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叩诊锤论坛moyamoaya氏病

 花瓣之雨 2010-12-30
典型影像竞猜
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典型影像竞猜

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  • SRB521
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Re:典型影像竞猜
DAVF?
和这个类似

本贴已被 作者2008-7-7 22:31:47 编辑过
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  • hammer
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Re:典型影像竞猜
1.MoyaMoya:ivy征
http://www./forum/view.asp?id=3220
2.Sturge-Weber综合症
http://www./forum/view.asp?id=3901
3.DAVF
Quote: 以下是引用 yyzzhh 于 2008-6-4 20:17:39 的发言

引用其他朋友的一段话:
多发的点状血管流空影多见于以下几种情况:
A.以动脉为主的MOYAMOYA,以异常增生的小血管为主,但分布以双侧基底节为多。
B 动静脉均有的:
AVM——往往有明显的畸形血管团,其流空纵横交错,不呈散在点状分布。
DAVF——往往也流空纵横交错,部分只扫描到流空静脉,可呈散在点状分布,但以颅外供血为主往往有明显颅外血管流空,患者常有头痛头鸣史,头部有血管杂音,进一步行DSA检查明确。
C 以静脉为住:
静脉窦及皮层静脉血栓形成后相应引流区域皮层浅静脉迂曲扩张,在切面上呈散在点状分布流空影。该病人有发热史,可考虑上矢状窦血栓形成,但DSA肯定能明确。
另外还有脑静脉畸形:以扩张增多的髓静脉及粗大的引流静脉为主,在造影上呈典型水母头状,在MRI上亦有类似表现。

下面一例患者来源于其他论坛,最后的结论是硬脑膜动静脉漏。


本贴已被 作者2008-7-8 10:56:25 编辑过
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  • 神经新手
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Re:典型影像竞猜
如果是硬脑膜动静脉漏(DAVF),如何解释患者的白质脑病?
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  • 喋喋不休
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Re:典型影像竞猜
应该是典型的MoyaMoya病的ivy征(常青藤征)
看下面是以前收集的一个病例,几乎一样:

本贴已被 作者2008-7-9 14:49:44 编辑过
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  • yyzzhh
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Re:典型影像竞猜
白质脑病+T2相多发短T2异常信号(血管影,增粗的血管,静脉可能性大):硬脑膜动静脉瘘

下面是一个文献报道:
Dural arteriovenous fistula mimicking leukoencephalopathy.Neurology 2000;54:1123

A 49-year-old man had headache and fever for 1 month.Neurologic examination showed cognitive dysfunction: recent memory loss, dyscalculia, and disorientation. Muscle stretch reflexes were increased with Babinski signs. Sensory and cerebellar function were normal without meningeal signs. T2-weighted MRI revealed hyperintense signal areas in the internal capsules, globus pallidus, and subcortical white matter regions (A). Normal flow void appearance was not seen in the superior sagittal sinus (A, arrow).Diffusion-weighted imaging also disclosed diffuse hyperintensity in the subcortical white matter. In addition, T1-weighted MRI showed abnormal flow void sign in the cerebellum with gadolinium enhancement (B). Brain MR angiography suggested arteriovenous shunts. Arterial phase of the right external carotid arteriogram indicated dural arteriovenous fistula in the straight and transverse sinus (C). The venous phase of arteriogram demonstrated prominent venous collaterals and congestion in the great vein of Galen, inferior sagittal, and straight sinus (D). The internal carotid angiogram did not define the superior sagittal,transverse, and sigmoid sinus obviously. These images strongly support that perturbation of the venous outflow and sinus thrombosis could induce diffuse brain edema or infarction. Dural arteriovenous fistula occasionally causes a unique distribution of MRI lesions mimicking acute leukoencephalopathy.

图C提示:右侧颈外动脉直接和横窦和乙状窦相通
图D提示:直窦、下矢状窦和Galen静脉显影。
本贴已被 作者2008-7-10 21:31:42 编辑过
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Re:典型影像竞猜
都是高手,的确就是硬脑膜动静脉瘘。
从MRI上可以发现很多血管的流空信号:


补充病史:A 67-year-old woman had in her medical history
an operation for an acoustic neurinoma on the right. She presented
with a rapid cognitive decline.The T2-weighted images
(first two rows) show a diffuse signal increase in the deep white
matter of both cerebral hemispheres.Abnormal flow voids are
visible on the cerebral surface and in the brain parenchyma,
especially in the temporal lobes and in the posterior fossa.The
T1-weighted images after contrast (third and fourth rows) show
extensive enhancement of cortical and parenchymal veins

公布DSA:

Angiography of the patient
presented in Fig. 101.2. Selective
injection of the external carotid artery
(first row, left) shows hypertrophy of
the superficial temporal artery and
middle meningeal artery. Immediate
enhancement of the superior sagittal
sinus is seen, suggesting the presence
of a DAVF. Selective internal carotid
artery injection (first row, right; middle
row, left) shows filling of the artery of
the falx cerebri through a (hypertrophied)
ophthalmic artery (first row,
right).There is early enhancement of
the superior sagittal sinus, consistent
with a DAVF.There is slow passage of
contrast through the brain parenchyma
because of venous congestion,
resulting in a late parenchymal and
venous phase.This is also illustrated
by the poor visibility of peripheral
arteries in the early phase (middle row,
left) and by the “pseudo-phlebitic”
aspect of the brain parenchyma in a
later phase of the angiogram (middle
row, right).After treatment by both an
endovascular approach (selective glue
injections in external carotid branches
feeding the arteriovenous fistula) and
by direct placement of coils in the
superior sagittal sinus (third row, left;
middle row, right), there is a marked
reduction in the size of external carotid
artery branches.The internal carotid
artery injection after treatment shows
abnormal drainage of the brain due to
occlusion of the superior sagittal sinus
(third row, right).The brain is no longer
using the superior sagittal sinus for its
drainage.However the transit time of
contrast is much shorter.The cognitive
symptoms of the patient have disappeared
almost completely



本贴已被 作者2008-7-11 21:47:10 编辑过
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  • 稀里糊涂
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Re:典型影像竞猜
好病例,学习了。
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  • rose
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Re:典型影像竞猜
ivy征一例:


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本贴已被 作者2009-6-1 22:12:43 编辑过
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