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目的应用CT血管成像(CTA),回顾性研究急性严重头痛病人颅内血管病变的患病率及特征。方法系统性地搜集神经功能健全、急性严重头痛且头颅CT平扫正常的病人。研究组包括512例病人,男性251例,平均年龄(46.2±12.4)岁。所有病人在头痛发作1d~2个月内行CTA检查。2名有经验的神经放射学医生对CTA影像进行判读,明确是否存在血管病变。结果 34例病人(34/152,6.6%)于CTA上发现颅内血管病变,包括33例动脉瘤(其中2例病人分别有2个动脉瘤)、2例烟雾病和1例动脉夹层。无性别及年龄相关性差异。动脉瘤起源于颈内动脉(n=12)者最多见,其次为前交通动脉(n=7)和大脑中动脉(n=7)。最大直径范围2.0~13.1mm[均值(3.9±2.6)mm]。结论 CTA可用于诊断急性严重头痛病人颅内血管病变。血管病变在本组研究中患病率为6.6%,高于在普通人群的预期发生率。要点①未破裂的大脑动脉瘤可能是急性严重头痛的原因之一。②CTA可用于评估急性严重头痛病人的颅内血管病变。③本组研究病人血管病变的发生率为6.6%。
Objective To evaluate the prevalence and characteristics of intracranial vascular lesions in patients with acute severe headache by CT angiography (CTA). Methods Systematic collection of patients with neurologically sound, acute and severe headache with normal cranial CT scan. The study group consisted of 512 patients, 251 males, mean age (46.2 ± 12.4 years). All patients underwent a CTA examination within 1 to 2 months of the onset of headache. Two experienced neuroradiologists interpret CTA images to determine whether there is a vascular lesion. Results 34 patients (34 / 152,6.6%) had intracranial vascular lesions on CTA, including 33 aneurysms (2 of them had 2 aneurysms respectively), 2 moyamoya disease and 1 arterial dissection. No gender and age-related differences. Aneurysms originated in the internal carotid artery (n = 12), the most common, followed by the anterior communicating artery (n = 7) and the middle cerebral artery (n = 7). The maximum diameter range of 2.0 ~ 13.1mm [mean (3.9 ± 2.6) mm]. Conclusion CTA can be used to diagnose intracranial vascular lesions in patients with acute severe headache. The prevalence of vascular disease in this study was 6.6%, higher than the expected rate in the general population. Key points ① Unruptured cerebral aneurysms may be one of the causes of acute, severe headaches. ② CTA can be used to assess acute severe headache in patients with intracranial vascular lesions. ③ The study of patients with vascular disease incidence was 6.6%.