64排CT血管成像评价前交通动脉复合体变异类型及与前交通动脉瘤相关性

目的 研究前交通动脉复合体变异的64排CT血管成像(CTA)类型和影像表现及其与前交通动脉瘤(ACoAA)发病相关性.方法 回顾性分析169例脑部CTA表现及临床资料,其中48例ACoAA患者为研究组,121例无动脉瘤患者为对照组,分析两组A1段、前交通动脉影像表现及类型,比较ACoAA发病、破裂出血与复合体变异、变异侧别的相关性.结果 大脑前动脉A1段成窗畸形少见,约4.7%,与ACoAA发病无相关性.ACoAA患者A1段变异发生率为50%,对照组患者A1段变异发生率为31%,研究组A1段变异发生率要高于对照组,差异有统计学意义(χ2＝5.12,P<0.05),且存在明显左侧优势(χ2＝7.79,P<0.01).前交通动脉异常型发生率在ACoAA患者中与对照组无显著差异(χ2＝0.72,P>0.05).结论 CTA能清晰地显示前交通动脉复合体变异情况,前交通复合体变异与ACoAA发病相关.     

脊髓前动脉综合征1例报道并文献复习

目的:探讨脊髓前动脉综合征(ASAS)的临床特点、MRI特点、病因和预后,提高医师对脊髓梗死的认识。方法:回顾1例ASAS患者的临床特点、MRI特点及治疗和预后,并结合文献进行回顾性分析。结果:患者临床表现为急性起病,后背疼痛,双下肢瘫,痛温觉障碍,深感觉和触觉正常,尿潴留及排便障碍,MRI检查弥散序列显示T_(7-8)、T_(11-12)水平脊髓横断前部区域呈高信号影,稍长T2信号,综合治疗后预后良好。搜索既往报道的ASAS患者207例,临床表现特征是急性或亚急性起病,病变水平神经根痛,病变节段以下瘫痪和分离性感觉障碍及植物神经功能障碍,以胸段脊髓梗死多见,发病早期MRI弥散序列检查可显示脊髓梗死范围。207例患者中,病因不明者74例(35.8%)。颈部外伤是年龄18岁患者脊髓梗死的首位病因;主动脉疾病是年龄18～45岁患者脊髓梗死的首位病因,动脉粥样硬化是年龄45岁患者脊髓梗死的首位病因。结论:ASAS较罕见,临床表现和病因差异很大,脊髓MRI检查弥散序列有助早期诊断,早期诊断和综合治疗是改善预后的关键。     

三维数值模拟前交通动脉复合体的血流动力学

目的 对大脑前交通动脉复合体区进行三维数值模拟,分析其血流动力学特征.方法 运用Gambit软件建立前交通动脉复合体区(包括前交通动脉、大脑前动脉A1、A2段)几何模型,再用Fluent软件进行数值模拟及血流动力学分析[包括壁面切应力(WSS)、流速及压力],并应用SPSS 13.0软件进行统计学分析.结果 随着非优势侧大脑前动脉A1段管径逐渐减小,优势侧大脑前动脉A1段近前交通动脉处WSS增大,双侧大脑前动脉A1段近A2段和前交通动脉分叉处压力逐渐变小.流速变化与WSS的变化趋势一致.结论 WSS在前交通动脉瘤的发生中可能起主要作用.     

经前交通动脉路径行对侧大脑前动脉取栓术1例

正急性大血管闭塞性缺血性卒中发生后,在有效时间内尽早开通闭塞血管,恢复脑缺血区域的灌注,可改善大多数患者的预后。本文报道1例在治疗急性大血管闭塞性缺血性卒中患者术中,取栓装置经常规路径到位困难后,从对侧近端血管入口,经前交通动脉路径行左侧大脑前动脉取栓术。最终,靶血管再通成功,患者获得良好结果。     

1例前交通动脉瘤合并大脑中动脉动脉瘤的报道

对未破裂脑动脉瘤非保守的治疗方法,现在还没有一定的见解[1].而近年来开发的可脱离型弹簧圈(guglielmi detachable coil,GDC)形成的血管内栓塞术,对于部位复杂、年龄偏高、临床症状较重的动脉瘤患者来说,同直接开颅进行动脉瘤夹闭手术相比越来越成为这类疾病治疗的第一选择[2～5],拓宽了这类疾病治疗的方法[4,6].     

