Germans Menno R, Coert Bert A, Majoie Charles B L M, van den Berg René, Verbaan Dagmar, Vandertop W Peter
Deparment of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center (AMC), H2-241 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,
J Neurol. 2014 Nov;261(11):2199-203. doi: 10.1007/s00415-014-7480-y. Epub 2014 Sep 3.
In 15 % of all spontaneous subarachnoid hemorrhages (SAH), no intracranial vascular pathology is found. Those non-aneurysmal hemorrhages are categorized into perimesencephalic SAH (PMSAH) and non-perimesencephalic SAH (NPSAH). Searching for spinal pathology might reveal a cause for the hemorrhage in some patients. Our goal was to assess the yield of magnetic resonance (MR) imaging of the complete spinal axis in search for a spinal origin in non-aneurysmal SAH. In a prospective, observational study at a tertiary SAH referral center, we assessed clinical and radiological characteristics of patients who consecutively presented with spontaneous non-aneurysmal SAH, diagnosed by computed tomography (CT) or lumbar puncture, and negative CT angiography and digital subtraction angiography (DSA). Eligible patients were enrolled for investigation of the complete spinal axis by standard T1- and T2-weighted MR-imaging. Ninety-seven non-aneurysmal SAH patients were included in the study. Baseline characteristics were comparable between PMSAH and NPSAH patients. DSA and spinal MR-imaging were performed in 95 and 91 % of patients, respectively. This revealed one lumbar ependymoma in a 43-year-old male who was diagnosed by LP (yield 1 %). No spinal origin for the SAH was found in 51 PMSAH patients. The yield of MR-imaging of the complete spinal axis in spontaneous non-aneurysmal SAH patients is low. Routine radiological investigation of the spinal axis in non-aneurysmal SAH patients is therefore not recommended.
在所有自发性蛛网膜下腔出血（SAH）病例中，有15%未发现颅内血管病变。这些非动脉瘤性出血可分为中脑周围SAH（PMSAH）和非中脑周围SAH（NPSAH）。对某些患者进行脊髓病变检查可能会发现出血原因。我们的目标是评估对整个脊柱进行磁共振（MR）成像，以寻找非动脉瘤性SAH的脊髓起源的诊断价值。在一家三级SAH转诊中心进行的一项前瞻性观察研究中，我们评估了连续出现自发性非动脉瘤性SAH患者的临床和放射学特征，这些患者经计算机断层扫描（CT）或腰椎穿刺诊断，且CT血管造影和数字减影血管造影（DSA）结果为阴性。符合条件的患者通过标准T1加权和T2加权MR成像对整个脊柱进行检查。97例非动脉瘤性SAH患者纳入研究。PMSAH和NPSAH患者的基线特征具有可比性。分别有95%和91%的患者进行了DSA和脊柱MR成像。这在一名43岁男性患者中发现了1例腰椎室管膜瘤，该患者通过腰椎穿刺确诊（诊断率1%）。51例PMSAH患者未发现SAH的脊髓起源。对自发性非动脉瘤性SAH患者进行整个脊柱的MR成像诊断率较低。因此，不建议对非动脉瘤性SAH患者常规进行脊柱放射学检查。
