Shimonaga Koji, Mitsuhara Takafumi, Hosogai Masahiro, Kawasumi Tomohiro
Department of Neurosurgery, Hiroshima City Asa Citizens Hospital.
No Shinkei Geka. 2018 Jun;46(6):501-508. doi: 10.11477/mf.1436203759.
We report a case of cerebral hyperperfusion syndrome accompanied by postoperative intracerebral hemorrhage following blood flow reconstruction for quasi-moyamoya disease associated with Graves' disease that had caused cerebral infarctions. A 44-year-old woman presented with repeated sensory impairment of the fingers on the left hand and weakness of the right lower limb and multiple cerebral infarctions developed in the bilateral frontal lobes. Magnetic resonance angiography and cerebral angiography suggested quasi-moyamoya disease. On hospitalization, untreated Graves' disease was identified and treated first. Revascularization was performed in the region of the right middle cerebral artery, where reduced cerebral blood flow and depressed vascular reactivity persisted half a year after treatment of Graves' disease, but postoperative cerebral hemorrhage appeared after 5 days due to hyperperfusion syndrome around the anastomotic site. Lethal hyperperfusion syndrome following revascularization of quasi-moyamoya disease associated with Graves' disease appears very rare and has not been reported previously.
我们报告了一例与格雷夫斯病相关的类烟雾病患者，因脑梗死进行血流重建术后发生脑过度灌注综合征并伴有术后脑出血的病例。一名44岁女性出现左手手指反复感觉障碍及右下肢无力，双侧额叶发生多处脑梗死。磁共振血管造影和脑血管造影提示类烟雾病。住院时，发现未治疗的格雷夫斯病并首先进行了治疗。在格雷夫斯病治疗半年后，对右侧大脑中动脉区域进行了血运重建，该区域脑血流量减少且血管反应性降低，但术后5天因吻合口周围的过度灌注综合征出现了脑出血。与格雷夫斯病相关的类烟雾病血运重建后发生致命性过度灌注综合征似乎非常罕见，此前未见报道。
