中脑周围非动脉瘤性蛛网膜下腔出血的诊治体会

Clinical comprehension of perimesencephalic nonaneurysmal subarachnoid hemorrhage

目的：进一步了解中脑周围非动脉瘤性蛛网膜下腔出血（PNSAH）的临床影像学特点及预后。方法对我院诊治的28例PNSAH患者观察其临床经过，来院48 h内行头CT检查，入院后3 d内行数字减影造影（DSA）检查，阴性时行头颅及颈椎MRI并2周后复查DSA或CTA。结果患者 Hunt-Hess分级Ⅰ～Ⅱ级25例，Ⅲ级3例，CT显示出血位于脑干周围脑池内，CTA或DSA检查未见颅内动脉瘤和脑血管畸形，头颅及颈椎MRI检查未见其他病变。所有患者均治愈出院，出院时GOS评分均为优。28例PNSA H患者的随访期为3～24个月，平均随访18个月。患者均无再出血、脑缺血和脑积水等。结论 PNSA H为一种临床症状较轻，预后良好的特殊类型蛛网膜下腔出血，首次造影阴性后需结合头颅及颈椎M RI检查以排除其他病变，必要时复查DSA或CTA。

Objective To further investigate the clinical imaging features and the prognosis of perimesencephalic nonaneu-rysmal subarachnoid hemorrhage.Methods 28 patients were retrospectively investigated ,all patients in the group were exam-ined by CT scan in 48 hours from onset ,the Digital subtraction angiography （DSA） were taken for all patients in 3 days ,those who initially present with a negative angiogram received head and cervical spine MRI. For negative angiography SAH patients , were given DSA or CTA re-examination after 2 weeks.Results The Hunt-Hess scales of 25 patients were Grade Ⅰ or Ⅱ ,3 of them were Grade Ⅲ. All the CT scan revealed SAH located in the perimesencephlic cistern. The CTA and DSA did not show any positive finding of aneurysm or brain vascular malformations. Head and cervical spine MRI was not found other lesions. All patients recovered when they discharged. The follow-up period was ranged from 3 to 24 months （mean 18 months）. There was no rebreeding ,cerebral ischemia or hydrocephalus.Conclusion The PNSAH was a distinct clinical entity ,with a slight clinical symptoms ,had a good prognosis. The primary negative patients were recommended to do head and cervical spine MRI. A sec-ond DSA or CTA should be considered.