自发性蛛网膜下腔出血造影阴性148例临床分析

【目的】提高对自发性蛛网膜下腔出血(SAH)中特殊类型的中脑周围非动脉瘤性蛛网膜下腔出血(PNSH)的认识水平,指导临床诊治。【方法】回顾性分析148例首次造影阴性的自发性SAH病人的临床表现、影像学资料、治疗及预后情况。【结果】本组148例患者Ⅱ级以下133例,除5例患者行腰穿检查确诊为SAH外,其余患者均于发病1~2d内行头颅CT检查确诊。根据CT表现,出血仅位于中脑周围池者,和此部位延及一侧或两侧侧裂池者?延及纵裂池者?并有脑室出血者共122例。全部病人均在发病1~20d内首次行DSA检查,均为阴性。88例复查无阳性发现。139例病人愈后较好;3例有轻度的神经功能障碍;3例行脑室腹腔分流术恢复较好;3例因高龄合并其它脏器并发症家属放弃治疗。百余例患者随访6~36m,均无再出血发生。【结论】PNSH是一种特殊类型的SAH,无严重的脑血管痉挛、脑积水和再出血发生。提高对其的认识,对临床诊疗工作有重要的指导意义。对于非典型的PNSH患者,在除外脑血管痉挛的情况下,要有技术充分的6条血管的脑血管造影,多个角度投照。

The clinical study on the negative angiogram of spontaneous subarachnoid hemorrhage:148 cases reports

ObjectiveTO promote the understanding of perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH) and show light on the clinical diagnosis and treatment of it.Methods148 cases were restrospectively investigated, including the clinical data, imaging features, treatments and prognosis.Results5 of 148 patients with SAH in the group were diagnosed by lumbar puncture, others of them were all diagnosed by CT in two days from onset. According to CT scan, SAH was only in perimesenphalic cisterns or entered into sylvian fissure unilaterally or bilaterally, or entered into interhemisphereic cistern, totally in 123 cases. All patients were examined by DSA in 20 days from onsets, as a result, no aneurysm was ever found. 88 of the patients were examined secondly by DSA, MRA or CTA, no positive outcome was found. Outcome was considered good in 139 cases, fair in 3 cases, 3 patients receiced V-P operation. The treatments of 3 aged patients were abandoned by their family, 130 cases were follow-up from 6 to 36 months, who had no bleeding.ConclusionThe PNSH is a special SAH. Further understanding for PNSH is absolutely important for its diagnosis and treatment, while not typical PNSH need angiography of six artery from mutiple angles excluding cerebral vasospasms.