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Neurology：相继发生的梗死和蛛网膜下腔出血该怎么诊断？

2018-04-10 杨中华 脑血管病及重症文献导读

梗死蛛网膜下腔出血诊断
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60岁，男性。表现为眩晕，勾引障碍和左侧无力。

60岁，男性。表现为眩晕，勾引障碍和左侧无力。

MRI和CTA显示多发性梗死和椎基底动脉延长扩张（下图A和B）：





高分辨MR显示基底动脉和椎动脉夹层（图C）：



10天时发生SAH（下图D），第30天死亡：



作者认为基底动脉扩张延长合并夹层可以相继出现梗死和SAH，这往往预示着预后不良。高分辨核磁是检测基底动脉扩张延长合并夹层的有用工具。基底动脉扩张延长症的治疗方案尚无一致性意见；抗血小板、抗凝、外科和血管内治疗都是治疗选项。

原始出处：

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    2018-11-16 aliceclz

    #蛛网膜#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1654453, encodeId=5198165445341, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Fri Nov 16 22:54:00 CST 2018, time=2018-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000389, encodeId=7067200038973, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Feb 14 06:54:00 CST 2019, time=2019-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1724462, encodeId=92c01e24462df, content=<a href='/topic/show?id=78ece8958b2' target=_blank style='color:#2F92EE;'>#继发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78958, encryptionId=78ece8958b2, topicName=继发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=499d33645837, createdName=feifers, createdTime=Fri Jun 29 23:54:00 CST 2018, time=2018-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304720, encodeId=97c5304e20b0, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Wed Apr 11 07:42:51 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304709, encodeId=9dbe304e090e, content=学习了., beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9b042022872, createdName=1e217aeem71(暂无匿称), createdTime=Wed Apr 11 07:30:34 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304660, encodeId=d4543046600b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Wed Apr 11 06:18:17 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304639, encodeId=22fb30463938, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Wed Apr 11 05:00:42 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304626, encodeId=4ce7304626ba, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Wed Apr 11 04:42:09 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304615, encodeId=48f530461534, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Wed Apr 11 00:18:01 CST 2018, time=2018-04-11, status=1, ipAttribution=)]
    2019-02-14 yinhl1978

    #Neurol#

    0

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    2018-06-29 feifers

    #继发#

    0

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    2018-04-11 131****1460

    学习了受益匪浅

    0

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    2018-04-11 1e217aeem71(暂无匿称)

    学习了.

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1654453, encodeId=5198165445341, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Fri Nov 16 22:54:00 CST 2018, time=2018-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000389, encodeId=7067200038973, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Feb 14 06:54:00 CST 2019, time=2019-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1724462, encodeId=92c01e24462df, content=<a href='/topic/show?id=78ece8958b2' target=_blank style='color:#2F92EE;'>#继发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78958, encryptionId=78ece8958b2, topicName=继发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=499d33645837, createdName=feifers, createdTime=Fri Jun 29 23:54:00 CST 2018, time=2018-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304720, encodeId=97c5304e20b0, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Wed Apr 11 07:42:51 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304709, encodeId=9dbe304e090e, content=学习了., beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9b042022872, createdName=1e217aeem71(暂无匿称), createdTime=Wed Apr 11 07:30:34 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304660, encodeId=d4543046600b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Wed Apr 11 06:18:17 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304639, encodeId=22fb30463938, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Wed Apr 11 05:00:42 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304626, encodeId=4ce7304626ba, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Wed Apr 11 04:42:09 CST 2018, time=2018-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=304615, encodeId=48f530461534, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Wed Apr 11 00:18:01 CST 2018, time=2018-04-11, status=1, ipAttribution=)]
    2018-04-11 121832a9m88暂无昵称

    学习了

    0

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    2018-04-11 changjiu

    学习一下谢谢

    0

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    2018-04-11 swfzhanggui

    非常好.谢谢分享

    0

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    2018-04-11 jihuaijun1112

    学习学习学习

    0

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