手术联合重组活化凝血因子Ⅶ治疗脑淀粉样血管病相关性脑出血1例并文献复习

Surgery combined with recombinant activated factor Ⅶ for cerebral amyloid angiopathy-associated intracerebral hemorrhage:a case report and literature review

目的观察开颅血肿清除术联合凝血因子Ⅶ治疗脑淀粉样血管病相关性脑出血的疗效,探讨脑淀粉样血管病相关性脑出血的治疗方案。方法分析1例脑淀粉样血管病相关性脑出血患者的临床表现、影像学、治疗经过及预后等资料,并复习相关文献。结果患者男性,78岁,以头晕起病,病情快速进展至左侧肢体偏瘫及嗜睡,头部CT显示右侧额叶脑出血,予开颅血肿清除术清除血肿。术后血肿脑组织病理显示脑血管壁可见淀粉样蛋白沉积,显示为脑淀粉样血管病,予重组活化凝血因子Ⅶ2mg静脉注射1次。术后90d患者无明显功能障碍,能完成日常工作及生活,改良Rankin量表评分1分。结论手术联合凝血因子Ⅶ治疗可能对脑淀粉样血管病相关性脑出血患者有效。

Objective To observe the efficacy of surgery and recombinant activated factor Ⅶ in the treatment of cerebral amyloid angiopathy （CAA） -associated intracerebral hemorrhage （ICH） in a case, then to investigate treatment programs for CAA-associated ICH. Methods The clinical manifestation, brain imaging, treatment programs and prognosis were analyzed and related literatures were reviewed. Results The 78 years old male patient presented with dizziness, then rapidly progressed to left hemiplegia and somnolence. Head CT revealed a right frontal brain hematoma. The pathological examination confirmed CCA by showing amyloid deposition in cerebrovascular wall. After craniotomy hematoma evacuation and intravenous injection of recombinant activated factor Ⅶ 2 mg, he achieved satisfactory results. The modified Rankin Scale score was 1 point 90 days after the surgery, he could complete his daily work, with no significant dysfunction. Conclusions Some patients with CAA-associated ICH may benefit from surgery and recombinant activated factor Ⅶ.