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。     

中脑周围非动脉瘤性蛛网膜下腔出血

目的:探讨中脑周围非动脉瘤性蛛网膜下腔出血(PNSAH)的临床特点、影像学特点、诊断及治疗。方法:分析我科收治的脑血管造影病例420例,造影阴性68,例,符合PNSAH的12例。PNSAH患者均行CT检查、全脑血管造影。3例MRl检查.复查全脑血管造影10例。结果:所有患者无意识障碍,Hunt-Hess分级1～2级,CT上SAH位于中脑周围的脑池内。脑血管造影和MRI均无阳性发现。采取对症治疗,无再出血、症状性脑血管痉挛和脑积水等并发症,10例复查脑血管造影未发现异常。结论:PNSAH是一种预后良好的特殊类型的SAH。     

中脑周围非动脉瘤性蛛网膜下腔出血的诊治

目的本探讨中脑周围非动脉瘤性蛛网膜下腔出血(PNSAH)的临床发病特点、影像学特点以及诊治。方法回顾性分析我科连续收治的92例脑血管造影(CAG)阴性SAH，发现PNSAH21例。所有患均进行CT、全脑血管造影、MR检查，16例行CT血管造影(CTA)检查。结果所有患无意识障碍，Hunt Hess分级1～2级，CT上SAH位于中脑周围的脑池内，Fisher分级梗阻2～3级。CAG、CTA和MR均无阳性发现。采用对症治疗，无再出血、症状性脑血管痉挛和脑积水等并发症，GOS均为优。结论PNSAH是一种预后佳且并发症低的良性SAH。首次CAG和CTA检查均正常的典型患，1月后可只行CTA省肯略CAG复查。     

症状性基底动脉高度狭窄血管内介入治疗的临床研究

目的对血管内介入治疗症状性基底动脉高度狭窄的有效性、安全性,以及近期疗效进行探讨。方法对经磁共振血管造影(magnetic resonance angiography,MRA)、CT血管成像(computed tomography angiography,CTA)或脑血管造影术(digital subtraction angiograyhy,DSA)证实为基底动脉高度狭窄(90%)并有相应临床症状的213例患者进行血管内介入治疗,对临床症状变化、手术成功率以及随访结果进行评估。结果 209例(209/213)基底动脉高度狭窄患者成功的进行血管内介入治疗,手术成功率为98.12%,平均狭窄率从术前的(93.70%±2.51%)降至术后的(11.60%±3.90%)。围手术期并发症8例(3.76%),缺血性卒中7例,蛛网膜下腔出血1例。平均随访(18.70±3.80)个月,202例患者再次行DSA,平均狭窄率为(13.80%±4.20%)。5例患者发生支架内再狭窄,其中1例表现为症状性狭窄。结论基底动脉高度狭窄的血管内介入治疗具有有效、安全的优点,术后1.5年随访结果显示血管通畅率好以及能够较好的预防后循环缺血事件的发生。     

脑磁共振灌注成像对于大脑中动脉狭窄患者的临床意义

目的探讨脑磁共振灌注成像(perfusion-weighted imaging,PWI)对于大脑中动脉狭窄患者的临床运用价值。方法选取本院2013年1月~2014年1月神经内科经颅内数字减影血管造影(Digital subtraction angiography,DSA)诊断为单侧大脑中动脉(middle cerebral artery,MCA)狭窄或闭塞的35例患者,并行脑磁共振灌注成像(Perfusion Weighted Imaging,PWI)检查,并对不同程度MCA狭窄状态下患侧和健侧大脑半球的脑灌注参数局部脑血容量(r CBV)、局部脑血流量(r CBF)、局部平均通过时间(r M...     

中脑周围非动脉瘤性蛛网膜下腔出血的诊治分析简

目的总结脑干前非动脉瘤性蛛网膜下腔出血（PMSAH）的临床特点及治疗效果。方法对我科2011年12月至2012年11月共收治的43例PMSAH患者的临床表现、影像学资料、诊断及治疗情况进行分析。结果首次全脑数字减影血管造影（DSA）检查阴性的43例PMSAH患者，2周左右复查DSA或320排CT血管造影，结果仍为阴性。所有病例均治愈出院，住院期间未发生再出血。43例出院后均随访6～12个月无再出血发生。结论PMSAH是一种预后佳，临床症状较轻、并发症少、主要位于脑干前方而病因不明的蛛网膜下腔出血。     

全脑血管造影术相关护理

<正> 全脑数字减影血管造影(digital subtraction angiography,DSA)因其能准确的显示血管影像,已经成为诊断脑血管畸形和脑动脉狭窄的金标准。作为一种有创性检查,DSA围手术期护理也成为脑血管病患者日常护     

