Hirsch Karen G, Froehler Michael T, Huang Judy, Ziai Wendy C
Department of Neurology, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., Baltimore, MD, USA.
Neurocrit Care. 2009;10(3):339-43. doi: 10.1007/s12028-009-9189-9. Epub 2009 Jan 30.
Perimesencephalic subarachnoid hemorrhage (P-SAH) is a benign subset of subarachnoid hemorrhage with a favorable prognosis and low rate of re-bleeding. Risk factors may include hypertension and tobacco use, but it has not previously been reported during pregnancy.
We report two cases of P-SAH in pregnant women, a 40-year-old female, 8-weeks pregnant and a 37-year-old female at 35 weeks gestational age.
CT scan confirmed P-SAH in both cases. CT angiography in one case and cerebral angiogram in the other did not reveal aneurysm or other potential bleeding source. The patients underwent transcranial Doppler ultrasound monitoring without evidence of vasospasm.
P-SAH hemorrhage may occur during early or late pregnancy. We do not propose an increased risk of P-SAH during pregnancy. The clinical course appears favorable and CT angiography alone may be considered the preferred diagnostic test to assess for aneurysm in first trimester pregnancy.
脑池周围蛛网膜下腔出血（P-SAH）是蛛网膜下腔出血的一个良性亚型，预后良好，再出血率低。危险因素可能包括高血压和吸烟，但此前尚未有在妊娠期发生的报道。
我们报告了两例妊娠期P-SAH病例，一例为40岁、孕8周的女性，另一例为37岁、孕35周的女性。
CT扫描证实两例均为P-SAH。其中一例进行了CT血管造影，另一例进行了脑血管造影，均未发现动脉瘤或其他潜在出血源。患者接受了经颅多普勒超声监测，未发现血管痉挛迹象。
P-SAH出血可能发生在妊娠早期或晚期。我们认为妊娠期P-SAH风险并未增加。临床病程似乎良好，对于孕早期评估动脉瘤，仅CT血管造影可被视为首选诊断检查。
