自发性脑内血肿的病因诊断和治疗

Etiological diagnosis and treatment of spontaneous intracerebral hematomas

目的:探讨自发性脑内血肿的病因,临床特点和治疗。方法:总结47例患者的临床资料。结果:全部病例均行全脑DSA检查,发现病变30例(63.8％),MRI检查13例,阳性8例(61.5％)。出血原因:动脉瘤14例(30.1％),动静脉畸形11例(23.4％),合并动脉瘤2例,烟雾病4例(8.5％),其它8例(17.0％),不明原因10例(21.3％)。针对病因分别采取病变部位切除或栓塞等有效治疗,出院时愈后GOS分级Ⅲ级7例,Ⅳ级13例,Ⅴ级27例。结论:自发性脑内血肿均应进行全脑DSA检查,阴性患者在血肿基本消失后行MRI扫描尽可能查清病因;自发性脑内血肿以动脉瘤,动静脉畸形常见;及时处理脑内血肿,脑积水等危及生命并发症,根据出血原因,采取病变部位切除或栓塞等病因治疗。

Objective: To investigate the etiology, clinical findings and treatment of spontaneous intracerebral hematoma (ICH). Methods:47 cases were reviwed. Results: All patients were examined by DSA, and we found 30 (63. 8% ) lesions, MRI showed 8 vascular abnomal in 13 patiens; The most common hemorrhagic factor is aneurysm (30. 1% ) while arteriovenous malformation (AVM) in the second (23.4% ) , moyamoya disease(8.5% ) and other disorders (17.0% ) were less; The patients were classified into level 3 (Teases) , level 4 (13 cases) , and level 5 (27 cases) after the lesions were surgical operated on interventional neuroradiological treated. Conclusion: For all the spontaneous ICH patients, DSA examination is necessary. If the result is negative, they should be done MRI after hematomas disappear, aneurysm and AVM are common. In ICH. Most of the patients need etiological treatment including operation or embolization after emergent management for intracerebral hematoma or hydrocephalus.