Izumi M, Terao S, Nakamori T, Inoue H, Mitsuma T, Yamada H, Nakayama M
Fourth Department of Internal Medicine, Aichi Medical University, Japan.
No To Shinkei. 1998 Dec;50(12):1119-24.
We report a 19-year-old man who developed a cerebral infarction in the territory of the anterior choroidal artery and showed a hypercoagulable state and nephrotic syndrome after diarrhea and appetite loss. He had suffered from nephrotic syndrome from the age of three and had been treated for five years. MR-angiography showed an occlusion originating in the right internal carotid artery. The right anterior and middle cerebral arteries were imaged from the left internal carotid artery via the anterior communication artery. He showed symptoms of left hemiparesis, agnosia, loss of activity, anasarca and left hypacusis following his clinical course, but had recovered from all but left hemiparesis following medical treatments including steroid therapy. The histologic finding by a renal biopsy revealed focal glomerulosclerosis. In this case, we considered that when he was in a hypercoagulable state and had a second attack of nephrotic syndrome because of inflammation and dehydration due to diarrhea and appetite loss, his hypercoagulable state grew worse, and he then developed a cerebral infarction. When one see a patient with nephrotic syndrome, one should be attentive to the possibility of a complication of cerebral infarction.
我们报告一名19岁男性,其在脉络膜前动脉供血区域发生脑梗死,且在腹泻和食欲减退后出现高凝状态及肾病综合征。他自3岁起患有肾病综合征,已接受治疗5年。磁共振血管造影显示起源于右侧颈内动脉的闭塞。右侧大脑前动脉和大脑中动脉通过前交通动脉由左侧颈内动脉显影。在其临床病程中,他出现了左侧偏瘫、失认、活动丧失、全身水肿和左耳听力减退等症状,但在包括类固醇治疗在内的医学治疗后,除左侧偏瘫外的所有症状均已恢复。肾活检的组织学检查结果显示局灶节段性肾小球硬化。在该病例中,我们认为当他处于高凝状态,且由于腹泻和食欲减退导致的炎症及脱水而再次发作肾病综合征时,其高凝状态恶化,随后发生了脑梗死。当见到肾病综合征患者时,应留意脑梗死并发症的可能性。