Oda Shinri, Shimoda Masami, Hoshikawa Kaori, Osada Takahiro, Yoshiyama Michitsura, Matsumae Mitsunori
Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2011;51(1):30-6. doi: 10.2176/nmc.51.30.
Patients with non-traumatic, non-aneurysmal, and non-perimesencephalic subarachnoid hemorrhage (SAH) tend to have clots circumscribed along the cortical convexity, a condition referred to as acute cortical SAH. Cerebral venous thrombosis (CVT) is a potential cause of cortical SAH. The study tried to establish the diagnosis and management of cortical SAH caused by CVT. Retrospective review of 145 patients with non-traumatic SAH identified 15 patients with no ruptured aneurysm. Clinical features were investigated with a specific focus on patients with SAH caused by CVT. Eight of the 15 patients had perimesencephalic SAH, and 7 had cortical SAH. SAH caused by CVT was diagnosed in 4 of the 7 patients with cortical SAH. The cortical SAH involved the unilateral convexity or sylvian cistern and spared the basal cistern on computed tomography in all 4 patients. CVT occurred in the transverse sinus and cortical vein (1 patient), insular vein (1 patient), and cortical vein (2 patients). Identification of thrombosed veins or sinuses was established directly by T(2)-weighted and diffusion-weighted magnetic resonance (MR) imaging in the acute stage and diffusion-weighted and T(1)-weighted MR imaging in the subacute stage. All patients had cortical swelling without findings of venous hemorrhagic infarction on T(2)-weighted MR imaging. None of the 4 patients received active treatment, and all had favorable outcomes. CVT in patients with non-traumatic cortical SAH should be first excluded as a potential hemorrhagic cause by MR imaging for thrombosed veins or sinuses before initiating antifibrinolytic therapy.
非创伤性、非动脉瘤性、非脑池周围性蛛网膜下腔出血（SAH）患者的血凝块往往局限于皮质凸面，这种情况称为急性皮质SAH。脑静脉血栓形成（CVT）是皮质SAH的一个潜在原因。该研究试图确定由CVT引起的皮质SAH的诊断和治疗方法。对145例非创伤性SAH患者进行回顾性研究，确定了15例无动脉瘤破裂的患者。对临床特征进行了调查，特别关注由CVT引起的SAH患者。15例患者中有8例为脑池周围性SAH，7例为皮质SAH。7例皮质SAH患者中有4例被诊断为由CVT引起。在所有4例患者的计算机断层扫描中，皮质SAH累及单侧凸面或外侧裂池，基底池未受累。CVT发生于横窦和皮质静脉（1例）、岛叶静脉（1例）和皮质静脉（2例）。在急性期通过T(2)*加权和扩散加权磁共振（MR）成像直接确定血栓形成的静脉或窦，在亚急性期通过扩散加权和T(1)加权MR成像确定。所有患者均有皮质肿胀，T(2)*加权MR成像未发现静脉出血性梗死。4例患者均未接受积极治疗，所有患者预后良好。在开始抗纤溶治疗之前，对于非创伤性皮质SAH患者，应首先通过MR成像排除CVT作为潜在出血原因，以确定血栓形成的静脉或窦。
