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首次脑血管造影阴性21例临床分析

目的 总结首次脑血管造影（DSA）呈阴性的自发性蛛网膜下腔出血（SAH）患者治疗经验。方法 回顾性分析我科自2005年1月至2013年6月收治的21例首次DSA呈阴性的SAH患者的临床资料。结果 21例头颅CT检查均发现SAH,其中伴脑室内出血3例、硬膜下血肿1例。所有患者首次DSA均呈阴性,18例患者复查DSA,确诊为颅内动脉瘤5例、硬脑膜动静脉瘘1例、脊髓动静脉畸形1例,余11例复查仍为阴性;3例患者拒绝复查DSA,其中1例出院后半月再出血死亡。18例复查DSA的患者出院后随访6个月至8年,未发现再出血病例。结论 SAH患者首次造影存在假阴性可能,复查DSA对此类病人十分重要。     

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     

蛛网膜下腔出血脑血管造影假阴性原因分析

目的 探讨蛛网膜下腔出血(SAH)脑血管造影假阴性发生的可能原因,提高SAH病因诊断的准确性.方法 回顾性分析452例SAH患者的脑血管造影结果初次阴性52例,复查造影25例,发现6例有异常病变:4例前交通动脉瘤,1例C<,2>段动脉瘤,1例脑血管畸形.结果 结合文献对这6例初次脑血管造影假阴性的原因进行分析,总结发生假阴性的原因.结论 SAH造影时应采用高分辨率的造影机;二维造影时要多角度投射,避开血管间的重叠;必要时采用三维血管重建;提高阅片医生的能力;初次阴性病例可配合CTA、MRA检查且必须强调全面细致复查造影.     

自发性蛛网膜下腔出血脑血管造影阴性的诊治对策

目的 探讨蛛网膜下腔出血(SAH)病人可能存在的出血原因，寻求当首次脑血管造影阴性时的诊治对策。方法 回顾性分析我科近5年来322例SAH出血病人，其中55例病人首次血管造影阴性。结果 17例因再出血或遵医嘱行2次脑血管造影，3例发现颅内动脉瘤，l例发现左颞叶底部脑动静脉畸形(AVM)。2例重复脑血管造影阴性行开颅手术探查，证实分别为前交通动脉瘤和左侧颈内动脉后交通动脉瘤；8例行MRI检查，1例发现胼胝体AVM；8例行CTA检查，1例发现前交通动脉瘤。1例因出现典型的下肢放射痛而行脊髓血管造影，发现L2AVM。结论 对于SAH后首次造影阴性的病人，应行重复血管造影，结合MRI、MRA及CTA检查可提高诊断率，必要时行手术探查。     

自发性蛛网膜下腔出血病人全脑血管造影假阴性观察与防范对策

目的 观察自发性蛛网膜下腔出血患者首次全脑血管造影检查(DSA)的假阴性率,探讨减少假阴性率、提高真阳性率的方法.方法 对惠州市中心人民医院神经外科2007-2008年的136例SSAH病例进行回顾性分析,统计及比较DSA初检及复查的假阴性率.结果 136例中DSA检查阳性122例,阴性14例,其中首次DSA检查阳性113例,阴性23例;2周后DSA检查阳性9例(高颈段硬脑膜动静脉瘘1例,前交通动脉瘤4例,大脑中动脉瘤1例,后交通动脉瘤3例),阴性14例;第3次DSA检查中未发现阳性病例.首次DSA检查真阳性率为83.1%,假阴性率为16.9%;2周后DSA复查真阳性率为89.7%.结论 SSAH首次DSA检查具有较高假阴性率,2周后复查DSA是降低假阴性率提高真阳性率的合理方法.     

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     

蛛网膜下腔出血全脑血管造影43例分析

我科自2003-03～2008-10收治宝鸡市及各县区的蛛网膜下腔出血患者56例,其中43例行全脑血管造影检查,现总结如下.     

蛛网膜下腔出血首次全脑血管造影阴性的原因分析及处理

目的探讨蛛网膜下腔出血(SAH)首次行全脑血管造影呈阴性的原因及治疗策略。方法对我院2001￣2005年间15例首次全脑血管造影呈阴性的SAH病人的诊断、治疗进行回顾性分析。结果所有病人首次造影均阴性,3例重复造影明确诊断,1例手术探查明确诊断,5例结合CT,MRI/MRA,CTA明确诊断,1例重复造影后死亡,5例重复造影仍阴性,仅CT表现为中脑周围池出血。结论首次造影阴性的SAH病人应重复DSA检查,同时辅助行CT、MRI/MRA检查,必要时行CTA进一步检查;对同一部位的反复出血,CT或MRI又高度怀疑有病灶的病人,尽管DSA检查阴性必要时也可以直接手术探查。     

