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。

Etiology and treatment of spontaneous intracranial hemorrhage

To study the etiology and treatment of spontaneous intracranial hemorrhage the cases of hypertension hemorrhage were excluded. Method: CT, MRI, angiography and lumbar puncture examinations were used in order to defect the etiology of spontaneous intracranial hemorrhage,74 cases were operated,21 of the 74 cases were treated with endovascular embo-lization,9 cases by gamma knife. Result: Among 121 cases of spontaneous intracranial hemorrhage, there were 46 cases of cerebral aneurysm, 45 cases of cerebral arteriovenous malformation ( AVM ), 2 cases of aneurysms combined with AVM, 5 cases of stroke of intracranial tumor, 2 cases of moyamoya disease and 21 cases of unknown causes.Conclusion:The most common cause of spontaneous intracranial hemorrhage was cerebral aneurysm and cerebral vascular malformation, accounting for 74. 4 % . CT scan and MRI can give the clue of etiology, and angiography can confirm it. Our conclusion is that cerebral angiography should be performed on every patient with spontaneous intracranial hemorrhage in order to verify the causes of hemorrhage. Proper therapeutic methods were selected according to various disease. The large AVM should be treated in combination with the endovascular embolization and operation or gamma knife.