Traumatic subarachnoid hemorrhage visualized with transesophageal echocardiography

Computed tomography (CT) is the current standard for the early diagnosis of traumatic subarachnoid hemorrhage (tSAH). It is, however, not feasible when a patient is hemodynamically unstable. We report a novel method of visualizing tSAH with transesophageal echocardiography (TEE). The spinal cord was visualized through the intervertebral disc with the transducer directed posteriorly in the esophagus. TEE findings of the spinal cord in three patients with tSAH were compared with those of 19 patients without it. In the former, fibrin-like mobile images were present, the ratio of diameter of spinal cord to internal diameter of spinal canal was significantly larger (0.59 +/- 0.07 vs. 0.45 +/- 0.04, p = 0.0070) and the pia mater was significantly thicker (1.41 +/- 0.12 mm vs. 0.66 +/- 0.15 mm, p = 0.0001). Our findings suggest that TEE may be an alternative way of diagnosing early tSAH at bedside in patients in which CT is not feasible.     

Acute intracranial hemorrhage caused by acupuncture

A 44-year-old Chinese man developed severe occipital headache, nausea, and vomiting during acupuncture treatment of the posterior neck for chronic neck pain. Computed tomography of the head showed hemorrhage in the fourth, third, and lateral ventricles. A lumbar puncture confirmed the presence of blood. Magnetic resonance angiography with gadolinium did not reveal any saccular aneurysms or arteriovenous malformations. The patient's headache resolved over a period of 28 days without any neurological deficits. Acupuncture of the posterior neck can cause acute intracranial hemorrhage.     

蛛网膜下腔出血患者意识状态的分析

目的：分析影响蛛网膜下腔出血（ＳＡＨ）患者意识障碍的相关因素，为临床抢救提供依据。方法：回顾性分析１９８０～１９９５年收治的３９５例ＳＡＨ患者的临床资料。结果：本组３９５例ＳＡＨ，病后发生意识障碍者２２２例（５６．２０％），无意识障碍者１７３例。有、无意识障碍两组病例病程中发生脑疝者分别为３４．６８％和６．３６％，并发肺炎者分别为１１．６２％和２．３１％，并发消化道出血者分别为８．１０％和１．７３％。两组病死率分别为３４．６８％和８．６７％。脑动脉瘤破裂所致ＳＡＨ２２８例中意识障碍者１３９例（６０．９６％），非动脉瘤所致ＳＡＨ１６７例中有意识障碍者８３例（４９．７０％）。结论：观察ＳＡＨ患者有无意识障碍有助于对患者预后的分析判断，应尽早进行脑血管造影检查，如有脑动脉瘤则应争取尽早采取外科手术进行病因治疗。     

自发性蛛网膜下腔出血患者再出血的原因分析及护理对策

目的探讨自发性蛛网膜下腔出血(SAH)术后再出血的危险因素,从而提出相应的护理对策。方法以192例SAH患者作为观察对象,分为出血组和未出血组,将患者年龄、首次血压、哥拉斯哥(GCS)评分、术后有无躁动、有无糖尿病史、吸烟史作为观察内容,进行成组比较的对照研究。结果术后24h再出血主要与患者年龄、高血压、术后躁动及吸烟史有关,而与患者的GCS评分、糖尿病史无关。结论术后有效控制血压,合理应用镇静剂,对有吸烟史的老年患者加强监护,可以减少颅内再出血的发生。     

蛛网膜下腔出血炎性抑制与头痛的相关性研究

目的 :探讨蛛网膜下腔出血 (SAH)头痛的发生机制是否与 SAH时炎性改变有关 ,同时观察地塞米松的免疫抑制作用对头痛的疗效。方法 :选择意识清醒能主诉头痛者 ,凡病情严重伴有意识障碍以及继发大面积脑梗死伴有痴呆不能主诉头痛者除外。将患者随机分为 4组治疗 :单独应用甘露醇治疗头痛 (甘露醇组 )及在甘露醇应用的基础上行脑脊液置换 (置换组 )、地塞米松鞘内注射 (鞘内组 )和静脉注射 (静脉组 ) ,对比观察 4个组的止痛效果。结果 :根据疗效判定标准 ,各组总有效率分别是 :甘露醇组 2 7.2 7%、置换组 6 6 .6 7%、鞘内组92 .36 %、静脉组 30 .0 0 % ,鞘内组与其它组比较均有显著统计学意义 (P均 <0 .0 1) ,其头痛缓解时间显著延长。结论 :鞘内注射地塞米松治疗 SAH头痛效果显著 ,表明发生质变的血性脑脊液引起蛛网膜下腔广泛的免疫炎性反应是导致头痛的重要原因。     

Increased concentration of serum periostin is associated with poor outcome of patients with aneurysmal subarachnoid hemorrhage

Objective

To explore the role of serum periostin in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Method

We conducted a retrospective study and 124 aSAH patients treated in Shenzhen People's hospital during March 1st 2015 to December 30th 2016 were included. Baseline information, neurological status and clinical outcome were recorded. Blood samples on admission were collected and enzyme linked immunosorbent assay (ELISA) kits were used to detect the serum level of periostin. Spearman's Correlation Analysis was used to analyze the correlation between periostin and clinical severity. Receiver operating characteristic (ROC) curve was performed to investigate variables’ prognostic value in patients with aSAH.

