1例因大脑前动脉夹层分离继发颈内动脉夹层分离导致蛛网膜下腔出血的节段性动脉中层溶解病例。
A case of segmental arterial mediolysis with subarachnoid hemorrhage due to anterior cerebral artery dissection followed by internal carotid artery dissection.
作者信息
Yasuda Shoji, Uematsu Kodai, Yamashita Kentaro, Kuroda Tatsuya, Murase Satoru, Kumagai Morio
机构信息
Department of Neurosurgery, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan.
Department of Neurosurgery, Gifu Prefectural General Medical Center, 4-6-1 Noishiki, Gifu, Gifu 500-8717, Japan.
出版信息
Surg Neurol Int. 2021 May 25;12:240. doi: 10.25259/SNI_138_2021. eCollection 2021.
BACKGROUND
Segmental arterial mediolysis (SAM) causes subarachnoid hemorrhage (SAH) due to intracranial aneurysm rupture and arterial dissection. We encountered a case of SAM-related SAH due to ruptured dissection of the A1 segment of the anterior cerebral artery concomitant with internal carotid artery (ICA) dissection.
CASE DESCRIPTION
A 53-year-old man presented with SAH due to a ruptured right A1 dissecting aneurysm. The aneurysm was trapped; however, 7 days after the onset of SAH, he experienced right hemiparesis and aphasia. Angiography showed left ICA dissection; urgent carotid artery stenting was performed, leading to symptom improvement. Abdominal computed tomography angiography showed aneurysms of the celiac and superior mesenteric arteries. He was diagnosed with SAM based on clinical, imaging, and laboratory findings.
CONCLUSION
In the acute phase of SAM-related SAH, cerebral ischemia could occur due to both cerebral vasospasm and intracranial or cervical artery dissection.
背景
节段性动脉中层溶解（SAM）可因颅内动脉瘤破裂和动脉夹层导致蛛网膜下腔出血（SAH）。我们遇到一例因大脑前动脉A1段夹层破裂伴颈内动脉（ICA）夹层而导致的与SAM相关的SAH病例。
病例描述
一名53岁男性因右侧A1段夹层动脉瘤破裂导致SAH就诊。该动脉瘤被栓塞；然而，在SAH发病7天后，他出现了右侧偏瘫和失语。血管造影显示左侧ICA夹层；紧急进行了颈动脉支架置入术，症状得以改善。腹部计算机断层扫描血管造影显示腹腔干和肠系膜上动脉有动脉瘤。根据临床、影像学和实验室检查结果，他被诊断为SAM。
结论
在与SAM相关的SAH急性期，脑血管痉挛以及颅内或颈动脉夹层均可导致脑缺血。
Zotero 插件