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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Biphasic Development of Focal Cerebral Hyperperfusion After Revascularization Surgery for Adult Moyamoya Disease Associated With Autosomal Dominant Polycystic Kidney Disease
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Biphasic Development of Focal Cerebral Hyperperfusion After Revascularization Surgery for Adult Moyamoya Disease Associated With Autosomal Dominant Polycystic Kidney Disease

机译：成人Moyamoya病后血运重建术后局灶性脑高温灌注的双相发展

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BackgroundCerebral hyperperfusion (CHP) syndrome is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD), but its biphasic and delayed development is extremely rare. Case reportA 47-year-old woman with autosomal dominant kidney disease (ADPKD) presented with transient ischemic attacks due to MMD, and underwent left STA-MCA anastomosis. N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography (123IMP-SPECT) 1 day after surgery revealed asymptomatic CHP at the site of anastomosis. Strict blood pressure control and minocycline hydrochloride relieved CHP at postoperative day 7. However, 2 days later, the patient complained of sensory aphasia, and123IMP-SPECT demonstrated significant focal CHP at the site of anastomosis accompanying high-intensity signal on magnetic resonance (MR) imaging of fluid attenuated inversion recovery (FLAIR) in her left temporal lobe near the site of anastomosis. We continued strict blood pressure control and additionally administered free radical scavenger (Edaravone) and antiepileptic agents, which gradually improved sensory aphasia. MR imaging and123IMP-SPECT also confirmed the amelioration of the FLAIR-high lesion and focal CHP in her left temporal lobe. Two months later, the patient underwent right STA-MCA anastomosis without complications. ConclusionsAlthough the underlying mechanism is unknown, biphasic development of focal CHP after revascularization surgery in an MMD patient with ADPKD is unique. Due to the potential vulnerability of the systemic vessels in ADPKD, it is conceivable that intrinsic vascular wall fragility in MMD could be enhanced by ADPKD and have partly led to this rare complication.
机译：背景，脑高温灌注（CHP）综合征是浅谈浅表颞动脉 - 中动脉（STA-MCA）吻合术对Moyamoya病（MMD）的潜在并发症，但其双相和延迟的发育极为罕见。案例报告47岁女性具有常染色体占优势肾病（ADPKD）由于MMD而呈现出瞬态缺血性发作，并进行了左右的STA-MCA吻合术。 N-异丙基-P-[123i]碘苯丙胺单光子发射计算断层扫描（123IMP-SPECT）手术后1天显示在吻合术部位的渐近CHP。术后第7天严格血压控制和百分之霉素缓解CHP 7.然而，2天后，患者抱怨感觉厌氧病，123imp-Spect在伴随磁共振上的高强度信号（MR）伴随高强度信号的吻合术部位显示出显着的局灶性CHP在吻合术部位附近她左颞叶中的流体减毒反转恢复（Flair）的成像。我们持续严格的血压控制，另外施用自由基清除剂（赤纬）和抗癫痫药物，其逐渐改善了感觉性厌食症。 MR Imaging And123imp-Spect还证实了在左颞叶中的Flair-High病变和焦虑的改善。两个月后，病人接受了右侧的STA-MCA吻合术而无需并发症。结论虽然潜在的机制未知，但血型患者血型患者患者患者患者患者的双相发育是独一无二的。由于ADPKD中全身血管的潜在脆弱性，可以想到MMD中的内在血管壁脆性可以通过ADPKD增强，并且部分导致这种罕见的并发症。

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