Results

The average age of patients included was 57.23 years old. Preliminary analysis revealed that serum periostin was significantly correlated with clinical severity. Patients with poor outcome at 12 months had higher level of periostin than patients with good outcome. Multivariate logistic regression analysis showed elevated level of periostin was significantly associated with poor outcome and the AUC was 0.85 for periostin in predicting poor outcome of patient with aSAH.

Conclusion

Elevated serum periostin concentrations are significantly associated with clinical severity and poor outcome of aSAH patients, which indicate serum periostin can be used as a prognostic biomarker in patients with aSAH.

     

外伤性蛛网膜下腔出血的CT分析

目的:提高对外伤性蛛网膜下腔出血的认识水平。方法:86例外伤性蛛网膜下腔出血,每例最少复查1次以上,详细观察脑沟、脑池异常变化情况。结果:CT扫描显示局限于纵裂池积血53例;局限于部分脑沟及脑池17例;广泛性蛛网膜下腔出血,表现为大片脑沟、脑池内高密度影16例。86例中,单纯蛛网膜下腔出血仅15例,其余71例均合并有其他颅脑损伤。结论:蛛网膜下腔出血常伴有其他颅脑损伤。CT复查可诊断不典型少量蛛网膜下腔出血。     

PICC在自发性蛛网膜下隙出血病人中的应用

[目的]探讨经外周静脉置入中心静脉导管(PICC)在自发性蛛网膜下隙出血病人中的应用。[方法]将70例自发性蛛网膜下隙出血病人随机分为观察组和对照组,每组35例,观察组采用PICC穿刺置管,对照组采用浅静脉留置针。比较两组病人静脉炎、堵管、渗漏的发生情况。[结果]观察组静脉炎、堵管、渗漏发生率均低于对照组(P<0.05)。[结论]在自发性蛛网膜下隙出血病人中采用PICC穿刺置管,可降低静脉炎、渗漏、堵管的发生率,效果优于浅静脉留置针。     

蛛网膜下腔出血并发低钠血症及预后分析

目的:探讨自发性蛛网膜下腔出血(SAH)急性期低钠血症的发生情况及其对预后的影响。方法:收集首次发病的急性期SAH病人76例,测定其血清钠,对发生低钠血症患者的预后及并发症进行分析。结果:SAH后低钠血症占同期自发性SAH的46.1%;并发低钠血症病人的死亡恶化率高于血钠正常的病人,有统计学意义(P﹤0.05),低钠血症患者发生血管痉挛及继发脑梗死、脑积水者也高于血钠正常者(P﹤0.05)。结论:SAH后低钠血症发生率很高;是预后差的危险因素;且与脑血管痉挛,脑积水关系密切。     

动脉瘤性蛛网膜下腔出血后再出血分析

目的 评估动脉瘤性蛛网膜下腔出血（aSAH）后再出血的临床特征及危险因素,为aSAH再出血的预防提供指导。方法 对12例再出血患者的临床特征、影像学资料、治疗及预后进行分析。结果 12例再出血患者首发症状表现为头痛10例（83％）,意识障碍8例（67％）;入院时Hunt Hess评分Ⅲ~Ⅳ级8例（67%）,改良Fisher Ⅲ~Ⅳ级10例（83%）。在SAH后的最初24小时内发生再出血7例（58％）。入院后再出血时平均动脉压显著增加。再出血患者责任动脉瘤位于大脑前动脉（ACA）及前交通动脉（AComA）4例（33％）,多发动脉瘤5例（42％）,所有患者均对动脉瘤进行处理。SAH后并发急性脑积水9例（75％）,行脑室外引流6例（50%）,减压颅骨切除术1例（8%）,最终死亡5例（42％）。结论 SAH后院内再出血死亡率高、预后差,积极干预危险因素,从而减少残疾率及病死率。     

Carotid rete mirabile associated with subarachnoid hemorrhage from intracranial aneurysm: A case report and systematic review

Carotid rete mirabile (CRM) is a rare physiological vascular network in humans that is most often found in Eastern populations. This paper describes a CRM associated with an aneurysmal subarachnoid hemorrhage (aSAH) and discusses the details of the patient’s treatment. A 28-year-old woman was admitted to our service with clinical signs and symptoms of a spontaneous aSAH. Computed tomography revealed a diffuse and extensive SAH (Fisher group IV), while an angiogram showed an abnormal collateral network in the right carotid system and a hypoplastic aspect to the internal carotid artery (ICA) on the same side. In addition, a saccular aneurysm with a diameter of 9.5 mm was present in the ophthalmic segment of the left ICA. This case is extremely uncommon. To avoid rebleeding in the patient, we successfully treated the patient by clipping the aneurysmal lesion. No procedure was performed for the CRM.     

