Lee Yong-Seok, Yoon Byung-Woo, Roh Jae-Kyu
Seoul Municipal Boramae Hospital.
J Neuroimaging. 2003 Apr;13(2):169-71.
A nonpulsatile cerebral perfusion may be encountered in an artificial cardiopulmonary bypass used in cardiac surgery, which is exceptional in physiological conditions. The authors report on a 37-year-old woman with Takayasu's arteritis (TA) who had been suffering from progressive visual loss and recurrent seizures. Ocular findings of chronic ischemia and multiple, subcortical, high-signal lesions in magnetic resonance (MR) imaging were indicative of significant hemodynamic impairment. MR angiography showed the complete occlusion of the innominate artery, the left common carotid artery (CCA), and the subclavian artery from the orifice of the aortic arch. The patient's transcranial Doppler (TCD) waveform was flat throughout all segments of the intracranial arteries. Intravenous acetazolamide injection confirmed the severe impairment of vasoreactivity. After a bypass graft from the aorta to the left CCA, flow velocity and pulsatility were dramatically increased without postoperative complications. A nonpulsatile cerebral perfusion indicates severe hemodynamic impairment and is partially reversible by a surgical bypass graft. TCD seems to be useful to detect "high-risk" patients and to follow up in TA.
在心脏手术中使用的人工心肺转流过程中可能会出现非搏动性脑灌注，这在生理状况下是罕见的。作者报告了一名37岁患有高安动脉炎（TA）的女性，她一直遭受进行性视力丧失和反复发作的癫痫。慢性缺血的眼部表现以及磁共振成像（MR）中多个皮质下高信号病变提示存在明显的血流动力学损害。MR血管造影显示无名动脉、左颈总动脉（CCA）以及主动脉弓开口处的锁骨下动脉完全闭塞。患者颅内动脉各节段的经颅多普勒（TCD）波形均呈平坦状。静脉注射乙酰唑胺证实血管反应性严重受损。在进行从主动脉到左CCA的旁路移植术后，血流速度和搏动性显著增加，且无术后并发症。非搏动性脑灌注提示严重的血流动力学损害，通过手术旁路移植可部分逆转。TCD似乎有助于检测TA中的“高危”患者并进行随访。
