脑淀粉样病变致脑出血的机制探讨

Mechanism exploration of cerebral amyloid angiopathy induced cerebral hemorrhage

目的探讨淀粉样脑血管病(CAA)引发脑出血的临床特点、发病机制及预后相关因素分析。方法对我院近3年收治的CAA引发的23例脑出血患者,均行头颅CT、MRI及SWI检查,计算颅内出血的体积、进行入院及出院时GCS评分及出院时m RS评分,进行预后分析,并结合文献对其发病机制进行深入探讨。结果 CAA引发的脑出血有自发性、多灶性及短期复发的特点,头颅CT对新鲜出血敏感,MRI对新鲜出血和陈旧性出血均可显示,SWI显示皮质及皮质下有多个微出血灶,而基底节区、脑干、小脑无微出血灶。结论 CAA是非高血压脑出血的重要原因;SWI示脑出血特征性表现可作为诊断依据,GCS评分出院比入院增加,出院时m RS评分与入院时GCS评分及脑出血体积有相关性。

Objective To investigate the clinical features, pathogenesis and prognosis related factors of cerebral amy- loid angiopathy（CAA） induced cerebral hemorrhage. Methods Twenty-three patients with CAA induced cerebral hem- orrhage who had been treated in our hospital in the recent 3 years were given head CT, MRI and SWI examination. The intracranial hemorrhage volume, GCS scores at hospital admission and discharge and mRS scores at hospital discharge were calculated, and the prognosis analysis was conducted. The patbogenesis was investigated in-depth combining lit- erature. Results CAA induced cerebral hemorrhage had the features of spontaneity, mulifocality and short-term recur- rence. Head CT was sensitive to fresh hemorrhage, MRI could display both fresh hemorrhage and old hemorrhage, and SWI displayed cortical and subcortical multiple microbleeds but no basal ganglia region, brainstem or cerebellum mi- crobleeds. Conclusion CAA is an important cause of non-hypertensive cerebral hemorrhage. Cerebral hemorrhage fea- tures displayed by SWI can serve as the diagnostic reference; The GCS scores at hospital discharge increase compared to those at hospital admission; The mRS scores at hospital discharge are correlated to the GCS scores and cerebral hemorrhagic volume at hospital admission.