自发性蛛网膜下腔出血CTA阴性患者21例分析(1)
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[摘要] 目的 探讨CTA阴性自发性SAH患者的可能原因及处理方法。 方法 对21例CTA阴性自发性SAH患者的资料进行回顾分析。 结果 21例CTA阴性自发性SAH患者中发现动脉瘤4例，Moyamoya病1例，动静脉畸形1例。其中3例动脉瘤在本院经治疗后按GOS进行疗效评价，恢复良好2例，轻残1例，没有死亡。 结论 对于弥漫性SAH，强烈怀疑动脉瘤出血的患者，如CTA阴性应抓紧进一步行DSA检查；DSA检查阴性仍不能完全排除动脉瘤者，等脑血管痉挛期结束后先复查CTA，如仍为阴性，于1~3个月后再复查CTA或DSA。
[关键词] CTA阴性；自发性SAH；动脉瘤；DSA
[中图分类号] R651.1+2 [文献标识码] B [文章编号] 1673-9701(2012)06-0147-03
The analysis of 21 spontaneous subarachnoid hemorrhage cases with negative CTA
FENG Lu1 XU Lingshuang2 HUANG Rui2
1.Department of Neurosurgery, Taizhou Central Hospital, Taizhou 318000， China; 2. Department of Neurology, Taizhou Central Hospital, Taizhou 318000
[Abstract] Objective To investigate the possible reasons for the CTA negative patients with spontaneous SAH and the processing method. Methods Total 21 spontaneous SAH patients with CTA negative were retrospectively analyzed. Results In 21 spontaneous SAH patients with CTA negative, aneurysms were found in 4 cases, Moyamoya disease was found in 1 case, arteriovenous malformation was found in 1 case. Among 3 patients with aneurysms which were treated in our hospital were evaluated with GOS after treatment. Good recovery in 2 cases, mild disability in 1 case, there was no death. Conclusion For the diffuse SAH patients which are strongly suspected aneurysm hemorrhage, if CTA outcomes are negative, they should be further examined by DSA. If DSA outcomes are also negative, but they can not be completely excluded aneurysm, CTA should be reviewed after the end of vasospasm period. If the outcomes are still negative, CTA or DSA should be reviewed in 1-3 months.
[Key words] CTA negative; Spontaneous SAH; Aneurysm; DSA
自发性蛛网膜下腔出血(subarachnoid hemorrhage，SAH)常见原因有颅内动脉瘤破裂、脑动静脉畸形等。尤其是动脉瘤破裂患者病情往往进展迅速，如不及时处理，预后极差，所以早期诊断和治疗的意义重大。本院2008年1月～2011年10月，共收住自发性SAH患者106例，所有患者入院明确SAH后均先行计算机断层扫描血管造影(computed tomography angiography，CTA)检查。其中85例CTA结果阳性，发现颅内动脉瘤89个；21例CTA结果阴性。现对这21例CTA阴性患者进行回顾分析，报道如下。
1 资料与方法
1.1 一般资料
本组患者男9例，女12例；年龄21～78岁。Hunt-Hess分级：Ⅰ级12例，Ⅱ级6例，Ⅲ级3例。头颅CT明确SAH 17例；头颅CT阴性，腰穿证实SAH 2例；头颅MRI明确SAH 2例。
1.2 影像学检查
本组19例患者先行头颅CT检查，2例先行头颅MRI检查。发现SAH局限于脑池或脑叶内8例；弥漫性SAH 6例；中脑周围SAH 5例；头颅CT阴性2例。确诊SAH后立即行CTA检查 ......
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