Nontraumatic Intracerebral Hemorrhage in Young Adult

非外傷性年青型腦出血的原因分析

林志隆(Chih-Lung Lin) ； 洪純隆(Shen-Long Howng)

《The Kaohsiung Journal of Medical Sciences》 13卷4期 (1997/04) Pp. 237-242

https://doi.org/10.6452/KJMS.199704.0237

摘要

從1994年至1994年我們收集91例年紀在15至40歲非外傷性腦出血的病人。發現在其中68例可找到共超過10種以上的病因。最主要的病因為高血壓及動靜脈畸型瘤破裂。在腦葉出血中，26.5%為動靜脈畸型瘤硇裂所引起。而背殼出血則60%導因於動脈性高血壓。36例接受腦血管攝影，其中23例有發現血管疾病。3例有藥物濫用的病史。一個月的存活率為82.4%，6個月為78.0%，一年為76.9%。出血後一個月的預後：32%回微到出血前狀況，35%恢復良好僅有些許功能損失，15%有嚴重功能損失，18%死亡。高血壓引起的年青型腦出血在我們的病例中約30%，這提醒我們即使年青人血壓的檢查與控制也是相當重要的。血管攝影對非外傷性年青型腦出血是一種極有價值的檢查。另一方面臨床醫師也要想到藥物濫用的可能性。

並列摘要

We reviewed our experience with 91 patients aged 15 to 40 years with nontraumatic intracerebral hemorrhage (ICH) from January 1991 through December 1994 and found more than ten presumed causes for the nontraumatic ICH in 68 patients (74.7%). The leading two causes were arterial hypertension and ruptured arteriovenous malformations. Most cases of ICH were lobar and putaminal. Of the lobar hemorrhages, 26.5% resulted from ruptured arteriovenous malformations. Of the putaminal hemorrhages, we found 60% resulted from arterial hypertension. Arteriography was performed in 36 patients, and was diagnostic in 23. A history of drug abuse was found in 3 patients. The survival rate was 82.4% at 1 month, 78.0% at 6 months and 76.9% at 1 year. The in-hospital survival rate of all patients in this study was 78.0%. The outcome was determined at one month after hemorrhage. Thirty-two percent of our cases made a good recovery (back to normality), 35% a fair recovery (moderately disabled but independent), 15% a poor recovery (severely disabled and dependent), and 18% died. Arterial hypertensive hemorrhage accounted for almost 30% of our young ICH patients which reminds us of the importance of regular control of blood pressure even in the young adults. Arteriography performed early in the course of nontraumatic ICH in young adults, particularly in lobar hemorrhages, is a valuable adjunct in determing cause. Although the details of history of drug abuse were frequently lacking, physicians should keep this abuse in mind as a possible cause for nontraumatic ICH.

並列關鍵字

intracerebral hemorrhage ； young adult ； arteriography