高血压脑溢血的脑血管造影诊断

ANGIOGRAPHIC DIAGNOSIS OF HYPERTENSIVE CEREBRAL HEMORRHAGE

对经手术证实的21例高血压脑溢血患者的脑血管造影表现作了分析。其中:1.占位征象21例,包括外侧型18例、内侧型1例、皮层下型2例;2.水肿征21例;3.深静脉过早充盈征12例;4.造影剂外溢征1例;5.其他11例,包括血肿破入脑室征3例和脑疝征8例。脑血管造影不仅能确定血肿位置、大小、蔓延范围和估计预后,而且在出现造影剂外溢征时可直接指出出血部位。在国内目前CT尚未普及情况下仍可作为一种重要的检查方法。

This article presents the experience in angiographie diagnosis of 21 cases of hypertensive cerebral hemorrhage,including 18 cases of lateral type,1 case of medial type and 2 cases of subcortical type hematoma.The x-ray appearance of the hypertensive cerebral hemorrhage is an avascular space occupying lesion.In the lateral type,the lenticulostriate arteries are displaced medially and the Sylvian segment of the middle cerebral artery displaced laterally,forming an avascular area.In the medial type,both the lenticulostriate arteries and the anterior choroidal artery are displaced laterally.The subcortical hematoma is usually the result of lateral or medial type hemorrhage and is seen as a large avascular space occupying lesion in the temporal lobe.Extravasation of contrast media,rupture of the hematoma into the ventricular system and the decending uncal herniation of the temporal lobe usually suggest that the condition is very serious and emergency surgery is indicated.