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蛛网膜下腔出血(SAH)的年发病率稳定在6/10万左右,但在日本和芬兰较高。其发病率任何明显的下降都归因于较高的CT打描率,因为通过CT扫描可排除其他出血性疾病。大多数SAH患者的年龄在60岁以下。总体上SAH的危险因素与率中相似,遗传因素只起一小部分作用。总体病死率在50％左右(包括院前死亡),1/3的存活者生活不能自理。突发性爆裂样头痛在SAH诊断中是一个最重要,但并非特异性的特征:一般来说,如果这是惟一的症状,那么10例患者中有9例其病因是无害的。所有患者都必须行CT扫描,如结果阴性,再行腰穿,在SAH的病因中,动脉瘤破裂占85％,非动脉瘤性中脑周围出血(预后良好)占10%,各种罕见病因占5％。检测动脉瘤的导管血管造影正逐步被CT或MR血管造影所替代。入院时临床病情差可能是由原发或再发出血引起的可挽救的并发症,包括颅内血肿、急性脑积水或全脑缺血所致。闭塞动脉瘤能有效预防再出血,但还缺乏评估早期手术(3 d内)和晚期手术(10-12 d)相对益处的对照试验。如动脉瘤的部位和结构许可,血管内闭塞比手术治疗更好。降纤药可降低再出血的危险性,但不会改善总体转归。口服尼莫地平可降低迟发性脑缺血的危险,其他一些得到观察性研究支持的措施包括不限制液体输入和避免使用降压药。一旦出现缺血,联合采用诱导高
The annual incidence of subarachnoid hemorrhage (SAH) is stable at about 6 / 100,000 but higher in Japan and Finland. Any significant decrease in its morbidity is attributed to the higher CT scan rate because other hemorrhagic diseases can be ruled out by CT scan. The majority of SAH patients are under 60 years of age. In general, the risk factors for SAH are similar to those in the rate, and genetic factors play only a small part. The overall case fatality rate is around 50% (including pre-hospital deaths) and one-third of survivors can not take care of themselves. Sudden burst-like headache is one of the most important but not specific features of SAH diagnosis: In general, if this is the only symptom, then 9 of 10 patients are etiologically non-toxic. All patients must have a CT scan. If the result is negative, the patient is again lumbar punctured. In the etiology of SAH, aneurysm rupture accounts for 85%, non-aneurysmal midbrain hemorrhage (good prognosis) accounts for 10% 5%. Catheter angiography to detect aneurysms is being replaced by CT or MR angiography. The poor clinical condition at admission may be a salvageable complication resulting from primary or secondary bleeding, including intracranial hematoma, acute hydrocephalus, or global cerebral ischemia. Occlusive aneurysms are effective in preventing rebleeding, but control trials evaluating the relative benefits of early surgery (within 3 days) and late surgery (10-12 days) are also lacking. As the site and structure of the aneurysm permits, intravascular occlusion is better than surgery. Fiber-lowering drugs can reduce the risk of rebleeding, but will not improve the overall outcome. Oral nimodipine reduces the risk of delayed cerebral ischemia, and other measures supported by observational studies include no restrictions on fluid input and avoidance of antihypertensive drugs. In the event of ischemia, the combined use of induced high