原发性脑室出血的诊断、病因及预后(附20例病例报告)

目的 :探讨原发性脑室出血 (PIVH)的诊断、病因和预后。方法 :回顾性分析 2 0例 PIVH患者的临床资料、辅助检查、治疗结果。结果 :2 0例中 19例经头颅 CT、 1例经 MRI检查证实为 PIVH,8例行脑血管造影检查 ,病因为脑动静脉畸形者 5例 (2 5 % ) ,脑动静脉畸形伴动脉瘤者 1例 (5 % ) ,Moyamoya病 1例 (5 % ) ,高血压者 5例 (5 5 % ) ,病因不明者 2例 (10 % )。 5例全脑室出血者全部存活 ,15例部分脑室出血者 3例发生再出血 ,其中 2例死亡。结论 :头颅CT可以确诊 PIVH,脑血管造影对于明确出血的病因很有帮助 ,PIVH的病死率与出血量之间关系不大 ,而与再出血之间关系密切     

原发性脑室出血型Moyamoya病21例临床分析

目的通过回顾性分析我院10年来收治的21例原发性脑室出血型Moyamoya病患者的临床资料,探讨非高血压性原发性脑室出血与Moyamoya病及其影像学特征的关系。方法对我院神经外科10年来确诊的原发性脑室出血Moyamoya病患者的CT、DSA和临床治疗进行回顾性分析。结果 25例非高血压性原发性脑室出血患者中DSA证实21例为Moyamoya病。3例合并基底动脉动脉瘤。所有患者出血侧均存在脉络膜前动脉异常扩张扭曲及异常分支。该组患者首次治疗均获得良好结果。结论 Moyamoya病是成人非高血压性原发性脑室出血的主要病因,对成人非高血压性原发性脑室出血应常规行DSA明确是否存在Moyamoya病。成人非高血压性原发性脑室出血与脉络膜前动脉的扩张扭曲或异常分支密切相关,并且后者可作为前者的预测指标。     

原发性脑室出血的病因、治疗与预后(附35例报告)

35例经CT证实的原发性脑室出血(PIVH)患者。病因是高血压、烟雾病、动静脉畸形、动脉瘤。PIVH分为三型:Ⅰ型室管膜下出血、Ⅱ型部分脑室出血、Ⅲ型全脑室出血。对Ⅰ型非手术治疗。对Ⅱ、Ⅲ型合并意识障碍手术治疗。多数病人生存下来(35例生存29例),但记忆力减退持续存在。     

原发性脑室内出血

成人非外伤性原发性脑室内出血(PIVH)罕见.PIVH是指出血发生于接近脑室系统或脑室系统内,而邻近部位出血量很少及脑室周围无出血.CT前,诊断只能依靠尸检或有损伤的放射学检查.较早的文献报道PIVH预后不良,死亡率高.作者分析了经CT证实的225例脑内出血病人,其中有7例PIVH(占3.1%).本文对引起PIVH的原因及PIVH后遗症的神经心理学问题进行了研究分     

自发性脑室内出血的病因分析及治疗

目的探讨自发性脑室内出血(SIVH)的病因诊断、治疗和预后。方法回顾性分析41例SIVH患者的临床资料及CT、DSA检查结果。根据脑室内出血的CT表现分别采取保守治疗或脑室外引流术,并对DSA检查阳性患者进行病因治疗。结果烟雾病12例,行颅内外血管搭桥术9例,保守治疗3例;脑动静脉畸形(AVM)7例,行γ-刀治疗5例,先行栓塞再手术切除2例;脑动脉瘤6例,行手术夹闭3例,介入治疗2例,1例术前死于动脉瘤破裂。高血压病致脑室出血9例。出血原因不明7例。共死亡6例,死亡率14.6%(6/41)。结论SIVH主要病因有烟雾病、AVM、动脉瘤和高血压病。本组SIVH患者行DSA检查阳性率达71.4%(25/35),故尽早行DSA检查明确病因,并应针对病因进行治疗。     

血管检查在自发性脑内出血或脑室出血病因诊断中的应用价值

目的 探讨血管检查在自发性脑内出血或脑室出血的病因诊断中的应用价值.方法 回顾性分析2018年7月至2019年7月救治的100例自发性脑内出血或脑室出血的临床资料,其中脑内血肿56例,单纯脑室内积血19例,脑内出血破入脑室25例,接受320-CTA或DSA检查,查找出血原因.结果 320-CTA检查40例,检出动脉瘤5...     

