Maslehaty Homajoun, Barth Harald, Petridis Athanassios K, Doukas Alexandros, Maximilian Mehdorn Hubertus
Department of Neurosurgery, University Hospitals Schleswig-Holstein, Campus Kiel, Germany.
Neurol Res. 2012 Jan;34(1):91-7. doi: 10.1179/1743132811Y.0000000025.
The aim of this study was to work out the special features of subarachnoid hemorrhage (SAH) of unknown origin in respect of diagnostic evaluation, clinical course, and outcome in a large cohort of patients.
We reviewed the data of 179 patients with SAH of unknown origin during 1991 and 2008. The differentiation between perimesencephalic (PM-SAH) and non-perimesencephalic SAH (NON-PM-SAH) was done under consideration of the bleeding pattern on CT scanning.
Among 1226 treated patients with spontaneous SAH over a time period of 17 years, a bleeding source remained undetected on first digital subtraction angiogram (DSA) in 179 patients (16.7%)--47 PM-SAH (26.3%) and 132 NON-PM-SAH (73.7%). The clinical signs of patients with PM-SAH were less marked compared to those with NON-PM-SAH, equally to the Hunt and Hess grade. magnetic resonance imaging (MRI) and MR angiography had 100% negative findings for non-aneurismal bleeding sources in all patients. Second DSA revealed a bleeding source in the NON-PM group in 10.8%. The clinical course of the patients with NON-PM-SAH showed a significantly higher rate of complications and a mortality of about 10%. The outcome was excellent in the PM group, in contrast to a fatal course in 13 cases in the NON-PM group.
PM-SAH imposed with a mild clinical course and an excellent outcome, without severe complications. In contrast to this, NON-PM-SAH has a significant higher rate of dreaded complications and mortality. It is crucial to make an exact diagnosis of PM-SAH, considering CT scanning during the first 24 hours after occurrence of symptoms and the radiological features.
本研究旨在明确一大群不明原因蛛网膜下腔出血（SAH）患者在诊断评估、临床病程及预后方面的特点。
我们回顾了1991年至2008年间179例不明原因SAH患者的数据。根据CT扫描的出血模式区分中脑周围型（PM - SAH）和非中脑周围型SAH（NON - PM - SAH）。
在17年期间接受治疗的1226例自发性SAH患者中，179例（16.7%）在首次数字减影血管造影（DSA）时未发现出血源——47例PM - SAH（26.3%）和132例NON - PM - SAH（73.7%）。与NON - PM - SAH患者相比，PM - SAH患者的临床症状不那么明显，Hunt和Hess分级也是如此。磁共振成像（MRI）和磁共振血管造影对所有患者的非动脉瘤性出血源的检查结果均为阴性。第二次DSA显示NON - PM组有10.8%的患者发现出血源。NON - PM - SAH患者的临床病程显示并发症发生率显著更高，死亡率约为10%。PM组预后良好，相比之下，NON - PM组有13例患者病程致命。
PM - SAH临床病程较轻，预后良好，无严重并发症。与此相反，NON - PM - SAH的可怕并发症和死亡率显著更高。考虑症状出现后24小时内的CT扫描及放射学特征，准确诊断PM - SAH至关重要。
