自发性凸面蛛网膜下腔出血的临床和影像学特点

摘要/Abstract

摘要：

目的总结并探讨自发性大脑凸面蛛网膜下腔出血（convexal subarachnoid hemorrhage，cSAH）临床特点、影像学表现及其可能的发病机制。方法回顾自2001年12月～2013年1月在首都医科大学附属北京天坛医院神经病学中心住院和急诊就诊的cSAH病例，分析其人口学特征、临床表现、血管影像，探讨其危险因素及可能的病因。结果共纳入54例cSAH患者，其中男性34例，女性20例，中位数年龄58.5（48.8，70.8）岁。患者中脑血管病危险因素患病率：脂代谢紊乱23例（42.6%），高血压21例（38.9%），糖尿病11例（20.4%），吸烟8例（14.8%）。37例患者住院，住院患者症状发生频率：头痛14例（37.8%）、肢体无力13例（35.1%）、麻木8例（21.6%）、构音障碍8例（21.6%）；症状呈发作性（n=16，43.2%）或持续性（n=23，56.8%）。计算机断层扫描（computed tomography，CT）显示cSAH多位于中央沟附近。39例接受血管造影检查，最常见的血管异常是病灶同侧颈内动脉/大脑中动脉狭窄或闭塞（23例，59.0%），病灶范围内均未发现动脉瘤。50岁以上的cSAH患者30例（76.9%）明显多于50岁及以下的患者9例（23.1%）。并且50岁以上的30例患者中，脑动脉狭窄或闭塞在各种病因中所占比例最高（66.7%）；50岁及以下的9例患者中，脑动脉狭窄或闭塞少见（33.3%）。就cSAH患者中脑动脉狭窄或闭塞者的数量和所占比例来说，男性（18例，69.2%）多于女性（5例，38.5%）。结论脑动脉狭窄或闭塞可能是cSAH的重要原因。

文章导读： 通过相对较多的病例分析提示脑动脉狭窄或闭塞可能是国人凸面蛛网膜下腔出血的重要原因。

关键词: 凸面蛛网膜下腔出血; 动脉狭窄; 动脉闭塞; 短暂性脑缺血发作; 脑梗死

Abstract:

Objective Spontenous cerebral convexal subarachnoid hemorrhage (cSAH) is different from aneurysmal subarachnoid hemorrhage (aSAH). This study was to describe the clinical and vascular imaging characteristics and discuss the potential causes of cSAH. Methods We retrospectively selected patients admitted to Department of Neurology of Beijing Tiantan Hospital, from Dec. 2001 to Jan. 2013, who presented with cSAH. Data of demographic characteristics, clinical presentations and cerebrovascular imaging were collected. Results Fifty-four patients (34 men and 20 women) were included. Median age was 58.5 years (interquartile range 48.8~70.8). Prevalences of risk factors for cerebrovascular disease were as follows:dyslipidemia (n=23, 42.6%), hypertension (n=21, 38.9%), diabetes mellitus (n=11, 20.4%), smoking (n=8, 14.8%).Thirty-seven patients was admitted to the hospital, in whom the frequencies of symptoms were as follows:headache (n=14, 37.8%), weakness (n=13, 35.1%), numbness (n=8, 21.6%), dysarthria (n=8, 21.6%). The symptoms were transient (n=16, 43.2%) or persistent (n=23, 56.8%). computed tomography (CT) or magnetic resonance imaging (MRI) showed that hemorrhage mostly located in or near the central sulcus. Cerebral angiography was performed in 39 patients. The most common vascular abnormalities were isolateral internal carotid artery or middle cerebral artery stenosis or occlusion (n=23). No aneurysm was found in the field of cSAH.Patients >50 years old (n=30, 76.9%) are more than patients 50 years (n=9, 23.1%).In the 30 patients >50 years, cerebral artery stenosis or occlusion is in the highest proportion in a variety of causes (66.7%). While in the 9 patients 50 years old, cerebral artery stenosis or occlusion is rare (33.3%). On the number and proportion of cerebral artery stenosis or occlusion, male (n=18, 69.2%) is than female (n=5, 38.5%). Conclusion Cerebrovascular stenosis or occlusion may be the main cause of cSAH.

