Torihashi Koichi, Chin Masaki, Sadamasa Nobutake, Yoshida Kazumichi, Narumi Osamu, Yamagata Sen
Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
Neurol Med Chir (Tokyo). 2011;51(7):503-6. doi: 10.2176/nmc.51.503.
A 62-year-old man presented with dissection of the right middle cerebral artery (MCA) manifesting as mild headache, right hemiparesis, and slurred speech. Magnetic resonance (MR) imaging and MR angiography revealed fresh infarction in the right basal ganglia, and severe stenosis and dilatation of the right MCA. Digital subtraction angiography approximately 24 hours after admission revealed a linear contrast defect indicating an intimal flap of the M(1) segment. The diagnosis was dissection of the MCA. His neurological deficits improved gradually. Although he was neurologically stable, diffusion-weighted MR imaging revealed enlarging infarct size over the right MCA territory, and the right M(1) segment had progressive stenosis. Superficial temporal artery (STA)-MCA anastomosis was performed on the 26th day. Follow-up angiography showed good patency of the STA-MCA anastomosis, repair of the dissection of the M(1) segment, and improvement of the flow in the MCA. The patient was discharged from our hospital with no neurological deficits. Although the dissection in this case was spontaneously repaired, STA-MCA anastomosis was useful to get through a critical time. If the stenosis shows further progression or the infarction size enlarges, STA-MCA anastomosis may be effective.
一名62岁男性因右侧大脑中动脉（MCA）夹层分离入院，表现为轻度头痛、右侧偏瘫及言语不清。磁共振成像（MR）及磁共振血管造影显示右侧基底节区新发梗死，右侧大脑中动脉严重狭窄及扩张。入院约24小时后数字减影血管造影显示线性造影剂充盈缺损，提示M（1）段内膜瓣。诊断为大脑中动脉夹层分离。其神经功能缺损逐渐改善。尽管其神经功能稳定，但扩散加权磁共振成像显示右侧大脑中动脉供血区梗死面积增大，且右侧M（1）段狭窄进行性加重。于第26天行颞浅动脉（STA）-大脑中动脉吻合术。随访血管造影显示STA-大脑中动脉吻合口通畅，M（1）段夹层分离修复，大脑中动脉血流改善。患者出院时无神经功能缺损。尽管该病例中的夹层分离自行修复，但STA-大脑中动脉吻合术有助于度过关键时期。如果狭窄进一步进展或梗死面积增大，STA-大脑中动脉吻合术可能有效。
