246例非高血压性自发性脑出血的病因与DSA分析

目的 探讨非高血压性自发性脑出血的病因并分析其DSA结果。方法 非高血压性自发性脑出血246例，全部做了DSA检查。结果 脑动静脉畸形l16例(47．2％)，以顶、颞叶从MVM见。颅内动脉瘤85例(34．6％)，以Willis环动脉瘤多见。Moyamoya病15例(6．1％)。硬脑膜动静脉瘘7例(2．8％)。23例DSA未发现异常。结论 非高血压性自发性脑出血常见病因是脑动静脉畸形和颅内动脉瘤，临床DSA检查是确诊病因的重要手段之一。     

继发性脑室内出血（附48例分析）

报告继发性脑室内出血４８例临床资料。病因以高血压性脑出血为主占８３．３％，原发出血部位以基底节最多占６４．５％，破入脑室的脑实质内血肿量依次为脑叶、基底节、丘脑、小脑。根据脑实质内血肿量的多少及波及脑室程度的不同分别采用内科治疗、侧脑室穿刺引流、锥颅血肿抽吸、血肿抽吸加脑室引流，死亡率２９．１％。     

自发性脑叶出血73例病因分析

报告73例经CT证实的自发性脑叶出血,均行DSA检查,确定病因者61例(84％)。包括25例AVM,5例隐匿性血管畸形(经手术病理证实),28例动脉瘤,烟雾病、高血压和肿瘤各1例,其余12例原因未明。在30例脑血管畸形中,年龄40岁以下者29例,说明年青人脑叶出血的主要病因是AVM。28例动脉瘤中,前交通动脉瘤破裂的发生率最高,为16例(57％),且均造成额叶血肿,年龄50岁以上者13例,提示对年长者的额叶血肿,应注意前交通动脉瘤破裂的可能性。54例经手术治疗去除出血病因获痊愈。     

非高血压性幕上出血性卒中头CT与DSA对比分析

目的 探讨非高血压性幕上出血性卒中头CT与DSA的关系。方法 对连续120例患者做回顾性分析。结果 全组CT示蛛网膜下腔出血（SAH）76例、脑叶出血22例、脑室出血15例、基底节区出血7例；DSA异常93例，异常率77％，以动脉瘤最常见（46％），动静脉畸形（AVM）次之（23％），烟雾病较少（6％）及其它异常（3％）。在SAH中动脉瘤占显著优势（64％），而在脑叶及脑室出血中AVM多见（分别为59％、40％）。年龄≥40岁组动脉瘤的发生率是＜40岁组的2．4倍，相反＜40岁组AVM的发生率是≥40岁组的6．4倍。结论 SAH的病因多为动脉瘤，而脑叶出血或脑室出血以AVM多见。对非高血压性幕上出血性卒中，患者的年龄是鉴别血管病因的重要指征之一。     

青年人脑出血的病因、危险因素及预后分析

目的 分析青年人脑出血的病因、危险因素及预后。方法 回顾性分析146例青年脑出血患者的临床资料。结果 有明确病因者115例(78．8％)，病因不明者31例(21．2％)，其中先天性血管畸形57例(39．0％)，动脉粥样硬化52例(35．6％)，烟雾病4例(2．7％)，脑静脉血栓形成引发脑出血2例(1．4％)。主要危险因素有：高血压病、吸烟、过量饮酒、高脂血症、家族史。经治疗痊愈106例(72．6％)，显著进步19例(13％)，死亡21例(14．4％)。结论 青年人脑出血的病因以脑动静脉畸形和动脉粥样硬化最常见，以高血压为最常见的危险因素，大多数患者预后较好。     