影响蛛网膜下腔出血预后的因素分析及护理对策

目的 探讨影响蛛网膜下腔出血预后的因素及护理对策。方法 对60例蛛网膜下腔出血患者的一般资料,临床表现,实验室检查结果与预后的关系进行初步分析。结果 蛛网膜下腔出血的预后受多种因素影响,蛛网膜下腔出血患者病死率与有无昏迷、脑疝、并发症及脑脊液中RBC的升高分别经X2检验均有显著性差异(P<0.001、P<0.01、P<0.05);而有无肢体瘫痪、抽搐、外周血象增高,经X2检验,无显著性差异(P>0.05)。结论 在护理对策上,密切观察病情变化,预防各种并发症,准确执行抗纤溶止血治疗,以防止发生再出血。     

蛛网膜下腔出血后早期脑损伤的研究进展

蛛网膜下腔出血是神经外科常见病,死亡率高,目前国内外对蛛网膜下腔出血后迟发性脑血管痉挛的研究已相当深入,但临床工作发现蛛网膜下腔出血后早期死亡的患者脑组织普遍存在严重的缺血损伤,涉及到迟发性脑血管痉挛出现（3 d~2周）之前脑组织内所发生的病理生理事件,包括脑灌注、微循环变化,基质金属蛋白酶、纤溶酶原激活剂等酶的消化作用导致基底膜IV型胶原蛋白缺失,分布于蛛网膜下腔的血清、富含血小板的血浆促成蛛网膜下腔出血后急性血管收缩,血小板的活化及在微血管内聚集打断脑循环导致脑灌注不足、局部缺血加剧等一系列病理生理学变化。针对这些现象,本文就蛛网膜下腔出血后早期脑损伤的机制及进展做一综述,为未来能更好控制这些继发性事件、有效治疗急性蛛网膜下腔出血提供初步的理论基础依据。     

蛛网膜下腔出血患者致死因素分析

目的：对蛛网膜下腔出血（ＳＡＨ）患者的致死因素进行统计分析。方法：应用Ｌｏｇｉｓｔｉｃ多元回归分析ＳＡＨ患者住院期间病死的有关因素。结果：筛出影响病死的重要因素有：入院查体时意识障碍及其严重程度、再出血和高血压病史。结论：在筛出的因素中查体时意识障碍及其严重程度对ＳＡＨ预后影响最大,且在这３项因素中具备项目越多者越易死亡     

尼莫地平联合脑脊液置换治疗蛛网膜下腔出血疗效研究

目的：探讨尼莫地平联合脑脊液置换治疗蛛网膜下腔出血（SAH）的疗效。方法将122例SAH患者分成观察组和对照组,每组各61例。对照组采用尼莫地平常规治疗,观察组患者在对照组基础上加以脑脊液置换治疗。结果观察组左大脑前动脉（ACA）、右ACA、左大脑中动脉（MCA）、右MCA收缩峰流速值均高于对照组（P＜0．05）;观察组脑膜刺激征缓解率优于对照组（P＜0．05）;观察组血管痉挛、梗阻性脑积液、再出血发生率低于对照组（P＜0．05）。结论采用尼莫地平联合脑脊液置换治疗SAH ,能及时清除蛛网膜下腔积血,改善脑部血液循环,降低不良反应发生率,提高患者生存质量。     

Evaluating the sensitivity of visual xanthochromia in patients with subarachnoid hemorrhage

Combined computed tomography and cerebrospinal fluid (CSF) analysis has been shown to be 100% sensitive for detecting subarachnoid hemorrhage (SAH) when CSF is obtained between 12 h and 2 weeks from time of headache onset and spectrophotometry is used to evaluate CSF for xanthochromia. Because most hospitals do not use spectrophotometry, we sought to evaluate the sensitivity of CSF analysis for xanthochromia by visual inspection. We retrospectively identified all patients seen in the Emergency Department (ED) with an ED discharge diagnosis of SAH from June 1993 to November 2005. A structured chart review was performed on all patients with the additional billed procedure charge for "lumbar puncture" or "spinal tap." Data collected included: CSF color, time from headache onset to CSF collection, and confirmation of SAH by advanced imaging. There were 1323 patients diagnosed with SAH, and 102 of these also had CSF collected. Of these, 81 charts were available for review. By predetermined protocol, 35 were excluded for lack of a report of CSF color, 1 was excluded because the time from headache onset to CSF collection was < 12 h, and 26 were excluded for lack of documentation of a definitive imaging study. Of the remaining 19, 9 were found to have xanthochromic CSF and 10 were found to have colorless CSF, resulting in a sensitivity for visual inspection of CSF of 47.3% (95% confidence interval 24.4-71.1%). Visual inspection of CSF supernatant for xanthochromia lacks the sensitivity necessary to reliably exclude the diagnosis of SAH.     

