全球精选文摘 - 非外伤性脑凸面蛛网膜下腔出血：临床表现、成像模式与病因

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非外伤性脑凸面蛛网膜下腔出血：临床表现、成像模式与病因

Atraumatic convexal subarachnoid hemorrhage: Clinical presentation, imaging patterns, and etiologies

Kumar S, Goddeau RP Jr., Selim MH 2010/9/14 9:51:09

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Neurology, 2010,

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Objective:
To identify patterns of clinical presentation, imaging findings, and etiologies in a cohort of hospitalized patients with localized nontraumatic convexal subarachnoid hemorrhage.

Methods:
Twenty-nine consecutive patients with atraumatic convexal subarachnoid hemorrhage were identified using International Classification of Diseases–9 code from 460 patients with subarachnoid hemorrhage evaluated at our institution over a course of 5years. Retrospective review of patient medical records, neuroimaging studies, and follow-up data was performed.

Results:
There were 16 women and 13 men between the ages of 29 and 87years. Two common patterns of presentations were observed. The most frequent presenting symptom in patients ≤60years (n=16) was a severe headache (n=12; 75%) of abrupt onset (n=9; 56%) with arterial narrowing on conventional angiograms in 4 patients; 10 (p=0.003) were presumptively diagnosed with a primary vasoconstriction syndrome. Patients >60years (n=13) usually had temporary sensory or motor symptoms (n=7; 54%); brain MRI scans in these patients showed evidence of leukoaraiosis and/or hemispheric microbleeds and superficial siderosis (n=9; 69%), compatible with amyloid angiopathy (n=10; p<0.0001). In a small group of patients, the presentation was more varied and included lethargy, fever, and confusion. Four patients older than 60years had recurrent intracerebral hemorrhages in the follow-up period with 2 fatalities.

Conclusion:
Convexal subarachnoid hemorrhage is an important subtype of nonaneurysmal subarachnoid bleeding with diverse etiologies, though a reversible vasoconstriction syndrome appears to be a common cause in patients 60years or younger whereas amyloid angiopathy is frequent in patients over 60. These observations require confirmation in future studies.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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