脑血管造影阴性患者自发性蛛网膜下腔出血的原因

Analysis of the causes of spontaneous subarachnoid hemorrhage with a negative result in the first digital subtraction angiography

目的:探讨首次全脑血管造影阴性患者自发性蛛网膜下腔出血的发病原因。方法:回顾性分析30例首次DSA阴性的SAH患者的临床表现、影像学特征、治疗及预后。结果:本组30例病例,有7例在随后的手术或再次DSA检查中被证实为颅内动脉瘤,有18例至少2次DSA阴性的患者诊断考虑为中脑周围非动脉瘤性SAH;另外4例1次DSA阴性,MRA阴性的患者诊断考虑PNSN可能大,1例考虑为高血压脑出血;还有1例出院2月后死亡的患者,考虑动脉瘤的可能性大。结论:首次DSA阴性的SAH患者,其病因诊断要谨慎,在条件许可的情况下,最好复查全脑血管造影,避免误诊和漏诊。2次DSA检查阴性者才可考虑诊断为PNSN。

Objective：To explore the causes of spontaneous subarachnoid hemorrhage which have a negative result in the first digital subtraction angiography. Methods：A retrospective analysis of the clinical data（including clinical features, radiographic feature treatment and prognosis） of 30 cases with spontaneous subarachnoid hemorrhage which have a negative result in the first digital subtraction angiography in Chengdu No.2 People＇s Hospital. Results： In all 30 cases, 7 cases were confirmed as intracranial aneurysm in the surgery or the second DSA. 18 eases were considered as perimesencephalic nonaneurysmal SAH（PNSN）, 4 cases＇ diagnosis could be PNSN, I case was diagnosed hypertensive intracerebral hemorrhage and I patient was considered possibly as aneurysm who had died 2 months after discharge. Conclusions：It must be cautious when we are making etiological diagnosis for the spontaneous subarachnoid hemorrhage patients with a negative result in the first digital subtraction angiography. We＇d better do another DSA to avoid the error diagnosis and the missed diagnosis were happened. PNSN was considered when the patients had gotten negative result in twice DSA at least.