Halpin S F, Britton J A, Byrne J V, Clifton A, Hart G, Moore A
Department of Neuroradiology, Atkinson Morley's Hospital, London, UK.
J Neurol Neurosurg Psychiatry. 1994 Oct;57(10):1180-6. doi: 10.1136/jnnp.57.10.1180.
One hundred and two consecutive patients with cerebral haematoma were prospectively allocated to one of two groups according to their CT on admission. Group 1 patients were thought to have a high probability of an underlying structural lesion and underwent cerebral angiography acutely. If normal, this was repeated at three months. Group 2 patients were thought not to have such a lesion and underwent angiography at three months. Patients older than the mean age of the study population, and hypertensive patients were much less likely to harbour an aneurysm or arteriovenous malformation than younger or normotensive patients (p < 0.01; sensitivity 87.9%, specificity 88.6%). An aneurysm or arteriovenous malformation was the cause of haemorrhage in 12.8% of hypertensive patients, in 30.9% of patients with haematoma involving the basal ganglia, and 18.2% of those with posterior fossa haemorrhage. Features of CT in isolation give a sensitivity of 77.2% and a specificity of 84.2%. Follow up angiography in group 1 showed an arteriovenous malformation in one of seven patients in whom the original study was normal. These results contrast sharply with data from previous retrospective studies. The decision to investigate a patient with cerebral haematoma should be primarily based on the patient's clinical condition, rather than on the site of haemorrhage.
102例连续性脑血肿患者根据入院时的CT前瞻性地分为两组。第1组患者被认为存在潜在结构性病变的可能性较高，急性期接受脑血管造影。如果结果正常，则在3个月时重复检查。第2组患者被认为不存在此类病变，在3个月时接受血管造影。年龄大于研究人群平均年龄的患者以及高血压患者比年轻或血压正常的患者患动脉瘤或动静脉畸形的可能性要小得多（p<0.01；敏感性87.9%，特异性88.6%）。12.8%的高血压患者、30.9%的基底节区血肿患者以及18.2%的后颅窝出血患者的出血原因是动脉瘤或动静脉畸形。单纯CT表现的敏感性为77.2%，特异性为84.2%。第1组的随访血管造影显示，在最初检查正常的7例患者中有1例存在动静脉畸形。这些结果与以往回顾性研究的数据形成鲜明对比。对脑血肿患者进行检查的决定应主要基于患者的临床状况，而非出血部位。
