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目的 研究不明原因蛛网膜下腔出血 (SAH)的临床特征。方法 对 45例经全脑血管造影未发现明确病因的 SAH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 本组病例意识障碍及局灶神经功能障碍发生率低 ,仅 6例 (13.33% ) ;头颅 CT显示大部分 (2 9例 ,6 4.4% )出血以脑底池 ,特别是中脑包围池为主 ,亦较常波及脚间池、四叠体池及后纵裂 ;全脑血管造影均为阴性。但 1例尸检发现有动脉瘤 ;绝大部分 (4 1例 ,91.11% )预后良好 ,2例伴发脑梗死 ,3例死亡。结论 不明原因 SAH患者意识障碍及局灶性神经功能障碍发生率低 ;早期头颅 CT扫描正常或显示出血以中脑包围池为主 ;全脑血管造影阴性 ;通常预后良好。临床上与一般动脉瘤性 SAH有些区别 ,但须谨慎处理 ,必要时重复全脑血管造影检查
Objective To study the clinical characteristics of unexplained subarachnoid hemorrhage (SAH). Methods The clinical data, neuroimaging, complications and prognosis of 45 patients with SAH who did not find the definite etiology by whole brain angiography were analyzed. Results The incidence of disturbance of consciousness and focal neurological dysfunction in this group was low, only 6 cases (13.33%). The cranial CT showed that the majority (29 cases, 6.44%) of hemorrhage were cerebral pool, especially midbrain surrounding pool Mainly, also more often wave and foot pool, quadruple pool and longitudinal fissure; cerebral angiography were negative. However, an autopsy revealed an aneurysm in one patient. The vast majority (41 patients, 91.11%) had a good prognosis, 2 patients had cerebral infarction, and 3 patients died. Conclusions The incidence of unconsciousness and focal neurological dysfunction in patients with SAH is unknown. The early CT scans of the head are normal or show that the blood is mainly mesolimbic pool. The cerebrovascular angiography is negative. The prognosis is usually good. Clinical differences with the general aneurysm SAH, but to be cautious, if necessary, repeat the whole cerebrovascular angiography