血管内栓塞术治疗大脑深部动静脉畸形的意义

位于幕上大脑深部的动静脉畸形(AVMs)是指那些位于中脑、基底节及内囊区域的AVM,约占所有脑AVM的3％～12％。其治疗相当困难。本文报 道从1988年～1992年对14例位于丘脑、基底节及内囊区的AVM病人采用血管内栓塞术进行治疗的经验。 本组男性9例,女性5例,平均年龄29.1岁。6例外有过颅内出血(4例栓塞前有偏瘫和记忆力缺失),另8例在栓塞前3个月神经系统体征进行性加     

复发性脑出血103例临床分析

目的 探讨复发性脑出血的临床特点和发病机制。方法 对我院经CT证实的住院脑出血病人3200例中有复发性脑出血103例患者,分析其临床表现并探讨其可能的发病机制。结果 100例为2次出血,3例为3次出血,脑出血复发率为3．2％,2次出血者以基底节－基底节型最多（60％）,3次出血者3例均同时有基底节出血。61．2％再出血病灶位于首次出血的对侧,2例出血间隔时间大多在1年内（40．7％）,基底节－基底节型预后较差。结论 复发性脑出血有其特殊的临床表现,高血压控制不良可增加再出血的危险;基底节－基底节型出血原因多考虑高血压,而脑叶－脑叶型出血很可能与淀粉样脑血管病有关。     

急性多灶性脑出血21例临床分析

目的 探讨急性多灶性脑出血（AMCH）的病因、发病机理和临床特征。方法对21例急性多灶性脑出血患者临床资料进行分析。结果AMCH占同期脑出血患者的2．4％。主要病因为高血压。出血以基底节和脑叶多见。临床表现复杂多样。结论本病发病率低，但死亡率高，高血压为主要病因。头颅CT有助于诊断。     

年轻人脑出血50例临床分析

目的：探讨年轻人脑出血的病因及临床特点。方法：分析50例患者的临床病情、CSF、CT、MRI及DSA结果。结果：临床病因：高血压26例,AVM及动脉瘤13例,其它病因11例。出血部位：基底节区14例,SAH13例,脑叶9例,脑干6例。丘脑2例,其它部位6例。预后：多数患者瘫痪恢复较快,死亡8例。结论：年轻人脑出血常见原因为高血压、AVM和动脉瘤,CT是首选的诊断性检查,DSA对明确病因有重要价值。     

脑出血诊治中值得探讨的问题

脑出血是神经科最为常见的急重症,近半个世纪以来,尽管众多学者对该疾病进行了广泛研究,但不少问题仍未解决.在此前笔者所发表的相关述评及文章中,已对脑出血手术指征、手术技巧及血压管理等重要问题进行了介绍,但仍有不少尚无定论之处,值得重视和争鸣,如命名、病因及术后各种处理等. 一、命名 脑出血即国内传统所称的高血压脑出血,是指排除了肿瘤、动静脉畸形(AVM)、动脉瘤、血液病等继发因素的脑内出血,部位以基底节区和丘脑最常见,也可发生在脑室、脑叶、脑干及小脑等部位.脑出血在亚洲发生率较高,约占卒中患者的25％～50％,欧美仅占卒中患者的5％ ～15％[1-3].在国内外的文献中,对脑出血至今缺乏公认的命名和分型,有欧洲学者将脑出血分为原发性脑出血、继发性脑出血和原因不明性脑出血[4-5],在美国将脑出血命名为非动脉瘤性、非AVM性、非肿瘤性自发性脑出血[6].     

Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis

BACKGROUND AND PURPOSE: The frequency of intracerebral hemorrhages (ICHs) in people aged 31 years (odds ratio, 3.48), and those with ICH that resulted from arteriovenous malformations were aged <20 years (odds ratio, 2.80). The final outcome was considered favorable in 60%. CONCLUSIONS: ICHs in young people are mainly lobar in location and result from vascular malformation. Hypertension causes most cases in which the ICH is located in the basal ganglia. Mortality and morbidity in the acute phase are low and are related to hypertension as the cause of ICH.     

