自发性蛛网膜下腔出血首次CTA检查阴性31例分析.docVIP

作者简介：李平（1971-），男，四川省泸州市人，汉族，硕士研究生，主治医师，主要从事脑血管疾病研究，已发表论文3篇。电话E-mail:lipingboshi@163.com。 通讯作者：杨福兵，电话E-mail:fubingyang1@ 自发性蛛网膜下腔出血首次CTA检查阴性31例分析 李平 杨福兵 耿保伟 董劲虎 李定君 黄昌仁 陈礼刚 王海全 泸州医学院附属医院神经外科 泸州 646000 四川 泸州 [摘要] 目的探讨自发性蛛网膜下腔出血首次(computed tomography angiography,CTA)检查阴性的原因及治疗策略。方法 对本院自2008年 1月-2009年11月之间31例首次CTA检查呈阴性的SAH患者的诊断、治疗进行回顾性分析。结果本组31例（男性12例，女性19例）中29例重复CTA检查，发现动脉瘤7例，其中3例为小脑后下动脉瘤，2例大脑中动脉M3段动脉瘤，1例大脑前动脉A2段动脉瘤，1例大脑后动脉P3段动脉瘤；3例颅内动脉远端显示不清晰，怀疑AVM。再次CTA检查的22例阴性患者同期行DSA检查，发现前交通动脉瘤2例，均小于1.5mm；AVM3例；C5-7颈髓AVM1例；硬脑膜动静脉瘘1例。延期MRA检查7例，发现海绵状血管瘤3例。其余14例均无阳性发现，其中1例做了2次CTA,2次DSA,2次MRA检查，仍无阳性发现。结论：首次CTA阴性蛛网膜下腔出血患者，应根据CT平片上蛛网膜下腔出血特点确定进一步检查手段，以便提高诊断率。 关键词 蛛网膜下腔出血 ； 颅内动脉瘤； 脑血管造影 ； （CT )血管造影 Spontaneous Subarachnoid Hemorrhage with Negative CTA Result in 31 Cases LI-Ping YANG Fubing GENG Baowei DONG Jinghu LI Dingjun HUANG Changren CHEN Ligang WANG Haiquan Department of Neurosurgery,the Affiliated Hospital of LuZhou Medical College LuZhou 646000 SiChuan LuZhou [Abstract] Objective To study the clinical strategy of spontaneous subarachnoid hemorrhage with CTA . Methods The clinical negative CTA results in 31 cases of spontaneous subarachnoid hemorrhage were analyzed retrospectively.The factors to results in negative CTA result were analyzed.Results 29 of the 31 cases had been rechecked by CTA,22 cases had been checked by DSA,7 cases had been checked by MRA,1 case had been repeated CTA,DSA,MRA.We found 9 cases of intracranial aneurysms,3 cases of arteriovenous malformation,1 case of cervical arteriovenous malformation,3 cases of cavernous malformation,1 case of dural arteriovenous fistula.Conclusion For patients of SAH with negative CTA，repeated examination combined with CTA、DSA or MRA according to the characteristics of the blood diffusion in the SAH. Key words Subarachnoid hemorrhage Intracranial aneurysm cerebral angiography Computed tomography angiography 蛛网膜下腔出血（Subarachnoid hemorrhage,SAH）是指各种原因出血血液流入蛛网膜下腔的统称，临床上分自发性蛛网膜下腔出血和外伤性蛛网膜下腔出血，本文所指蛛网膜下