原发性脑室出血的治疗与选择

目的探讨原发性脑室内出血的病因及其治疗效果。方法从临床角度分析、比较了原发性脑室内出血患者的病因及疗效。结果病因首推高血压（占58.1%）,其次为动静脉畸形（占9.7%）,外伤及其它原因（占9.7%）,不明病因者占22.6%。疗效①保守治疗18例;GOS5分者15例,4分者1例,1分者2例。②侧脑室外引流10例;GOS5分者4例,3分者3例,2分者1例,1分者2例。③采取急诊开颅血肿清除、AVM切除、脑室外引流者4例;GOS5分者3例,4分者1例。①与②之间疗效经t检验,P＜0.05,具有显著差异。结论对于非AVM的PIVH治疗方法选择,我们认为①只要没有伴发急性梗阻性脑积水,即使患者为全脑室出血和（或）伴有轻度意识障碍,也应暂时采用保守治疗。②对于伴发轻或中度脑积水者,是否手术应结合患者意识障碍及动态CT所见决定。③对于无伴发急性梗阻性脑积水的患者,过分积极的脑室外引流有加重脑室内再出血的危险。     

原发性脑室出血：附40例报告

本文报告40例经 CT 及病理剖检证实为原发性脑室出血。CT 应用前PIVH 诊断主要靠剖检,其诊断率为0.3%,CT 应用后发现率逐年上升(8.6%)。说明PIVH 并非罕见。     

脑池及脑室出血为主的颅脑损伤27例临床分析

目的分析有明确外伤病史,CT表现为脑池及脑室出血为主的颅脑损伤患者的影像资料,提高颅脑损伤合并脑血管病的诊断,减少漏诊。方法回顾分析我院神经外科自2012-06—2014-06间颅脑CT表现为脑池及脑室出血为主的27例颅脑损伤患者的影像资料,对其CTA或DSA诊断的结果进行分析。结果 27例患者男19例,女8例,年龄23~74岁,平均(49±9.8)岁。25例均行CTA或DSA检查,发现无阳性14例,阳性11例(颅内动脉瘤5例,多发颅内外血管严重狭窄或闭塞3例,脑动静脉畸形2例,烟雾病1例)。结论以脑池及脑室出血为主的颅脑损伤病人应常规进行CTA或DSA的检查,减少对脑血管病的漏诊。     

脑室出血82例临床治疗分析

目的总结脑室出血治疗的体会。方法对2003年6月至2006年6月我院收治的82例脑室出血病人的临床资料进行回顾性分析。此82例病人中，经DSA或CTA检查发现，脑动静脉畸形8例，颅内动脉瘤4例，Moyamoya病2例，余未查明出血原因（有的未做脑DSA或CTA检查）。采用脑室外引流术并尿激酶治疗68例，开颅手术治疗6例（4例颅内动脉瘤和2例脑动静脉畸形），介入治疗6例（均为脑动静脉畸形），保守治疗2例。大部分行双侧脑室穿刺（3例单侧）外引流治疗。发病至手术时间为2。24h。结果82例中，治愈30例，好转37例，长期植物状态3例，死亡12例。结论脑室出血患者意识障碍与脑室积血的量有直接关系，脑室外引流是治疗脑室出血的一种有效方法；脑室出血的病因治疗也非常重要。     

Pathological and clinical features of primary ventricular hemorrhage due to moyamoya disease]

