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血性脑脊液是诊断蛛网膜下腔出血的重要依据,但在临床工作中偶可遇到在发病后6～8小时内进行腰穿,脑脊液仍无色透明。为了探索出现这类现象的原因,我们将89年至今遇到的2例报告如下:例1:贺××,女,63岁,因突然头痛、呕吐3小时来院。查体:Bp:15/9kPa,神清语明,双眼底乳头界清,静脉略增粗。四肢活动自如,肌力对称。未引出病理反射。项强一横指,克尼格氏征(-)。考虑蛛网膜下腔出血,给以脱水止血治疗。于病后6.5小时进行腰穿,脑脊液外观无色透明,显微镜下 RBC 150×10~6/L,其中可见皱缩 RBC。15小时后,再次腰穿,脑脊液呈均匀一致血性。本例经脑血管造影后证实为颅底动脉瘤。
Bloody cerebrospinal fluid is an important basis for the diagnosis of subarachnoid hemorrhage, but occasionally encountered in clinical work within 6 to 8 hours after onset of lumbar puncture, cerebrospinal fluid is still colorless and transparent. In order to explore the reasons for such phenomena, we report the following two cases encountered from 1989 to now: Example 1: He × ×, female, 63 years old, hospitalized due to sudden headache and vomiting for 3 hours. Physical examination: Bp: 15 / 9kPa, clear and clear statement, binocular nipple clear, slightly thick vein. Limb movements freely, muscular symmetry. Did not lead to pathological reflex. Xiangqiang a horizontal finger, Koneg’s sign (-). Consider subarachnoid hemorrhage, give dehydration to stop bleeding. At 6.5 hours after the disease, lumbar puncture was performed. The appearance of cerebrospinal fluid was colorless and transparent. Under the microscope, the RBC was 150 × 10 ~ 6 / L, of which, the shrinkage of RBC was observed. After 15 hours, again lumbar puncture, cerebrospinal fluid was uniform and bloody. This case confirmed by cerebral angiography as a skull base aneurysm.