Shen W C, Lee W Y
Department of Radiology, China Medical College Hospital, Taichung, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Oct;61(10):619-23.
A 59-year-old woman suffered from sudden onset of severe headache and vomiting for five days, with normal consciousness. A computerized tomography (CT) scan showed acute subdural hematomas in the right frontal and left frontotemporoparietal regions. As there was no history of head injury, the patient underwent bilateral carotid angiography. The left carotid angiogram showed total occlusion of the left middle cerebral and anterior cerebral arteries with a moyamoya pattern of collateral circulation. Five days later, the patient suddenly lost consciousness associated with right hemiparesis. An emergency CT scan disclosed diffuse acute brain tissue edema in the left cerebral hemisphere with uncal/transtentorial herniation, caused by acute infarction in the territory of the left middle cerebral artery. The patient died 10 hours later. The acute infarction was considered to have been caused by subdural hematomas compressing the transdural anastomoses, thus eliminating all blood supply to the region of the left middle cerebral artery.
一名59岁女性，突发严重头痛和呕吐5天，意识正常。计算机断层扫描（CT）显示右额叶和左额颞顶叶区域急性硬膜下血肿。由于无头部受伤史，患者接受了双侧颈动脉血管造影。左侧颈动脉血管造影显示左侧大脑中动脉和大脑前动脉完全闭塞，伴有烟雾状侧支循环模式。五天后，患者突然失去意识并伴有右侧偏瘫。急诊CT扫描显示左大脑半球弥漫性急性脑组织水肿，伴有钩回/小脑幕切迹疝，由左侧大脑中动脉供血区域的急性梗死引起。患者10小时后死亡。急性梗死被认为是由硬膜下血肿压迫硬膜外吻合支导致，从而消除了左侧大脑中动脉区域的所有血液供应。
