诊断
为了诊断蛛网膜下腔出血,医务人员可能建议:
- CT 扫描。这种影像学检查可以检测脑出血。虽然在操作正确的情况下 CT 扫描是一项非常有效的检查,但如果您的红细胞计数较低(贫血),并且在出血时只有少量失血,扫描可能无法发现出血。医生可能注射造影剂,以更详细地查看您的血管(CT 血管造影)。
- MRI。这种影像学检查也可以检测脑出血。医务人员可能将染色剂注射到血管中,以更详细地查看动脉和静脉(MR 血管造影),并突出显示血流。在 CT 扫描未显示出蛛网膜下腔出血迹象的极少数情况下,这种方法可能显示出相关迹象。
- 脑血管造影。医务人员将一根细长管(导管)插入动脉并穿行至大脑。然后,将染色剂注入脑部血管,以让它们显示在 X 线影像中。医务人员可能建议进行脑血管造影,以获得更详细的图像。如果怀疑是蛛网膜下腔出血,但原因不明确或其他影像学检查未检出,他们也可能建议进行该项检查。如果第一次未显示出动脉瘤,但医务人员认为很可能存在动脉瘤,您可能需要进行第二次脑血管造影。
在一些动脉瘤性蛛网膜下腔出血病例中,初始影像学检查可能无法发现出血。如果首次 CT 扫描检查未显示出血,医生可能建议进行腰椎穿刺。腰椎穿刺是将针头插入下背部,以抽取少量脑脊液(大脑和脊髓周围的液体)。然后检查这些液体中是否有血液,有则可能意味着您存在蛛网膜下腔出血。
治疗
治疗的重点是稳定病情,治疗动脉瘤(如有),并预防并发症。
医务人员会检查您的呼吸、血压和血流。
如果出血是由脑动脉瘤破裂引起,医务人员可能会建议:
- 外科手术。外科医生在头皮上开一个切口,并找到脑动脉瘤。在动脉瘤上放置金属夹,以阻止血液流向动脉瘤。
- 血管内栓塞术。外科医生将导管插入一根动脉中,然后将其引导至大脑中。引导可脱铂丝弹簧圈穿过导管,将其置于动脉瘤中。弹簧圈会填塞动脉瘤,减少流入动脉瘤囊的血液并使血液凝结。已经开发出了各种类型的弹簧圈用于治疗各种动脉瘤。
- 其他血管内治疗。某些动脉瘤可采用血管内栓塞治疗,这种治疗方法使用较新的技术,例如支架辅助或球囊辅助的弹簧圈或血流导向装置。
由于您可能会再次出血,大脑血流不畅,血液中的钠等盐含量偏低,脑内积液过多,或者血糖偏高或偏低,因此务必要预防并发症。药物尼莫地平(Nymalize)已被证明可以减少蛛网膜下腔出血后的脑部循环问题。
脑血管迟发性痉挛是动脉瘤性蛛网膜下腔出血后常见的一种并发症。如果血流量因此下降到一定水平以下,就会导致卒中。当发生脑血管迟发性痉挛时,可以静脉注射药物提高血压或使用药物扩张大脑血管,以防止卒中。
另一种常见的并发症是脑积水,也就是液体在脑腔隙中的积聚。脑积水可以通过在头部(脑室造口导管)或下背部(腰椎引流管)插入引流管来治疗。
有时,需要重复这些医疗程序。您需要到医务人员那里定期复诊,以观察是否有任何变化。您还可能需要物理、作业和言语治疗。
临床试验
探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法,旨在预防、检测、治疗或控制这种疾病。
在 Mayo Clinic 治疗
Aug. 31, 2022
- Winn HR. Perioperative management of subarachnoid hemorrhage. In: Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, Pa.: Elsevier; 2023. https://www.clinicalkey.com. Accessed May 6, 2022.
- Connolly ES, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for the healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; doi: 10.1161/str.0b013e3182587839
- Siddiq F. Nonaneurysmal subarachnoid hemorrhage. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
- Ferri FF. Subarachnoid hemorrhage. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed May 6, 2022.
- Singer RJ, et al. Aneurysmal subarachnoid hemorrhage: Epidemiology, risk factors, and pathogenesis. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
- Dubosh NM, et al. Diagnosis and initial emergency department management of subarachnoid hemorrhage. Emergency Medical Clinics of North America. 2021; doi: 10.1016/j.emc.2020.09.005
- Chakraborty T, et al. CT-negative subarachnoid hemorrhage in the first six hours. Journal of Stroke and Cerebrovascular Diseases. 2020; doi: 10.1016/j.jstrokecerebrovasdis.2020.105300
- Singer RJ, et al. Clinical manifestations and diagnosis of aneurysmal subarachnoid hemorrhage. https://www.uptodate.com/contents/search. Accessed May 6, 2022
- Torregrossa F, et al. Therapeutic approaches for cerebrovascular dysfunction after aneurysmal subarachnoid hemorrhage: An update and future perspectives. World Neurosurgery. 2022; doi: 10.1016/j.wneu.2021.11.096
- Singer RJ, et al. Treatment of aneurysmal subarachnoid hemorrhage. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
- Tawk, RG, et al. Diagnosis and treatment of unruptured intracranial aneurysms and aneurysmal subarachnoid hemorrhage. Mayo Clinic Proceedings. 2021; doi: 10.1016/j.mayocp.2021.01.005
- Daroff RB, et al. Intracranial aneurysms and subarachnoid hemorrhage. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed May 6, 2022.
- Singer RJ, et al. Treatment of cerebral aneurysms. https://www.uptodate.com/contents/search. Accessed July 5, 2022.
- Youssef PP, et al. Woven endobridge(WEB) device in the treatment of ruptured aneurysms. Journal of Interventional Surgery. 2021; doi: 10.1136/neurintsurg-2020-016405
- Gupta R, et al. Primary results of the Vesalio NeVa VS for the treatment of symptomatic cerebral vasospasm following aneurysm subarachnoid hemorrhage (vital) study. Journal of Interventional Surgery.2021; doi: 10.1136/neurintsurg.2021.017859
- Guerra H, et al. The first CT in a subarachnoid hemorrhage: A picture tells a story. Practical Neurology. 2017; doi: 10.1136/practneurol-207-001639
- Kramer CL, et al. Refining the association of fever with functional outcome in aneurysmal subarachnoid hemorrhage. Neurocritical Care. 2017; doi: 10.1007/s12028-0160281-7
- Rinaldo L, et al. Transfer to high-volume centers associated with reduced mortality after endovascular treatment of acute stroke. Stroke. 2017; doi: 10.1161/strokeaha.116360
- Pegoli M, et al. Predictors of excellent functional outcome in aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2015; doi: 10.3171/2014.10jns14290
- Nguyen HT. Allscripts EPSi. Mayo Clinic. April 22, 2022.
- Rabinstein AA (expert opinion). Mayo Clinic. July 1, 2022.
相关
产品与服务