非外伤性脑凸面蛛网膜下腔出血的病因分析及诊疗对策

Etiological Analysis and Diagnosis and Treatment of Non-traumatic Brain Convex Subarachnoid Hemorrhage

目的非外伤性脑凸面蛛网膜下腔出血(convexal subarachnoid hemorrhage,cSAH)是蛛网膜下腔出血的罕见类型,与最常见的动脉瘤性蛛网膜下腔出血的诊疗明显不同。该文对不同年龄段cSAH患者的临床资料进行了回顾性研究及对比,以便更深入地了解该病的特点,指导临床工作。方法方便收集2014年1月—2019年12月收住福建省立医院的428例蛛网膜下腔出血患者的临床资料,将其中诊断为cSAH的21例患者按年龄分为2组:A组年龄≥60岁,B组年龄<60岁,并对其性别、基础疾病、临床表现、影像学特点、推测病因、治疗方案、发病时美国国立卫生研究院卒中量表(NIHSS)评分、发病12月改良Rankin量表评分(mRS)等进行回顾性分析及对比。结果在428例蛛网膜下腔出血患者中,cSAH患者为21例,占4.91%。其中男性9例,女性12例,平均年龄(52.8±19.3)岁。推测病因方面,60岁以上患者以脑淀粉样血管病(4例)、脑血管重度狭窄或闭塞(3例)最多见;60岁以下以可逆性脑血管收缩综合征(3例)、可逆性后部脑白质病(2例)最多见。结论不同年龄cSAH的病因及治疗明显不同。应对不同年龄段cSAH患者进行针对性检查以明确病因,指导治疗。

Objective Nontraumatic convex brain subarachnoid hemorrhage(convexal subarachnoid hemorrhage,cSAH)is a rare type of subarachnoid hemorrhage,which is significantly different from the diagnosis and treatment of the most common aneurysmal subarachnoid hemorrhage.This article has retrospectively studied and compared the clinical data of cSAH patients of different ages,in order to have a deeper understanding of the characteristics of the disease and guide clinical work.Methods Clinical data of conveniently select 428 patients with subarachnoid hemorrhage admitted to Fujian Provincial Hospital from January 2014 to December 2019 were collected,and 21 patients diagnosed with cSAH were divided into 2 groups according to age:the age of group A was≥60 years old,and that of group B was<60 years old.The gender,underlying diseases,clinical manifestations,imaging characteristics,presumed etiology,treatment plan,National Institutes of Health Stroke Scale(NIHSS)score at onset and modified Rankin Scale(mRS)score 12 months after onset were retrospectively analyzed and compared.Results Among 428 patients with subarachnoid hemorrhage,21 patients 4.91%were cSAH patients.There were 9 males and 12 females with an average age of(52.8±19.3)years.In terms of etiology,amyloid vascular disease(4 cases)and severe cerebrovascular stenosis or occlusion(3 cases)were the most common in patients over 60 years old.Reversible cerebral vasoconstriction syndrome(3 cases)and reversible posterior leukoencephalopathy(2 cases)were most common under 60 years old.Conclusion The etiology and treatment of cSAH in different age group are obvious different.We should apply targeted examinations in different age group in order to make clear the etiology and guide the treatment.