非高血压脑淀粉样血管病相关脑出血临床特征分析

Clinical Characteristics of Intracerebral Hemorrhage Related to Non-Hypertensive Cerebral Amyloid Angiopathy

目的:本研究旨在阐明非高血压脑淀粉样血管病(CAA)相关脑出血(ICH)临床特征。方法:笔者回顾了74例,年龄>55岁,CAA相关ICH患者的发病年龄、出血部位、临床表现、发病模式及复发次数、治疗方式、小血管疾病伴发情况。结果:患者平均发病年龄(77.14±7.45)岁,发病率随年龄增长而增加,女性占优势;ICH在额叶和顶叶中常发;在皮质体积校正后,顶叶是最常受影响的部位;ICH以急性起病为主,单一脑叶出血占到67.6%;其中8.1%的患者存在1次以上复发;在治疗中,83.8%行保守治疗,共16.3%接受了神经外科手术和微创血肿清除治疗。此外,CAA相关ICH约1/3伴发小血管病变;急性期常表现为运动障碍、意识障碍、高级皮质功能异常,慢性期则以认知障碍、癫痫发作及帕金森症状为主。结论:本研究显示了CAA相关ICH的临床特征,包括其顶叶偏好及年龄特点,未来的研究将扩大样本进一步探讨。

Objective:This study was designed to elucidate the clinical characteristics of intracerebral hemorrhage(ICH)related to non-hypertensive cerebral amyloid angiopathy(CAA).Methods:We reviewed 74 patients,age>55 years,with CAA-related ICH.We investigated the age at onset,the sites of hematoma,clinical manifestations,occurrence and recurrence of the hemorrhage,treatment modalities,and small vessel disease markers.Results:The average age of onset was(77.14±7.45)years old,and the incidence increased with age,with significant female predominance.ICH is common in the frontal and parietal leaves;however,after correcting for the estimated cortical volume,the parietal lobe is the most frequently affected site.ICH is mainly acute onset,single lobe bleeding accounts for 67.6%,and 8.1%had more than one recurrence.In treatment,83.8%of the patients underwent conservative treatment,and 16.3%received operation and hematoma suction treatment.In addition,about one-third of CAA-related ICH is associated with small vessel disease.Common manifestations in acute phase included dyskinesia,disturbance of consciousness,and abnormalities in higher brain functions.In the chronic stage,cognitive disorders,seizures,and Parkinson’s symptoms are predominant.Conclusion:Our study demonstrates the clinical features of CAA-related ICH,including its parietal lobe preferences and age characteristics,which will expand the sample for further study.