年轻人脑出血110例病因分析

目的 :探讨年轻人脑出血的病因和危险因素。方法 :选择 110例经过影像学证实为脑出血且年龄介于 15～ 4 4岁的患者 ,分析其危险因素、出血部位和发病原因。结果 :最常见的危险因素是高血压 (39.1% )和高甘油三酯血症(38.7% )。出血部位分别是基底节出血 38例 ,脑叶出血 34例 ,其他部位出血 38例。发病原因 :高血压病 4 1例 ,脑血管畸形 (含动静脉畸形、海绵状血管瘤及其他血管畸形 ) 18例 ,动脉瘤 2例 ,肿瘤 6例 ,其他 3例 ,原因不明 4 0例。结论 :高血压病、脑血管畸形和肿瘤是年轻人脑出血的常见原因 ,高血压和高甘油三酯血症是常见危险因素     

Nontraumatic cerebral hemorrhage in the young: A study of 107 cases.

Background: Reports on intracerebral hemorrhage (ICH) in the young are rare, and information on the cause and prognosis of ICH in this age-group is sparse. Methods: All cases of ICH admitted to three major hospitals in Saudi Arabia over a 15-year period were retrospectively reviewed. Patients aged between 6 months and 45 years at stroke onset were studied. Pooling of our data with those published from other centers was used for final analysis. Results: One hundred seven cases (69 male, 38 female), including 12 children younger than 10, were analyzed. The causes of hemorrhage were as follows: arteriovenous malformations (AVMs), 23%; systemic hypertension, 20%; blood dyscrasias, 16%; berry aneurysms, 8%; other causes, 7%. No cause was found in 26%. Sixty-two percent of the ICHs were lobar and 3% multiple. Early death rate was high (27%). Twelve percent of the patients were lost to follow-up, and only 26% returned to a state of complete autonomy. Conclusion: The pooling of the causative data from our cases and the 253 others reported in the literature showed that even before 45 years of age systemic hypertension is the leading cause of ICH. It accounts for approximately 30% of the cases, with AVMs (20%) being next. The pooled overall early mortality rate is approximately 20%, and only one third of the patients return to independent living.     

青年和中老年患者脑出血危险因素及预后的相关性探讨

目的探讨青年和中老年患者脑出血的危险因素及预后。方法选取我院2013-06—2014-06自发性脑出血患者362例,根据年龄不同分为青年组(≤45岁)142例与中老年组(45岁)220例。探讨2组患者脑出血的危险因素。并于治疗结束后1a进行电话随访,随访内容主要包括死亡情况、有无残疾、有无复发脑出血及预后情况。结果高血压是发生脑出血的最主要原因及危险因素,中老年组脑出血患者高血压发生率明显高于青年组,差异有统计学意义(P0.05)。青年组患者脑出血危险因素主要是高血压与脑部动静脉畸形,中老年组患者脑出血危险因素主要是高血压、糖尿病、高血脂、高NIHSS评分,差异有统计学意义(P0.05)。脑出血好发部位为基底核区,其次是丘脑。中老年组预后情况较差,病死率、残疾率较高,差异有统计学意义(P0.05)。脑出血复发率2组无明显差异(P0.05)。结论高血压是各个年龄阶段造成脑出血的独立危险因素。糖尿病、高血脂与高NIHSS评分是中老年组患者脑出血的危险因素。预后主要与年龄有关,年龄45岁是导致预后差的主要因素之一。     

High ethanol consumption as risk factor for intracerebral hemorrhage in young and middle-aged people

We examined the prevalence of high ethanol intake, hypertension, and other risk factors for intracerebral hemorrhage in a case-control study of 24 young and middle-aged patients with intracerebral hemorrhage. We recorded ethanol consumption, history of hypertension, liver disease, cigarette smoking, and mild or severe coagulation disorder in each case of intracerebral hemorrhage and in 48 control patients matched by sex and age. In univariate matched analyses, the frequencies of high ethanol intake (p = 0.009), hypertension (p = 0.05), and coagulation disorder (p = 0.05) were higher in the cases than in the controls. After controlling for possible confounding factors, we found that high ethanol intake and hypertension were the only independent risk factors for intracerebral hemorrhage (p = 0.02 and p = 0.05, respectively). The hemorrhagic lesion found in cases with a high ethanol intake tended to be located in the cerebral lobes (p = 0.01), contrasting with the typical basal ganglia location of hypertensive hematomas (p = 0.009). We conclude that chronic, high ethanol intake should be considered as an important risk factor for lobar hematomas in young and middle-aged people.     

