以凸面蛛网膜下腔出血为影像特征的脑淀粉样血管病临床特点分析  

The clinical and imaging features of cerebral amyloid angiopathy with acute convexity subarachnoid hemorrhage

作　　者：张玮玮[1] 王力[1] 李晓晴[1] 杨琼 ZHANG Weiwei;WANG Li;LI Xiaoqing;YANG Qiong(Department of Neurology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所神经内科,100029

出　　处：《心肺血管病杂志》2024年第2期164-167,189,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨以急性凸面蛛网膜下腔出血(convexity subarachnoid hemorrhage,cSAH为影像特征的脑淀粉样血管病(cerebral amyloid angiopathy,CAA)的临床和影像学特点,及与患者脑出血再发的风险相关性。方法:回顾性分析2013年6月至2020年12月,北京安贞医院就诊的以cSAH为特征合改良Boston诊断标准的18例很可能的CAA患者,分析其流行病学资料、临床特点、头颅CT/头颅磁共振成像(magnetic resonance imaging,MRI)等信息。结果:18例患者男女比例为1:1.25,发病年龄59~91岁,平均(75±9)岁,最常见的临床症状为短暂性局灶性神经系统症状发作(transient focal neurological episodes,TFNE,12/18),头颅影像学表现为局限型(14/18)和弥漫型c SAH(4/18)。随访15个月,平均(15±5)个月,8例患者出现反复TFNE发作,4例再发c SAH,4例脑出血。结论:以cSAH为特征的CAA多见于老年人,TFNE为最常见的临床表现,头颅CT/MRI是最重要的诊断方法,应尽量避免抗栓治疗。Objective:To investigate the clinical and imaging features of cerebral amyloid angiopathy(CAA)with acute convexity subarachnoid hemorrhage(cSAH)as the imaging characteristic,as well as its association with the risk of recurrent brain hemorrhage in patients.Methods:A retrospective analysis was performed on 18 probable CAA patients with cSAH as the imaging feature who met the modified Boston diagnostic criteria and were treated at Beijing Anzhen Hospital from June 2013 to December 2020.Epidemiological data,clinical characteristics,and information on head computed tomography(CT)/head magnetic resonance imaging(MRI)were analyzed.Results:The male-to-female ratio of the 18 patients was 1:1.25,with an onset age of 59-91,mean age(75±9)years.The most common clinical symptom was transient focal neurological episodes(TFNE)in 12 out of 18 patients.The head imaging findings showed localized(14/18)and diffuse cSAH(4/18).During a follow-up of 15 months(mean),8 patients experienced recurrent TFNE,4 had recurrent cSAH,and 4 had brain hemorrhage.Conclusions:CAA with cSAH as the imaging feature is more common in elderly individuals,and TFNE is the most common clinical manifestation.Head CT/MRI is the most important diagnostic method,and antiplatelet therapy should be avoided if possible.

关 键 词：凸面蛛网膜下腔出血 脑淀粉样血管病 短暂性局灶性神经系统症状发作 

分 类 号：R54[医药卫生—心血管疾病]