Alobeidi Farah, Aviv Richard I
Front Neurol Neurosci. 2015;37:13-26. doi: 10.1159/000437110. Epub 2015 Nov 12.
Spontaneous intracerebral haemorrhage (ICH) is a devastating condition with high mortality and morbidity despite advances in neurocritical care. Early deterioration is common in the first few hours after ICH onset, secondary to rapid haematoma expansion and growth. Rapid diagnosis and aggressive early management of these patients are therefore crucial. Imaging plays a key role in establishing the diagnosis and the underlying aetiology of ICH, identifying complications and predicting patients who are at high risk for haematoma expansion. In this chapter, we present an evidence-based imaging framework for the management of spontaneous ICH in the acute setting. Non-enhanced computed tomography is long established as the gold standard for ICH diagnosis but has limitations in demonstrating the underlying aetiology in cases of secondary ICH. There is now growing evidence for the ability of non-invasive angiography to establish the underlying aetiology and to predict further haematoma expansion. The presence of small enhancing foci within the haematoma on computed tomography angiography (CTA), the CTA Spot Sign, has been prospectively validated as a predictor of haematoma expansion. Early identification of patients at risk of haematoma expansion allows for the appropriate escalation of care to a neurosurgical team, admission to a neurocritical care unit, appropriate supportive therapy and targeted novel medical and surgical interventions. Catheter angiography, which remains the gold standard for identifying underlying secondary vascular lesions, should be used in selected cases. However, non-invasive vascular imaging should be considered as an important step in the diagnosis and early management of secondary ICH patients. Previous concerns related to the radiation dose, contrast-induced nephropathy and cost are addressed in this chapter. Recently, animal models have enabled the qualitative assessment of haematoma expansion, and our increased understanding of ICH may inform future trials of targeted medical and surgical therapies.
自发性脑出血（ICH）是一种严重的疾病，尽管神经重症监护取得了进展，但死亡率和发病率仍然很高。ICH发病后的最初几个小时内，早期病情恶化很常见，这是由于血肿迅速扩大所致。因此，对这些患者进行快速诊断和积极的早期治疗至关重要。影像学在确立ICH的诊断、潜在病因、识别并发症以及预测血肿扩大高危患者方面发挥着关键作用。在本章中，我们提出了一个基于证据的急性自发性ICH管理影像学框架。非增强计算机断层扫描长期以来一直是ICH诊断的金标准，但在显示继发性ICH病例的潜在病因方面存在局限性。现在，越来越多的证据表明，无创血管造影能够确立潜在病因并预测血肿进一步扩大。计算机断层扫描血管造影（CTA）上血肿内出现的小强化灶，即CTA斑点征，已被前瞻性验证为血肿扩大的预测指标。早期识别有血肿扩大风险的患者，有助于将治疗适当升级至神经外科团队，收入神经重症监护病房，进行适当的支持治疗以及有针对性的新型药物和手术干预。导管血管造影仍是识别潜在继发性血管病变的金标准，应在特定病例中使用。然而，无创血管成像应被视为继发性ICH患者诊断和早期治疗的重要步骤。本章讨论了以往对辐射剂量、对比剂肾病和成本的担忧。最近，动物模型已能够对血肿扩大进行定性评估，我们对ICH的进一步了解可能为未来有针对性的药物和手术治疗试验提供参考。
Front Neurol Neurosci. 2015
Stroke Vasc Neurol. 2019-9-26
Biomed Res Int. 2017-8-9
Zotero 插件