The clinical and pathological features of 20 cases of moyamoya disease complicated with primary intraventricular hemorrhage (PIVH) and verified by CT scanning, cerebral angiography and autopsy were reported. It seemed to the author that moyamoya disease appeared to be prone to cause PIVH, this hemorrhage being likely due to ischemic malacia in the ventricular wall. The tortuous, abnormal network vessels ruptured and bled as a result of infarction and damage of the walls of the miliary aneurysms. PIVH might be divided into two types: the panventricular hemorrhage and partial ventricular hemorrhage, according to the amount of blood that filled into the ventricles. 6 cases of the panventricular type were fatal. The symptoms were in conformity with the traditional concept of the most critical, intraventricular hemorrhage. The external ventricular drainage in combination with lumber puncture drainage would be the better way of treatment for these patients. 14 cases of the partial ventricular hemorrhage type showed the clinical features of acute subarachnoid hemorrhage (SAH). The treatment was similar to SAH too, and the prognosis was much better. It would be worth noting that moyamoya disease should be a factor not to be neglected in causing PIVH.     

Primary intraventricular hemorrhage in adults: etiological causes and prognostic factors in Chinese population

Primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke that is poorly understood. We aimed to explore the features of this disease in Chinese population via an institutional prospective study. Adult patients diagnosed with PIVH from January 2013 to January 2016 were enrolled in this study. Data, including clinical variables, radiological features, and yield of angiography, were collected to evaluate the clinical features, etiological causes, and prognostic factors of this disease. A total of 67 patients (73.6%) were diagnosed with PIVH which constituted 3.2% of contemporary patients with hemorrhagic stroke in our hospital. Thirty-four patients (52.3%) were diagnosed with vascular structural abnormality (VSA)-related PIVH, and the etiologies included Moyamoya disease (22.4%), arteriovenous malformations (17.9%), aneurysms (7.5%), bilateral internal carotid artery dissection (1.5%), and tumor (1.5%). Idiopathic PIVH was diagnosed in 31 patients (47.7%), including coagulopathy in 3 (4.5%). Patients with VSA-related PIVH were younger than idiopathic PIVH patients, with a mean age of 37.1 ± 14.6 years, and idiopathic PIVH patients were more commonly hypertensive. The overall mortality rate was 11.9%, and 21 patients (31.3%) had a poor outcome at the 6-month follow-up. Patients with younger age, lower Graeb score, and a known etiology of arteriovenous malformation might be associated with a favorable outcome. We recommended routine thin-slice computed tomography (CT) scan, computed tomographic angiography (CTA), and digital subtraction angiography (DSA) for patients with PIVH. The etiological causes and prognostic factors of PIVH in Chinese patients were associated with distinctive features.     

Primary intraventricular hemorrhage: clinical and neuropsychological findings in a prospective stroke series

Seven cases of primary intraventricular hemorrhage (PIVH) constituted 3.1% of intracerebral hemorrhages in a prospective stroke series of 2,950 patients. All patients collapsed suddenly and had a depressed state of consciousness. Focal signs, if present, were minimal and contralateral to the major site of hematoma. Angiography in four patients revealed three intracranial arteriovenous malformations and one moyamoya. We conclude that PIVH may be readily diagnosed radiologically and underlying vessel malformations should be sought by angiography. Survival is common (five of seven cases), but a severe amnesic state may be a persisting deficit.     

原发性脑室内出血47例前瞻性临床研究

目的 研究并明确原发性脑室内出血(PIVH)的病因、临床特征、危险因素和预后.方法 前瞻性地制订严格的纳入标准,连续收集2008年9月至2010年10月在我院诊治的PIVH患者,对其临床资料、辅助检查、治疗方式及预后进行分析.结果 共纳入47例患者,男27例,女20例,比例为1.35∶1,平均年龄(52.6±126)岁.GCS评分10.8±2.6;Graeb评分5.8±26;合并梗阻性脑积水者22例(47%);确诊Moyamoya病12例(26%),动静脉畸形10例(21%)和动脉瘤5例(11%),病因不详20例(43%).单纯开颅手术12例(26%),开颅联合脑-硬膜-血管-肌肉血管融合术(EDAMS)6例(13%),单纯EDAMS治疗5例(11%),EDAMS联合吻合手术1例(2%),脑室外引流3例(6%),γ-刀治疗8例(17%),介入治疗2例(4%o),保守治疗10例(21%).患者均随访6个月,住院死亡7例(15%),6个月末mRS评分＜3分者31例(66%),≥3分者9例(19%),出院后无死亡病例.结论 PIVH临床少见,发病年龄相对较小;Moyamoya病、动静脉畸形和动脉瘤是排前三位的病因,高血压是最主要的危险影响因素;通过合理治疗,PIVH可获得较好的预后;年龄、高血压、糖尿病、吸烟史及入院时GCS评分可不同程度预测住院死亡率.

