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中脑周围非动脉瘤性蛛网膜下腔出血 (Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage),Concept,定义 : A. 出血的中心位于脑干前缘(主要在脚间池), 伴或不伴扩展。 B. 动脉造影未见动脉瘤或其他动脉异常,van Gijn, et al., In 1985 首先提出,Incidence,动脉造影阴性的SAH中,21-68%诊断为PNSH,在非动脉瘤和动静脉畸形的自发性SAH中,占8-11%,动脉造影阴性的SAH(15-20%): 未被发现的脑动脉瘤 非脑动脉瘤性,如:静脉血栓形成、血液病、感染、肿瘤,Location,出血中心位于脑干前缘:位于脚间池( 96%),外侧裂外侧部,视交叉池( 46%),外侧裂基底部( 37%),环池( 88%),四叠体池( 19%),可以扩展:,但不扩展:,大脑纵裂前部,可以有脑室内积血,但是血液沉降作用所致(侧脑室枕脚),病原学,原因尚未明确.,静脉出血:发现了更多的静脉结构的异常,假设,2. 脑干的小穿通动脉闭塞后的继发渗血,肯定的是:高血压、吸烟是其可控制的危险因素,临床表现,症状: 1. 头痛进展较慢 2. 极少伴意识障碍 3. 临床症状较轻(Hunt Hess分级),并发症: 1. 几乎不会再次出血 2.较少血管痉挛(1-5%) 3. 脑积水发生率约20%,但很少需做分流,CT scanning,The criteria( within 3 days of the onset ): center of bleeding located immediately anterior to the midbrain; 出血位于中脑前方 (2) possible extension of blood to the posterior part of the anterior interhemispheric fissure, but not complete filling of the anterior interhemispheric fissure; 可能会向纵裂池延伸,但不会填满 (3) extension of blood to the basal part of the sylvian fissure is permitted, but not extension to the lateral sylvian fissure; 可以向外侧裂基底部延伸,但不会延伸至外侧裂池 (4) sedimentation of small amounts of intraventricular blood is allowed, but not frank intraventricular hemorrhage; 可并发脑室出血,但不明显 (5) absence of intracerebral hematoma 无脑内血肿,Angiography,阴性,DSA: 金标准,排除动脉瘤,MRA: 敏感性不如 CTA,CTA: 诊断后循环动脉瘤的特异性和敏 感性均为100%,Diagnosis,Clinical course of SAH (出血时无昏迷, Hunt Hess分级),CT scanning: perimesencephalic pattern of hemorrhage within 3 days of the onset of the SAH,Angiography: normal,Differentiate diagnosis,Importance of differentiation,Prognosis: the final outcome was typically excellent,PNSH may have a major psychological impact (非典型性头痛、抑郁、遗忘、疲倦等),However,谢谢 Thanks For Watching,
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