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目的:探讨首次全脑血管造影阴性患者自发性蛛网膜下腔出血的发病原因。方法:回顾性分析30例首次DSA阴性的SAH患者的临床表现、影像学特征、治疗及预后。结果:本组30例病例,有7例在随后的手术或再次DSA检查中被证实为颅内动脉瘤,有18例至少2次DSA阴性的患者诊断考虑为中脑周围非动脉瘤性SAH;另外4例1次DSA阴性,MRA阴性的患者诊断考虑PNSN可能大,1例考虑为高血压脑出血;还有1例出院2月后死亡的患者,考虑动脉瘤的可能性大。结论:首次DSA阴性的SAH患者,其病因诊断要谨慎,在条件许可的情况下,最好复查全脑血管造影,避免误诊和漏诊。2次DSA检查阴性者才可考虑诊断为PNSN。
Objective: To investigate the etiology of spontaneous subarachnoid hemorrhage in patients with negative first cerebral angiography. Methods: The clinical manifestations, imaging features, treatment and prognosis of 30 patients with primary DSA-negative SAH were retrospectively analyzed. Results: Thirty patients in this group of 7 patients were confirmed as intracranial aneurysms on subsequent surgery or re-DSA. In 18 patients with at least 2 DSA-negative patients, the diagnosis was considered as non-aneurysmal SAH. Another 4 cases of DSA-negative, MRA-negative patients may be considered in the diagnosis of PNSN may be large, 1 case of hypertensive intracranial hemorrhage; and 1 patient discharged after 2 months, the possibility of considering the aneurysm. Conclusions: The first DSA-negative patients with SAH should be cautious in the diagnosis of etiology. When conditions permit, it is best to review whole cerebral angiography to avoid misdiagnosis and missed diagnosis. Two negative DSA examinations should be considered for diagnosis of PNSN.