颅内动脉瘤性蛛网膜下腔出血的治疗

动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage, aSAH）是一种具有高致残率、高致死率的急性出血性脑血管病。目前治疗aSAH的外科手术方式主要包括开颅夹闭术及血管内介入栓塞术。两种手术方式各有其优缺点,目前根据动脉瘤瘤体形状、直径、位置及瘤颈大小等因素选择具体术式,但临床具体选择尚有争议。本综述通过回顾相关文献,对目前关于aSAH不同治疗方式及其疗效进行综合性阐述。     

PTX-3在蛛网膜下腔出血后脑血管痉挛发病机制中的作用

目的探讨正五聚蛋白-3(PTX-3)在蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)发生过程中的作用机制。方法分别检测SAH患者和健康对照组外周血白细胞(WBC)、中性粒细胞百分比(NE%)和脑脊液(CSF)中WBC、PTX-3水平。结果 SAH患者外周血WBC、NE%和CSF WBC、多个核细胞数均显著高于健康对照组(P<0.01,P<0.05);并且,血清和CSF PTX-3水平也显著高于健康对照组(P<0.01,P<0.05)。SAH患者痉挛组WBC、NE%与未痉挛组相比,差异无统计学意义(P>0.05),与之相反,SAH患者痉挛组CSF WBC、多个核细胞数显著高于未痉挛组,差异具有统计学意义(P<0.05),值得关注的是,血清PTX-3水平与未痉挛组相比,差异无统计意义(P>0.05),而CSF PTX-3水平显著高于未痉挛组(P<0.01)。SAH患者痉挛组WBC、NE%和CSF WBC、多个核细胞数在1、2、3、5、7d均显著高于健康对照组,差异具有统计学意义(P<0.01);并且,SAH患者痉挛组血清和CSF PTX-3水平在1、2、3、5、7d均显著高于健康对照组,差异具有统计学意义(P<0.01)。结论 SAH患者机体存在高强度的全身和局部炎症反应。局部炎症反应与CVS的发生密切相关。CSF高水平PTX-3可能通过诱导局部炎症反应而介导CVS的发生。CVS的发生依赖于患者机体高强度炎症反应的持续存在,而PTX-3可能是介导高强度炎症反应持续存在的关键效应分子。     

蛛网膜下腔出血的CT研究

目的研究蛛网膜下腔出血(SAH)的CT分型、伴随改变和不典型表现的鉴别诊断。方法对123例SAH患者(外伤性81例,自发性42例)头颅CT进行回顾性研究。结果 SAH分为单纯型和复合型,多累及2个脑池以上;自发性SAH多伴随脑室积血、脑积水和脑组织血肿,外伤性SAH颅内其他改变以硬膜下血肿、脑组织血肿和脑挫裂伤为主。结论认识SAH的CT表现和分型,有助于临床治疗。     

外伤性蛛网膜下腔出血患者血管痉挛状态的前瞻性临床研究

目的 探讨t-SAH患者中脑血管痉挛(CVS)的发生率、CVS的时间窗及危险因素.方法 前瞻性地对2007年6月至2008年12月期间绍兴县中心医院神经外科收治的t-SAH患者临床资料进行收集、分析,并于患者入院7 d内每天和第14天通过TCD观察大脑中动脉的血流动力学变化,以MCA平均血流速度(VmMCA)≥120 cm×s-1为CVS的标准,统计t-SAH患者中CVS的发生率、CVS的时间窗及相关的危险因素.结果 共98例t-SAH患者纳入本研究,CVS发生率为41.8%(共41例),其中GCS≤8分患者的MCA平均血流速度明显高于GCS≥9分患者;t-SAH积血Hijdra法计算6分以下45例(45.9%)中有2例(4.44%),6～13分31例(37.8%)中有9例(29.0%),13分以上22例(20.0%)中有8例(36.4%)发生CVS.手术组中37例(37.8%)中有13例(35.1%)发生重度CVS,通过对症治疗仍出现4例局部脑梗死,并入院3 d后的MCA平均血流速度明显高于非手术组.结论 t-SAH患者的原发伤程度、出血量及部位、手术操作等是导致CVS的主要危险因素,对t-SAH的防治有指导性意义.