Stroke in young adults

Strokes in young adults are uncommon and often a diagnostic challenge. A retrospective study of strokes due to intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral infarction was undertaken. We reviewed the medical records of 113 young patients aged 15-45 years who were admitted to the Medical Center Hospital of Vermont with a diagnosis of stroke between 1982 and 1987. This group comprised 8.5% of patients of all ages admitted for stroke, 2.3 times the proportion observed in the National Survey of Stroke. Nontraumatic intracerebral hemorrhage was diagnosed in 46 young patients (41%); the main causes included aneurysms, arteriovenous malformations, hypertension, and tumors. Subarachnoid hemorrhage was found in 19 young patients (17%); the majority were due to aneurysms. The remaining 48 young patients (42%) had cerebral infarction, the majority due to cardiogenic emboli and premature atherosclerosis. Mitral valve prolapse, the use of oral contraceptives, alcohol drinking, and migraine were infrequent sole causes of cerebral infarction in the absence of other risk factors. The case-fatality rate for this group of young patients with stroke was 20.4% compared with 23.9% for the National Survey of Stroke. Young adults with stroke deserve an extensive but tailored evaluation, which should include angiography and echocardiography.     

Nontraumatic intracerebral hemorrhage in young adults

We reviewed our experience with 72 patients, aged 15 to 45 years, who were hospitalized for nontraumatic intracerebral hemorrhages (ICHs) between 1978 and 1985. Evaluation included arteriography in 61 patients. Computed tomography demonstrated 41 lobar, 11 putaminal, four thalamic, four pontine, four intraventricular, two caudate, two midbrain, two cerebellar, one globus pallidum, and one corpus callosum hemorrhage. Forty-three patients, with either progressive neurologic deterioration, arteriovenous malformations (AVMs), or saccular aneurysms underwent surgery. The overall in-hospital survival, including those patients treated medically, was 87.5%. A presumed cause for the ICH was found in 55 (76.4%) patients. The main causes were ruptured arteriovenous malformations (21), hypertension (11), ruptured saccular aneurysms (seven), and sympathomimetic drug abuse (five). Surgical explorations demonstrated a necrotizing angiitis in one patient and arteriovenous malformations in two patients who had negative arteriograms. Young patients with nontraumatic ICHs represent a heterogeneous group. A cause can be established in most patients. Arteriovenous malformations account for less than one third of the hemorrhages in young adults, and other causes should be sought.     

121例自发性颅内出血的病因和治疗方法探讨

目的:研究自发性颅内出血的病因诊断,并探讨其治疗方法。方法:病例经计算机体层摄影(CT)、磁共振成像(MRI)和腰穿等检查明确诊断及病因。74洲经手术治疗,21例经血管内治疗.9咧经伽玛刀(γ—刀)治疗,17例保守治疗。结果:121例自发性颅内出血中,动脉瘤46例,瞄血管畸形45例,动脉瘤合并血管畸形2例,颅内肿瘤卒中5例,烟雾病2例,21鲕J原因不明。结论:脑动脉瘤和血管畸形是自发性颅内出血最常见的病因(占74.4％),CT和MRI对出血的病因提供诊断线索,脑血管造影能明确病因诊断,根据病因不同、病变大小和部位不同选择合适的治疗方法,大型脑动静脉畸形(AVM)主张联合治疗。