Key words: Convexal subarachnoid hemorrhage; Arterial stenosis; Arterial occlusion; Transient ischemic attack; Cerebral infarction

杜万良，荆京，王伊龙，王拥军. 自发性凸面蛛网膜下腔出血的临床和影像学特点[J]. 中国卒中杂志, 2015, 10(07): 580-585.

DU Wan-Liang, JING Jing, WANG Yi-Long, WANG Yong-Jun. . Clinical and Imaging Characteristics of Spontenous Convexal Subarachnoid Hemorrhage [J]. Chinese Journal of Stroke, 2015, 10(07): 580-585.

参考文献

参考文献

1 Beitzke M, Gattringer T, Enzinger C, et al. Clinical presentation, etiology, and long-Term prognosis in patients with nontraumatic convexal subarachnoid hemorrhage[J]. Stroke, 2011, 42:3055-3060.

2 Mangla R, Drumsta D, Alamst J, et al. Cerebral convexity subarachnoid hemorrhage:various causes and role of diagnostic imaging[J]. Emerg Radio, 2015, 22:181-195.

3 Cuvinciuc V, Viguier A, Calviere L, et al. Isolated acute nontraumatic cortical subarachnoid hemorrhage[J]. Am j Neuroradiol, 2010, 31:1355-1362.

4 Ferguson GG, Eliasziw M, Barr HW, et al. The North American Symptomatic Carotid Endarterectomy Trial :surgical results in 1415 patients[J]. Stroke, 1999, 30:1751-1758.

5 Sakaguchi M, Kitagawa K, Okazaki S, et al. Sulcus subarachnoid hemorrhage is a common stroke subtype in patients with implanted left ventricular assist devices[J]. Eur Neurol, 2015:n/a-n/a.

6 Geraldes R, Sousa PR, Fonseca AC, et al. Nontraumatic convexity subarachnoid hemorrhage:Different etiologies and outcomes[J]. J Stroke Cerebrovasc Dis, 2014, 23:e23-e30.

7 Rico M, Benavente L, Para M, et al. Headache as a crucial symptom in the etiology of convexal subarachnoid hemorrhage[J]. Headache:The Journal of Head and Face Pain, 2014, 54:545-550.

8 Geraldes R, Santos C, Canhão P. Atraumatic localized convexity subarachnoid hemorrhage associated with acute carotid artery occlusion[J]. Eur Neurol, 2011, 18:e28-e29.

9 Kumar S, Goddeau RP, Selim MH, et al. Atraumatic convexal subarachnoid hemorrhage:Clinical presentation, imaging patterns, and etiologies[J]. Neurol, 2010, 74:893-899.

10 Nakajima M, Inatomi Y, Yonehara T, et al. Nontraumatic convexal subarachnoid hemorrhage concomitant with acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2014, 23:1564-1570.

11 Kleinig TJ, Kimber TE, Thompson PD. Convexity subarachnoid haemorrhage associated with bilateral internal carotid artery stenoses[J]. J Neurol, 2009, 256:669-671.

12 Chandra RV, Leslie-Mazwi TM, Oh D, et al. Extracranial internal carotid artery stenosis as a cause of cortical subarachnoid hemorrhage[J]. Am J Neuroradiol, 2011, 32:E51-E52.

13 Ertl L, Morhard D, Deckert-Schmitz M, et al. Focal subarachnoid haemorrhage mimicking transient ischaemic attack - do we really need MRI in the acute stage?[J]. BMC Neurol, 2014, 14:80.

14 Wu H, Song S, Zhang X, et al. Nonaneurysmal Subarachnoid hemorrhage and cerebral infarction associated with moyamoya disease[J]. J Craniofac Surg 2014, 25:e358-e359.

