Wijdicks E F, Schievink W I, Miller G M
Department of Neurology, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1998 Aug;73(8):745-52. doi: 10.4065/73.8.745.
To review the diagnostic evaluation and the clinical course of patients with pretruncal nonaneurysmal subarachnoid hemorrhage.
The study population consisted of a consecutive series of patients with a pretruncal nonaneurysmal subarachnoid hemorrhage encountered at Mayo Clinic Rochester during a 6-year interval. We reviewed the clinical manifestations, the neuroimaging characteristics, and the appropriate management.
The 15 male and 9 female patients with a pretruncal nonaneurysmal subarachnoid hemorrhage ranged from 3 to 72 years of age (median, 45). Of the 24 patients, 18 had a sudden explosive headache at the time of initial assessment. Ventricular shunting for acute hydrocephalus was indicated in one patient. Neuroimaging studies demonstrated that the center of the hemorrhage was prepontine, and it extended into the interpeduncular or premedullary cisterns. In two patients, a small focal hemorrhage was not noted on an admission computed tomographic scan but was identified on repeated study. A second four-vessel cerebral angiogram, obtained in most patients, showed normal findings in four patients who had had cerebral vasospasm on the first study. In one patient, moderate cerebral vasospasm was found on the second angiogram. No patient had rebleeding. One patient had transient dysphasia associated with cerebral vasospasm after cerebral angiography. Two patients had a family history of aneurysmal subarachnoid hemorrhage.
The excellent outcome in patients with pretruncal nonaneurysmal subarachnoid hemorrhage is in distinct contrast to the overall somber outcome associated with aneurysmal subarachnoid hemorrhage. A ruptured aneurysm of the posterior circulation may mimic a pretruncal nonaneurysmal subarachnoid hemorrhage and should be excluded on the basis of a technically satisfactory cerebral angiogram.
回顾躯干前非动脉瘤性蛛网膜下腔出血患者的诊断评估及临床病程。
研究对象为梅奥诊所罗切斯特分院在6年期间连续收治的躯干前非动脉瘤性蛛网膜下腔出血患者。我们回顾了临床表现、神经影像学特征及适当的治疗方法。
15例男性和9例女性躯干前非动脉瘤性蛛网膜下腔出血患者年龄在3至72岁之间（中位数为45岁）。24例患者中，18例在初次评估时有突发剧烈头痛。1例患者因急性脑积水而行脑室分流术。神经影像学研究显示出血中心位于脑桥前，并延伸至脚间池或延髓前池。2例患者入院时计算机断层扫描未发现小灶性出血，但在复查时发现。大多数患者进行了第二次四血管脑血管造影，4例首次检查时有脑血管痉挛的患者第二次检查结果正常。1例患者第二次血管造影发现中度脑血管痉挛。无患者再出血。1例患者脑血管造影后因脑血管痉挛出现短暂性失语。2例患者有动脉瘤性蛛网膜下腔出血家族史。
躯干前非动脉瘤性蛛网膜下腔出血患者的良好预后与动脉瘤性蛛网膜下腔出血总体的严峻预后形成鲜明对比。后循环动脉瘤破裂可能酷似躯干前非动脉瘤性蛛网膜下腔出血，应根据技术上满意的脑血管造影予以排除。
