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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Paradoxical Association of Symptomatic Local Vasogenic Edema with Global Cerebral Hypoperfusion after Direct Revascularization Surgery for Adult Moyamoya Disease
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Paradoxical Association of Symptomatic Local Vasogenic Edema with Global Cerebral Hypoperfusion after Direct Revascularization Surgery for Adult Moyamoya Disease

机译：成人Moyamoya病直接血运重建术后症状局部血管生殖水肿与全球性脑低渗的矛盾协会

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Background: Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is the standard treatment for Moyamoya disease (MMD). Cerebral hyperperfusion syndrome is a potential complication of this procedure and can cause local vasogenic edema and/or delayed intracerebral hemorrhage. Cerebral hypoperfusion is a contradictory postoperative pathophysiological condition implicated in MMD, but its association with symptomatic local vasogenic edema has not been reported. Case Report: A 31-year-old woman with MMD underwent left STA-MCA anastomosis 3 months after a minor completed stroke in bilateral hemispheres. Eight hours after the operation, the patient developed neurological deterioration of dysarthria and mono-paresis in her right hand. Magnetic resonance (MR) angiography showed apparently patent STA-MCA bypass, whereas MR imaging of fluid-attenuated inversion recovery demonstrated a local high-signal-intensity lesion at the vascular territory supplied by the bypass. The apparent diffusion coefficient value was significantly increased in this lesion, suggesting local vasogenic edema formation. N-isopropyl-p-[I-123] iodoamphetamine single-photon emission computed tomography revealed global hypoperfusion in the left hemisphere. The administration of a free-radical scavenger and antiepileptic agent gradually relieved her symptoms, and MR imaging 1 month after surgery confirmed the complete disappearance of local vasogenic edema. Conclusions: Vasogenic edema may be associated not only with cerebral hyperperfusion but also with hypoperfusion after STA-MCA anastomosis for MMD. Although the exact mechanism of this rare association is unknown, the intrinsic vulnerability of intracranial vascular wall structures and the increased vascular permeability in MMD may partly explain the paradoxical association of hypoperfusion and local vasogenic edema.
机译：背景：浅表颞动脉 - 中间脑动脉（STA-MCA）吻合术是Moyamoya疾病（MMD）的标准处理。脑超灌注综合征是该程序的潜在并发症，可以引起局部血管性水肿和/或延迟脑内出血。脑低渗是涉及MMD的矛盾的术后病理病症，但尚未报道其与症状局部促血管生殖水肿的关联。案例报告：一名31岁的女性，MMD在双边半球的轻微完成中风后3个月内接受了左下方的STA-MCA吻合术。手术后八小时，患者在右手中发育了神经系统的神经系统恶化和单谱系。磁共振（MR）血管造影显示出明显的专利STA-MCA旁路，而流体衰减反转恢复的MR成像在旁路供应的血管围条上表现出局部高信号强度病变。在这种病变中，表观扩散系数值显着增加，表明局部促血管性水肿形成。 N-异丙基-P-[I-123]碘邻丙胺单光子发射计算机断层扫描显示左半球的全局低血量灌注。自由基清除剂和抗癫痫药剂的给药逐渐缓解了她的症状，并且手术后1个月的Mr成像证实了局部血管生成的水肿的完全消失。结论：促血管生成的水肿不仅可能与脑高灌注，而且在MMD的STA-MCA吻合后的低灌注中也有相关性。虽然这种稀有关联的确切机制未知，但颅内血管壁结构的内在脆弱性和MMD中增加的血管渗透性可能部分解释过血管灌注和局部血管内水肿的矛盾协会。

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