[医药卫生]脉络膜前动脉

[医药卫生]脉络膜前动脉 第1例:征集脉络膜前(后)动脉相关图片 Yyzzhh:临床医生定位诊断的时候，经常忽略脉络膜前 (后)动脉。现在征集脉络膜前(后)动脉相关图片，让大 家对他们有新的认识。 Chinastroke: 原来一直也在思考这个问，但给人的感觉是 临床上变异挺大的～先占个位置! Yyzzhh:先抛砖 D. Axial T2-weighted image(2500/80) reveals the presence of an inhomogeneous mass in the right lateral ventricle. The low signal intensity suggets the presence of calcification and hemorrhage. E. Angiogram of the right internal carotid artery obtained on day 3 demonstrates a hypervascular mass fed from the right anterior choroidal artery (arrows). Yyzzhh:A 9-year-old previously healthy girl was admitted to the Emergency Room with an eight-hour history of sudden onset of severe headache. The pain was pulsatile ['p?ls?tail] 脉动的, 悸动的, 跳动的and bilateral and not accompanied by other symptoms. There is no history of migraine['maigrein] 偏头疼, epilepsy or stroke. Parents reported that soon after the onset of the headache the patient became drowsy [?drauzi] 昏昏欲睡的for about one hour. No trigger factor was identified. On the neurological examination, the patient was alert and well oriented with no other abnormalities but mild nuchal['nju:k?l] 项的, 颈背的 rigidity. [ri?d?id?ti] 固执，坚定，僵化 Computed tomography of the brain revealed hemorrhage in the right lateral ventricle (Fig 1) and gadolinium-enhanced magnetic resonance imaging study of the brain disclosed a heterogeneous lesion in the mesial['mi:zi?l] 中央的, 中间的 portion of the right temporal lobe, above and inside the temporal horn of the lateral ventricle. The lesion extended until the subependimary area of the trigono of the right ventricle. The lesion was hypointense on T1 and T2-weighted images and enhanced with the contrast. Other hyperintense T1 and T2-weighted images lesions were seen in the right lateral ventricle suggesting bleeding. Magnetic resonance angiography and cerebral angiography disclosed an arteriovenous malformation in part of the choroid plexus, supplied by the anterior choroidal artery (Figs 2 and 3). The AVM was classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2). A surgical procedure was done resulting in an almost complete excision [ek'si ??n] 切除, 删除, 切除之物 of the AVM and without sequelae[si'kwi:li:] 后遗 症, 结局. The patient remains asymptomatic after one year of follow-up. This report was approved by the Hospital Ethics Committee and her parents signed the informed consent. Yyzzhh:Quote: 以下是引用 潜水换气 于 2007-9-3 21:10:48 的发言 脉络膜前动脉，1,4支，以3支最多，为一组较细小而恒定的血管，在后交通动脉起始远侧2 mm处由颈内动脉脉直接发出。该动脉在未穿入侧脑室下脚之前，除发1,3个皮质支外，还发出2,3个穿支，1支穿视神经内侧至大脑脚，另两支即为纹状体内囊动脉。此动脉主要营养尾状核尾，行程长，管径较小，易发生栓塞。 脉络膜后动脉，多为1支，占81%。该动脉恒定地平大脑脚外侧面 从大脑后动脉外侧段发出，向外行，进入海马裂至侧脑室下脚，形成 脉络丛，由丛发支至尾状核 Yyzzhh:: Angiograms obtained in a 49-year-old woman presenting with a Hunt and Hess Grade III SAH. The aneurysm that had ruptured could not be identified. All aneurysms were treated in one session to prevent mistaken treatment of only the unruptured aneurysms. Upper Left: Left ICA angiogram revealing aneurysms at the anterior choroidal artery (arrow), the ICA bifurcation (open arrow), and the pericallosal artery (curved arrow). Upper Center: Right ICA angiogram demonstrating additional aneurysms at the PCoA (arrow) and the ACoA (open arrow). Upper Right: Left ICA angiogram revealing GDCs in the three left-sided aneurysms. Lower Left: Right ICA angiogram revealing GDCs in the two right-sided aneurysms. Lower Right: Unsubtracted angiogram, anteroposterior view, revealing GDCs in the five aneurysms. Yyzzhh: : Selective lateral