Moriyoshi Hideyuki, Furukawa Soma, Iwata Mai, Suzuki Junichiro, Nakai Noriyoshi, Nishida Suguru, Ito Yasuhiro
Department of Neurology, Stroke Center, TOYOTA Memorial Hospital.
Rinsho Shinkeigaku. 2017 Mar 28;57(3):124-129. doi: 10.5692/clinicalneurol.cn-000989. Epub 2017 Feb 22.
A 78-year-old man was admitted to our hospital because of sudden right hemiparesis and dysarthria. His cranial MRI showed an area of hyperintensity in left pons on DWI and MRA revealed dilated, elongated and tortuous intracranial artery. We diagnosed as acute phase ischemic stroke and intracranial arterial dolichoectasia (IADE). Intravenous infusion of rt-PA was performed 157 minutes after the onset of symptoms, and his hemiparesis improved. However, he subsequently suffered from cerebral infarction 4 times in 6 months, and we treated him twice with thrombolytic therapy. Although thrombolytic therapy was effective in the short term and antithrombotic therapy was continued, he had bilateral hemiplegia and severe dysphagia because of repeated cerebral infarctions. Hence basilar artery was dilated with intramural hemorrhage over 6 months, and we discontinued antithrombolytic therapy. It is possible that antithrombolytic therapy affects enlargement of IADE. Antithrombolytic therapy for IADE should be done carefully.
一名78岁男性因突发右侧偏瘫和构音障碍入院。其头颅磁共振成像（MRI）在弥散加权成像（DWI）上显示左侧脑桥有高信号区，磁共振血管造影（MRA）显示颅内动脉扩张、延长和迂曲。我们诊断为急性期缺血性脑卒中及颅内动脉冗长扩张症（IADE）。症状发作157分钟后进行了静脉注射重组组织型纤溶酶原激活剂（rt-PA），其偏瘫症状有所改善。然而，他随后在6个月内发生了4次脑梗死，我们对他进行了两次溶栓治疗。尽管溶栓治疗在短期内有效且继续进行了抗栓治疗，但由于反复脑梗死，他出现了双侧偏瘫和严重吞咽困难。因此，在6个月内基底动脉出现扩张并伴有壁内出血，我们停止了抗栓治疗。抗栓治疗可能会影响IADE的扩大。对IADE进行抗栓治疗时应谨慎。
