急性多灶性脑出血5例报告及32篇相关文献复习(急性多灶性脑出血786例临床分析)

Acute multiple cerebral hemorrhage:report of 5 cases and literature review of 32 reference papers-Clinical analysis of 786 cases

目的探讨急性多灶性脑出血(AMCH)的病因、临床特点及诊断。方法通过5例病例报告及检索32篇国内相关文献,共33组病例资料进行分析研究。结果符合急性多灶性脑出血病例786例,男:女之比为1.97:1;29组共700例报告了1469个血肿发生部位,基底节区678个血肿(46.15%)、脑叶461个(31.38%)、丘脑150个(10.21%)、脑干108个(7.35%)、小脑70个(4.77%)、其它2个(0.14%);20组共469例进行了CT分型,幕上型最为常见,为328例(69.94%);混合型次之,112例(23.88%);幕下型29例(6.18%),相对少见;29组共661例报告了血肿数目,2个血肿586例(88.65%),3个血肿61例(9.23%),4个以上血肿占14例(2.12%);33组共786例进行了出血原因分析,高血压脑动脉硬化占绝对优势(591例,75.19%),可能及确诊脑血管淀粉样变54例(6.87%),血液病17例(2.16%),抗凝溶栓治疗15例(1.91%),脑血管畸形14例(1.79%),瘤卒中10例(1.27%),静脉窦血栓形成2例(0.25%),烟雾病2例(0.25%),梗死后出血1例(0.13%),不明原因80例(10.18%);33组共786例急性期总体死亡率为39.31%;9组共249例进行了CT分型及死亡报告,幕下型死亡率最高,为76.47%,混合型为66.67%,均明显高于总体死亡率(39.31%);幕上型最低,为33.13%,稍低于总体死亡率(39.31%)。结论 AMCH病因复杂,多为高血压性动脉硬化所致,不可忽视少见原因,且不明原因比例较高,有进一步确诊空间;本病发病率低,但病死率高,尤其是累及后颅窝;DSA有不可替代的的诊断价值。

Objective To investigate the pathophysiology, clinical characteristics, diagnosis and outcome of acute multiple cerebral hemorrhage（AMCH）. Methods We reported 5 cases with AMCH and reviewed 32 reference papers re- garding AMCH in China. The relevant clinical data were summarized. Results A total of 786 cases of AMCH were found. The male to female ratio was 1.97 ： 1. There were 1469 hematomas reported in 700 cases among 29 references. Among them,678 hematomas were located in basal ganglion （46. 15% ） , 461 in cortical area （ 31. 38% ） , 150 in thalamus （ 10.21% ）, 108 in brainstem （ 7.35 % ） ,70 in cerebellum （4.77 % ）, and 2 in other location （ 0.14% ）. In 469 cases, the distribution of hematoma was reported with 328 cases （ 69.94% ） in supratentorium, 29 （ 6.18% ） in infratentorium, and 112 （23.88%） in both supra-and infratentorium. In 661 cases among 29 references,there were 586 cases（88.65% ）with 2 he- matomas ,61 （9.23%） with 3 hematomas, and 14 （ 2.12% ） with more than 4 hematomas. In 786 cases among 33 references, the causes of bleeding were hypertension in 591 cases （75.19%） , amyloid angiopathy in 54 cases （6.87%） , hematologic disease in 17 cases （2.16%）, anticoagulation or thrombolysis in 15 cases （1.91%）, brain vascular malformation in 14 ca- ses（ 1.79% ）,tumor bleeding in 10 cases （1.27%）, dural sinus thrombosis in 2 cases（0.25% ）, moyamoya disease in 2 cases （0.25 % ）and unknown in 80 cases （10.18% ）. The overall mortality rate was 39.31%. Mortality rate was highest in patients with only infratentorial hematoma （76. 47% ）. and lowest in patients with only supratentorial hematoma （33.13%）. Conclusion The causes of AMCH are diverse and most frequently related to hypertensive hemorrhage. Al- though AMCH is not frequently seen, higher mortality rate is noted especially related to irrfratentorial hematoma. DSA has an irreplaceable diagnostic value.