Fujii Mutsumi, Takasato Yoshio, Masaoka Hiroyuki, Ohta Yoshihisa, Hayakawa Takanori, Honma Masato
Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Japan.
No To Shinkei. 2006 Jun;58(6):489-93.
Seven hundred and fifty five cases of acute non-traumatic subarachnoid hemorrhage were admitted to the department of neurosurgery of our hospital from July, 1995 to March, 2004. In 555 patients cerebral angiography was conducted but initial angiography was negative in 30 patients. Except 10 general condition poor patients, in 20 initial angiogram-negative patients were undergone repeated angiography. The cause of SAH could not be demonstrated in 13 cases. The SAH in perimesencephalic and non-perimesencephalic cisturns was seen in 7 and 6 cases, respectively. Occipital and/or neck pain on admission was statistically more common among patients with perimesencephalic SAH than those with non-perimesencephalic SAH (p = 0.029), and the prognosis of perimesencephalic SAH was good. We conclude that repeat angiography should not be recommended in patients with perimesencephalic SAH. Patients with non-perimesencephalic SAH had a higher rate of complication. In the non-perimesencephalic group, 3 patients developed hydrocephalus and 3 patients had vasospasm, which were found by repeated angiography. Therefore, repeated angiography is recommended for better clinical outcome by early detection and management of serious complications in this group of patients.
1995年7月至2004年3月，我院神经外科收治了755例急性非创伤性蛛网膜下腔出血患者。555例患者接受了脑血管造影，但30例患者初次造影结果为阴性。除10例一般情况较差的患者外，对20例初次造影阴性的患者进行了重复造影。13例患者的蛛网膜下腔出血病因无法明确。中脑周围池和非中脑周围池蛛网膜下腔出血分别见于7例和6例。入院时枕部和/或颈部疼痛在中脑周围池蛛网膜下腔出血患者中比非中脑周围池蛛网膜下腔出血患者在统计学上更常见（p = 0.029），且中脑周围池蛛网膜下腔出血的预后良好。我们得出结论，不建议对中脑周围池蛛网膜下腔出血患者进行重复造影。非中脑周围池蛛网膜下腔出血患者的并发症发生率较高。在非中脑周围池组中，3例患者发生脑积水，3例患者发生血管痉挛，这些是通过重复造影发现的。因此，建议对该组患者进行重复造影，以便通过早期发现和处理严重并发症获得更好的临床结果。
