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目的报道1例自发性大脑中动脉夹层病例。方法回顾性分析1例自发性大脑中动脉夹层患者的临床资料、实验室检查、影像学检查结果及治疗效果,并复习相关文献进行讨论。结果患者为中年男性,临床表现为反复发作性左侧肢体无力,三酰甘油及糖化血红蛋白升高,TOF-MRA及数字减影血管造影(DSA)显示右侧大脑中动脉M1段局限性狭窄,TOF-MRA可见右侧大脑中动脉M1段局限性狭窄、双腔征及夹层活瓣,高分辨磁共振(HR-MRI)T1可见右侧大脑中动脉M1段后上壁血肿致管腔狭窄,T2可见后壁偏心型高信号。经溶栓及双联抗血小板治疗后症状消失。结论自发大脑中动脉夹层病例报道较少,临床上需引起重视。HR-MRI较DSA能更清楚显示血管壁的情况,在诊断动脉夹层上具有一定优势。
Objective To report a case of spontaneous middle cerebral artery dissection. Methods The clinical data, laboratory findings, imaging findings and therapeutic effects of a patient with idiopathic middle cerebral artery dissection were analyzed retrospectively. The related literatures were reviewed. Results The patients were middle-aged men. The clinical manifestations were recurrent left limb weakness, elevated triglycerides and glycated hemoglobin, TOF-MRA and digital subtraction angiography (DSA) showed limited stenosis of the right middle cerebral artery M1 segment The TOF-MRA showed limited stenosis of M1 segment of the right middle cerebral artery, double lumen sign and dissection flap. High-resolution magnetic resonance (HR-MRI) T1 showed the stenosis of the upper wall hematoma after M1 segment of the right middle cerebral artery , T2 visible posterior wall eccentric high signal. Symptoms disappeared after thrombolysis and double antiplatelet therapy. Conclusion There are few reports of cases of spontaneous middle cerebral artery dissection, so it needs clinical attention. Compared with DSA, HR-MRI can clearly show the situation of the vessel wall, which has some advantages in diagnosing the arterial dissection.