无蛛网膜下腔出血的大脑中动脉动脉瘤破裂

Ruptured middle cerebral artery aneurysms without subarachnoid hemorrhage

目的总结无蛛网膜下腔出血（SAH）的大脑中动脉（MCA）动脉瘤破裂的临床特点。方法对6例在首次CT扫描上表现为脑内出血（ICH），或壁内出血（IMH）而无SAH的MCA动脉瘤破裂患者的临床表现、影像学检查、治疗方法和预后进行回顾性总结。结果本组首次CT扫描时间为起病后0—2d，表现为单纯ICH者4例，IMH者2例。DSA和手术证实为MCA动脉瘤破裂。开颅动脉瘤切除1例，夹闭5例，其中4例同时行血肿清除术。术后无死亡。结论MCA动脉瘤破裂首次CT扫描可仅表现为ICH或IMH而无SAH，与动脉瘤的部位、出血量以及CT扫描时间相关。

Objective To summarize the clinical features of ruptured middle cerebral artery （MCA） aneurysms without subarachnoid hemorrhage （SAH）. Methods We retrospectivdy reviewed the clinical manifestations, neuroradiological examination, treatment and prognosis of 6 cases of ruptured MCA aneurysm presented as intracerebral hemorrhage （ICH） or intramural hemorrhage （IMH） without SAH on initial CT scanning. Results The initial CT scanning was obtained on 0-2 days after onset. IMH was showed in 2 cases and simple ICH was in 4 cases, of which 3 were located in temporal lobe and 1 in frontal lobe. All cases were identified as MCA aneurysm by DSA and operation. Aneurysm was resected in 1 case and clipped in 5 cases, of which hematoma was also evacuated in 4 cases. Of these patients, 5 cases were good recovery, and 1 case was in moderate disability. Conclusions Ruptured MCA aneurysm may only present as ICH or IMH without SAH. It relates to the location of aneurysm, the amount of hemorrhage and the time of CT scanning after onset.