Kwon Hyon-Jo, Lim JeongWook, Park Bumsoo, Koh Hyeon-Song, Choi Seung-Won, Kim Seon-Hwan
Department of Neurosurgery, School of Medicine, Chungnam National University Hospital, Daejeon, Korea.
Department of Neurosurgery, School of Medicine, Chungnam National University Hospital, Daejeon, Korea.
World Neurosurg. 2018 Oct;118:265-268. doi: 10.1016/j.wneu.2018.07.116. Epub 2018 Jul 23.
Known facts are that a long period of central catheterization or hemodialysis causes central venous occlusion or stenosis and its further development brings about superior vena cava syndrome. Major symptoms of superior vena cava syndrome include venous congestion caused by the occlusion or stenosis of the central vein in the sites of the head, face, neck, and upper extremity. Clinical manifestations of superior vena cava syndrome are less likely to cause intracranial hypertension, and intracranial venous hypertension does not appear to be a clinical symptom of cavernous sinus-dural arteriovenous fistula.
A 35-year-old female patient visited our hospital with chief complaints of a 2-week-old headache, chemosis, pulsatile and exophthalmos and the deteriorating ptosis in the right eye. The patient has been on continuous hemodialysis since diagnosis of renal failure due to diabetes for 20 years. Magnetic resonance images led us to a strong suspicion of cavernous sinus-dural arteriovenous fistula. However, an additionally performed digital subtraction angiogram led us to the diagnosis of superior vena cava syndrome of severe stenosis in both brachiocephalic veins. Balloon angioplasty was performed to the narrowed right-side brachiocephalic vein. No more intracranial venous reflux was to be seen in the postballoon angiogram.
In our case, the clinical manifestations of superior vena cava syndrome seemed to be cavernous sinus-dural arteriovenous fistula and symptoms disappeared when resolving central vein stenosis. We report a case of superior vena cava syndrome with atypical clinical features.
已知长期进行中心静脉置管或血液透析会导致中心静脉闭塞或狭窄，其进一步发展会引发上腔静脉综合征。上腔静脉综合征的主要症状包括头、面、颈及上肢部位中心静脉闭塞或狭窄所导致的静脉充血。上腔静脉综合征的临床表现不太可能引起颅内高压，而颅内静脉高压似乎并非海绵窦 - 硬脑膜动静脉瘘的临床症状。
一名35岁女性患者因头痛2周、结膜水肿、搏动性眼球突出及右眼上睑下垂加重为主诉前来我院就诊。该患者自因糖尿病导致肾衰竭确诊20年来一直在持续进行血液透析。磁共振成像使我们强烈怀疑为海绵窦 - 硬脑膜动静脉瘘。然而，额外进行的数字减影血管造影确诊为双侧头臂静脉严重狭窄的上腔静脉综合征。对右侧狭窄的头臂静脉进行了球囊血管成形术。球囊血管造影术后未见颅内静脉反流。
在我们的病例中，上腔静脉综合征的临床表现看似为海绵窦 - 硬脑膜动静脉瘘，但在中心静脉狭窄解除后症状消失。我们报告了一例具有非典型临床特征的上腔静脉综合征病例。
