CAJ | 학술논문

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.
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.