感染性心内膜炎合并颅内动脉瘤伴出血一例

doi:10.11817/j.issn.1673-9248.2021.02.011

中华脑血管病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 118 -122. doi: 10.11817/j.issn.1673-9248.2021.02.011

所属专题：经典病例；文献；

病例报告

感染性心内膜炎合并颅内动脉瘤伴出血一例

李茂华¹, 王礼¹, 段春梅¹, 杨清武¹, 王玥¹^,^†(

)

^1. 400037　重庆，中国人民解放军陆军军医大学（原第三军医大学）第二附属医院（新桥医院）神经内科

收稿日期:2020-11-24 出版日期:2021-04-01
通信作者: 王玥

Infective endocarditis complicated with cerebral aneurysms and intracerebral hemorrhage: a case report

Maohua Li¹, Li Wang¹, Chunmei Duan¹

Received:2020-11-24 Published:2021-04-01

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图1 患者的多模式颅脑影像学检查结果。图a~h：颅脑MRI平扫加增强，左侧半卵圆中心（图a，b）、左侧颞叶（图c）、右侧枕叶（图d）可见小结节状信号影，T2 flair信号增高，部分周围可见水肿，左侧半卵圆中心（图e，f）、左侧颞叶（图g）、右侧枕叶（图h）增强扫描呈环形、结节状强化。图i~p：头颅螺旋CT及增强，左侧半卵圆中心（图i，j）见结节状高密度影、左侧颞叶（图k）、右侧枕叶（图l）见斑片状低密度影，左侧半卵圆中心（图m，n）见结节状高密度影、左侧颞叶（图o）、右侧枕叶（图p）可见小结节样、环形异常强化灶，部分周围可见水肿

图2 患者经食道心脏彩色多普勒超声检查声像图。图a：左心室长轴切面，左心房切面异常回声，考虑赘生物，二维超声测值范围约14.7 mm×9.9 mm，三维超声测值范围约16.5 mm×10.0 mm。图b：前后瓣叶开放受限，瓣上记录到花色湍流。图c，d：双平面图像同时显示二尖瓣前后瓣异常回声。红色箭头示左心房切面一絮状高回声结节，蓝色箭头、白色箭头分别示二尖瓣前后瓣呈结节样增厚

图3 患者入院后第12天头颅CT复查图像。左侧半卵圆中心、双侧顶叶结节状高密度影（图a），左侧颞叶内侧片状低密度影（图b，c），右侧外侧裂可见条索状高密度影（图c），右侧枕叶片状低密度影（图d）

图4 患者在转心血管外科治疗后第2天复查头颅CT及头颈部CT血管造影检查结果。图a~d：头颅CT示双侧顶叶见大小不等结节状高密度影（图a），右侧颞顶叶团片影（图b~d）；左侧额叶及侧脑室前角旁梗死灶（图b，c）。图e~h为头颈部CT血管造影，蓝色箭头示右侧大脑中动脉M2段远端动脉瘤，大小约8.7 mm×9.9 mm（图e，h）；红色箭头示左侧大脑前动脉远端分支小动脉瘤，大小约3.0 mm×3.3 mm（图f）；白色箭头示左侧大脑中动脉M1段远端闭塞，中动脉中远段分支稀疏（图g）

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