Division of Neurosurgery, Department of Neuroscience, University of Torino, Via Cherasco 15, 10126, Torino, Italy.
Neurosurg Rev. 2011 Oct;34(4):477-84. doi: 10.1007/s10143-011-0323-8. Epub 2011 May 24.
The aim of this study was to investigate the long-term natural history of nontraumatic angiogram-negative subarachnoid hemorrhage with typical pretruncal (P-SAH) and diffuse (D-SAH) pattern of hemorrhage. A retrospective review of 102 patients who experienced angiographically negative SAH at our institution was undertaken (11.6% of 882 spontaneous SAH). Follow-ups were obtained at 7.9 to 16 years. In the D-SAH group, 11 patients (13.9%) out of 79 had an aneurysm, and four (5.1%) had rebleeding episodes. In the P-SAH group, the second angiography was negative in all of the 23 cases, and no rebleeding episodes were recorded. The long-term follow-up confirms that P-SAH is a benign disease. A second angiography could not be necessary. D-SAH is probably due to an aneurysm that thrombose early after the bleeding. At short-term follow-up, the sack could frequently recanalize and rebleed, whereas a late follow-up shows that rebleeding is very rare.
本研究旨在探讨非创伤性血管造影阴性蛛网膜下腔出血的长期自然史，其出血表现为典型的颅前（P-SAH）和弥漫性（D-SAH）模式。对在我院经历血管造影阴性蛛网膜下腔出血的 102 例患者进行了回顾性分析（882 例自发性蛛网膜下腔出血的 11.6%）。随访时间为 7.9 至 16 年。在 D-SAH 组中，79 例患者中有 11 例（13.9%）存在动脉瘤，4 例（5.1%）发生再出血事件。在 P-SAH 组中，23 例患者的第二次血管造影均为阴性，且无再出血记录。长期随访证实 P-SAH 是一种良性疾病，可能无需再次进行血管造影检查。D-SAH 可能是由于出血后早期血栓形成的动脉瘤所致。在短期随访中，血肿常可再通并再次出血，而在晚期随访中则显示再出血非常罕见。
