ĐẶC ĐIỂM LÂM SÀNG, HÌNH ẢNH CẮT LỚP VI TÍNH 128 DÃY VÀ SIÊU ÂM DOPPLER XUYÊN SỌ Ở BỆNH NHÂN CHẢY MÁU DƯỚI NHỆN

Abstract

Objective: To describe the clinical characteristics of patients with cerebral venous thrombosis. Subjects and methods: A prospective, cross-sectional descriptive study was performed on 32 patients with subarachnoid hemorrhage treated at the Neurology Center, Bach Mai Hospital from June 2021 to July 2022. Results: The mean age of the study group was 55.12 ± 14.33. The male/female ratio is 1/3. The most common symptoms were headache (100%), nausea and vomiting (75%), neck stiffness and kernig's sign (68.8%), confusion (31.2%), convulsions (6.2%), hemiplegia (6.2%). The clinical picture is diverse, in which the most common symptom is headache combined with vomiting - nausea, stiff neck, kernig sign accounting for 31.2%. The most common clinical severity assessed by the Hunt and Hess scale is level 2 (56.5%), followed by level 3 (25%), level 1 (12.5%), and level 4 (6.2%). Evaluation on clinical examination by Fisher's scale found that the most common level was Fisher 4 (37.5%). The 128-slice computed tomography image showed that subarachnoid hemorrhage caused by ruptured cerebral aneurysm accounted for 65.6%, of which ruptured saccular aneurysms accounted for the highest rate of 80.9%, and ruptured fusiform aneurysms accounted for a small percentage of 19.1%, no case of subarachnoid hemorrhage due to arteriovenous malformation has been recorded. The study showed that vasospasm detected by transcranial doppler ultrasound was highest at the second time performed within 6-8 days after symptom onset with a rate of 50%. Vasospasm detected at the first ultrasound examination was 18.7%, the third ultrasound examination was 12.5%. Conclusion: The clinical symptoms of the disease are varied and non-specific, headache symptom is seen in all patients (100%), besides, nausea and vomiting (75%), stiff neck and kernig sign (68.8%), consciousness disorder (31.2%). The most common Hunt and Hess score for assessing clinical severity is 2, but the most common subclinical severity assessed by Fisher score is 4. Subarachnoid hemorrhage due to ruptured cerebral aneurysm accounts for 65.6%, mostly saccular aneurysms. Vasospasm occurs in 50% of patients on day 6 to day 8 after symptom onset detected by transcranial doppler ultrasound.