减数血管造影阴性的蛛网膜下腔出血临床分析

The Clinical Analysis in Patients Suffered from SAH with Normal DSA Results

目的:探讨减数血管造影(DSA)阴性的蛛网膜下腔出血(SAH)的病因,临床特点和预后。方法:回顾对比分析30例DSA阴性的SAH及102例DSA阳性的SAH的临床资料。结果:DSA阴性SAH患者年龄偏大,精神症状多见,伴有高血压、高血脂多,而头痛相对较轻,颅神经损害、癫痫发作较少,出血量较小,尤其是再出血率、脑积水等并发症较少.死亡率较低,与DSA阳性SAH相比有显著差异。结论:DSA阴性SAH症状相对较轻但不典型,易误诊,预后较好;DSA阴性主要原因是环中脑池出血、微小动脉瘤,少数可能为假阴性,必要时需行DSA复查。

Objective: To investigate the etiology,the clinical characteristics and the prognosis in patients suffered from subarachnoid hemorrhage(SAH) with normal Digital Subtraction Angiography (DSA) results. Methods: The clinical materials in 30 cases of patients suffered from SAH with normal DSA results and 102 cases of patients with abnormal DSA results were analyzed retrospectively. Results: The patients suffered from SAH with normal DSA results are aged, with more mental symptom and hypertension and hyperlipemia,but they have rather mild headache,less cranial nerve influence, epilepsy attack and hemorrhage amount. Their complications such as rehemorrhage and hydrocephalus are mild and the mortality is lower. There was significant difference from those patients of SAH with abnormal DSA results. Conclusion: The symptom in patients suffered from SAH with normal DSA results was slighter and atypical,and easy to be misdiagnosed, with better prognosis. The main causes are microaneurysm,perimesencephalic nonaneuryomal SAH,a minority of them might be false negative. So sometimes DSA should be taken repeatly.