摘要
目的总结中脑周围蛛网膜下腔出血（PMSAH）的临术特点和长期预后情况。方法系统总结2001年1月至2005年1月之间我科收治的经早期（发病48h之内）CT证实并行全脑血管造影的PMSAH 32例的临床特征,比较与动脉瘤性蛛网膜下腔出血患者之间的区别。对PMSAH患者进行长期随访,了解预后情况。结果32例PMSAH中30例全脑血管造影无阳性发现,2例为后循环动脉瘤,同期后循环动脉瘤共19例。PMSAH患者中动脉瘤的发生率是6．25%（2/32）,10．5%（2/ 19）的后循环动脉瘤破裂可表现为PMSAH。非动脉瘤性PMSAH患者以中年患者为主,男性稍常见,既往高血压史少见,但发病前有更多诱发因素,临床症状较轻,绝大多数患者无意识障碍,以Hunt与HessⅠ、Ⅱ级为主,只有少数（6．7%）患者有脑室内出血,脑积水罕见。经长期（13-60个月,平均28个月）随访,无患者遗留永久性神经功能障碍,无再出血患者,大部分恢复原工作,有34．4%患者有轻微不适。结论PMSAH患者绝大多数全脑血管造影无阳性发现,但仍有少数患者存在后循环动脉瘤。其临床症状较轻,预后良好,一般无再出血发生。
Objective To investigate the clinical characteristics and long term follow up of the perimesencephalic subarachnoid hemorrhage （PMSAH）. Methods Thirty-two patients of PMSAH were involved in a series of consecutive 318 patients of spontaneous subarachnoid hemorrhage （SAH）. All patients were examined by CT （〈48hrs） and DSA. Their clinical data were compared with the patients of SAH due to the posterior circulation aneurysms. Long term follow up was evaluated about their perceived recovery, residual complaints and present occupational status. Results In the 32 cases of PMSAH, thirty cases were with the negative results of four-vessel angiography and two patients with the posterior circulation aneurysm, which were involved in 19 cases of posterior circulation aneurysm in this series. The likelihood of finding aneurysms on angiographic studies in patients with PMSAH is 6. 25%. Conversely, ruptured aneurysms of the posterior circulation present with an early perimesencephalic SAH pattern in 10.5% of cases. The clinical features of non-aneurysmal PMSAH differed from the aneurysmal SAH in previous hypertension, strain-related onset, loss of consciousness, Hunt and Hess grade, intraventricular bleeding and hydrocephalus predominantly （P 〈 0. 05 ）. At long term follow up （ at least 13 months）, no patients had neurological deficits. However, 34.4% of the patients had complaints consisting of mild headaches, depression, forgetfulness, weariness and diminished endurance. Two patients of the aneurysmal PMSAH did not return to their previous occupation. In 18 patients of the non-aneurysmal PMSAH who had not retired before the onset, 16 patients returned to their previous occupation. No one had the recurrent bleeding. Conclusions There is the possibility of finding an aneurysm in PMSAH. The patients of PMSAH has a benign clinical course and also with good prognosis.
出处
《中华神经外科杂志》
CSCD
北大核心
2007年第3期191-193,共3页
Chinese Journal of Neurosurgery
关键词
中脑周围蛛网膜下腔出血
后循环动脉瘤
脑血管造影
Perimesencephalic subarachnoid hemorrhage
Posterior circulation aneurysm
Four-vessel angiography
