Flaherty Matthew L, Haverbusch Mary, Kissela Brett, Kleindorfer Dawn, Schneider Alexander, Sekar Padmini, Moomaw Charles J, Sauerbeck Laura, Broderick Joseph P, Woo Daniel
J Stroke Cerebrovasc Dis. 2005 Nov-Dec;14(6):267-71. doi: 10.1016/j.jstrokecerebrovasdis.2005.07.004.
Nonaneurysmal perimesencephalic subarachnoid hemorrhage (PMSAH) appears to have an etiology and natural history distinct from aneurysm rupture. Referral-based studies suggest that 15% of SAH patients have no discernable cause of bleeding, but the incidence of PMSAH is unknown. We describe the first population-based study of PMSAH and place it in the context of all non-traumatic SAH, with presentation of incidence rates, patient demographics, and clinical outcomes.
All patients age >/= 18 hospitalized with first-ever, non-traumatic SAH in the Greater Cincinnati area were identified from 5/98-7/01 and 8/02-4/04. PMSAH was defined as hemorrhage restricted to the cisterns surrounding the brainstem and suprasellar cistern and a negative cerebral angiogram. Incidence rates were age, race, and sex adjusted to the 2000 US population.
There were 431 SAHs identified. Cases in Asian-Americans (2) were excluded, leaving 429 SAHs for analysis. Of these patients, 77 did not have angiograms. Among remaining cases, 285 had aneurysm rupture, 43 had nonaneurysmal hemorrhage not of the PMSAH pattern, and 24 had PMSAH. The overall annual incidence rates for SAH and PMSAH were 8.7 (95% CI 7.9-9.5) and 0.5 (95% CI 0.3-0.7) per 100,000 persons age >/= 18. Patients with PMSAH were younger (p = 0.018) and less likely to be female (p = 0.020) or hypertensive (p = 0.005) than other SAH patients. There was one death among PMSAH patients during 14 months mean follow-up.
PMSAH represents approximately 5% of all SAH. Its risk factors and outcome differ from other forms of SAH.
非动脉瘤性脑池周围蛛网膜下腔出血（PMSAH）的病因和自然病史似乎与动脉瘤破裂不同。基于转诊的研究表明，15%的蛛网膜下腔出血（SAH）患者没有可辨别的出血原因，但PMSAH的发病率尚不清楚。我们描述了第一项基于人群的PMSAH研究，并将其置于所有非创伤性SAH的背景下，呈现发病率、患者人口统计学特征和临床结果。
从1998年5月至2001年7月以及2002年8月至2004年4月期间，确定大辛辛那提地区所有年龄≥18岁、首次因非创伤性SAH住院的患者。PMSAH定义为出血局限于脑干周围脑池和鞍上池且脑血管造影阴性。发病率根据年龄、种族和性别调整至2000年美国人口标准。
共确定431例SAH。排除2例亚裔美国人病例，剩余429例SAH用于分析。其中77例患者未进行血管造影。在其余病例中，285例为动脉瘤破裂，43例为非PMSAH模式的非动脉瘤性出血，24例为PMSAH。年龄≥18岁人群中SAH和PMSAH的总体年发病率分别为每10万人8.7（95%可信区间7.9 - 9.5）和0.5（95%可信区间0.3 - 0.7）。与其他SAH患者相比，PMSAH患者更年轻（p = 0.018），女性比例更低（p = 0.020），高血压比例更低（p = 0.005）。在平均14个月的随访期间，PMSAH患者中有1例死亡。
PMSAH约占所有SAH的5%。其危险因素和预后与其他形式的SAH不同。
