协和医学杂志

2012, (04)

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皮层蛛网膜下腔出血临床影像特征及其病因
Cortical subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies

崔丽英;周立新;倪俊;彭斌;张瑶

摘要(Abstract):

背景及目的:皮层蛛网膜下腔出血(cSAH)是一种少见的特殊的自发性非动脉瘤性蛛网膜下腔出血。本研究通过总结cSAH病例的临床表现,影像学特征,并分析病因,旨在增加对该病的认识。方法:回顾性总结我院神经科2007年9月至2011年12月期间诊断为cSAH患者8例临床及影像学特点,并分析其病因。结果:1)男性4例,女性4例。起病年龄21~78岁。2)最常见的临床表现为癫痫发作(75%),头痛少见(12.5%)。3)头颅CT均表现为沿大脑凸面皮层沟回分布的线样高信号,顶叶中央沟内最为多见(5例)。7例患者进行了动脉血管影像检查,均未见动脉瘤。4)5例病因明确,分别为皮层静脉血栓2例,静脉窦血栓1例,脑淀粉样血管病1例,血管炎1例。结论:cSAH是一类具有特征性临床及影像学表现的特殊类型蛛网膜下腔出血,临床上应给予重视。病因诊断上,青年患者需重点除外皮层静脉血栓,老年人应重点考虑脑淀粉样血管病。
Objective: To identify patterns of clinical presentation, imaging findings, and etiologies in a case series with cortical subarachnoid hemorrhages. Methods: Eight patients with cSAH were identified using cranial CT or MRI at our department during Sep 2007 to Dec 2011. Retrospective review of patient medical records, neuroimaging studies, and follow-up data was performed. Results: 1) There were four women and four men between the ages of 21 and 78 years. 2) Seizure was the most common presentation. Headache was unusual in our case series. 3) Cranial CT findings of all patents demonstrated linear hyperdensities localized to one or a few cortical sulci at the convexity of the brain 4) The known etiologies of 5 case included cortical venous thrombosis in 2 patients, venous sinus thrombosis in one, cerebral amyloid angiopathy in one and vasculitis in one. Conclusions: Cortical subarachnoid hemorrhage is an important subtype of nonaneurysmal SAH with diverse etiologies. Cortical venous thrombosis appears to be a common cause in young patients, while cerebral amyloid angiopathy may be a frequent cause in old patients.

关键词(KeyWords): |皮层蛛网膜下腔出血 皮层静脉血栓 脑淀粉样血管病|
|cortical subarachnoid hemorrhage| cortical venous thrombosis| cerebral amyloid angiopathy.|

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作者(Author): 崔丽英;周立新;倪俊;彭斌;张瑶

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