Ito Ai, Ii Yuichiro, Higashigawa Takatoshi, Murashima Shuichi, Tomimoto Hidekazu
Department of Neurology, Mie University Graduate School of Medicine.
Brain Nerve. 2013 Dec;65(12):1509-13.
We report a case of spectacular shrinking deficit caused by paradoxical cerebral embolism through pulmonary arteriovenous fistula (AVF). A 79-year-old female suddenly developed right hemiplegia, paresthesia, and speech disturbance symptoms that were improved within 20 min, indicating a diagnosis of spectacular shrinking deficit. Brain magnetic resonance imaging revealed acute cerebral infarcts in the left parietal cortex of the left middle cerebral arterial territory. A contrast-enhanced chest computed tomography scan revealed a pulmonary AVF in the middle lobe of the right lung. The patient had deep venous thrombosis in her left lower leg. She had no clinical signs of telangiectasia, did not exhibit recurrent epistaxis, and had no family history of hereditary hemorrhagic telangiectasia (HHT). Therefore, she was diagnosed with paradoxical cerebral embolism secondary to the pulmonary AVF without HHT. Pulmonary AVF should be considered in patients with cerebral embolism, even when presenting with spectacular shrinking deficit.
我们报告一例因通过肺动静脉瘘（AVF）发生反常脑栓塞导致的显著缩小性缺损病例。一名79岁女性突然出现右侧偏瘫、感觉异常和言语障碍症状，这些症状在20分钟内得到改善，提示诊断为显著缩小性缺损。脑部磁共振成像显示左侧大脑中动脉供血区的左侧顶叶皮质有急性脑梗死。胸部增强计算机断层扫描显示右肺中叶有肺动静脉瘘。患者左小腿有深静脉血栓形成。她没有毛细血管扩张的临床体征，未出现反复鼻出血，也没有遗传性出血性毛细血管扩张症（HHT）的家族史。因此，她被诊断为继发于无HHT的肺动静脉瘘的反常脑栓塞。对于脑栓塞患者，即使表现为显著缩小性缺损，也应考虑肺动静脉瘘。
