自发性蛛网膜下腔出血首次脑血管造影阴性病例的临床分析

Clinical analysis of patients with spontaneous subarachnoid hemorrhage and a negative result in the first digital subtraction angiography

目的探讨自发性蛛网膜下腔出血(SAH)首次脑血管造影(DSA)阴性病例的病因、诊疗策略及预后等。方法对大连医科大学附属第一医院神经外科50例自发性SAH首次DSA阴性患者的临床资料进行回顾性分析。本组50例患者首次DSA均在发病后1周内检查,均为阴性。后经DSA复查并行MRI或MRA检查,根据结果总结SAH的原因、重复造影情况、治疗及预后。结果 50例经复查的患者中,共发现检查结果阳性病例10例,包括动脉瘤5例、隐匿性脑或脊髓血管畸形3例及海绵状血管瘤2例,其中9例行手术或栓塞治疗治愈出院,1例病人外院行伽马刀治疗痊愈;40例患者行非手术治疗,39例治愈出院,1例因合并严重内科疾病患者死亡。诊断中脑周围非动脉瘤性SAH(perimesencephalic nonaneurysmal subarachnoid hemorrhage,PNSH)21例,复查14例,均为阴性。结论对于首次DSA阴性的患者在执行科学规范的治疗基础上,应积极复查DSA并行MRI,根据结果,及时治疗。但对于诊断PNSH的病人,建议避免二次造影,但必须随诊CTA或MRI。

Objective To investigate the etiology,diagnosis and treatment strategy for patients with spontaneous subarachnoid hemorrhage（ SAH） and a negative result in the first digital subtraction angiography（ DSA）. Methods The clinical data were retrospectively evaluated in 50 patients,who were treated in the First Affiliated Hospital of Dalian Medical University with a negative result of DSA examined within a week after onset. Results Upon reexamination,10 cases had positive results,including 5 cases of aneurysm,3 cases of occult vascular malformations and 2 cases of cavernous hemangioma. Among them,9 cases were cured by surgery or embolization; another one were cured after gamma knife treatment. The other 40 patients received non- operative treatment; 39 cases were cured and 1 patients died due to combination with severe internal medicine disease. Conclusions Patients with the first time negative DSA should be paid more attention and taken to the second DSA or MRI actively. However,for patients who were diagnosed with PNSH,we suggest to avoid the second DSA,but they must be followed up with CTA or MRI.