头痛与非外伤性皮质凸面蛛网膜下腔出血

Headache and Nontraumatic Convexity Subarachnoid Hemorrhage

目的分析非外伤性皮质凸面蛛网膜下腔出血(convexity subarachnoid haemorrhage,cSAH)患者头痛的特点及出血病因,提高神经科医师对该病的认识。方法收集自2010年1月-2014年12月在北京大学第三医院就诊的14例cSAH病例,回顾性分析其头痛特点、临床表现、影像学检查及实验室检测结果。结果 14例cSAH患者中,8例(57.1%)表现为急性头痛,其中6例(75.0%)为偏侧轻中度胀痛;4例(50%)头痛为一过性,持续时间一般不超过30 min。病因学方面,12例(85.7%)患者病因明确:8例(57.1%)存在cSAH同侧颈内动脉系统血管重度狭窄或闭塞,颅内静脉窦血栓形成、脑动静脉畸形、使用抗凝药物以及可疑脑淀粉样血管变性各1例。结论急性头痛是cSAH最常见的临床表现,一过性头痛或轻中度头痛的患者需注意cSAH的可能;同侧颈内动脉系统主干血管动脉粥样硬化性重度狭窄是cSAH的重要病因。

Objective To analyze the characteristics of headache and the possible cause of convexity subarachnoid hemorrhage（cSAH）, so as to increase the understanding of cSAH.Methods A total of 14 cases of cSAH who came to Peking University third hospital between January 2010 and December 2014 were enrolled. Retrospective review was made upon the characteristics of headache, clinical manifestations, clinical medical records, and neuroimaging studies.Results Among 14 patients, acute headache（n =8, 57.1%） was the most common clinical manifestations, including 6 cases（75%） for unilateral. And 4 cases（50%） had a transient headache, usually lasting no longer than half an hour. There were 12 cases（85.7%） with clear etiology; there were 8 cases（57.1%） with severe stenosis or occlusion in ipsilateral internal carotid artery system of cSAH; and there were 4 cases： one with intracranial venous sinus thrombosis, one with cerebral arteriovenous malformation, one using anticoagulant and one with suspected cerebral amyloid vascular degeneration, respectively.Conclusion In the present study, acute headache was the most common clinical manifestation of cSAH. The patients with transient headache or with mild to moderate headache should be aware of the possibility of cSAH. Severe atherosclerotic stenosis or occlusion in the main branch of ipsilateral internal carotid artery system was an important cause of cSAH.