Kleptomania: a report of 20 cases

OBJECTIVE: The authors' objective was to provide phenomenologic, family history, and treatment response data on a group of rigorously diagnosed patients with kleptomania. METHOD: Twenty consecutive inpatients and outpatients met DSM-III-R criteria for current kleptomania or a past history of kleptomania. These patients were given structured diagnostic interviews, and their family histories of psychiatric disorders were assessed blindly. The patients' responses to psychosocial and biological treatments were also assessed. RESULTS: All of the kleptomanic patients had lifetime diagnoses of major mood disorders, 16 had lifetime diagnoses of anxiety disorders, and 12 had lifetime diagnoses of eating disorders. A high morbid risk of major mood disorders (0.31) was found in their first-degree relatives. Ten of 18 patients receiving thymoleptic medications reported reduction or remission of their stealing behavior. CONCLUSIONS: Kleptomania may be related to major mood disorder and perhaps may represent another form of "affective spectrum disorder."     

流行性癔病（附20例分析）

本文报告１９９４年３月在本市一所山区中学发生的流行性癔病２０例，患者均为女性。以短暂阵发性胸闷、心悸、呼吸紧促。四肢发麻、双下肢无力、昏倒为发作形式。指出患者的发病与生活环境、性别、性格特征、学习负担重、测验频繁、夜间睡眠不足及精神紧张等因素有关，与不良暗示尤为密切。     

Alpha coma: rectrospective presentation of 20 cases

Alpha coma is a relatively rare variety of EEG resulting from diffuse cerebral anoxia, focal brainstem lesions, metabolic disturbances or intoxications. It is a monotonous, unreactive and anteriorly predominant activity of less than 50 microV and of 8 to 13 Hz. Twenty cases of alpha coma are reported: 16 resulting from anoxic encephalopathy, 2 from brain stem strokes, and 2 from metabolic encephalopathy. Cardiac arrest was the main cause of alpha coma (10 cases); a large number of patients (7 cases) died, or have survived with severe neurologic deficits (2 cases). In 2 cases there was a metabolic-toxic cause (benzodiazepines and parathion intoxication). The 2 patients with pontomesencephalic haemorrhage died. The physiopathogenicity of alpha coma, which remains obscure, is also discussed.     

Multiple system atrophy: an analytic study of 20 cases

An analytic study was made on 20 cases of multiple system atrophy. The patients included OPCA 12, SND 3, and SDS 5. This study showed that in 90% of the cases, the symptom began in middle life. Both sexes affected similarly and the mean course was about 5 years. Approximately three years after the appearance of the primary symptom, the features of other central nervous system lesions were presented. Comparative study of clinical features of the three types repealed the following: Cerebellar symptom: OPCA greater than SDS greater than SND. Symptoms and signs of extrapyramidal system: SND greater than SDS greater than OPCA, autonomic dysfunction: SDS greater than OPCA greater than SND.     

Neuroleptic malignant syndrome: long-term follow-up of 20 cases.

The authors obtained long-term follow-up data on 20 (91%) of the 22 patients who had experienced index episodes of neuroleptic malignant syndrome (NMS) at McLean Hospital between 1983 and 1990. Eleven of the 20 patients resumed neuroleptic treatment after the index episode and have now collectively received more than 16 years of neuroleptic exposure with no recurrences of the syndrome. Furthermore, 14 of the 20 patients had already collectively accumulated more than 71 additional years of neuroleptic exposure before their index episodes; only 1 had experienced a possible episode of NMS in the past. These findings suggest that NMS may not predictably develop even in predisposed individuals upon neuroleptic exposure and that additional cofactors must be present for the full syndrome to evolve.     

Friedreich''s ataxia: a clinical review of 20 childhood cases

The authors report the clinical review of 20 childhood cases with Friedreich's ataxia. The mean age at onset of symptoms was 6.1 years. The main presenting symptom was abnormal gait (100%). Ataxia of gait and limbs and depressed or absent tendon reflexes were found in all cases. Clinical findings are in accordance with the findings of Harding and Werdelin. Neurophysiological studies (especially sensory) are important in the confirmation of the diagnosis. Of the 10 cases in which sensory nerve conduction velocity measurements were performed, 7 had absent sensory action potentials, 2 had decreased potentials and one was normal. In our study, it is shown that in patients having ataxic gait, ataxia of limbs and tendon reflexes depression or loss, Friedreich's ataxia may be diagnosed with the help of electrophysiological studies.     

Radioclinical aspects of cerebral and muscular cysticercosis: 20 cases

We report a series of 20 cases of cysticercosis. Cysticercosis is a rather wide-spread disease in North Vietnam with clinical signs such as myalgia, headache, epileptic seizures. It is often seen in male adults 30 to 60 years old, not in children. CT-scan is a good method for detecting cerebral cysticercosis at different stages of evolution: cysts with scolex, calcified cysts or both simultaneously, which is the evidence of several successive infestations. Muscular cysticerci can be detected by palpation or by radiography when they are calcified. Cerebral and muscular locations of cysticercosis are nearly always simultaneous, therefore we must always explore these both seats by CT scan (for the brain) and by radiography (for the muscles and the subcutaneous tissue).