while 5 patients (15%) had some form of focal neurologic deficit. Twenty patients had cerebral venous sinus thrombosis in at least two different sinuses. The superior sagittal sinus was the most common location for CVSTs (79%), followed by the transverse sinus (57.5%). Twenty‐nine cases (89%) were managed with anticoagulation alone and one case had a mechanical thrombectomy. We have performed a comprehensive review of cases that had the simultaneous occurrence of SAH and CVST and have identified their peculiarities and the challenges to management. Further research is needed in order to identify a causal relationship and to serve as a basis for the development of a standard management guideline across the board.     

磁共振DWI在高血压脑病及急性期脑梗死中的鉴别诊断价值

目的探讨3.0T磁共振（Magnetic Resonance Imaging,MRI）弥散加权成像DWI（Diffusion Weighted Imaging）对高血压脑病（Hypertensive Encephalopathy）及急性期脑梗死的鉴别诊断价值。方法回顾性分析高血压脑病（HE）及急性期脑梗死各15例患者的常规MRI平扫及DWI图像,分别测量HE患者病灶区和急性期脑梗死患者病灶区的ADC值及ADC值变化范围,并进行统计学分析。结果 （1）15例HE和15例急性脑梗死患者的MRI平扫图像均可见长T1长T2信号,其中15例HE病灶区DWI呈低或等信号,少部分不典型呈高信号,ADC呈高信号;15例急性期脑梗死病灶区DWI全部为高信号,ADC呈低信号。（2）HE病灶的ADC值为（1.418±0.17）×10^-3 mm^2/s,明显高于急性期脑梗死病灶的ADC值（0.448±0.11）×10^-3 mm^2/s,差异具有统计学意义（P〈0.05）。结论常规MRI扫描无法区分高血压脑病及急性期脑梗死,而磁共振弥散加权成像作为一种简便易行的诊断方法,其DWI图像及ADC值测量在两者的鉴别诊断中有一定临床价值。     

Spinal intradural schwannoma presenting with acute subarachnoid hemorrhage: a case report and review of published reports

Acute subarachnoid hemorrhage (SAH) presentation is a very rare occurrence in spinal schwannomas. We report a case of lumbar schwannoma in a patient presenting first with acute SAH. A 40-year-old man was referred to our department 7 days after the sudden onset of headache, neck pain, and fever. SAH was suspected; however, head computed tomography (CT) findings were normal. A lumbar puncture indicated blood-stained cerebrospinal fluid (CSF). Moreover, the CSF pressure changed from 200 mmH₂O to 90 mmH₂O after drainage of 10 mL of CSF indicating a blockage of CSF. Subsequent magnetic resonance imaging (MRI) confirmed an intradural tumor with SAH, which also caused blockage of the CSF circulation. The patient underwent immediate surgery and fully recovered. In conclusion, the early diagnosis and total removal of the tumor and blood clot significantly improved the patient’s outcome. There is a high index of suspicion for spinal tumors resulting in SAH when there is a CSF pressure change after lumbar puncture in an SAH patient.