The Etiology Study Of Spontenous Convexal Subarachnoid Hemorrhage

Background The Spontenous Convexal Subarachnoid Hemorrhage is a rare subtype of nonaneurysmal subarachnoid hemorrhage.Bleeding generally confined to several cortex ditch within a small area on the unilateral hemisphere convex.Its clinical symptoms,imaging characteristics,causes,treatment and prognosis are different from aneurysmal subarachnoid hemorrhage.It has significant specificity.This subtype of the disease was began to be researched and reported in recent years from both at home and abroad,it had not a unified understanding.Further studying of its etiology and pathogenesiso of c SAH can better understand the clinical characteristics and treatment strategies,and correctly and efficiently help clinicians make a diagnosis and give treatment the disease.Objective To fully understand various kinds of clinical manifestations and imaging characteristics and etiology classification of Spontenous Convexal Subarachnoid Hemorr-hage,and to delve into the etiology and mechanism,so as to improve clinical physician awareness of the disease and guide on the diagnosis and treatment of the disease in clinical work.Methods We retrospectively selected 36 patients admitted to Nanyang City Central Hospital from Jan.2010 to Jun.2015,who presented with c SAH by imageological examination.Summarise and analysis the demographic characteristics,clinical presentations,imaging characteristics,causes and mechanism,treatment and prognosis of the 36 patients,and review the related literatures,so as to have an in-depth study of its etiology.Results1.A total in 36 patients(23 men and 13 women)were included.Median age was 60 years.The medical history of the group of patients were as follows:hypertension(n =21,58.3%),diabetes mellitus(n =16,44.4%),dyslipidemia(n =8,22.2%),coronary heart disease(n =8,22.2%),high D.D immer disease(n =11,30.6%),smoking(n =17,47.2%),drinking(n =9,25%).2.The symptoms were as follows:transient neurologic symptoms(n=16,44.4%),persistent neurologic symptoms(n=5,13.9%),epilepsy(n=6,16.7%),accompanying mildto-moderate headache(n=13,33.3%),dizziness(n=3,8.3%),coma(n=2,5.6%)and psychiatric disorder(n=1,2.7%).3.Etiology classification results were as follows:arteriosclerotic cerebrovascular stenosis or occlusion(n=18,50%),moyamoya disease(n=3,8.3%),cerebral venous thrombosis(n=3,8.3%),the upper cervical spinal dural arteriovenous fistula(n=1,2.7%),eversible cerebral vasoconstriction syndrome(n=5,13.8%),reversible posterior encephalopathy syndrome(n=2,5.6%),suspicious cerebral amyloid angiopathy(n=4,11.1%).4.In terms of gender,male(63.1%,23/36)is significantly higher than female(36.1%,13/36)in the incidence of c SAH.Arteriosclerotic cerebrovascular stenosis or occlusion was the main etiology in male(60.9%,14/23).In terms of age,c SAH mainly occurs in the patients over the age of 50(61.6%,22/36),especially on the 61-61-year-old age group.Arteriosclerotic cerebrovascular stenosis or occlusion was the mainetiology on the group of patients over the age of 50(77.3%,17/22),instead,reversible cerebral vasoconstriction syndrome was the most common etiology of the patients under the age of 50(35.7%,5/14).5.97.2% of the patients were cured and discharged with a relatively short recovery time.No neurological symptoms were left over.So the prognosis was good.Conclusion Arteriosclerotic cerebrovascular stenosis or occlusion may be the main cause of c SAH of Chinese people,especially in the older men,but this needs to be verified in the study of large sample.The Middle cerebral artery was in the majority on the proportion.The rupture of leptomeningeal anastomosis was the structural basis of c SAH.Poor management of blood pressure is the direct cause.