Tamura Takamitsu, Rex David E, Marosfoi Miklos G, Puri Ajit S, Gounis Matthew J, Wakhloo Ajay K
Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA Department of Neurosurgery, University of the Ryukyus, Nishihara, Okinawa, Japan.
Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
BMJ Case Rep. 2016 Jul 5;2016:bcr2016012517. doi: 10.1136/bcr-2016-012517.
We describe an interesting case of trigeminocardiac reflex (TCR) caused by selective angiography of the middle meningeal artery (MMA). A 28-year-old woman presented with a symptomatic meningioma. Preoperative tumour embolisation was performed. In the procedure, when selective MMA angiography was done with Omnipaque 300 mg I/mL for 3 mL by manual injection, the patient complained of flashing lights in her eye followed by vomiting and bradycardia down to 40 bpm without increased intracranial pressure signs. On selective MMA angiography, the choroidal crescent and arteries of the periorbital region were opacified by anastomosis from the MMA via the meningo-ophthalmic artery. We diagnosed that her symptoms were caused by selective MMA angiography leading to high pressure stimulation towards the ophthalmic nerve innervation around the orbit as a TCR. We suggest that the operator should be prepared to manage TCR during treatment with expected selective MMA angiography, and gentle low pressure contrast injection should be attempted.
我们描述了一例由脑膜中动脉（MMA）选择性血管造影引起的三叉神经心脏反射（TCR）的有趣病例。一名28岁女性患有有症状的脑膜瘤，术前行肿瘤栓塞术。在该手术中，当用欧乃派克300mgI/mL以手动注射3mL进行MMA选择性血管造影时，患者主诉眼前有闪光，随后出现呕吐，心率减慢至40次/分，且无颅内压升高迹象。在MMA选择性血管造影时，脉络膜新月区和眶周区域的动脉通过MMA经脑膜眼动脉的吻合而显影。我们诊断她的症状是由MMA选择性血管造影导致对眼眶周围眼神经支配的高压刺激引起的TCR。我们建议操作人员在预期进行MMA选择性血管造影的治疗过程中应做好处理TCR的准备，并尝试轻柔的低压造影剂注射。
