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[颅内动脉瘤破裂致蛛网膜下腔出血后的脑积水与血管痉挛]

[Hydrocephalus and vasospasm after subarachnoid hemorrhage from ruptured intracranial aneurysms].

作者信息

Izawa I, Korosue K, Hamano S, Nagao Y, Tamaki N, Matsumoto S

机构信息

Department of Neurosurgery, Nagao Hospital, Kochi, Japan.

出版信息

No Shinkei Geka. 1988;16(5 Suppl):487-92.

PMID:3399001
Abstract

The relationship of the amount of subarachnoid blood to the incidence of acute hydrocephalus, delayed vasospasm, and chronic hydrocephalus was investigated in 47 patients with subarachnoid hemorrhage from ruptured intracranial aneurysms. Acute hydrocephalus, delayed vasospasm, and chronic hydrocephalus occurred in 29%, 7%, and 14% of Fisher Group 1 & 2 patients respectively, in contrast, 70%, 64%, and 58% of Fisher Group 3 patients (p less than 0.01). Thirty six percents of all patients had both acute hydrocephalus and vasospasm; Thirty two percents had neither. Twenty one percents had acute hydrocephalus, but no spasm; Eleven percents had spasm, but no acute hydrocephalus. Acute hydrocephalus and vasospasm were significantly associated (p less than 0.05). Most of patients with chronic hydrocephalus showed severe subarachnoid hemorrhage on initial CT scan, followed acute hydrocephalus, and highly associated with vasospasm. These sequelae of SAH are closely linked, mainly by the presence of subarachnoid clot, but there may be some direct causal relationship between them.

摘要

对47例因颅内动脉瘤破裂导致蛛网膜下腔出血的患者,研究了蛛网膜下腔出血量与急性脑积水、迟发性血管痉挛及慢性脑积水发生率之间的关系。Fisher 1级和2级患者中,急性脑积水、迟发性血管痉挛及慢性脑积水的发生率分别为29%、7%和14%;相比之下,Fisher 3级患者的发生率分别为70%、64%和58%(p<0.01)。所有患者中,36%同时发生急性脑积水和血管痉挛;32%两者均未发生。21%有急性脑积水但无痉挛;11%有痉挛但无急性脑积水。急性脑积水和血管痉挛显著相关(p<0.05)。大多数慢性脑积水患者在初次CT扫描时显示严重蛛网膜下腔出血,继之发生急性脑积水,且与血管痉挛高度相关。蛛网膜下腔出血的这些后遗症紧密相关,主要是由于蛛网膜下腔血凝块的存在,但它们之间可能存在一些直接因果关系。

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