中华脑血管病杂志(电子版)
中華腦血管病雜誌(電子版)
중화뇌혈관병잡지(전자판)
CHINESE JOURNAL OF CEREBROVASCULAR DISEASES(ELECTRONIC VERSION)
2012年
2期
19-25
,共7页
刘子凡%许治强%陈敦金%匡永锋%关海涛%林永强
劉子凡%許治彊%陳敦金%劻永鋒%關海濤%林永彊
류자범%허치강%진돈금%광영봉%관해도%림영강
产后脑血管病%脑血管痉挛%磁共振成像
產後腦血管病%腦血管痙攣%磁共振成像
산후뇌혈관병%뇌혈관경련%자공진성상
Postpartum cerebral angiopathy%Vasoconstriction%Magnetic resonance image
目的 探讨产后脑血管病的病因、临床特征、诊断及治疗.方法 对一例产后脑血管病患者的临床症状、体征、辅助检查、治疗和预后进行报道,结合38例文献报道的病例进行复习.结果 均急性发病,雷击样头痛是共同的临床症状,可伴有短阵性血压升高.MRI检查大多数患者表现双侧大脑半球皮质、皮质下白质多发斑片状T2WI、Flair高信号,DWI高信号、ADC图呈高信号或低信号.脑血管造影或TCD检查存在颅内大动脉及其分支多发节段性、可逆性痉挛.病理检查无血管炎性改变.绝大部分患者预后良好,复查MRI异常信号影消失.结论 (1)产后脑血管病病因未明,可能与免疫机制异常有关,雷击样头痛是主要的临床表现.(2)MRI检查多表现为可逆性后部白质脑病综合症改变,可伴有皮质、皮质下或分水岭区腔隙性脑梗塞、少量脑出血和蛛网膜下腔出血.(3)颅内大动脉及其分支可逆性痉挛是产后脑血管病的病理生理改变.(4)解除脑血管痉挛是治疗成功的关键.
目的 探討產後腦血管病的病因、臨床特徵、診斷及治療.方法 對一例產後腦血管病患者的臨床癥狀、體徵、輔助檢查、治療和預後進行報道,結閤38例文獻報道的病例進行複習.結果 均急性髮病,雷擊樣頭痛是共同的臨床癥狀,可伴有短陣性血壓升高.MRI檢查大多數患者錶現雙側大腦半毬皮質、皮質下白質多髮斑片狀T2WI、Flair高信號,DWI高信號、ADC圖呈高信號或低信號.腦血管造影或TCD檢查存在顱內大動脈及其分支多髮節段性、可逆性痙攣.病理檢查無血管炎性改變.絕大部分患者預後良好,複查MRI異常信號影消失.結論 (1)產後腦血管病病因未明,可能與免疫機製異常有關,雷擊樣頭痛是主要的臨床錶現.(2)MRI檢查多錶現為可逆性後部白質腦病綜閤癥改變,可伴有皮質、皮質下或分水嶺區腔隙性腦梗塞、少量腦齣血和蛛網膜下腔齣血.(3)顱內大動脈及其分支可逆性痙攣是產後腦血管病的病理生理改變.(4)解除腦血管痙攣是治療成功的關鍵.
목적 탐토산후뇌혈관병적병인、림상특정、진단급치료.방법 대일례산후뇌혈관병환자적림상증상、체정、보조검사、치료화예후진행보도,결합38예문헌보도적병례진행복습.결과 균급성발병,뢰격양두통시공동적림상증상,가반유단진성혈압승고.MRI검사대다수환자표현쌍측대뇌반구피질、피질하백질다발반편상T2WI、Flair고신호,DWI고신호、ADC도정고신호혹저신호.뇌혈관조영혹TCD검사존재로내대동맥급기분지다발절단성、가역성경련.병리검사무혈관염성개변.절대부분환자예후량호,복사MRI이상신호영소실.결론 (1)산후뇌혈관병병인미명,가능여면역궤제이상유관,뢰격양두통시주요적림상표현.(2)MRI검사다표현위가역성후부백질뇌병종합증개변,가반유피질、피질하혹분수령구강극성뇌경새、소량뇌출혈화주망막하강출혈.(3)로내대동맥급기분지가역성경련시산후뇌혈관병적병리생리개변.(4)해제뇌혈관경련시치료성공적관건.
Objective To study the etiology,clinical manifestations,diagnosis and treatment of postpartum cerebral angiopathy (PCA).Methods We present one case of PCA,including the symptoms,signs,diagnostic examination,treatment and prognosis.We also include a review of 38 PCA cases reported in the literature.Results All patients experienced sudden onset of symptoms.Thunderclap headache was a common complaint,which could be accompanied by transient hypertension.Most patients' MRI exams showed multiple patchy high-signal-intensity lesions in bilateral cerebral cortex and subcortex white matter on T2WI and FLMR,high signal intensity on DWI and low or high signal intensity on ADC.Cerebral angiography or TCD exams showed multi-segmental functional vasoconstriction of intracranial large arteries and their branches.No vascular inflammatory changes were found in histopathologic analysis.Most patients followed a relatively benign course. Follow-up MRI exams showed the abnormal signals disappeared.Conclusions ( 1) The etiology of PCA was unknown. Thunderclap headache is the main clinical manifestation. (2) In the majority of PCA cases, MRI exams showed reversible posterior leukoencephalopathy syndrome,which could be accompanied by subarachnoid hemorrhage,lacunar cerebral infarction and/or minor cerebral hemorrhage in cortex,subcortex or watershed area. (3) Functional vasoconstriction of intracranial large arteries and their branches is the primary pathophysiologic process in PCA.(4) Treatment for vasoconstriction is essential to improve outcome.