Clinical Differences Between Angiographically Negative, Diffuse Subarachnoid Hemorrhage and Perimesencephalic Subarachnoid Hemorrhage
Clinical Differences Between Angiographically Negative, Diffuse Subarachnoid Hemorrhage and Perimesencephalic Subarachnoid Hemorrhage
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DOI：
10.1007/s12028-009-9203-2
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发表时间：
2009-08-01
影响因子：
3.5
通讯作者：
Zhang, Y. Jonathan
中科院分区：
文献类型：
--
作者：
Hui, Ferdinand K.;Tumialan, Luis M.;Zhang, Y. Jonathan
为了确定血管造影阴性、非创伤性弥漫性蛛网膜下腔出血（d-SAH）患者血管痉挛、脑积水和临床结局的预后因素。对过去6年在我们机构经历血管造影阴性SAH的患者进行了回顾性审查。根据SAH的临床表现、严重程度和模式，将患者分为中脑周围型和弥漫型。根据血管痉挛、脑积水和所需治疗以及临床结局进一步区分患者。如果随后发现了病因性病变，则排除患者。共有31例患者被认为患有中脑周围（p-SAH）亚型，而63例患者符合弥漫性（d-SAH）亚型的标准。与p-SAH亚型相比，d-SAH亚型患者发生SAH相关并发症的风险显著更高，脑积水（50.8% vs. 9.6%）、需要脑室外引流（41% vs. 9.6%）和需要最终永久性脑脊液分流的脑积水（20.6% vs. 0%）的发生率增加。d-SAH患者发生症状性血管痉挛的风险也增加（28.6% vs. 9.6%）。最终，只有76%的d-SAH患者完全康复并独立生活，而p-SAH患者为96.7%。这些患者发生血管痉挛和脑积水的风险增加，需要积极治疗，因此应进行更高水平的监测。
To identify prognostic factors for vasospasm, hydrocephalus, and clinical outcomes in patients with angiographically negative, non-traumatic, diffuse subarachnoid hemorrhage (d-SAH).Retrospective review of patients who experienced angiographically negative SAH at our institution over the past 6 years was undertaken. The patients were stratified based on grade at presentation, severity, and pattern of SAH on initial non-enhanced, computed tomography (CT) of the head into perimesencephalic and diffuse subtypes. The patients were further differentiated based on the development of vasospasm, hydrocephalus and required treatments, and clinical outcomes. Patients were excluded if a causative lesion was discovered subsequently.Ninety-four patients with angiographically negative SAH were identified. A total of 31 patients were considered to have the perimesencephalic (p-SAH) subtype, while 63 patients fit criteria for the diffuse (d-SAH) subtype. Compared to the p-SAH subtype, those patients with d-SAH subtype had significantly higher risk for complications related to SAH with an increased incidence of hydrocephalus (50.8% vs. 9.6%), requirement for external ventricular drainage (41% vs. 9.6%), and for the hydrocephalus requiring eventual permanent cerebrospinal fluid diversion (20.6% vs. 0%). Patients with d-SAH were also at an increased risk for symptomatic vasospasm (28.6% vs. 9.6%). Ultimately, only 76% of d-SAH patients achieved complete recovery and independent living, compared to 96.7% of p-SAH patients.The angiographically negative d-SAH pattern is associated with worse presentations and outcome. These patients are at increased risk for vasospasm and hydrocephalus requiring aggressive treatment and should therefore be cared for with a higher level of surveillance.