急性多灶性脑出血的病因、发病机制及临床分析

The observation on the causes, pathogenic mechanisms and clinical characteristics for acute multifocal cerebral hemorrhage

目的探讨急性多灶性脑出血（AMCH）的病因、发病机制及临床特点。方法通过CT、病理和临床检查，对47例病人进行观察分析。结果AMCH占同期脑出血病人的3％。主要病因为高血压（77％），淀粉样脑血管病（4％），脑血管畸形（4％），瘤卒中（2％），白血病（2％），原因不明5例（11％）。出血好发部位依次为基底节（51％），脑叶（39％），脑干和小脑（各5％）。按出血部位将其分为小脑幕上型、小脑幕下型和混合型3型，并阐述了AMCH复杂多变的临床特点。结论AMCH病因多为高血压。本病发病率低，但病死率高。借助临床上出现的多灶性体征，部分病人临床可以诊断。

Objective To investigate tha pathogenesis and clinical characteristics of acute multifocal cerebral hemorrhage (AMCH). Methods After CT, biopsy of the brain and necropsy, 47 patients with AMCH were observed and analysed. Results The main causes of AMCH were hypertension (36 cases,77%),cerebral amyloid angiopathy (2 cases, 4%), crebrovascular malformation (2 cases,4%), apoplexy caused by trmor (1 case, 2%),leukaemia (1 case, 2%) and unknow reason (5 cases, 11%). The predilective lesions of AMCH were in turn basal ganglion area (51%), cerebral lobes (39%), cereblum (5%) and brainstem (5%).According to the different positions, AMCH were divided into the supratemtorial type, the subtentorial type, and mixed type. The complicated clinical characterisics of AMCH were described. The mortality rate was 60%.Conclusions The cause of ANCH in the most patients was hypertension. The morbidity rate was lower and the mortality rate was higher. If thare was no CT, through multifocal aigns and symptoms the patientes with AMCH could be diagnosed.