硬脑膜动-静脉瘘合并髓静脉扩张的临床及影像学表现(附1例报告及文献复习)  

Clinical and Imaging Findings of Dural Arteriovenous Fistulas with Medullary Dilatation(A Case Report and Literature Review)

作　　者：陈晓莉[1] 陈瑞利[1] 雷琦[1] 李伟[1] 郭生龙[1] 杨谦[1] 宋允章[1] CHEN Xiao-li;CHEN Rui-li;LEI Qi;LI Wei;GUO Sheng-long;YANG Qian;SONG Yun-zhang(Department of Neurology,Shaanxi Provincial People's Hospital,Xi'an 710068,China)

机构地区：[1]陕西省人民医院神经内二科,西安710068

出　　处：《中国临床神经科学》2020年第1期48-51,65,共5页Chinese Journal of Clinical Neurosciences

基　　金：陕西省社会发展科技攻关项目(编号:2017SF-289)。

摘　　要：目的报道1例硬脑膜动-静脉瘘(DAVF)合并髓静脉扩张病例的临床资料,探讨DAVF合并髓静脉扩张的临床及影像学表现。方法回顾性收集1例DAVF合并髓静脉扩张患者的临床及影像学资料,并结合文献复习进行分析。结果患者以症状性癫痫起病。头颅MRI表现为脑白质内迂曲、扩张血管影,并继发性脑梗死和脑水肿;全脑数字减影血管造影(DSA)提示右侧颈内动脉造影静脉期上矢状窦前1/3不显影,静脉晚期颅内多发髓静脉迂曲增粗,经室管膜下静脉-大脑内静脉回流,右侧颈外动脉造影示DAVF形成,大脑上静脉逆向回流,左侧颈内动脉造影示左侧发育性静脉畸形。经血管内介入栓塞DAVF治疗后患者病情改善。结论DAVF合并髓静脉扩张少见,可继发脑实质病变进而出现神经功能缺损症状与体征;影像学表现为头颅MRI提示髓静脉扩张涉及的疾病谱较多,需仔细鉴别;MRI和DSA联合检查能更好评价脑实质和血管情况。Aim A case of dural arteriovenous fistulas with medullary dilatation was reported to discuss the clinical and imaging findings.Methods The clinical and imaging data of one patient of dural arteriovenous fistulas(DAVF)and medullary dilatation was collected and analyzed.Results This case was caused by symptomatic epilepsy,MRI revealed tortuous and dilated vascular shadow in the white matter,and secondary cerebral infarction and edema.The anterior 1/3 of the superior sagittal sinus was not visualized,and multiple medullary veins were thickened in the venous late intracranial,then drained by the subependymal veins to internal cerebral veins.The right external carotid artery angiography showed DAVF,which drained by superior cerebral vein,and left developmental venous malformation.The patients' condition was improved after transarterial embolization.Conclusion DAVF with engorged medullary vein was a rare condition,which has characteristic on the image.It may be secondary to brain parenchymal lesions and causes neurological deficit symptoms and signs.In addition,the cerebral venous dilatation on magnetic resonance imaging(MRI)may be easily misdiagnosed,which can be effectively discriminated by digital subtraction angiography(DSA).

关 键 词：硬脑膜动-静脉瘘 髓静脉 磁共振成像 数字减影血管造影 

分 类 号：R743[医药卫生—神经病学与精神病学]