双侧胼胝体梗死1例报道

脑梗死是由于脑部血液供应障碍,缺血、缺氧导致局部脑组织坏死,因此又称为缺血性脑卒中.基底节区、颞叶、顶叶、枕叶、丘脑、小脑、脑干等部位是脑梗死的常见部位.胼胝体由于血供丰富,同时接受大脑前动脉和大脑后动脉的双重血供,故临床发生于胼胝体梗死比较少见[1].双侧胼胝体梗死更是罕见,现将我们发现的一例报道如下.     

三倍体的交通后段大脑前动脉显微解剖研究

三倍体的交通后段大脑前动脉(triplication of the postcommunical anterior cerebral artery)属于少见的血管变异，多在解剖、脑血管造影或手术过程中被发现。我们在对46具尸脑标本进行解剖时，发现1例有这种变异，现报告如下。     

腓动脉变异及其交通支穿胫神经裂隙1例

成年男尸1具.解剖其左下肢时发现左侧腓动脉自小腿骨间膜下方的裂孔穿出后，发出一交通支，自胫神经形成的裂隙中间穿过，并与胫后动脉相交通，其降支直接移行为足背动脉（图1）。     

脾动脉起自肠系膜上动脉1例报道并文献复习

脾动脉的解剖变异在临床上比较少见,一般情况下脾动脉直接起源于腹腔干(90.6％)[1].在这篇文章中,我们将描述一个脾动脉起自肠系膜上动脉的病例.这是在一个胰头肿块病人的术前增强CT上发现的,后行CTA及术中探查进一步证实.在既往的文献中这种变异的发生概率小于1.3％[1].血管变异的知识,尤其是腹腔干及肠系膜上动脉分支变异的知识对普外科的临床工作十分重要,国外已有大量文献报道此区域的血管变异[2-8].如果术前没有发现这个变异,按正常的解剖关系行胰头肿块局部切除时可能损伤异位的脾动脉,导致大出血,并且有可能需要切除脾脏,所以在临床工作中发现与手术相关的重要血管的变异是十分重要的,而术前增强CT及CTA能够做到这一点[9-10];我们将结合术前增强CT、CTA及术中所见详细描述此病例的动脉变异情况,以提高大家对此区域血管变异重要性的认识.     

Bilateral cerebral infarction in diabetic ketoacidosis and bilateral internal carotid artery occlusion: A case report and review of literature

BACKGROUNDDiabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus (T1DM). Very rarely does DKA lead to cerebral edema, and it is even rarer for it to result in cerebral infarction. Bilateral internal carotid artery occlusion (BICAO) is also rare and can cause fatal stroke. Moreover, case reports about acute cerebral infarction throughout both internal carotid arteries with simultaneous BICAO are very scarce. In this study, we present a patient with BICAO, T1DM, hypertension, and hyperlipidemia, who had a catastrophic bilateral cerebral infarction after a DKA episode. We briefly introduce BICAO and the mechanisms by which DKA results in cerebral infarction. CASE SUMMARYA 41-year-old woman presented with ischemic stroke that took place 3 mo prior over the left corona radiata, bilateral frontal lobe, and parietal lobe with right hemiplegia and Broca’s aphasia. She had a history of hypertension for 5 years, hyperlipidemia for 4 years, hyperthyroidism for 3 years, and T1DM for 31 years. The first brain magnetic resonance imaging not only revealed the aforementioned ischemic lesions but also bilateral internal carotid artery occlusion. She was admitted to our ward for rehabilitation due to prior stroke sequalae. DKA took place on hospital day 2. On hospital day 6, she had a new massive infarction over the bilateral anterior cerebral artery and middle cerebral artery territory. After weeks of aggressive treatment, she remained in a coma and on mechanical ventilation due to respiratory failure. After discussion with her family, compassionate extubation was performed on hospital day 29 and she died.CONCLUSIONDKA can lead to cerebral infarction due to several mechanisms. In people with existing BICAO and several stroke risk factors such as hypertension, T1DM, hyperlipidemia, DKA has the potential to cause more serious ischemic strokes.     

