Stroke:CT阴性、腰穿可疑蛛网膜下腔出血患者血管造影可获益

2013-05-09 Stroke dxy

可疑动脉瘤性SAH病人首先运用非对比的头部CT评价,如果CT为阴性结果,但是临床考虑SAH可能性较大,则常常行腰穿脑脊液分析,Mallinckrodt放射学研究所的Wallace AN等人开展此研究以评价脑脊液黄变和红细胞增多对诊断动脉瘤性SAH的准确性。研究发现:CT阴性、腰穿可疑SAH患者的血管造影可获益。该研究回顾了2002年7月-2012年4月Barnes Jewish医院CT阴性而腰穿可

可疑动脉瘤性SAH病人首先运用非对比的头部CT评价,如果CT为阴性结果,但是临床考虑SAH可能性较大,则常常行腰穿脑脊液分析,Mallinckrodt放射学研究所的Wallace AN等人开展此研究以评价脑脊液黄变和红细胞增多对诊断动脉瘤性SAH的准确性。研究发现:CT阴性、腰穿可疑SAH患者的血管造影可获益。
该研究回顾了2002年7月-2012年4月Barnes Jewish医院CT阴性而腰穿可疑SAH的临床诊断考虑为脑动脉瘤破裂并最后行导管血管造影术的所有病人的医学记录,记录其脑脊液分析结果、血管造影发现及病例的临床结局。
57例病人确认入选,脑脊液黄变者有2例造影确认血管病变(2/24,8.3%),这2例都明确了动脉瘤破裂;红细胞增多和无黄变者(血管病变)的诊断率为6.3%(1/16),但是这个血管病变并非是SAH的病因。
CT为阴性而腰穿结果可疑SAH,尤其是出现黄变时应该行导管血管造影术,仅有红细胞增多的病人行血管造影术的获益尚不明确,需要进一步的研究。
血管造影相关的拓展阅读:


Yield of Cather Angiography After Computed Tomography Negative, Lumbar Puncture Positive Subarachnoid Hemorrhage.
BACKGROUND AND PURPOSE
Patients suspected of having aneurysmal subarachnoid hemorrhage (SAH) are initially evaluated with noncontrast head computed tomography. If the computed tomography is negative, but clinical concern for SAH is high, a lumbar puncture with cerebrospinal fluid analysis is typically performed. The purpose of this study was to evaluate the accuracy of cerebrospinal fluid xanthochromia and erythrocytosis for aneurysmal SAH.
METHODS
Medical records of all patients who underwent catheter angiography at Barnes Jewish Hospital between July 2002 and April 2012 for clinical suspicion of a ruptured brain aneurysm after a negative computed tomography scan and a lumbar puncture suspicious for SAH were reviewed. The cerebrospinal fluid analysis results, angiographic findings, and outcomes of each case were recorded.
RESULTS
Fifty-seven patients were identified. Two angiographic lesions were identified in patients with xanthochromia (2/24 patients, ie, 8.3%), both of which were confirmed to have ruptured. The diagnostic yield in patients with nonclearing erythrocytosis and no xanthochromia was 6.3% (1/16 patients), although this lesion was not considered the source of SAH.
CONCLUSIONS
Catheter angiography should be performed in patients with computed tomography negative but suspicious lumbar puncture, particularly in the presence of xanthochromia. The benefit of angiography in patients with erythrocytosis only is unclear and deserves future study.

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