Abstract：

Objective To define the clinical features, risk factors, etiology and prognosis of primary intraventricular hemorrhage (PIVH).Methods We prospectively formulated strict inclusive criteria and consecutively collected patients with diagnosis and treatment for PIVH in our hospital from September 2008 to October 2010.The clinical information, laboratory examinations, treatment and prognosis were analyzed.Results 47patients(27 males and 20 females, a ratio of 1.35: 1, with an average age of 52.6 ± 12.6 years old) were internalized in the study.The initial symptoms were headache in 24 cases, and disturbance of consciousness in 23 cases.The GCS score was 10.8 ± 2.6 and Graeb score was 5.8 ± 2.6.Combined obstructive hydrocephalus was found in 22 cases (47%).The diagnosis of moyamoya disease was confirmed in 12 patients (26%), while vascular malformations in 10 (21%) and aneurysm in 5( 11% ).The other 20 patients had unknown etiology (43%).Craniotomy was performed in 12 cases (26%), craniotomy combined EDAMS in 6(13%), EDAMS in 5(11% ), EDAMS combined with anastomosis in 1(2% ), ventricular drainage in 3(6% ), γ-knife in 8( 17% ), interventional therapy in 2(4% ), and conservative treatment in 10 patients (21%).All patients were followed - up for 6 months.7 cases of hospital mortality (15%) were found.31 patients (66%) got less than 3 points of mRS score at the end of the 6th month, and 9 patients ( 19% ) had greater than or equal to 3 points.After discharge there was no death.Conclusion PIVH is relatively rare in clinical practice.The age of onset for PIVH is relatively small.Moyamoya disease, AVM and aneurysm are ranked the top three causes, and hypertension is the most important risk factor.Through reasonable treatment, patients with PIVH could get better prognosis.Age, hypertension, diabetes, smoking history and admission GCS score could predict hospital mortality in varying degrees.     

An institutional experience of 26 patients with Moyamoya disease: A study from Northwest India

Aim:

Moyamoya disease (MMD) is a slowly progressive bilateral stenocclusive process of the distal internal carotid and proximal portions of the anterior and middle cerebral arteries and the formation of an abnormal vascular network at the base of the brain. The purpose of this retrospective study was to identify clinical features, salient features, radiological features and yield of diagnostic cerebral angiography in MMD.

Materials and Methods:

We analyzed the records of 26 patients with MMD evaluated and treated at our institute from August 2010 until March 2013. Diagnosis of MMD was made on the basis of features of angiographic findings. Cerebral angiography showed typically fine network of vessels at the base of the brain with puff of smoke appearance suggestive of MMD. CT angiography (CTA) was done in 25 (96.15%) patients where as Digital substraction angiography (DSA) was done in 18 (69.23%) patients.

Results:

Out of the 26 patients 13 were in the pediatric age group and 13 were adults. At presentation 14 patients had infarcts and 10 patients had hemorrhages. Among the hemorrhagic group 20% had isolated intracerebral hemorrhage (ICH), 50% patients had ICH with intraventricular extension (IVE) and 30% patients had primary intraventricular hemorrhage (PIVH). 50 % of the patients had involvement of the posterior circulation.

Conclusion:

Posterior circulation involvement is frequent in MMD. Though parenchymal bleed with/without intraventricular extension is the usual presentation of hemorrhagic MMD, isolated intraventricular hemorrhage could also be the mode of presentation.     

