摘要
目的探讨合并单纯颅内血肿的颅内破裂动脉瘤患者的临床特征。方法回顾性连续纳入2012年10月至2018年12月南华大学附属第二医院神经外科颅内破裂动脉瘤住院患者410例,其中表现为无蛛网膜下腔出血的单纯颅内血肿的颅内破裂动脉瘤8例,分析该类患者的临床资料,包括心脑血管危险因素、格拉斯哥昏迷量表评分、Hunt-Hess分级、Fisher分级、影像学征象、颅内动脉瘤特征、手术方式及随访结果等。心脑血管危险因素包括高血压病、糖尿病等病史,影像学征象包括出血特点、位置等,颅内动脉瘤特征包括动脉瘤大小(纵横比)等,手术方式包括初次手术与再次手术的方式,并采用改良Rankin量表(mRS)评分评价患者治疗3个月预后。结果 (1)单纯颅内血肿的颅内破裂动脉瘤占同期所有颅内破裂动脉瘤的比例为2.0%(8/410),8例患者初诊或首诊时颅内动脉瘤漏诊5例:1例首次诊断为急性创伤性硬膜下血肿,经CT血管成像(CTA)进一步确诊为后交通动脉动脉瘤;1例首次诊断为自发性基底节脑出血,经CTA确诊为大脑中动脉瘤;1例在外院初次诊断为自发性基底节脑出血,开颅血肿清除术中发现大脑中动脉分叉部动脉瘤,术后2周DSA检查显示合并前交通动脉动脉瘤;1例在外院因头痛诊断为自发性额叶脑出血,经CTA确诊为大脑前动脉瘤;1例首次诊断为自发性基底节脑出血,经头部CTA确诊为大脑后动脉瘤。(2)影像学特征:头部CT平扫均无明显蛛网膜下腔出血征象。有2例患者血肿边缘可见类圆形稍高密度影,后经CTA和手术证实为动脉瘤体部;大脑中动脉瘤导致的基底节区血肿边缘紧邻外侧裂,部分血肿扩展至颞叶;大脑前交通动脉动脉瘤导致的额叶血肿中心则位于额底直回;脑室出血的血肿贯穿颞叶皮质充满侧脑室颞角,颞角血肿多于侧脑室体部;硬膜下血肿患者无颅骨骨折征象。CTA显示,有5例患者动脉瘤
Objective To explore the clinical features of patients with ruptured intracranial aneurysm combined with simple intracranial hematoma. Methods A total of 410 continuous patients with ruptured intracranial aneurysms in the Neurosurgery of the Second Affiliated Hospital of University of South China from October 2012 to December 2018 was enrolled retrospectively. Eight cases of those combined with simple intracranial hematoma but without subarachnoid hemorrhage. The clinical data of these patients were collected, including cerebrovascular risk factors, Glasgow Coma Scale score, Hunt-Hess classification, Fisher classification, imaging signs, the characteristics of intracranial aneurysm, the type of surgical treatment, and the outcomes of follow-up. After 3 months of treatment, the prognosis was evaluated by modified Rankin scale(mRS) score. Results(1) The proportion of ruptured intracranial aneurysms with simple intracranial hematoma accounted for 2.0%(8/410). Five patients ignored the diagnosis of intracranial aneurysm at initial diagnosis: one case was diagnosed with acute traumatic subdural hematoma at the first time, and then diagnosed as posterior communicating artery aneurysm by CT angiography(CTA);one case was diagnosed with spontaneous basal ganglia hemorrhage at the first time, and then diagnosed as middle cerebral aneurysm by CTA;one case was diagnosed with spontaneous basal ganglia cerebral hemorrhage in the other hospital at the first time, and then diagnosed as middle cerebral artery bifurcation aneurysm during the craniotomy hematoma removal, and further diagnosed as anterior communicating artery aneurysm 2 weeks after surgery by DSA;one case was diagnosed with spontaneous frontal lobe hemorrhage due to headache in the other hospital at the first time, and then diagnosed as anterior cerebral aneurysm by CTA;one case was diagnosed with spontaneous basal ganglia hemorrhage at the first time, and then diagnosed as posterior cerebral aneurysm by CTA.(2) Imaging features: hematoma in the basal ganglia is imm
作者
段永红
梁日初
廖勇仕
蒋园丁
刘小飞
Duan Yonghong;Liang Richu;Liao Yongshi;Jiang Yuanding;Liu Xiaofei(Department of Neurosurgery,the Second Affiliated Hospital of University of South China,Hengyang,Hunan 421001,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2020年第5期252-258,共7页
Chinese Journal of Cerebrovascular Diseases
基金
湖南省卫生健康委员会科研计划(B2019110)。
关键词
颅内动脉瘤
蛛网膜下腔出血
血肿
硬膜下
颅内
脑实质血肿
Intracranial aneurysm
Subarachnoid hemorrhage
Hematoma,subdural,intracranial
Intraparenchymal hemorrhage
