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目的探讨原发性蛛网膜下腔出血(SAH)的病因、症状影像及临床预后。方法回顾性分析167例SAH患者起病病因、症状,引起病情恶化和死亡的主要原因和临床表现。结果动脉瘤是SAH患者的主要病因,以中年青年多见;高血压动脉硬化次之,以中老年多见;血管畸形所致的SAH以青年多见。头痛、呕吐和脑膜刺激征等SAH等典型症状在中青年患者中最常见,肌力、精神症状和语言障碍等不典型症状在老年SAH患者中最常见。SAH恶化、死亡以<45岁病例、出血后14 d内多见,以后枕部疼痛、意识障碍为首发症状,后颅窝为常见出血部位。结论动脉瘤和血管畸形是青中年SAH的主要病因,高血压动脉硬化、动脉瘤是老年SAH主要病因;老年SAH患者临床症状不如中青年患者典型;以后颅窝为主的SAH是<45岁患者病情、恶化死亡的主要原因,多发生在出血后14 d内。
Objective To investigate the etiology, symptoms and signs of primary subarachnoid hemorrhage (SAH) and its clinical prognosis. Methods Retrospective analysis of 167 cases of SAH patients etiology, symptoms, causes of disease progression and death of the main causes and clinical manifestations. Results Aneurysm was the main cause of SAH patients, more common in middle-aged young people; followed by hypertensive arteriosclerosis, more common in middle-aged and elderly; SAH caused by vascular malformations more common in young people. Typical symptoms of SAH such as headache, vomiting and meningeal irritation are most common in young and middle-aged patients, and atypical symptoms such as muscular strength, mental symptoms and speech impairment are most common in elderly patients with SAH. SAH exacerbation, death in <45 years of age, more common within 14 days after bleeding, after occipital pain, disturbance of consciousness as the first symptom, the posterior fossa is a common site of bleeding. Conclusions Aneurysms and vascular malformations are the major causes of SAH in young and middle-aged people. Hypertensive arteriosclerosis and aneurysm are the main causes of SAH in elderly patients. The clinical symptoms of elderly patients with SAH are not as typical as those in middle-aged and young patients. After the cranial fossa, SAH is <45 The patient’s condition, worsening the main cause of death, occurred within 14 days after bleeding.