蛛网膜下腔出血首次全脑血管造影阴性的原因分析及处理

Cause and treatment of negative result of initial aortocranial angiography in patients with subarachnoid hemarrhage

目的探讨蛛网膜下腔出血(SAH)首次行全脑血管造影呈阴性的原因及治疗策略。方法对我院2001￣2005年间15例首次全脑血管造影呈阴性的SAH病人的诊断、治疗进行回顾性分析。结果所有病人首次造影均阴性,3例重复造影明确诊断,1例手术探查明确诊断,5例结合CT,MRI/MRA,CTA明确诊断,1例重复造影后死亡,5例重复造影仍阴性,仅CT表现为中脑周围池出血。结论首次造影阴性的SAH病人应重复DSA检查,同时辅助行CT、MRI/MRA检查,必要时行CTA进一步检查;对同一部位的反复出血,CT或MRI又高度怀疑有病灶的病人,尽管DSA检查阴性必要时也可以直接手术探查。

Objective To explore the cause and the treatment of the negative result of the aortocranial angiography for the first time in the patients with subarachnoid hemorrhage （SAH）. Methods The diagnosis and treatment of the 15 SAH patients who were treated in our hospital during 2001-2005 and were negative in the first-time aortocranial angiography were analyzed retrospectively. Results 3 were diagnosed as anterior communicating aneurysm in another angiography 2 weeks later; 1 case was diagnosed through operation. In another case, the patient died suddenly 6 h after the angiography. 5 cases had negative results in 2 angiographies, with CT showing that there was only hematoma in the cirstem circle. Though the cause of the disease was not able to be identified in the end, the patients made a good recove. 5 cases were diagnosed after an examination combined with the use of MRI, CT and CTA, and the suspicion was later proved by the operation. Conclusion The SAH patient whose first angiography shows a negative result should have the DSA examination once again, with CT, MRI, or MRA being conducted as an assisting one at the same time; and CTA may be further adopted if necessary. For those patients who have hemorrhage repeatedly and whose CT or MRI results strongly suggest the focus, operations may be performed to detect directly despite the negative result of DSA.