vertebral angiogram identifying the posterior choroidal artery supply to an intraventricular AVM. The AVM (outlined by arrows) contains a venous aneurysm (V). This AVM had presented with an intraventricular hemorrhage and was identified by selective angiography. Yyzzhh: A:Pericallosal Artery B.Anterior Cerebral Artery C.Middle Cerebral Artery D.Anterior Choroidal Artery E.Ophthalmic Artery F.Internal Carotid Artery G.Posterior Cerebral Artery Yyzzhh: 你能从里面找到脉络膜前动脉吗, Yyzzhh: 高山流水:多好的图片,感谢斑竹的辛勤耕耘. Yichaoqi: Yyzzhh: 从外院转来实例一个，当地进行了动脉瘤夹闭术 患者SAH，DSA提示后交通动脉瘤，从瘤体上发出脉络膜前动脉和胚胎性大脑后动脉。 上图:术前的DSA。红圈代脉络膜前动脉，箭头为后交通动脉瘤，可以看到从瘤体上发出脉络膜前动脉和胚胎性大脑后动脉 下图:动脉瘤夹闭术后，箭头区域猜测应该是脉络膜前动脉供血区， 框区为胚胎性大脑后动脉分布区。 DOC80: 脉络膜前动脉梗死 稀里糊涂:都很漂亮，发一个特别的。脉络膜前动脉夹层: A:左侧内囊后肢梗死 B:动脉瘤样扩张 C:动脉瘤样扩张 D:静脉期造影剂滞留 E:发病118天时，DSA提示夹层消失 F:静脉期没有发现造影剂滞留 G:1年后，没有发现动脉瘤 Yyzzhh:我很久前发的帖子，今天又被翻出来了。贡献一个精彩的: Basal view of brain after transverse section of midbrain and partial excision of left temporal lobe to show magnified portions in Figure 2 (rectangle A) and in Figure 4 (rectangle B). The optic chiasm (1). The internal carotid artery (2). The left anterior choroidal artery (3). The middle cerebral artery (4). The optic tract (5). The hypothalamus (6). The basilar artery (7). The cerebral peduncle (8). The tegmentum (9) and the inferior colliculi (10) of the midbrain. The pulvinar (11). The lateral geniculate body (12). The choroid plexus (13) of the inferior horn of the ventricle. Basal view of left AChA (1) which follows the optic tract (2). The AChA gives off four perforating branches (3 through 6). The first perforator (3) divides into two branches (arrows). The second one (4) enters the brain just medial to the optic tract. The third perforator (5) represents the capsulothalamic artery. The fourth perforator (6) gives off two twigs (arrowheads) to the cerebral peduncle (7). The premammillary artery (8). The caudomedial part of the anterior perforated substance (9). The optic branches of the AChA (10). (The magnified part corresponds to rectangle A in Figure 1). Medial and slightly oblique view of the right AChA (1) of vascular cast. Note perforating branch (2) arising close to the AChA origin; remaining perforators (arrows); and uncal branch (arrowhead). Internal carotid artery (3) and its perforators (4). Basal view of a large capsulothalamic perforator (arrowheads) that arises from the left AChA (1) just rostral to the inferior horn and choroid plexus (2) of the lateral ventricle. The other perforators are indicated by arrows. The optic tract (3). The anterior perforated substance (4). The cut surface of the temporal lobe (5). The cerebral peduncle (6). The peduncular branch of the AChA (7). (The magnified part corresponds to rectangle B in Figure 1). Medial and slightly dorsal view of the right AChA (1). Note the short common trunk (arrowhead) of two smaller perforators (arrows). A large AChA perforator (2). The parahippocampal branch (3). The internal carotid artery (4) and its perforator (5). The middle cerebral artery (6). The anterior cerebral artery (7). Medial view of the left AChA (1). Note the common trunk (2) of the uncal branch (3) and two perforators (4). The other AChA perforators (5). The internal carotid artery (6). The posterior communicating artery (7) and its premammillary perforator (8). Basal view of the right AChA (1), which is slightly displaced medially. Note two perforators (arrows) that penetrate the optic tract (2). The parahippocampal branch (cut) (3). The internal carotid artery (4). The uncus (5). W88w: 脉络膜前动脉梗死:这个病例如果放到实际工作中，相信没有人敢肯 定是AChA。 