自发性凸面蛛网膜下腔出血的临床和影像学特点

Clinical and Imaging Characteristics of Spontenous Convexal Subarachnoid Hemorrhage

目的总结并探讨自发性大脑凸面蛛网膜下腔出血（convexal subarachnoid hemorrhage,c SAH）临床特点、影像学表现及其可能的发病机制。方法回顾自2001年12月~2013年1月在首都医科大学附属北京天坛医院神经病学中心住院和急诊就诊的c SAH病例,分析其人口学特征、临床表现、血管影像,探讨其危险因素及可能的病因。结果共纳入54例c SAH患者,其中男性34例,女性20例,中位数年龄58.5（48.8,70.8）岁。患者中脑血管病危险因素患病率：脂代谢紊乱23例（42.6%）,高血压21例（38.9%）,糖尿病11例（20.4%）,吸烟8例（14.8%）。37例患者住院,住院患者症状发生频率：头痛14例（37.8%）、肢体无力13例（35.1%）、麻木8例（21.6%）、构音障碍8例（21.6%）;症状呈发作性（n=16,43.2%）或持续性（n=23,56.8%）。计算机断层扫描（computed tomography,CT）显示c SAH多位于中央沟附近。39例接受血管造影检查,最常见的血管异常是病灶同侧颈内动脉/大脑中动脉狭窄或闭塞（23例,59.0%）,病灶范围内均未发现动脉瘤。50岁以上的c SAH患者30例（76.9%）明显多于50岁及以下的患者9例（23.1%）。并且50岁以上的30例患者中,脑动脉狭窄或闭塞在各种病因中所占比例最高（66.7%）;50岁及以下的9例患者中,脑动脉狭窄或闭塞少见（33.3%）。就c SAH患者中脑动脉狭窄或闭塞者的数量和所占比例来说,男性（18例,69.2%）多于女性（5例,38.5%）。结论脑动脉狭窄或闭塞可能是c SAH的重要原因。

Objective Spontenous cerebral convexal subarachnoid hemorrhage （cSAH） is different from aneurysmal subarachnoid hemorrhage （aSAH）. This study was to describe the clinical and vascular imaging characteristics and discuss the potential causes of cSAH. Methods We retrospectively selected patients admitted to Department of Neurology of Beijing Tiantan Hospital, from Dec. 2001 to Jan. 2013, who presented with cSAH. Data of demographic characteristics, clinical presentations and cerebrovascular imaging were collected. Results Fifty-four patients （34 men and 20 women） were included. Median age was 58.5 years （interquartile range 48.8~70.8）. Prevalences of risk factors for cerebrovascular disease were as follows：dyslipidemia （n=23, 42.6%）, hypertension （n=21, 38.9%）, diabetes mellitus （n=11, 20.4%）, smoking （n=8, 14.8%）.Thirty-seven patients was admitted to the hospital, in whom the frequencies of symptoms were as follows：headache （n=14, 37.8%）, weakness （n=13, 35.1%）, numbness （n=8, 21.6%）, dysarthria （n=8, 21.6%）. The symptoms were transient （n=16, 43.2%） or persistent （n=23, 56.8%）. computed tomography （CT） or magnetic resonance imaging （MRI） showed that hemorrhage mostly located in or near the central sulcus. Cerebral angiography was performed in 39 patients. The most common vascular abnormalities were isolateral internal carotid artery or middle cerebral artery stenosis or occlusion （n=23）. No aneurysm was found in the ifeld of cSAH. Patients 〉50 years old （n=30, 76.9%） are more than patients50 years （n=9, 23.1%）.In the 30 patients 〉50 years, cerebral artery stenosis or occlusion is in the highest proportion in a variety of causes （66.7%）. While in the 9 patients50 years old, cerebral artery stenosis or occlusion is rare （33.3%）. On the number and proportion of cerebral artery stenosis or occlusion, male （n=18, 69.2%） is than female （n=5, 38.5%）. Conclusion Cerebrovascular stenosis or occlusion may be the main cause of cSAH.