Incidence of peri-intraventricular hemorrhage in preterm newborn infants with birth weight less than 1500 gms: evaluation of brain ultrasonographic studies and necropsy]

From January to December 1986, 120 preterm infants were born with birth-weight under 1500 gm. Eighty-five infants were included in the study group either because they had a cranial sonographic evaluation or a necropsy. The mortality rate was 70% for the study group, but was 52.5% for the whole period. The sonographic examination was performed in 41 infants. The incidence of periventricular-intraventricular hemorrhage (PIVH) was 42.3%. Twenty-three cases had PIVH grade II (63.8%), 10 grade I (27.7%), and 3 (8.3%) grade IV. Thirteen infants had sonographic and necroscopic examinations. We observed a total agreement between sonographic and necroscopic diagnosis in 9 cases (69%). Two cases were classified as partial agreement as they differed only in the grading of PIVH, whereas in two cases there was a false negative diagnosis in the ultrasound examination. The interval between the examinations in these two false negative cases was 53 and 20 days, respectively. We conclude that the incidence of PIVH found in our study is comparable to that of the literature and that cranial ultrasonography is a sensitive neuroimage technique for the diagnosis of PIVH in the newborn preterm infant.     

蛛网膜下腔出血脑血管造影假阴性原因分析

目的 探讨蛛网膜下腔出血(SAH)脑血管造影假阴性发生的可能原因,提高SAH病因诊断的准确性.方法 回顾性分析452例SAH患者的脑血管造影结果初次阴性52例,复查造影25例,发现6例有异常病变:4例前交通动脉瘤,1例C<,2>段动脉瘤,1例脑血管畸形.结果 结合文献对这6例初次脑血管造影假阴性的原因进行分析,总结发生假阴性的原因.结论 SAH造影时应采用高分辨率的造影机;二维造影时要多角度投射,避开血管间的重叠;必要时采用三维血管重建;提高阅片医生的能力;初次阴性病例可配合CTA、MRA检查且必须强调全面细致复查造影.     

Neurosonographic assessment of twin pairs in the perinatal period

Twins have higher rates of perinatal mortality, prematurity and its complications, low birth weight, intrauterine growth retardation, congenital anomalies and long-term developmental morbidity. In 31 twin pairs we evaluated the incidence and severity of peri-intraventricular hemorrhage (PIVH) and post-hemorrhagic ventricular dilatation. On ultrasonography minor PIVH (grades I and II) was observed in 26% of A twins and 25% of B twins (p less than 0.5). Major PIVH (grades III and IV) was less common, occurring in 3% of A twins and 6% of B twins (p less than 0.5). Ventriculomegaly, mostly regressive was equally distributed between the two groups of babies. From these results it can be concluded that with efficient antenatal care and skillful perinatal management of twin pregnancy, the incidence of major perinatal neurological complications such as PIVH and ventriculomegaly are not higher in the second-born twin.     

Coagulation abnormalities in low birth weight infants with peri-intraventricular hemorrhage

Fifty-four appropriate for gestational age preterm infants (less than 35 weeks gestation) were followed prospectively from birth with coagulation and real-time ultrasound studies. Coagulation analyses included fibrinogen, prothrombin time, thrombin time and platelet count. The occurrence of peri-intraventricular hemorrhage (PIVH) was documented by portable 5 MHz Echo Scanner. Definite PIVH was present in 21 babies (38%). Coagulation studies showed especially lower values of fibrinogen levels in babies of less than 30 weeks gestation compared to a control group without PIVH (p less than 0.03). Furthermore, significant correlation was observed in these patients between platelet count and degree of PIVH. Infants with Grade 3 and 4 PIVH had lower platelet count than infants with less severe bleeding (Grade 1 and 2) (p less than 0.02). These data suggest that hemostatic abnormalities play a major role as co-factor in the incidence and severity of neonatal PIVH in very low birth weight infants of less than 30 weeks gestation.