自发性大脑凸面蛛网膜下腔出血合并急性脑梗死的病因及临床特点

Etiology and clinical characteristics of spontaneous convex subarachnoid hemorrhage complicated with acute cerebral infarction

摘要:

目的 探讨自发性大脑凸面蛛网膜下腔出血(cSAH)合并急性脑梗死(AIS)的病因及临床特点。方法 回顾性分析2012年1月至2020年1月在北京市顺义区医院神经内科住院的160例cSAH患者的临床资料,根据是否合并AIS,将患者分为cSAH组和cSAH合并AIS组。采用SPSS 19.0 软件进行统计分析,根据数据类型,组间比较采用t检验或χ²检验。结果 160例cSAH患者中,23例合并AIS。两组临床资料比较,cSAH合并AIS组男性比例高于cSAH组,平均年龄大于cSAH组,高血压、糖尿病、高脂血症、陈旧性脑梗死、吸烟比例均高于cSAH组,差异均有统计学意义(P＜0.05)；cSAH合并AIS组肢体无力、肢体麻木比例高于cSAH组,大脑中动脉狭窄比例高于cSAH组,差异均有统计学意义(P＜0.05)。结论 对于合并脑血管病危险因素的老龄cSAH患者,尤其是存在颅内大血管狭窄的患者,应高度重视局灶性神经系统受累的症状和体征,重点完善头部核磁及脑血管检查以明确是否合并AIS,避免漏诊或误诊。

Abstract:

Objective To investigate the causes and clinical characteristics of spontaneous convexal subarachnoid hemorrhage (cSAH) complicated with acute ischemic stroke (AIS). Methods Clinical data of 160 cases of cSAH patients hospitalized in our department from January 2012 to January 2020 were collected and retrospectively analyzed. Patients were divided into cSAH group and cSAH combined with AIS group according to whether patients were complicated with AIS. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison according to different data types. Results Among the 160 cSAH patients, 23 cases were combined with AIS. Comparison of clinical data between the 2 groups showed that the patients combined with AIS had significantly higher male ratio, older age, and greater ratios of hypertension, diabetes, hyperlipidemia, chronic cerebral infarction and smoking than the cSAH patients (P<0.05). What′s more, limb weakness and numbness and middle cerebral artery stenosis were more common in the cSAH combined with AIS group than the cSAH group (P<0.05). Conclusion For the elderly cSAH patients with cerebrovascular disease risk factors, especially those with intracranial large vessel stenosis, great attention should be paid to the symptoms and signs of focal nervous system involvement, and the focus should be on improving the head MRI and cerebrovascular examination to determine whether AIS is complicated, so as to avoid missed diagnosis and misdiagnosis.