Fig. 2. Axial T2-weighted fluid attenuated inversion recovery images of the brain at the level of the midbrain (a), hypothalamus (b), and thalamus (c).Hyperintense signal change is indicated by white arrows: in (a), the right mesial temporal lobe; in (b), the posterior limb of the right internal capsule; in (c),the right lateral geniculate body. Fig. 1. Automated perimetry showed a left incongruent homonymous hemianopsia predominantly affecting lower quadrant with central sparing.Left eye (a); right eye (b). 水货: Quote: 以下是引用 w88w 于 2008-3-22 16:43:46 的发言 脉络膜前动脉梗死:这个病例如果放到实际工作中，相信没有人敢肯定是AChA。 太精彩了，平日没有关注过脉络膜前动脉，如果临床上遇上这类 患者往往定位于大脑中动脉穿支血管，原来是AChA。 看这个病人的片子和图片上标识的几乎一模一样。 Yyzzhh:w88w的病例太精彩了，学习了。 Dementia: Quote: 以下是引用 yyzzhh 于 2008-3-22 20:40:30 的发言 w88w的病例太精彩了，学习了。 学习了。 驴肉火烧: 水立方:应该是海马吧～ Yyzzhh: 把这个帖子重新固顶，请大家讨论: 1.脉络膜前动脉是几级血管，它是穿支血管吗, 2.脉络膜前动脉闭塞，能够进行tPA溶栓治疗吗, Sunny: 各位大虾是否应该更进一步区分是外侧豆纹动脉和脉络膜前动脉梗死的位置～～ DOC80:回sunny版主，这是从文献上下载的，文献提示为脉络膜前动脉。豆纹动脉和脉络膜前动脉非常难鉴别。 奥运2008:个人认为，尽管起源于颈内动脉，但是脉络膜前动脉很 细，病灶一般都是腔隙性梗死，所以个人认为他应该是属于小血管范 畴。 小血管事件溶栓时往往出血风险大，所以不建议溶栓治疗。 DOC80:sunny版主对这个病史是不是脉络膜前动脉梗死提出异议， 现在把原文发上来与大家分享。同时也回答y版的一个问题，脉络膜 前动脉梗死能否溶栓治疗。 当然这个部位的梗死，很难区分脉络膜前动脉梗死和豆纹动脉梗死， 文献也不一定正确。大家自己分析吧～ DOC80:rtPA intravenous thrombolysis in anterior choroidal artery territory stroke.Neurology. 2000 Feb 8;54(3):666-73. Article abstract—Objective: To study the possible specific response to recombinant tissue plasminogen activator (rtPA) thrombolysis of anterior choroidal artery (AChA) stroke. Background: Outcome and response after rtPA thrombolysis are possibly better in small-vessel infarcts, but a specific study of AChA stroke has not yet been performed. Methods: The authors proposed an open trial of IV rtPA within 7 hours in patients age 20 and 81 years with all types of internal carotid artery territory stroke if the baseline Scandinavian Stroke Scale (SSS) score was less than 48. A dose of rtPA 0.8 mg/kg was infused over 90 minutes. Of 114 consecutive patients, 9 patients (7.9%) exhibited hypodensity in the AChA territory on day 1 brain CT. Results: Seven of nine patients with AChA infarct had a primary early recovery within 6 hours after the initiation of rtPA infusion. In addition, recovery was complete in five patients and partial in two patients. No intracerebral hematoma was observed. Three patients had a “reinfarct syndrome” at 12, 25, and 48 hours respectively.However, in the two latter patients treated with IV heparin, the deficit disappeared again with the increase of heparin dose in one patient and disappeared spontaneously in the other patient. The overall outcome at day 90 was six total recoveries in nine patients (66%). Patients with a final good outcome had a slight “unstructured” hypodensity in the AChA territory on day 1 brain CT, whereas patients with a bad outcome had the classic “structured” hypodensity of AChA territory stroke. Conclusion: These data support a specific quick response of AChA territory stroke to IV rtPA thrombolysis,probably due to the small size of the artery and of the “clot.” The high frequency of the reinfarct syndrome is a clinical act that is difficult to explain. Efficient heparin treatment after 24 hours may control the reinfarct syndrome in some patients. Key words: Recombinant tissue plasminogen activator—Intravenous—Choroidal artery—Reinfarct. MXWZ2001:very good !