Lin Ching-Hwung, Lo Yuk-Keung, Lin Yuh-Te, Li Jie-Yuan, Lai Ping-Hong, Gau Yung-Yen
Section of Neurology, Department of Medicine Kaohsiung Veterans General Hospital, Taiwan.
Acta Neurol Taiwan. 2006 Sep;15(3):192-6.
We report on the case of a 60-year-old man who suffered from hiccup, dysphagia and unsteady gait for three months. He was diagnosed with intracranial dural arteriovenous fistula in medulla with retrograde perimedullary vein drainage. He developed quadriplegia, persistent shock status and symptomatic bradycardia immediately after a conventional cerebral angiography study. After excluding cardiogenic, hypovolemic, anaphylactic and septic shock, central vasomotor failure caused by venous thrombosis of the lesion was considered. The patient's central vasomotor failure recovered after continuous dopamine infusion treatment for 42 days. We concluded that venous hypertension with venous thrombosis in rostral ventrolateral medulla (RVLM), a major vasomotor center in the brainstem, was the lesion site. In our case, vasomotor dysfunction caused by an RVLM lesion related to venous thrombosis is considered as causative.
我们报告了一例60岁男性患者，其出现呃逆、吞咽困难和步态不稳3个月。他被诊断为延髓颅内硬脑膜动静脉瘘伴髓周静脉逆行引流。在一次常规脑血管造影研究后，他立即出现四肢瘫痪、持续性休克状态和症状性心动过缓。在排除心源性、低血容量性、过敏性和感染性休克后，考虑为病变静脉血栓形成导致的中枢血管舒缩功能衰竭。经持续42天多巴胺输注治疗后，患者的中枢血管舒缩功能衰竭得以恢复。我们得出结论，延髓头端腹外侧区（RVLM）作为脑干主要的血管舒缩中枢，静脉血栓形成导致的静脉高压是病变部位。在我们的病例中，由与静脉血栓形成相关的RVLM病变引起的血管舒缩功能障碍被认为是病因。
