Rahme Ralph, Vyas Nilesh A, Hamilton John F
Division of Neurosurgery, Inova Neuroscience Institute; and Department of Neurosciences, Virginia Commonwealth University School of Medicine Inova Campus, Falls Church, Virginia, USA.
Division of Neurosurgery, Inova Neuroscience Institute; and Department of Neurosciences, Virginia Commonwealth University School of Medicine Inova Campus, Falls Church, Virginia, USA.
World Neurosurg. 2016 Jul;91:669.e1-5. doi: 10.1016/j.wneu.2016.03.037. Epub 2016 Mar 22.
Ischemic stroke is being increasingly recognized as a possible cause of spontaneous isolated convexity subarachnoid hemorrhage (SAH). However, it is a much less established cause of cisternal, aneurysmal-like SAH. Only 3 case reports of concomitant cisternal SAH and perforator infarcts exist in the literature, raising the possibility of perforating artery rupture as a potential mechanism. In contrast, embolic stroke is not recognized as a cause of aneurysmal-like SAH.
In 2 patients with embolic cerebral infarctions mimicking intracranial aneurysm rupture, diagnosis was confirmed by magnetic resonance imaging with diffusion-weighted imaging after cerebral angiography failed to reveal an underlying vascular lesion. Extracranial atherosclerosis was identified as the source of emboli in each case. One patient was started on antiplatelet therapy, and the other underwent surgical revascularization. Both patients had a favorable hospital course, with no recurrent hemorrhage or ischemia.
Based on these observations, embolic stroke should be included in the differential diagnosis of angiogram-negative SAH. Therefore, brain magnetic resonance imaging and vascular imaging of the neck should be part of the routine work-up of this relatively common entity.
缺血性中风日益被认为是自发性孤立性脑凸面蛛网膜下腔出血（SAH）的一个可能原因。然而，它作为脑池性、动脉瘤样SAH的病因则远未明确。文献中仅有3例关于合并脑池性SAH和穿支梗死的病例报告，提示穿支动脉破裂可能是一种潜在机制。相比之下，栓塞性中风不被认为是动脉瘤样SAH的病因。
在2例疑似颅内动脉瘤破裂的栓塞性脑梗死患者中，脑血管造影未能发现潜在血管病变，经磁共振成像及扩散加权成像确诊。每例均发现颅外动脉粥样硬化为栓子来源。1例患者开始接受抗血小板治疗，另1例接受了手术血运重建。2例患者住院过程顺利，无再发出血或缺血。
基于这些观察结果，栓塞性中风应纳入血管造影阴性SAH的鉴别诊断。因此，脑部磁共振成像和颈部血管成像应作为这种相对常见疾病常规检查的一部分。
