非外伤性脑凸面蛛网膜下腔出血的临床表现与影像学特点

Nontraumatic convexal subarachnoid hemorrhage: clinical presentations and imaging features

目的非外伤性脑凸面蛛网膜下腔出血(convexal subarachnoid hemorrhage,c SAH)是非动脉瘤性蛛网膜下腔出血的少见类型,虽然临床表现多样,但影像学特征明显.本文回顾性分析c SAH的临床表现及影像学特点,便于临床工作者深入了解该疾病类型。方法收集2012年1月至2018年1月就诊于中国医科大学附属盛京医院的自发性蛛网膜下腔出血患者并对其中诊断为c SAH患者的临床表现及影像学特点进行回顾性分析。结果在所收集到的230例自发性SAH中,13例(5.65%)患者诊断为c SAH,其中9例为男性,占69%,年龄分布在33~84岁,平均为65.9岁,临床表现以短暂性运动或感觉障碍7例(54%)最为常见,头痛2例,占15%。6例患者MRI-FLAIR序列可见与CT病变脑沟相应的高信号,以单侧顶叶脑沟受累最为多见,共5例,占39%。结论本组c SAH患者临床表现多样,影像学表现与病因直接相关,需注重与动脉瘤性SAH、短暂性脑缺血发作及癫痫的鉴别。

Objective Nontraumatic convexal subarachnoid hemorrhage(cSAH)is a rare type of nonaneurysmal subarachnoid hemorrhage.Although cSAH has a wide spectrum of clinical presentations,its imaging features are unique.The clinical presentations and imaging features of cSAH were retrospectively analyzed to provide more information on cSAH.Method The patients with the diagnosis of spontaneous subarachnoid hemorrhage were recruited from the Shengjing Hospital of Chinese Medical University between January 2012 and January 2018.The clinical presentations and imaging features of the patients with cSAH were analyzed retrospectively.Result There were 13 patients with cSAH among 230 patients with spontaneous subarachnoid hemorrhage.Among them,9 patients were male(69%)and mean age was 65.9 years(range,33-84 years).The most common clinical presentations were transient motor and/or sensory symptoms,which occurred in 7 patients(54%).Two patients(15%)presented with headache as the symptom onset.Six patients showed the same sulci involved which appeared hyperdensed on CT and hyperintense on MRI-FLAIR sequence.The parietal lobe was the most common brain region involved and occurred in 5 patients(39%).Conclusion The cSAH patients have a variety of presentations.The imaging features are directly linked to the etiology.A special attention should be paid to the differential diagnosis of cSAH with aneurysmal subarachnoid hemorrhage,transient ischemic attack and epilepsy.