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目的研究动脉瘤蛛网膜下腔出血(aSAH)伴脑室积血病例的临床特点。方法对25例aSAH首次头颅CT所见以蛛网膜下腔出血伴发明显的脑室积血患者的临床表现、神经影像学、并发症及预后等资料进行分析。结果本组患者表现头痛22例(88%),呕吐24例(96%),一过性意识障碍15例(60%),昏迷4例(16%),抽搐11例(44%)。表现局灶神经功能障碍12例(48%)。脑膜刺激征阳性14例(56%)。所有病例均经全脑血管造影检查(DSA)、和(或)手术、尸检证实颅内动脉瘤。21例于神经外科手术后出院。4例死于脑疝。结论aSAH伴发脑室积血病例一般病情较重,意识障碍及神经系统局灶定位体征的发生率高,内科及神经系统并发症发生率高,特别是易于发生脑脊液循环障碍,造成脑积水。脑室出血本身不具有动脉瘤定位意义。动态影像学观察一旦确诊脑积水,只要病情许可,最佳处理是尽快外科治疗。
Objective To study the clinical characteristics of aneurysmal subarachnoid hemorrhage (aSAH) with ventricular hemorrhage. Methods The clinical manifestations, neuroimaging, complications and prognosis of 25 patients with aSAH first head CT were analyzed with the data of patients with subarachnoid hemorrhage and with significant ventricular hemorrhage. Results Twenty-two patients (88%) had headache, 24 (96%) had vomiting, 15 had transient disturbance of consciousness (60%), 4 had coma (16%) and 11 had convulsions (44%). 12 cases showed focal nerve dysfunction (48%). Meningeal irritation sign in 14 cases (56%). All cases were confirmed by whole brain angiography (DSA), and / or surgery, autopsy confirmed intracranial aneurysms. Twenty-one patients were discharged after neurosurgery. 4 cases died of herniation. Conclusions The patients with aSAH complicated with ventricular hemorrhage are generally in severe condition, with high disturbance of consciousness and focal signs of the nervous system, high incidence of internal medicine and nervous system complications, especially prone to cerebrospinal fluid circulation disorder and hydrocephalus. Ventricular hemorrhage itself does not have the significance of positioning aneurysms. Dynamic imaging Once the diagnosis of hydrocephalus, as long as the condition permits, the best treatment is as soon as possible surgical treatment.