非动脉瘤性自发性蛛网膜下腔出血分析

目的总结非动脉瘤性自发性蛛网膜下腔出血的临床特点。方法自发性SAH患者首次CTA和DSA均未发现动脉瘤和其他血管病变者,3～4周复查CTA或DSA,结果仍为阴性者诊断为非动脉瘤性SAH。分为中脑周围非动脉瘤性蛛网膜下腔出血(PMN)组和非中脑周围非动脉瘤性蛛网膜下腔出血(nPMN)组。结果 51例患者首次CTA和DSA未发现动脉瘤和其他血管病变,其中4例复查CTA或DSA发现动脉瘤,另有6例患者未复查即死亡。诊断为非动脉瘤性蛛网膜下腔出血共41例,其中PMN组29例,nPMN组12例。平均随访2.3年,两组均无死亡,全部的PMN病例和83.3%的nPMN病例预后良好。结论非中脑周围非动脉瘤性蛛网膜下腔出血(nPMN)临床过程和预后介于动脉瘤性SAH和PMNSAH之间,需要通过重复造影检查排除动脉瘤的可能。     

中脑周围非动脉瘤性蛛网膜下腔出血4例

近年来,有关中脑周围非动脉瘤性蛛网膜下腔出血(perimesencephalic nonaneurysmal subarachnoid hemorrhage,PNSAH)的报道较多.该文报道作者医院诊断的4例PNSAH患者的临床特点.     

GDC血管内栓塞治疗颅内动脉瘤

颅内动脉瘤的病死率较高,是自发性蛛网膜下腔出血(subarachnoidhemorrhage,SAH)最常见的病因。我院自2001年6月～2003年1月采用血管内栓塞疗法治疗颅内动脉瘤患者45例,取得良好临床效果,结果报告如下。资料与方法一、一般资料45例患者,男19例,女26例;年龄35～76岁,平均56.5岁。病程6h～3d。临床表现为蛛网膜下腔出血37例,头痛伴视力障碍2例,动眼神经麻痹20例,脑干压迫症状17例。二、影像学检查本组45例患者均行头部CT和脑血管造影(digitalsubtractionangiography,DSA)检查。(1)CT检查:主要表现为蛛网膜下腔出血(37例),脑室出血(8例),脑…     

慢性进行性眼外肌麻痹的临床和病理研究

目的总结慢性进行性眼外肌麻痹(CPEO)的临床和病理特点。方法回顾分析2015年10月至2017年7月于我院确诊的5例CPEO患者的临床及骨骼肌病理特点。结果男性2例,女性3例,均为散发病例,平均起病年龄(27.8±12.56)岁(15～51岁)。4例首发症状为眼睑下垂,1例为复视。5例均有眼睑下垂及眼球活动障碍,2例伴复视,1例有轻度颈屈肌和四肢近端肌无力,1例19岁月经初潮且身体矮小。5例新斯的明试验及血清乙酰胆碱受体抗体均阴性。仅1例肌酸激酶(CK)水平轻度升高(251 U/L)。1例心电图完全性右束支传导阻滞。5例均行肌电图检查,其中2例部分被检肌呈肌源性改变,5例重复神经电刺激均正常。5例头颅MRI均正常。骨骼肌病理改变主要为异常增多的破碎红纤维(RRF)、破碎蓝纤维(RBF)和细胞色素C氧化酶(COX)阴性肌纤维。结论 CPEO患者主要临床特点为进行性眼睑下垂和眼球活动障碍,少数患者可伴复视或轻微肢体近端肌无力、心脏传导阻滞和发育迟缓等。主要诊断措施为骨骼肌病理可见异常增多的RRF和COX阴性肌纤维。     

iFlow成像技术对中脑周围非动脉瘤性蛛网膜下腔出血后脑血管痉挛的评估

目的 探讨iFlow成像技术在中脑周围非动脉瘤性蛛网膜下腔出血（PNSAH）后脑血管痉挛评估中的价值。方法 收集经CT及两次血管造影明确诊断为PNSAH 60例为观察组,收集我院同期颅内动脉瘤单纯弹簧圈栓塞治疗后半年以上随访复查造影时未见复发60例为对照组。利用西门子公司iFlow软件测量首次造影和复查造影时双侧颈内动脉分叉部、双侧大脑中动脉分叉部、双侧椎动脉造影基底动脉末端相同部位的造影剂达峰时间（TTP）。结果 与对照组相比,观察组首次造影中双侧椎-基底动脉末端造影剂TTP明显增高（P<0.05）,观察组复查造影中双侧椎-基底动脉末端、右侧颈内分叉部、右侧大脑中分叉部造影剂TTP均明显增高（P<0.05）。与首次造影相比,观察组复查造影双侧椎-基底动脉末端造影剂TTP明显增高（P<0.05）。结论 PNSAH后存在血管痉挛,且以基底动脉最明显,应用iFlow技术评估脑血管痉挛的具有可行性。     

