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动脉瘤破裂蛛网膜下腔出血沉积在基底池时能观察到血管痉挛,而由动静脉畸形(AVM)破裂致血管痉挛的报道少见。该文报告1例 AVM 破裂致脑室出血后血管痉挛,但无基底池内积血。患儿,女,11岁。因突然剧烈头痛、呕吐入院。查体:神志清楚,颈部轻微抵抗,无瘫痪及言语障碍。CT 示全部脑室出血,脑实质内无低密度区,基底池内无积血。先后行 CT 扫描及脑血管造影均显示左顶枕叶 AVM,无血管痉挛。经用甘油和糖皮质激素脱水治疗,病人仍出现右侧偏瘫、言语困难和右侧偏盲。3天后出现意识障碍,CT 示 AVM 周围有低密度区,无新鲜脑出血,未发现基底池内积血。MRI示中线部位脑梗塞,脑血管造影显示严重的脑血管痉挛。继续脱水治疗,18天后 CT 证实左额叶有新低密度区和右内囊有一不规则低密度区。重复脑血管造影显示持续的血管痉挛。1月后脑血管造影、脑血管痉挛消失。脑血管痉挛可能是因动脉瘤破裂,血液沉积在
Aneurysmal rupture of subarachnoid hemorrhage deposition in the basal cistern can be observed when the vasospasm, and arteriovenous malformations (AVM) ruptured vasospasm caused by rare. This article reports 1 case of AVM rupture after ventricular hemorrhage vasospasm, but no basal pool hemorrhage. Children, female, 11 years old. Due to sudden severe headache, vomiting admitted. Examination: Consciousness, slight neck resistance, no paralysis and speech impairment. CT showed all ventricular hemorrhage, no low-density brain parenchyma area, basal pool without hemorrhage. CT scan and cerebral angiography have shown the top left occipital AVM, no vasospasm. After treatment with glycerol and glucocorticoid dehydration, the patient still developed right hemiplegia, dyslexia and right hemianopia. 3 days after the onset of disturbance of consciousness, CT showed low density area around the AVM, no fresh cerebral hemorrhage, found no basal pool of blood. MRI showed midline cerebral infarction, cerebral angiography showed severe cerebral vasospasm. Continued dehydration treatment, CT confirmed after 18 days the left frontal lobe has a new low-density area and the right internal capsule has an irregular low-density area. Repeated cerebral angiography showed persistent vasospasm. After January cerebrovascular angiography, cerebral vasospasm disappeared. Cerebral vasospasm may be due to aneurysm rupture, blood deposition in