Tanaka Koji, Matsumoto Shoji, Yamada Takeshi, Kondo Daisuke, Chihara Hideo, Koga Motohisa, Hatano Taketo, Miyagi Tomoya, Yamasaki Ryo, Kira Jun-Ichi
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Department of Neurology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan.
Radiol Case Rep. 2018 Jul 13;13(4):917-920. doi: 10.1016/j.radcr.2018.06.007. eCollection 2018 Aug.
An elevated end-diastolic (ED) ratio of the common carotid artery (CCA) is an indicator of occlusive lesions of the distal portion of the internal carotid artery. We report 2 cases of cerebral arteriovenous malformation (AVM) showing an elevated ED ratio of the CCA, which decreased after surgery. Case 1 was a 28-year-old man with chronic recurrent headache with aura, and case 2 was a 29-year-old woman with sudden-onset headache and intracerebral hemorrhage without neurologic abnormality. In both cases, digital subtraction angiography revealed a Spetzler-Martin Grade IV AVM, which was mainly fed by branches of the left middle cerebral artery with venous drainage into superficial and deep cerebral veins. Preoperative carotid ultrasonography showed an elevated CCA ED ratio (1.38 in case 1 and 1.47 in case 2; left > right) without atherosclerotic lesions. Patients' AVMs were successfully resected. In both cases, the ED ratio was decreased after surgery (to 1.05 in case 1 and 1.20 in case 2). A decrease in vascular resistance on 1 side caused by cerebral AVM can result in an increase in the CCA ED ratio comparable to that of carotid axis occlusion.
颈总动脉（CCA）舒张末期（ED）比值升高是颈内动脉远端闭塞性病变的一个指标。我们报告2例脑动静脉畸形（AVM）患者，其CCA的ED比值升高，术后该比值下降。病例1是一名28岁患有慢性复发性先兆头痛的男性，病例2是一名29岁突发头痛且有脑出血但无神经功能异常的女性。在这两个病例中，数字减影血管造影显示为Spetzler-Martin Ⅳ级AVM，主要由左大脑中动脉分支供血，静脉引流至大脑浅静脉和深静脉。术前颈动脉超声显示CCA的ED比值升高（病例1为1.38，病例2为1.47；左侧＞右侧），且无动脉粥样硬化病变。患者的AVM均成功切除。在这两个病例中，术后ED比值均下降（病例1降至1.05，病例2降至1.20）。脑AVM导致一侧血管阻力降低可使CCA的ED比值升高，其程度与颈动脉轴闭塞时相当。
