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首页> 外文期刊>Neurologia medico-chirurgica. >Cerebral infarction along the distribution of perforating arteries during aneurysm surgery in a patient with pheochromocytoma--case report.
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Cerebral infarction along the distribution of perforating arteries during aneurysm surgery in a patient with pheochromocytoma--case report.

机译：嗜铬细胞瘤患者在动脉瘤手术期间沿穿孔动脉分布的脑梗塞-病例报告。

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A 58-year-old woman with refractory hypertension presented with subarachnoid hemorrhage. Digital subtraction angiography and three-dimensional computed tomography (CT) angiography revealed a ruptured left vertebral artery (VA) aneurysm and an unruptured left middle cerebral artery (MCA) aneurysm. The patient successfully underwent neck clipping of the left VA aneurysm. However, CT obtained just after the operation showed an asymptomatic cerebral infarction along the distribution of medial striate arteries of the right anterior cerebral artery in the caudate nucleus. The pathogenesis of the infarction was unknown. Before clipping surgery of the left MCA aneurysm, detailed examinations to find the cause of her refractory hypertension were performed. Laboratory tests revealed plasma serum level of norepinephrine at 15,521 pg/ml (normal range 100-450 pg/ml). Abdominal magnetic resonance imaging revealed a pheochromocytoma in the right adrenal gland. After preoperative management of the pheochromocytoma, the neck of the left MCA aneurysm was successfully clipped. When the patient awakened from anesthesia, she noticed right hemiparesis and motor aphasia. CT showed cerebral infarction along the distribution of lenticulostriate arteries of the left MCA in the putamen. Her symptoms gradually improved, and the pheochromocytoma was removed by laparoscopic surgery. Sustained severe hypertension and depletion of blood volume resulting from excess catecholamine release from the pheochromocytoma may have caused the complications. Hypervolemic fluid infusion and maintenance of normotensive blood pressure during surgery may avoid such ischemic events.
机译：一名58岁的难治性高血压患者出现蛛网膜下腔出血。数字减影血管造影和三维计算机断层扫描（CT）血管造影显示左椎动脉（VA）破裂，左中脑动脉（MCA）破裂。该患者成功接受了左VA动脉瘤的颈夹。然而，术后刚获得的CT显示，沿着尾状核右前脑动脉内侧纹状动脉的分布无症状性脑梗塞。梗死的发病机制未知。在对左MCA动脉瘤进行夹层手术之前，进行了详细检查以发现其难治性高血压的原因。实验室测试显示去甲肾上腺素的血浆血清水平为15,521 pg / ml（正常范围为100-450 pg / ml）。腹部磁共振成像显示右肾上腺有嗜铬细胞瘤。术前处理嗜铬细胞瘤后，成功切除了左MCA动脉瘤的颈部。当患者从麻醉中醒来时，她注意到右半身轻瘫和运动失语。 CT显示核壳沿左MCA的扁豆状动脉分布沿脑梗塞。她的症状逐渐好转，并通过腹腔镜手术切除了嗜铬细胞瘤。持续的严重高血压和嗜铬细胞瘤释放过量的儿茶酚胺导致血容量减少可能是引起并发症的原因。手术期间进行高容量静脉输液和维持血压正常可避免此类缺血事件。

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