自发性脑凸面蛛网膜下腔出血临床及影像学诊断分析:附五例典型病例报道

Atraumatic Convexal Subarachnoid Hemorrhage: Five Cases Report

目的探讨自发性脑凸面蛛网膜下腔出血(cSAH)患者的临床和影像学特点。方法回顾性分析5例cSAH患者的临床及影像学资料。结果 5例患者均急性起病,表现为反复偏侧肢体麻木、力弱及言语不清,每次持续10 min至1 h完全缓解,脑电图正常。均由急诊颅脑CT及随后的磁共振成像(MRI)+磁敏感加权成像(SWI)确诊为cSAH。5例患者分别行颅脑CT血管造影(CTA)/磁共振血管造影(MRA)检查,除外血管畸形、动脉瘤及Moyamoya病;均行血管炎及风湿免疫筛查,除外血管炎及感染性心内膜炎。3例SWI除发现cSAH外,还显示皮质及皮质下多个微出血,多处脑沟内含铁血黄素沉积,提示可能淀粉样脑血管病。1例MRA发现左侧颈内动脉狭窄中断,另1例颅脑CTA示左侧大脑中动脉M1段重度狭窄。结论临床遇到类似短暂性脑缺血发作的患者时,应急查颅脑CT,对于疑诊cSAH的患者,应进一步行包括液体衰减反转恢复(FLAIR)序列、SWI在内的颅脑MRI检查以证实诊断,并积极查找病因,决定下一步的治疗方案。

Objective To investigate the clinical and imaging characteristics of atraumatic convexal subarachnoid hem-orrhage（cSAH）. Methods The clinical and imaging data of 5 patients with cSAH were analyzed retrospectively. Results All the five patients had acute onset and showed hemianesthesia,hemiplegia and dysarthria,lasting 10 minutes to one hour. After complete remission,the electroencephalograms was normal. Brain CT,MRI and SWI were used to confirm cSAH. The five pa-tients were given CTA/MRA examination to exclude vascular malformation,aneurysm and Moyamoya disease,and vasculitis and autoimmune rheumatic screening were also given to exclude vasculitis and infectious endocarditis. In addition to cSAH,numerous cerebral microbleeds and superficial hemosiderin siderosis were also showed by SWI in the three patients,indicating the diagnosis of probable cerebral artery amyloidosis. Severe stenosis in carotid artery and left middle cerebral artery M1 section were demonstra-ted on MRA and CTA in two cases respectively. Conclusion When there is transient ischemic attack,brain CT should be given, and brain MRI including further FLAIR and SWI should also be used to confirm diagnosis. The cause of disease will be found to determine the treatment in the next stage.