Hatakeyama Junya, Yanagisawa Toshiharu, Kudo Erina, Togashi Shuntaro, Shimizu Hiroaki
Department of Neurosurgery, Akita University Graduate School of Medicine.
No Shinkei Geka. 2016 Oct;44(10):843-849. doi: 10.11477/mf.1436203388.
Progressive cerebral infarction in patients with hemorrhagic onset of moyamoya disease is rare, and a treatment strategy is not well established. Here, we report a case that was successfully treated with emergency bypass surgery. A 58-year-old woman presented with a sudden disturbance of consciousness and right-sided hemiparesis. Computed tomography(CT)showed intraventricular hemorrhage involving the head of the left caudate nucleus. Ventricular drainage was immediately performed, and the patient was treated conservatively. Magnetic resonance(MR)angiography revealed bilateral stenosis of the supraclinoid internal carotid artery(ICA), and arterial spin labeling(ASL)showed low signal intensity in the left cerebral hemisphere. The patient was diagnosed with hemorrhagic onset of moyamoya disease with cerebral infarction. Her neurological symptoms worsened on the 7th day after ictus despite medical treatment. MR imaging showed a new infarction in the left insular cortex. Based on the diagnosis of progressive stroke, emergency anastomoses between the superficial temporal artery and the middle and anterior cerebral arteries, along with encephalo-duro-myo-synangiosis, were performed. Her symptoms gradually improved following surgery, and 1 month later, she was able to regain independent function. Emergency bypass surgery may be the treatment of choice for patients with hemorrhagic onset of moyamoya disease presenting with progressive cerebral infarction, despite conservative treatments.
烟雾病出血起病患者发生进展性脑梗死较为罕见，且治疗策略尚未完全确立。在此，我们报告一例通过急诊搭桥手术成功治疗的病例。一名58岁女性突发意识障碍和右侧偏瘫。计算机断层扫描（CT）显示左侧尾状核头部脑室出血。立即进行了脑室引流，并对患者进行了保守治疗。磁共振（MR）血管造影显示鞍上颈内动脉（ICA）双侧狭窄，动脉自旋标记（ASL）显示左侧大脑半球信号强度降低。该患者被诊断为烟雾病出血起病合并脑梗死。尽管接受了药物治疗，但发病后第7天她的神经症状仍恶化。MR成像显示左侧岛叶皮质出现新的梗死灶。基于进展性卒中的诊断，进行了颞浅动脉与大脑中动脉和大脑前动脉之间的急诊吻合术，以及脑-硬脑膜-肌肉-联合血管吻合术。术后她的症状逐渐改善，1个月后能够恢复独立功能。对于烟雾病出血起病且出现进展性脑梗死的患者，尽管进行了保守治疗，急诊搭桥手术可能是首选治疗方法。
