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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：颞浅动脉-大脑中动脉（STA-MCA）吻合是烟雾病（MMD）的标准治疗方法。脑高灌注综合征是该手术的潜在并发症，可导致局部血管源性水肿和/或迟发性脑出血。脑灌注不足是与MMD相关的一种矛盾的术后病理生理条件，但其与症状性局部血管源性水肿的关系尚未见报道。病例报告：一名31岁女性MMD患者在双侧大脑半球发生轻微完全性卒中3个月后接受了左侧STA-MCA吻合术。手术8小时后，患者右手出现构音障碍和单侧轻瘫的神经恶化。磁共振（MR）血管造影显示明显的STA-MCA旁路未闭，而液体衰减反转恢复的MR成像显示旁路供应的血管区域存在局部高信号强度病变。该病变的表观扩散系数显著增加，提示局部血管源性水肿形成。N-异丙基-p-[I-123]碘安非他明单光子发射计算机断层扫描显示左半球整体灌注不足。服用自由基清除剂和抗癫痫药物后，她的症状逐渐缓解，术后1个月的磁共振成像证实局部血管源性水肿完全消失。结论：MMD患者STA-MCA吻合术后，血管源性水肿可能不仅与脑高灌注有关，还与低灌注有关。虽然这种罕见关联的确切机制尚不清楚，但MMD患者颅内血管壁结构的内在脆弱性和血管通透性增加可能部分解释了低灌注和局部血管源性水肿的矛盾关联。

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