目的:更新西班牙神经病学会蛛网膜下腔出血诊断和治疗指南。
方法:对现有文献的回顾和分析。根据所审查的每项研究的证据水平给出建议。
结果:自发性蛛网膜下腔出血(SAH)的最常见原因是脑动脉瘤破裂。其在西班牙的估计发病率为9/100.000居民/年,相对频率约为所有中风的5%。高血压和吸烟是主要的危险因素。中风患者需要在专门中心接受治疗。对于初始临床状况良好(Hunt和Hess量表的I级或II级)的SAH患者,应考虑入院卒中单元。我们建议早期从循环中排除动脉瘤。SAH的首选诊断研究是无对比的脑CT(计算机断层扫描)。如果检测结果为阴性,并且仍然怀疑SAH,然后应该进行腰椎穿刺。为了确定出血的来源,推荐的诊断测试是MRI(磁共振成像)和血管造影。多普勒超声检查对于诊断和监测血管痉挛非常有用。尼莫地平被推荐用于预防迟发性脑缺血。在治疗难治性血管痉挛时,可以考虑血压治疗和神经血管干预。
结论:SAH是一种严重而复杂的疾病,必须由在相关诊断和治疗过程中具有丰富经验的专业人员在专业中心进行管理。
OBJECTIVE: To update the Spanish Society of Neurology\'s
guidelines for subarachnoid haemorrhage diagnosis and treatment.
METHODS: A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed.
RESULTS: The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm.
CONCLUSIONS: SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.