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Clinical Manifestations, Imaging Patterns, and Etiologies of Cortical Subarachnoid Hemorrhage
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摘要:
目的 研究皮层蛛网膜下腔出血(cortical subarachnoid hemorrhage, cSAH)患者的临床表现及影像学特征, 并分析病因, 旨在增加对cSAH的认识。 方法 回顾性研究北京协和医院神经内科2007年9月至2011年12月8例诊断为cSAH患者的临床表现及影像学特点, 并分析病因。 结果 8例cSAH患者中男性4例, 女性4例; 发病年龄21~78岁; 最常见的临床表现为癫痫发作(75%), 头痛少见(12.5%)。8例cSAH患者头颅CT均表现为沿大脑凸面皮层沟回分布的线样高信号, 顶叶中央沟内最为多见(5例)。7例cSAH患者进行动脉血管影像检查, 均未见动脉瘤。5例患者病因明确, 分别为皮层静脉血栓2例, 静脉窦血栓1例, 淀粉样脑血管病1例, 血管炎1例。 结论 cSAH是一类具有特征性临床及影像学表现的特殊类型蛛网膜下腔出血, 临床上应予以重视。对于病因诊断, 青年患者需重点除外皮层静脉血栓, 老年患者应重点考虑淀粉样脑血管病。 Abstract:Objective To summarize the clinical manifestations, imaging patterns, and etiologies of cortical subarachnoid hemorrhages (cSAH). Methods The clinical data and imaging findings of 8 cSAH patients who were treated at our department from September 2007 to December 2011 were retrospectively analyzed. Results Among these patients, there were four women and four men aged 21-78 years. Seizure was the most common symptom, whereas headache was unusual. Cranial CT showed linear hyperdensities localized at one or more cortical sulci at the convexity of the brain, especially in the central sulcus of the parietal lobe. The known etiologies of 5 cases included cortical venous thrombosis (n=2), venous sinus thrombosis (n=1), cerebral amyloid angiopathy (n=1), and vasculitis (n=1). Conclusions cSAH is an important subtype of nonaneurysmal subarachnoid hemorrhage with diverse etiologies. Cortical venous thrombosis appears to be a common cause in young patients, while cerebral amyloid angiopathy may be a more frequent cause in old patients. -
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