Migrainous stroke causing bilateral anterior cerebral artery territory infarction

A 38-year-old man developed bilateral anterior cerebral artery territory infarction during the course of a migraine. Magnetic resonance imaging showed bilateral ischemic lesions involving the cortex of the paramedian region of the frontal and parietal lobes, more prominent on the right. Cerebral angiography was normal. To our knowledge, this is the first report of bilateral anterior cerebral artery territory infarction from migraine.     

Flow-diverter stenting of post-traumatic bilateral anterior cerebral artery pseudoaneurysm: A case report

The use of flow-diverter (FD) stents in recent years has positively changed the therapeutic approach to some vascular diseases, especially of certain types of aneurysms. This paper describes the case of a young patient after a major head trauma causing multiple skull fractures. The trauma occasioned two pseudoaneurysms from the A1 segment of the right anterior cerebral artery and from the A2 segment of the left anterior cerebral artery.Both lesions were treated with two Pipeline devices (ev3, Irvine, CA, USA) in two different sessions. The CT study and angiographic investigations performed in the following month showed a complete resolution of the post-traumatic pseudoaneurysmal lesions.Although the use of FD stents is described in the literature, particularly in the treatment of selected aneurysms, this paper shows good technical results in the use of these stents in cases of intracranial post-traumatic pseudoaneurysms with clinical improvement.     

Radiology of anterior cerebral artery infarction

Twenty patients with anterior cerebral artery infarction are reviewed. Usual and unusual clinical presentation and radiographic findings (angiography and computed tomography) are correlated.     

Spontaneous bilateral vertebral artery dissections: case report and literature review.

Vertebral artery dissection (VAD) has been increasingly identified as a cause of ischemic stroke in young adults. We report the clinical and radiographic findings in a case of spontaneous bilateral VADs and review the literature on the causes, pathophysiology, diagnostic considerations, and treatment options for VAD. A 29-year-old man was admitted to our hospital after sudden onset of headache and nuchal rigidity that progressed to a posterior lateral medullary syndrome in a 2-week period. The diagnosis of bilateral VADs was based on findings on cranial magnetic resonance imaging and conventional angiography. The patient was given anticoagulant therapy and had no further neurologic deterioration. The differential diagnosis of craniocervical pain in young patients should include arterial dissection of the neck because early diagnosis and treatment may reduce the chances of long-term neurologic sequelae.     

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

BACKGROUNDIleal hemorrhagic infarction after carotid artery stenting (CAS) is a fatal complication. The prognosis of ileal hemorrhagic infarction after CAS is very poor if not treated in a timely manner. We describe a rare case of ileal hemorrhagic infarction due to acute embolism of the mesenteric artery after CAS. CASE SUMMARYA 67-year-old man with acute ischemic stroke underwent CAS via the right femoral artery approach 21 d after intensive medical treatment. On the first day after surgery, the patient had abdominal distension and abdominal pain. Abdominal enhanced computed tomography revealed intestinal obstruction, severe stenosis of the superior mesenteric artery, and poor distal angiography. An exploratory laparotomy was performed, and pathological examination showed hemorrhagic ileal infarction. It was subsequently found that the patient had intestinal flatulence. With the guidance of an ultrasound scan, the patient underwent abdominal puncture, drainage, and catheterization. After 58 d of treatment, the patient was discharged from hospital with a National Institutes of Health Stroke Scale score of 2 points, and a Modified Rankin Scale score of 1 point. At the 6-mo follow-up, the patient had an excellent functional outcome without stroke or mesenteric ischemia. Furthermore, computed tomography angiography showed that the carotid stent was patent.CONCLUSIONIleal hemorrhagic infarction is a fatal complication after CAS, usually caused by mesenteric artery embolism. Thus, more attention should be paid to the complications of embolism in the vascular system as well as the nervous system after CAS, and the complications should be identified and treated as early as possible.