Chalela J A, Kasner S E, McGarvey M, Alsop D C, Detre J A
Department of Neurology, Hospital of the University of Pennsylvania, USA.
J Neuroimaging. 2001 Oct;11(4):444-6. doi: 10.1111/j.1552-6569.2001.tb00078.x.
Postpartum vasculopathy (PPV) is a rare heterogeneous nonatherosclerotic vasculopathy that occurs in the puerperium. It occurs spontaneously but may be triggered by vasoconstrictor substances. The angiographic findings vary and include narrowing of the intracranial arteries and vasospasm. The angiographic findings and the occurrence of ischemic infarcts suggest that cerebral blood flow (CBF) is impaired in PPV. The purpose of this study is to determine CBF in patients with PPV. The authors conducted a case study of 3 patients with clinical and laboratory criteria for PPV examined during a 2-year period. Clinical examination, computed tomography imaging, structural magnetic resonance imaging (MRI), cerebral angiography, and continuous arterial spin labeling perfusion (CASL-PI) MRI were performed in all patients. Mean global CBF was determined, and perfusion maps were visually inspected. The CBF values and perfusion maps were correlated with the clinical symptoms and the neuroimaging findings. Three women were studied (22, 34, and 36 years old). The median time of presentation was 4 days postpartum. One presented with intracranial hemorrhage and diffuse arterial narrowing, the other 2 with stroke-like lesions, encephalopathy, and segmental narrowing mainly in the posterior circulation. CASL-PI was performed within 1 week of symptom onset in all 3 patients. Global mean CBF values were 51.8, 39.3, and 41.8 cc/100 g/min. Although global CBF was mildly diminished, it was above ischemic levels. Visual inspection of the CASL-PI perfusion maps did not reveal areas of focal hypoperfusion or hyperperfusion. In this series of patients with PPV, CBF was close to normal. Although angiography often reveals diffuse arterial narrowing, the CBF values encountered in this study do not support a state of generalized or focal oligoemia. Vasomotor tone may change intermittently in patients with PPV.
产后血管病变（PPV）是一种罕见的异质性非动脉粥样硬化性血管病变，发生在产褥期。它可自发出现，但可能由血管收缩物质触发。血管造影结果各异，包括颅内动脉狭窄和血管痉挛。血管造影结果及缺血性梗死的发生提示PPV患者的脑血流量（CBF）受损。本研究的目的是测定PPV患者的CBF。作者对在2年期间检查的3例符合PPV临床和实验室标准的患者进行了病例研究。所有患者均进行了临床检查、计算机断层扫描成像、结构磁共振成像（MRI）、脑血管造影和动脉自旋标记连续灌注（CASL-PI）MRI。测定了平均全脑CBF，并对灌注图进行了视觉检查。CBF值和灌注图与临床症状及神经影像学结果相关。研究了3名女性（年龄分别为22岁、34岁和36岁）。中位就诊时间为产后4天。1例表现为颅内出血和弥漫性动脉狭窄，另外2例表现为类卒中病变、脑病，主要在后循环出现节段性狭窄。所有3例患者均在症状发作后1周内进行了CASL-PI检查。全脑平均CBF值分别为51.8、39.3和41.8 cc/100 g/min。虽然全脑CBF略有降低，但高于缺血水平。对CASL-PI灌注图的视觉检查未发现局部灌注减低或灌注增加区域。在这组PPV患者中，CBF接近正常。尽管血管造影常显示弥漫性动脉狭窄，但本研究中测得的CBF值不支持全身性或局灶性低灌注状态。PPV患者的血管运动张力可能会间歇性变化。
