蛛网膜下腔出血







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蛛网膜下腔出血
Subarachnoid hemorrhage

Subarachnoid haemorrhage.jpg

腦部的CT掃描顯示蛛網膜下腔出血，位於中央的白色區域
分类和外部资源
醫學專科
急救措施

ICD-10
I60

ICD-9-CM
430
DiseasesDB
12602
MedlinePlus
000701
eMedicine
med/2883 neuro/357 emerg/559

[编辑此条目的维基数据]




最可能的出血點


蛛网膜下腔出血（英文：Subarachnoid hemorrhage, SAH），是蛛网膜下腔中出血的现象 －蛛網膜和腦軟膜之間的空間。最常見的表現為突發劇烈頭痛，嘔吐，發燒，神智不清或癲癇。頸部僵硬和劇痛也極為常見。常见的病因是脑动脉畸形，动脉瘤，血液疾病等。它可以是自发生性的，通常来自破裂的脑动脉瘤，或可以由头部损伤引起。




目录






  • 1 症狀


  • 2 病發原因


  • 3 檢查


  • 4 預防


  • 5 治療


  • 6 事後併發


  • 7 参见


  • 8 外部链接


  • 9 参考文献





症狀


突然起病，極短時間內出現非常劇烈的頭痛是最常見的表現。其他症狀包括頸部僵直、頭痛、意識改變、偏癱、同側瞳孔放大。


西方國家的報告介於4-13例/10萬人口/每年，多發於45-60歲間男女性別比為2:3，[1]只佔所有腦中風的5%，但它有特殊且嚴重的致死率。



病發原因


85%是因為動脈瘤破裂造成的。



檢查



  • 腦斷層掃瞄：在出血後24小時內，高達92%可發現蜘蛛膜下腔出血。[2]

  • 脊椎穿刺檢查：出血量不多時斷層掃瞄可能看不出明顯出血，安排脊椎穿刺檢查，區別是蜘蛛膜下腔出血或是腦膜炎。

  • 腦部血管攝影：是診斷顱內動脈瘤的最標準檢查，以查明是否動脈瘤破裂。

  • 實驗室檢查：血常規，凝血功能，肝功能等找出其他出血原因。



預防


蛛網膜下腔出血所以嚴重在於常常無明顯的警訊即發生，使人無法預防，它的疾病致死率是所有腦中風最高。


能在例行性較高價的健康檢查中進行腦部掃描，提前發現動脈瘤與血管先天畸形做出手術處理，是唯一有效提前預防法。[3]



治療



  • 腦動脈栓塞法預防再出血

  • 手術治療顱內動脈瘤



事後併發


若挺過急性發病而存活，事後可能再有併發



  • 再出血

  • 血管痙攣：出血後4-14日最明顯，原本是一種正常的生理反應以阻止繼續出血但當收縮太厲害時，又會造成腦部缺血，如中風一樣使病人惡化。

  • 水腦症

  • 遲發性腦缺血

  • 癫癇[4]

  • 低血鈉



参见


  • 中风


外部链接




  • behindthegray.net Subarachnoid Haemorrhage support group with forums, articles, chat and general advice.

  • Addressing the Challenges Faced as a Result of Brain Haemorrhage or Brain Injury for Sufferers Families and Carers.


  • Neuroland SAH page



参考文献





  1. ^ 台灣腦學會


  2. ^ 榮總-醫藥查詢庫


  3. ^ International Study of Unruptured Intracranial Aneurysms Investigators (December 1998). "Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention". New England Journal of Medicine. 339 (24): 1725–33.


  4. ^ Servadei F, Murray GD, Teasdale GM, et al. (February 2002). "Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries". Neurosurgery. 50 (2): 261–67









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