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中华脑血管病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 48 -52. doi: 10.11817/j.issn.1673-9248.2021.01.009

所属专题: 经典病例 文献

病例报告

破裂出血的烟雾病侧支动脉瘤自然病史:病例系列并文献复习
梁群1, 杨咏波1,()   
  1. 1. 210008 南京大学医学院附属鼓楼医院神经外科
  • 收稿日期:2020-07-20 出版日期:2021-02-01
  • 通信作者: 杨咏波

Natural history of ruptured collateral vessel aneurysms in moyamoya disease: case series and literature review

Qun Liang1, Yongbo Yang1()   

  • Received:2020-07-20 Published:2021-02-01
  • Corresponding author: Yongbo Yang
引用本文:

梁群, 杨咏波. 破裂出血的烟雾病侧支动脉瘤自然病史:病例系列并文献复习[J]. 中华脑血管病杂志(电子版), 2021, 15(01): 48-52.

Qun Liang, Yongbo Yang. Natural history of ruptured collateral vessel aneurysms in moyamoya disease: case series and literature review[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(01): 48-52.

图1 病例1患者影像资料。图a为患者首次出血CT图像,显示患者主要为左侧脑室出血;图b为患者首次颈内动脉造影侧位图像,显示患者大脑前、中动脉闭塞,烟雾血管形成,并且患者为胚胎型大脑后动脉,并可见箭头所示处有一圆形阴影;图c为椎基底动脉造影正位图,图d为椎基底造影侧位图,二者显示动脉瘤位于左侧脉络膜后外侧动脉(白色箭头所示)。图e为患者10个月后复发出血时所查CT图像,显示与上次出血图像基本相同。图f、g、h为患者第2次脑出血造影图像,显示动脉瘤较上次有所增大,其余较上次无明显变化;图f为右侧颈内动脉侧位造影图,图g为左侧椎基底动脉造影正位图,图h为左侧椎基底动脉侧位图
图2 病例2患者影像资料。图a是患者首次出血外院CT图像,显示患者主要为右基底节区出血破入脑室;图b为患者距首次出血12个月后,与首次出血情况基本相同;图c为患者颈总动脉造影正位图像,显示患者颈内动脉末端狭窄闭塞,少量烟雾血管形成,并且颈外系统向脑内代偿较差,尤其大脑前区出现较大无造影剂充盈区(白色圆圈所示);图d为椎基底动脉造影正位图,图e为椎基底造影侧位图,二者显示动脉瘤位于右侧脉络膜后内侧动脉(白色箭头所示),结合正侧位造影图像可推测有多支血管向载瘤动脉吻合
图3 病例3患者影像资料。图a为患者出血CT图像,显示左侧颞叶、基底节区脑出血;图b为颈内动脉造影正位图,图c为颈内动脉造影侧位图,二者显示患者大脑中动脉闭塞,豆纹动脉扩张并有一圆形动脉瘤样阴影(白色箭头所示)
表1 既往文献有随访的保守治疗的烟雾病合并破裂CVA患者临床特征和脑血管造影特征总结
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