中腦周圍非動脈瘤性蛛網膜下腔出血

Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage

陳建志(Jiann-Jy Chen) ； 龔國倫(Kuo-Luon Kung) ； 沈顯章(Hin-Cheung Shum) ； 陳啟仁(Chi-Jen Chen) ； 陳登郎(Dem-Lion Chen)

《北市醫學雜誌》 9卷2期 (2012/06) Pp. 154-160

https://doi.org/10.6200/TCMJ.2012.9.2.05

摘要

中腦周圍非動脈瘤性蛛網膜下腔出血與一般的動脈瘤性中腦周圍蛛網膜下腔出血不同，與身體出力動作關係密切。一54歲男性，無其他過去病史，在一次晨泳後，突然感到頸部僵硬、劇烈頭痛與噁心，他院電腦斷層及電腦斷層血管攝影證實是此病，隨即轉診於本院。在本院住院共計兩週，接受保守治療，兩次數位減影血管造影均僅顯示左側顱內橫靜脈竇發育不全，並無其他血管異常。頭痛在住院第7日就已緩解，出院後1個月之電腦斷層顯示中腦周圍的血塊已經完全消失。追蹤迄今2個月，並無頭痛發作，情況依然穩定。因此，身體用力動作後所致之頭痛，要想到本病之可能性，病因目前仍為不明確，所幸預後良好，少有復發。

關鍵字

蛛網膜下腔出血 ； 游泳 ； 身體用力 ； 劇烈頭痛 ； 靜脈竇發育不全

並列摘要

Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is different from aneurysmal subarachnoid hemorrhage. It is closely related with physical exertion. A 54-year-old man did not have any systemic disease. He suddenly presented with nuchal stiffness, sever headache and nausea after he had swum in the morning. A computed tomography and computed tomographic angiography demonstrated PNSAH at another hospital. He was transferred to our hospital. Over the following two hospitalized weeks, he was conservatively treated, and the two digital subtraction angiographies demonstrated left transverse sinus hypoplasia rather than other vascular anomalies. The headache remitted in the seventh hospitalized day. The following computed tomography demonstrated the perimesencephalic hematoma was absent. The following two months were uneventful, and headache did not recur. In conclusion, headache following physical exertion is attributable to PNSAH, which is of yet unknown etiology, good prognosis and little recurrence.

並列關鍵字

subarachnoid hemorrhage ； swimming ； physical exertion ； severe headache ； venous sinus hypoplasia