15 Shuaib UA, Kate M, Homik J, et al. Recurrent non-aneurysmal subarachnoid haemorrhage in Takayasu arteritis:is the cause immunological or mechanical?[J]. BMJ Case Rep, 2013, 2013:r2013008825.

16 Lui YW, Tang ER, Allmendinger AM, et al. Evaluation of CT perfusion in the setting of cerebral ischemia:patterns and Pitfalls[J]. Am J Neuroradiol, 2010, 31:1552-1563.

[1]	马俊雯, 拜承萍. 血清炎症因子、脑血管反应性与短暂性脑缺血发作患者认知障碍的关系 [J]. 中国卒中杂志, 2022, 17(12): 1314-1320.
[2]	王恺闻, 卢宝全, 吴秀玲, 马佳丽. 基于MRA评估基底动脉闭塞预后评分预测非重症基底动脉闭塞患者预后效能的研究 [J]. 中国卒中杂志, 2022, 17(12): 1335-1342.
[3]	李如娟, 杨川, 马晓辉, 侯焕峰, 付会杰, 马晓丹, 方军涛, 靳金灵, 杨金波. DSA评估无症状大脑中动脉闭塞患者侧支循环状态研究 [J]. 中国卒中杂志, 2022, 17(12): 1355-1359.
[4]	胡红梅, 杨磊, 于玲, 秦伟, 白明悦, 胡文立. 急性单发小脑小梗死的临床特征 [J]. 中国卒中杂志, 2022, 17(11): 1221-1226.
[5]	刘亚杰, 李玉娣, 黎凯锋, 陈哲锋, 凌莉. 基于高通量RNA-Seq技术探讨补阳还五汤治疗小鼠脑梗死的作用机制 [J]. 中国卒中杂志, 2022, 17(11): 1238-1246.
[6]	王磊, 周春亭, 方洋, 王朝晖. 2例椎动脉漂浮血栓的治疗体会[J]. 中国卒中杂志, 2022, 17(11): 1247-1251.
[7]	林庆金, 杨雅玲, 卢武生. 寰椎变异致反复脑梗死1例报道[J]. 中国卒中杂志, 2022, 17(11): 1252-1256.
[8]	罗秋雁, 黄文利, 冯慧宇, 陈玲, 周鸿雁. 脑室出血合并大面积脑梗死1例报道并文献复习[J]. 中国卒中杂志, 2022, 17(10): 1103-1107.
[9]	张亮, 贺雄军, 黎凯锋, 周宏星, 胡明, 刘亚杰. 对比剂过敏患者在无造影下行颈动脉支架置入术1例报道[J]. 中国卒中杂志, 2022, 17(10): 1108-1111.
[10]	杨金波, 张英魁. 到底应该用面积还是用体积描述梗死病灶？[J]. 中国卒中杂志, 2022, 17(10): 1112-1113.
[11]	司倩倩, 李明利, 柳青, 徐蔚海. 青年颅内动脉狭窄合并维生素B₁₂缺乏相关的偏侧不自主运动1例报道[J]. 中国卒中杂志, 2022, 17(09): 944-949.
[12]	豆朋宇, 班梦苛, 贵永堃, 包万利, 张平. 脑白质高信号与孤立大脑中动脉重度狭窄或闭塞患者临床预后的相关性研究[J]. 中国卒中杂志, 2022, 17(09): 985-990.
[13]	董漪, 董强. 第2次机会，将走向何方？[J]. 中国卒中杂志, 2022, 17(08): 802-806.
[14]	张亮, 黄立安, 徐安定. CHANCE 2开创了基因指导下卒中抗血小板治疗的先河[J]. 中国卒中杂志, 2022, 17(08): 807-812.
[15]	何俊芳, 刘新平, 吕学海, 王斌. PI3K/AKT信号通路介导脂联素对脑缺血再灌注大鼠的保护作用 [J]. 中国卒中杂志, 2022, 17(08): 857-862.