小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 突发性局部神经功能缺损
- 惊厥
- 意识水平降低
其他诊断因素
- 突发头痛
- 恶心
- 呕吐
- 意识模糊
- 渐进性头痛
- 高血压
- 昏迷
- 渐进性局灶性神经功能缺损
- 认知功能障碍
危险因素
- 家族性（畸形）
- 出血史（出血危险因素）
- 药物滥用（出血危险因素）
- 异常静脉引流（出血的危险因素）
- 小的AVMs（出血的危险因子）
- 后颅窝及深的AVMs（出血危险因素）
- 并发的动脉瘤（出血的危险因素）
- 妊娠（出血的危险因素）
- 高血压（出血的危险因素）
诊断性检查
首要检查
- 头颅 CT
- 脑部 MRI
需考虑的检查
- 脑数字减影血管造影
- 脑CT血管造影
- 脑血管磁共振
- 全血细胞计数 (FBC）
- 凝血筛查及分组
- 电解质检查
- 药物毒理筛查
- 功能成像
- 超选择性Wada试验
- 神经心理学
- 脑灌注检查
- 脑电图检查
- 视野检查
新兴检查
- 4D CT 血管造影术 (CTA)/磁共振血管成像 (MRA)
治疗流程
合并明显占位效应的血肿
不宜手术的患者
具备手术治疗条件的患者
妊娠
撰稿人
作者
Mervyn Lim, MBBS, MRCS, MPH
Senior Resident
Department of Neurosurgery
National University Health System
Singapore
利益声明
ML declares that he has no competing interests.
Leonard Yeo, MBBS, MRCP, MMed, ASN
Senior Consultant
Department of Medicine (Neurology)
National University Health System
Assistant Professor
Yong Loo Lin School of Medicine
National University of SIngapore
Singapore
利益声明
LY declares that he has no competing interests.
Benjamin Tan, MBBS, MRCP, MMed
Associate Consultant
Department of Medicine (Neurology)
National University Health System
Singapore
利益声明
BT declares that he has no competing interests.
Adriel Leong, MBBS, MRCS
Senior Resident
Department of Neurosurgery
National University Health System
Singapore
利益声明
AL declares that he has no competing interests.
Audrey Tan, BSc Medical Sciences (Hons), MBChB, MRCS
Senior Resident
Department of Neurosurgery
National University Health System
Singapore
利益声明
AT declares that he has no competing interests.
Pervinder Bhogal, MBBS
Consultant
Department of Radiology
St Bartholomew's and The Royal London Hospital
London
UK
利益声明
PB declares that he has no competing interests.
Yang Cunli, MBBS, FRCR, MMed, FAMS
Senior Consultant
Department of Diagnostic Imaging
National University Health System
Assistant Professor
Yong Loo Lin School of Medicine
National University of Singapore
Singapore
利益声明
YC declares that he has no competing interests.
Anil Gopinathan, MBBS, MD, DNB, FRCR, FAMS
Head of Division of Interventional Radiology
Senior Consultant
Department of Diagnostic Imaging
National University Health System
Assistant Professor
Yong Loo Lin School of Medicine
National University of Singapore
Singapore
利益声明
AG declares that he has no competing interests.
鸣谢
Dr Leonard Yeo, Dr Benjamin Tan, Dr Adriel Leong, Dr Audrey Tan, Dr Mervyn Lim, Dr Pervinder Bhogal, Dr Yang Cunli, and Dr Anil Gopinathan would like to gratefully acknowledge Dr Charles Matouk, Dr Catherine E. Gilkes, and Dr Richard J. Edwards, previous contributors to this topic, and the additional contribution of Dr Branden Cord and Dr Ryan Hebert.
利益声明
CM, CEG, and RJE declare that they have no competing interests.
同行评议者
Bernhard Meyer, MD
Chairman
Professor of Neurosurgery
Department of Neurosurgery
Technical University of Munich
Munich
Germany
利益声明
BM declares that he has no competing interests.
Michael Chen, MD
Assistant Professor of Neurology
Neurosurgery and Radiology
Rush University Medical Center
Chicago
IL
利益声明
MC declares that he has no competing interests.
Jae H. Choi, MD
Research Director
Stroke Center/The Neurological Institute
Columbia-Presbyterian Medical Center
New York
NY
利益声明
JHC declares that he has no competing interests.
鉴别诊断
- 脑动脉瘤
- 海绵状血管瘤
- 硬脑膜动静脉瘘
更多 鉴别诊断指南
- 自发性颅内出血治疗指南
- 功能区脑动静脉畸形管理的临床实践指南
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