目的：探讨颅内动脉瘤破裂合并颅脑损伤的临床特征，以此鉴别创伤性蛛网膜下腔出血。方法对我院近三年来收治的5例颅内动脉瘤破裂合并颅脑损伤患者的临床资料进行回顾性研究，总结其临床特征。结果4例患者入院后急诊经CTA检查证实为颅内动脉瘤破裂出血，其中前交通动脉瘤2例，大脑中动脉瘤1例，颈内动脉-后交通动脉瘤l例；1例患者为动脉瘤再次破裂后行CTA检查示颈内动脉-后交通动脉瘤。急诊开颅血肿清除及动脉瘤夹闭术2例，动脉瘤夹闭术1例，血管内介入栓塞治疗术1例，药物保守治疗1例。恢复良好3例，重残1例，死亡l例。结论对伴有颅脑外伤史的蛛网膜下腔出血应注意考虑颅内动脉瘤破裂的可能，以便采取积极合理的治疗方案。%Objective To investigate the clinical features of the subarachnoid hemorrhage ( SAH) induced by the rupture of intracranial aneurysms and distinguish traumatic subarachnoid hemorrhage .Methods The clinical data of 5 patients with ruptured intracranial aneurysms accompanied with head trauma treated in our hospital during recent 3 years were analyzed retrospectively ,the clinical features were studied .Results Of 4 patients diagnosed by computer tomography angiography ( CTA ) , 2 suffered from anterior communicating artery aneurysm , 1 middle cerebral artery aneurysm, l posterior communicating-internal carotid artery aneurysm . 1 patient was diagnosed posterior communicating-internal carotid artery aneurysm by CTA after rupture again .2 patients were underwent operatively clipping the aneurysms and remove hematoma with craniotomy , 1 by operatively clipping the aneurysm with craniotomy,1 by Guglielmi detachable coil ( GDC) embolization, and 1 patient was treated by drugs .3 patients got good recovery ,l severe disability and one died .Conclusions Accompanied with head trauma , it should be noted that subarachnoid hemorrhage is induced by rupture of intracranial aneurysm .CTA is the early effective method to diagnoses .The curative effect can be heightened by active surgery and embolization .
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