淀粉样脑血管病患者相关性脑出血与治疗

Cerebral amyloid angiopathy-associated intracerebral hemorrhage in the very elderly- clinical manifestations, diagnosis and treatment

目的分析淀粉样脑血管相关性脑出血的临床特点、诊断及治疗方法。方法对4例病理确诊的淀粉样脑血管病相关性脑出血患者的临床表现、治疗、转归进行总结。结果4例患者均表现为大量脑叶出血，均行开颅血肿清除术，术后再出血1例，术后联合重组活化凝血因子Ⅶ治疗2例。6个月内再次出血3例，再出血死亡1例。结论淀粉样脑血管病相关性脑出血临床表现多样，再出血风险高，确诊仍需病理。高龄患者仍可手术治疗，大量出血虽存在手术风险，但仍是挽救患者生命较好的方法。

Objective To analyze the clinical manifestations, diagnosis and treatment of cerebral amyloid angiopathy （CAA）-associated intracerebral hemorrhage. Methods The clinical manifestations, treatment and prognosis of CAA-associated intracerebral hemorrhage were analyzed in 4 patients who were identified as CAA-related hemorrhage （CAAH） by pathology. Results All of the 4 patients showed massive lobar intracranial hemorrhage, and underwent craniotomy evacuation of hematoma. One patient had postoperative hemorrhage, and 2 patients were treated with recombinant activated factor VII after operation. In the next 6 months, r^hemorrhage was found in 3 patients in whom one patient died due to massive hemorrhage. Conclusions CAAH has varied clinical manifestations with high risk of cerebral hemorrhage, and pathological diagnosis is necessary for a definite diagnosis. The very elderly patients with CAAH can benefit from the craniotomy evacuation of hematoma. Although surgery for massive hemorrhage has risks in very elderly patients, it is a better treatment to save their lives.