Uglietta J P, O'Connor C M, Boyko O B, Aldrich H, Massey E W, Heinz E R
Department of Radiology, Duke University Medical Center, Durham, NC.
Radiology. 1991 Nov;181(2):555-9. doi: 10.1148/radiology.181.2.1924804.
Computed tomographic (CT) patterns of intracranial hemorrhage (ICH) were determined in 1,696 patients undergoing thrombolytic therapy for acute myocardial infarction. ICH occurred at 33 sites in 0.77% of patients (n = 13). Thirty-six percent of hemorrhages (n = 12) were intraparenchymal, 33% (n = 11) were subdural, 24% (n = 8) were subarachnoid, and 6% (n = 2) were intraventricular. Eight-four percent (n = 26) of all nonventricular hemorrhages were supratentorial in location. The most common site of ICH was supratentorial and intraparenchymal (10 of 33). In 11 of the 13 patients with ICH, clinical symptoms occurred within 24 hours of the initiation of thrombolytic therapy. A fatal outcome resulted in three of the four patients who had clinical symptoms within 3.5 hours after beginning thrombolytic therapy. The CT findings of multiple intracranial bleeding sites, substantial mass effect with midline shift, and large-volume intraparenchymal hematomas were associated with increased mortality. ICH associated with thrombolytic therapy for acute myocardial infarction has a grave prognosis, with 62% of patients dying during hospitalization.
对1696例接受急性心肌梗死溶栓治疗的患者进行了颅内出血（ICH）的计算机断层扫描（CT）模式测定。ICH发生在33个部位，占患者的0.77%（n = 13）。36%的出血（n = 12）为脑实质内出血，33%（n = 11）为硬膜下出血，24%（n = 8）为蛛网膜下腔出血，6%（n = 2）为脑室内出血。所有非脑室内出血的84%（n = 26）位于幕上。ICH最常见的部位是幕上和脑实质内（33例中的10例）。在13例ICH患者中的11例，临床症状在溶栓治疗开始后的24小时内出现。在开始溶栓治疗后3.5小时内出现临床症状的4例患者中，有3例死亡。颅内多个出血部位、伴有中线移位的明显占位效应以及大量脑实质内血肿的CT表现与死亡率增加相关。与急性心肌梗死溶栓治疗相关的ICH预后严重，62%的患者在住院期间死亡。
