脈絡(luò)膜動(dòng)脈病變課件

脈絡(luò)膜前動(dòng)脈病變FirstcaseSecondcaseFourthcase受累血管應(yīng)該都是脈絡(luò)膜前動(dòng)脈，該動(dòng)脈的特點(diǎn)是管腔細(xì)、行程長(zhǎng)、分布范圍廣，加上生長(zhǎng)發(fā)育的變異，這都為探討其解剖基礎(chǔ)和臨床特征帶來困難脈絡(luò)膜前動(dòng)脈的病變包括血栓形成、夾層、動(dòng)脈瘤性出血脈絡(luò)膜前動(dòng)脈的解剖影像DSA

Fig.1a–cDiffusion-weightedbrainimageswithdelineationofthe16areaswitharterialsupplyfromtheanteriorchoroidalartery(ACHA).ALICanteriorlimbofinternalcapsule,CCcruscerebri,GICgenuofinternalcapsule,LGBlateralgeniculatebody,LTlateralthalamus,MPPmedialpartofpallidum,MTLmedialtemporallobe,OARopticand/oracousticradiations,OTopticaltract,PCRposteriorcoronaradiata,PLICposteriorlimbofinternalcapsule,PPPposteriorpartofputamen,RNrednucleus,RPICretrolenticularpartofinternalcapsule,SNsubstantianigra,TCNtailofcaudatenucleus.TypeIareasaredepictedbyathickarrowandboldtype;typeIIareas,thinarrowandnormaltype;typeIII,dottedarrowsanditalics脈絡(luò)膜前動(dòng)脈夾層一例(A),Computedtomographyonadmission

revealedasmalllowdensityareaintheposteriorlimboftheinternalcapsule.

(,SpoiledGRASSMRimagerevealing

ananeurysmaldilatation(openarrow)oftheleftanteriorchoroidalartery.

Patients1through3.BrainCTscansofpatientswithanteriorchoroidalartery(AChA)strokeexperiencingaprimaryorsecondaryunfavorableevolution.Inallthreepatients,thehypodenseareaontheday1brainCTscaniswelldefined,dark,andcorrespondstothe“definite”AChAterritory.Thehypodensearearemainsunchanged(Patient1)orbecomesdarkerandlarger(Patient3)onday7brainCT.InPatient2(day7brainCTunavailable),aremoteleftinsularinfarctwasobservedandtheischemiclesionpersistedat1year.A,firstcolumn;B,secondcolumn;C,thirdcolumn.

From:Trouillas:Neurology,Volume54(3).February8,2000.666

Patients7through9.BrainCTscansofpatientswithanteriorchoroidalarterystrokeshowingaprimaryorsecondaryfavorableevolution(continued).Theday1brainCTscanshowsaclear,hypodenseareainPatient7,andshowsslightabnormalitiesinPatients8and9.Theday7brainCTscanshowsslighthypodensityinPatient7.InPatient9,T2-weightedMRIonday3showedaslightfragmentedhyperintensity.A,firstcolumn;B,secondcolumn;C,thirdcolumn.

From:Trouillas:Neurology,Volume54(3).February8,2000.666

Patients4through6.BrainCTscansofpatientswithanteriorchoroidalarterystrokeshowingaprimaryorsecondaryfavorableevolution.Theday1brainCTscanshowspoorlylimitedandslighthypodensities(“unstructured”)inPatients4and5,andslightabnormalitiesinPatient6.Ontheday7brainCTscan,onlyafainthypodenseareaisobservedinPatients4and6.A,firstcolumn;B,secondcolumn;C,thirdcolumn.

From:Trouillas:Neurology,Volume54(3).February8,2000.666

Aright-handed55-year-oldmanwhowasaheavysmokerwasadmittedtothehospitalafterarighthemiplegiaofsuddenonsetonNovember21,1995.Hehadhadaleftlowerlimbthrombophlebitisattheageof54years.

Atthetimeofhospitaladmissionthepatientwasalert,andclinicalexaminationrevealedarightglobalhemiplegiaincludingtheface,arightBabinski'ssign,andarighthemihypoesthesia.Thepatientcouldnotfeelpinprick,deeppain,touch,orvibratorystimuliinhisrightlimbs.Hewasdysarthric,butlanguageuse,repetition,andcomprehensionwerenormal.Nohomonymoushemianopiaandnovisualneglectwerenoted.Bloodpressurewas135/85mmHg.TheleftAChAdidnotfilloncerebralangiographyperformedatday8,whichwasotherwisenormal.兩例“純”AChA梗死：

Fig.2a–dDiffusion-weighted(DW)trace(averaged)images

ofthetwopatientswith“pure”anteriorchoroidalarteryinfarction.

a,bFirstpatient:damagedareasaretheposterior

MTL(arrowina),thePLICandtheRPIC(arrowinb).

c,dSecondpatient:damagedareasincludethePLICandthe

RPIC(arrowinc)withextensionintotheLT(arrowind)

上面同一患者的

C,AxialMRangiographicsourceimageobtainedusinga3D-TOFsequence(31/7/

1)showsareasoftheAVMwithhighbloodflow(curvedarrow),theoriginofthepatient’srightAChA(largestraightarrow),andenlargementoftheleftAChA(small

straightarrow)thatsuppliestheAVM.D,ReconstructedMRangiographicimage

orientedalongtheaxisofthecisternalcourseoftheleftAChAshowstheentire

cisternalcourseoftheleftAChA(arrow).

anteriorchoroidalartery遠(yuǎn)端動(dòng)脈瘤！

Patient1:FLAIRmagneticresonanceimageshowsasmalllowintensity

areawithintherightmedialtemporalhematomasuggestingan

aneurysm(arrow).

還是AChA動(dòng)脈瘤