破裂动静脉畸形脑出血量相关因素分析

目的筛选与脑动静脉畸形(brain arteriovenous malformation,BAVM)破裂后出血量相关的因素,为治疗策略制定提供参考。方法回顾性分析2014年1月至2016年6月就诊于中南大学湘雅医院神经外科的破裂BAVM患者,采用改良Rankin量表评价出血后的预后,应用线性回归筛选与出血量相关的因素。结果入组106例患者,26例病变位于后颅窝,57例位于脑室周围。后颅窝、非后颅窝BAVM平均出血量分别为8.81±5.12ml及15.00±10.00ml,脑室周围、非脑室周围BAVM平均出血量分别为15.28±8.78ml及10.00±14.00ml,多因素线性回归提示后颅窝(P=0.002)、脑室周围(P=0.04)病变与出血量相关联,卡方检验提示后颅窝(P=0.041)及脑室周围(P=0.042)病变出血后预后更差。结论脑室周围BAVM破裂出血量较多,后颅窝病变破裂出血量较少,两者出血后预后均更差,可用于指导未破裂患者治疗的选择。     

支架辅助弹簧圈栓塞治疗宽颈前交通动脉动脉瘤的临床分析

目的 探讨支架辅助弹簧圈栓塞治疗宽颈前交通动脉动脉瘤的安全性和有效性。方法 回顾性分析2012年1月至2014年3月35例采用支架辅助弹簧圈栓塞治疗宽颈前交通动脉动脉瘤患者的临床资料,术后随访6~12个月。结果 全部患者均成功栓塞,其中支架置入同侧A2段19例,对侧A2段16例。术后即刻造影显示,致密栓塞（栓塞程度>95%）27例,近全栓塞（90%~95%）6例,部分栓塞（<90%）2例。载瘤动脉保留完好。DSA随访6~12个月,33例未见明显动脉瘤复发,2例动脉瘤瘤颈部部分显影,考虑复发。按GOS评分评估预后,5分28例,4分3例,3分2例,2分2例。结论 支架辅助弹簧圈栓塞治疗宽颈前交通动脉动脉瘤安全、有效,致密栓塞度高,载瘤动脉保护良好,复发率低,但长期疗效需进一步观察。     

糖尿病性非酮症偏侧舞蹈症临床分析

目的分析糖尿病性非酮症偏侧舞蹈症的临床特性、血清学检查、影像学检查、发病机制及治疗,以指导临床诊断,提高对该病的认识。方法回顾性分析我院收集的糖尿病性非酮症偏侧舞蹈症7例患者的临床资料。结果 7例患者,男性3例,女性4例,年龄53～87岁,平均72. 1±11. 7岁。6例患者既往确诊为2型糖尿病,病史1月～20年,1例既往无糖尿病病史。发病时随机血糖波动于7～27 mmol/L,5例发病时随机血糖显著升高,2例发病时随机血糖偏高。6例患者糖化血红蛋白均显著升高,1例未查。临床症状表现主要为单侧或双侧肢体或面部不自主运动。7例患者中,3例头颅CT高密度影CT,4例阴性。2例MRI-T1W1高信号,3例未查,2例阴性。所有患者未复发类似症状,例4患者死于肺癌。结论出现不自主的偏身舞蹈动作的患者,既往血糖控制不佳或入院后查出高血糖,无论头颅CT及MRI有无典型影像学表现,控制血糖后不自主运动消失,均应考虑本病。积极控制血糖,可消除或减少舞蹈症状。     

Primary intraventricular hemorrhage in adults: etiological causes and prognostic factors in Chinese population

Primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke that is poorly understood. We aimed to explore the features of this disease in Chinese population via an institutional prospective study. Adult patients diagnosed with PIVH from January 2013 to January 2016 were enrolled in this study. Data, including clinical variables, radiological features, and yield of angiography, were collected to evaluate the clinical features, etiological causes, and prognostic factors of this disease. A total of 67 patients (73.6%) were diagnosed with PIVH which constituted 3.2% of contemporary patients with hemorrhagic stroke in our hospital. Thirty-four patients (52.3%) were diagnosed with vascular structural abnormality (VSA)-related PIVH, and the etiologies included Moyamoya disease (22.4%), arteriovenous malformations (17.9%), aneurysms (7.5%), bilateral internal carotid artery dissection (1.5%), and tumor (1.5%). Idiopathic PIVH was diagnosed in 31 patients (47.7%), including coagulopathy in 3 (4.5%). Patients with VSA-related PIVH were younger than idiopathic PIVH patients, with a mean age of 37.1 ± 14.6 years, and idiopathic PIVH patients were more commonly hypertensive. The overall mortality rate was 11.9%, and 21 patients (31.3%) had a poor outcome at the 6-month follow-up. Patients with younger age, lower Graeb score, and a known etiology of arteriovenous malformation might be associated with a favorable outcome. We recommended routine thin-slice computed tomography (CT) scan, computed tomographic angiography (CTA), and digital subtraction angiography (DSA) for patients with PIVH. The etiological causes and prognostic factors of PIVH in Chinese patients were associated with distinctive features.     

Comparisons of DSA and MR angiography with digital subtraction angiography in 151 patients with subacute spontaneous intracerebral hemorrhage

To exclude underlying vascular abnormalities in patients with spontaneous intracerebral hemorrhage, the traditional paradigm requires investigation using digital subtraction angiography (DSA) in both the acute and subacute phases. We investigated whether MRI and magnetic resonance angiography (MRA), in the subacute stage of intracerebral hematoma, had high positive predictive values (PPV) and negative predictive values (NPV) in screening for vascular abnormality in the routine clinical setting. In a regional neurosurgical center in Hong Kong, we retrospectively reviewed 151 patients investigated with both MRI and DSA for underlying structural vascular abnormalities during the subacute phase. Sensitivity, specificity, and intermodality agreement were assessed. A total of 70/151 (46%) vascular lesions accountable for the hemorrhage were found. Patients with vascular abnormalities tended to be younger (mean age ± standard deviation [SD], 33 ± 15 years), less likely to be hypertensive (6.3%), and the lesion was more likely to be accompanied by intraventricular hemorrhage (22%). In terms of cerebral arteriovenous malformation and dural arteriovenous fistulas, MRI/MRA had a PPV of 0.98 and a NPV of 1.00. We concluded that MRI/MRA was able to detect most structural vascular abnormalities in the subacute phase in most patients and, thus, its use is recommended as the screening test.     

软通道穿刺引流术治疗中等量高血压脑出血的临床研究

目的探讨软通道穿刺引流术与开颅血肿清除术及内科保守治疗在中等量高血压脑出血患者中的疗效差别。方法回顾性分析我科2016年3月至2019年3月收治的114例中等量高血压脑出血病例,根据治疗方法不同分为:穿刺组48例,开颅组34例,保守组32例,比较三组病例的并发症发生率、远期疗效及平均住院日。结果穿刺组并发症发生率较开颅组及保守组低,差异有统计学意义(P 0. 05);发病后3个月ADL分级比较,穿刺组明显优于开颅组及保守组;穿刺组的平均住院日(20. 3±2. 2) d明显短于开颅组(26. 4±3. 5) d及保守组(27. 6±2. 8) d(P 0. 05)。结论软通道穿刺引流术治疗中等量高血压脑出血预后优于开颅手术及保守治疗,适合在基层医院广泛开展。     

Can we predict benign multiple sclerosis? Results of a 20-year long-term follow-up study

Benign multiple sclerosis (MS) is a discussed clinical entity, with variable reported prevalence (6–64%) requiring at least 5–10 years of clinical observation. Moreover, many benign patients progress with time becoming no longer benign (NLB). The objective of this study is to compare benign MS patients (EDSS ≤3, 10 years from disease onset) who still fulfilled the definition at 20 years to those NLB. In our retrospective study based on Ottawa Hospital MS Clinic database, 175 benign patients fulfilled the inclusion criteria (clinically definite MS, EDSS ≤3 at 10 years, disease onset from 1983 to 1993, and clinical assessments performed at 10 ± 1 and 20 ± 1 years from onset). Out of the identified patients, 66.3% remained benign at 20 years; however, by changing the definition for benign to EDSS ≤2 or ≤1 at 10 years, they increased to 71.9 and 81.6%, respectively. Female sex, EDSS ≤1 at 10 years, and a pure sensory onset were associated with a benign course, while a pure motor onset with an NLB condition. According to multivariate analysis, an EDSS ≤2 at 10 years predicted a long-term benign course. Our study questions the current definition of “benign” MS, suggesting a more stringent EDSS cutoff at 10 years to predict long-term benign prognosis.