Suzuki S, Kayama T, Sakurai Y, Ogawa A, Suzuki J
Division of Neurosurgery, National Sendai Hospital, Japan.
Neurosurgery. 1987 Sep;21(3):310-3. doi: 10.1227/00006123-198709000-00005.
After the institution of computed tomography (CT), 814 cases of spontaneous subarachnoid hemorrhage (SAH) were treated during a period of 6 years and 9 months (April 1978 through December 1984). In 9 (22.0%) of 41 patients whose cause of SAH was not determined by the first four-vessel study (cerebral panangiography), ruptured aneurysms were found by repeated four-vessel study. Thus, of 814 cases, only 32 (3.9%) were diagnosed as cases of unknown etiology at discharge. The 32 cases were monitored by follow-up examination for 5 to 67 months (median, 27.1 months) after onset. No recurrence of SAH was reported, and all patients were rehabilitated except 2 who suffered terminal carcinoma. A third follow-up four-vessel study was performed 8 to 44 months (median, 22.0 months) after the second study in 14 of the 16 patients with SAH initially demonstrated by CT. In 1 of these cases, an aneurysm found 9 months after the initial SAH was treated surgically. Ultimately, 31 cases (3.8%) were diagnosed as cases of SAH of unknown cause. This incidence is low when compared with those in previous reports. Because of the strict examination schedule including repeated angiography, the incidence is lower and the prognosis is relatively favorable.
在采用计算机断层扫描（CT）之后，在6年9个月（1978年4月至1984年12月）期间对814例自发性蛛网膜下腔出血（SAH）患者进行了治疗。在最初的四血管造影研究（全脑血管造影）未确定SAH病因的41例患者中，有9例（22.0%）通过重复四血管造影研究发现了破裂的动脉瘤。因此，在814例病例中，出院时仅有32例（3.9%）被诊断为病因不明的病例。对这32例病例在发病后进行了5至67个月（中位数为27.1个月）的随访检查。未报告SAH复发情况，除2例患有晚期癌症的患者外，所有患者均康复。在最初经CT证实患有SAH的16例患者中的14例，在第二次研究后的8至44个月（中位数为22.0个月）进行了第三次随访四血管造影研究。在其中1例病例中，最初SAH后9个月发现的动脉瘤接受了手术治疗。最终，31例（3.8%）被诊断为病因不明的SAH病例。与先前报告中的发病率相比，这一发病率较低。由于包括重复血管造影在内的严格检查方案，发病率较低且预后相对良好。
