自发性蛛网膜下腔出血临床与脑血管造影分析

Clinical Characteristics and Cerebral Angiography Analysis in Spontaneous Subarachnoid Hemorrhage

目的分析自发性蛛网膜下腔出血(SAH)的临床特点与原因。方法对120例经头颅CT、腰椎穿刺术和临床症状诊断为SAH的患者进行全脑数字减影血管造影(DSA)检查,首次造影结果阴性的患者2周后行第2次DSA检查,对临床症状与造影结果进行分析。结果头痛、呕吐及脑膜刺激征阳性是SAH的主要症状;DSA造影阳性者95例(79.2%),其中脑动脉瘤72例(75.8%),常规正侧斜位DSA检出脑动脉瘤75个,旋转DSA检出7个;脑血管畸形19例(20.0%),烟雾病3例(3.2%),上矢状窦血栓形成1例(0.1%),正常者25例(20.8%)。结论颅内动脉瘤是自发性蛛网膜下腔出血的最常见原因,全脑数字减影血管造影是SAH诊断最有效的方法。

Objective To analyze the clinical characteristics and etiology of spontaneous subarachnoid hemorrhage（SAH）. Methods Digital subtraction angiography （DSA）was performed in 120 cases diagnosed as SAH by CT,lumbar puncture and clinic symptoms. The DSA was reexamined 2 weeks later in the cases that the first DSA showed negative results. The clinic symptoms and the DSA results were analyzed. Results Headache,vomiting and positive meningeal irritation signs were the main symptoms of SAH, and 95 cases （79.2%） showed positive DSA including 72 cases （75.8%） of cerebral aneurysm,75 cerebral aneurysms detected by routine antero-posterior projection,lateral projection and oblique projection,and 7 cases were detected by rotary DSA,19 cases（20.0%） of cerebral vascu- lax malformations,3 cases（3.2%） of moyamoya disease,and I case （0.1%） of superior sagittal sinus thrombosis,and 25 cases （20.8%）were normal. Conclusion Cerebral aneurysm is the most common cause for SAH,and the effective diagnostic method for SAH is DSA.