Clinical Analysis Of44Cases Of Initial DSA Negative Subarachnoid Hemorrhage

Objective:Subarachnoid hemorrhage (subarachnoid, hemorrhage, SAH) in patients with a first digital subtraction angiography (digital subtraction angiography, DSA) is a clinical characteristics, negative reason analysis and treatment strategies, and to analyze its first DSA positive group and subarachnoid hemorrhage in patients with different. To guide the first DSA therapy and prognosis in patients with subarachnoid hemorrhage with negative, reduce the mortality rate and disability rate.Methods:In2009September-2011year in September period were hospitalized in Affiliated Hospital of Jining Medical College neurology and neurosurgery in patients with spontaneous SAH307people, all from within1h after admission of patients after admission Hunt-Hess grade,3H CT examination of brain and according to the results of the CT to complete the modified Fisher grading, admitted to hospital within72h DSA, according to the results of DSA were divided into, divided into DSA positive group and DSA negative group. On two groups of gender, history of hypertension, history of diabetes, inducement, smoking history, seizures, admission Hunt-Hess classification, modified Fisher grading, CT performance meets perimesencephalic non-aneurysmal subarachnoid hemorrhage (Perimesencephalic Nonaneurysmal Subarachnoid Hemmorrhage, PNSAH), the number of patients in Department of internal medicine after treatment of headache, vomiting and disturbance of consciousness the duration, the rate of rebleeding, cerebral vasospasm, hydrocephalus rate, mortality rate and discharge NIHSS scores were compared and analyzed. In44cases of cerebral angiography was one of the first clinical data of the patients with negative subarachnoid hemorrhage clinical features, complications, prognosis, with perimesencephalic non-aneurysmal subarachnoid hemorrhage (PNSAH) are evaluated in terms of the number, and in the blood after2-3week for DSA or CTA, MRA review, analyze the clinical characteristics, possible causes and prognosis. Discuss the differences, the clinical features and DSA positive group analysis of causes, and evaluate the prognosis, in order to improve the understanding of the disease.Results:Cerebral angiography negative group differences in gender, age, Hunt-Hess grade and Fisher grade, hypertension inducement and DSA positive group, and the difference is statistically significant (P<0.05); for the first time, DSA negative patients with2-3underwent DSA examination,6patients regained aneurysm or vascular malformation diagnosis,14cases of perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) patients,2-3weeks after cerebral angiography is still found no positive, patients with hemorrhage of unknown cause in20patients with subarachnoid hemorrhage.6patients regained aneurysm or vascular malformation in subarachnoid hemorrhage patients, were treated with interventional embolization operation or surgical operation treatment, including1cases of patients with aneurysms after interventional embolization, and then bleeding to death; traffic artery in patients with frontal lobe hemorrhage complicated with the other1cases, the surgical evacuation of the hematoma operation recovered well, leave only a slurred speech sequela. Meet the perimesencephalic non-aneurysmal subarachnoid hemorrhage (PNSAH) patients accounted for31.8%ratio. None of the44patients with hydrocephalus, irreversible cerebral vasospasm. Follow-up results of42patients recovered to normal life and work, no clear sequelae of nervous system. Only1cases left slurred speech sequela.Conclusion:The first DSA test negative for SAH patients, more men than women, patients with hypertension for less. The first reason for patients with SAH negative angiography is PNSAH (31.8%). Other causes of the brain may be tiny aneurysm, cerebral vasospasm, occult intracranial vascular malformations, hypertensive arteriosclerosis, high spinal vascular malformation, a false negative result for the projection error. Patients with SAH negative cerebral angiography and less complications, low mortality, the prognosis is good. PNSAH patients with first negative angiography can need not repeat angiography. Other patients should be2-3weeks after DSA scan or CTA, MRA. Such as repeated the same site hemorrhage and DSA negative, should be considered. MRI inspection, if found to have vascular spasm, should repeat angiography, if still not found, with the consent of the consent of family members of patients with operation or operation.