自发性蛛网膜下腔出血脑血管造影阴性的诊治对策

Diagnosis and treatment of spontaneous subarachnoid hemorrhage with negative cerebral

目的探讨蛛网膜下腔出血(SAH)病人可能存在的出血原因,寻求当首次脑血管造影阴性时的诊治对策。方法回顾性分析我科近5年来322例SAH出血病人,其中55例病人首次血管造影阴性。结果17例因再出血或遵医嘱行2次脑血管造影,3例发现颅内动脉瘤,1例发现左颞叶底部脑动静脉畸形(AVM)。2例重复脑血管造影阴性者行开颅手术探查,证实分别为前交通动脉瘤和左侧颈内动脉后交通动脉瘤;8例行MRI检查,1例发现胼胝体AVM;8例行CTA检查,1例发现前交通动脉瘤。1例因出现典型的下肢放射痛而行脊髓血管造影,发现L2 AVM。结论对于SAH后首次造影阴性的病人,应行重复血管造影,结合MRI、MRA及CTA检查可提高诊断率,必要时行手术探查。

Objective To evaluate the etiology of spontaneous subarachnoid hemorrhage (SAH) with negative cerebral pan-angiography and to discuss its therapeutic measures. Methods Clinical data from 55 SAH cases with initial negative pan-angiography were analyzed retrospectively. Results Definite causes of SAH were found in 8 cases of these 55 patients. Intracranial aneurysms in 3 cases and left temporal lobe arteriovenous malformation in 1 case were discovered in 18 cases after repeated pan-angiography. Exploratory surgery found that 2 patients had anterior communicating aneurysm and left posterior communicating aneurysm respectively after negative repeated pan-angiography. One of eight patients was diagnosed as callus AVM by MRI, and one of eight patients was diagnosed as anterior communicating aneurysm by CTA. One patient was diagnosed as L2 AVM by spinal angiography because of typical radiating pain in lower limb. Conclusion For patients of SAH with initial negative cerebral pan-angiography,repeated pan-angiography combined with MRI, MRA and CTA examination can increase diagnosis rate. Sometimes exploratory surgery should be considered.