Aoki N, Kagawa M, Wanifuchi H, Takeshita M, Izawa M, Kitamura K
Department of Neurosurgery, Tokyo Women's Medical College, Japan.
No Shinkei Geka. 1989 Apr;17(4):399-403.
We reported an adult case with moyamoya disease in which unilateral obstructive process proceeded to the bilateral lesion during a period of 45 months. A 30-year-old female was admitted to our institute due to frequent ischemic episodes since she was 25 years old. At the time of admission, she was asymptomatic with slightly disturbed psychogenic reactions. At the time of the initial cerebral angiography when she was 25 years old, the right cerebral angiography demonstrated stenosis of the right ICA terminal portion with moyamoya vessels in the basal area and leptomeningeal anastomosis at the right parietal area. The left cerebral angiography revealed normal ICA system with a lightly narrowing Al portion, without Moyamoya vessels. The second cerebral angiography, taken 45 months after the initial angiography, demonstrated progression stenosis of the right ICA terminal portion, with decreasing moyamoya vessels at the basal area, obstruction of the left ICA terminal portion, stenosis at the Al portion with newly developed moyamoya vessels in the left basal area. We concluded at this time that this case was a definite case of moyamoya disease. The third cerebral angiography after right SDP (synangio-dural plasty), 49 months after the initial angiography, revealed, in the right angiography, newly formed anastomotic vessels perfusing the middle cerebral artery region via the extracerebral arteries and in the left cerebral angiography, and an increased obstruction of the ICA terminal portion, transdural anastomosis via the extracerebral arterial system, and a decrease of moyamoya vessels in the basal area. This rare case provided us a good picture of the pathogenic mechanism of moyamoya disease.
我们报告了一例成年烟雾病病例，该病例在45个月内，单侧阻塞性病变进展为双侧病变。一名30岁女性自25岁起因频繁出现缺血性发作而入住我院。入院时，她无症状，仅有轻微的精神性反应障碍。25岁初次进行脑血管造影时，右侧脑血管造影显示右侧颈内动脉终末段狭窄，基底区域有烟雾状血管，右侧顶叶区域有软脑膜吻合支。左侧脑血管造影显示颈内动脉系统正常，A1段轻度狭窄，无烟雾状血管。初次造影45个月后进行的第二次脑血管造影显示，右侧颈内动脉终末段狭窄进展，基底区域烟雾状血管减少，左侧颈内动脉终末段阻塞，A1段狭窄，左侧基底区域有新出现的烟雾状血管。此时我们判定该病例为明确的烟雾病病例。初次造影49个月后，在右侧进行颞浅动脉-硬脑膜贴敷术（SDP）后进行的第三次脑血管造影显示，右侧造影可见通过脑外动脉灌注大脑中动脉区域的新形成的吻合血管，左侧造影可见颈内动脉终末段阻塞加重，通过脑外动脉系统的经硬脑膜吻合，基底区域烟雾状血管减少。这个罕见病例为我们呈现了烟雾病发病机制的清晰图景。
