Neurology:急性凸面蛛网膜下腔出血:一个未被认识的CAA-ri表现

2019-08-12 zyx整理 神经科病例撷英拾粹

非创伤性急性凸面蛛网膜下腔出血(cSAH)是脑淀粉样血管病(CAA)的常见表现,但在CAA相关炎症(CAA-ri)患者中罕有报道。

非创伤性急性凸面蛛网膜下腔出血(cSAH)是脑淀粉样血管病(CAA)的常见表现,但在CAA相关炎症(CAA-ri)患者中罕有报道。

我们报道一例89岁女性的神经影像学表现,该患者有1个月的视幻觉,定向障碍和易激惹。脑MRI(图A-F)可见双侧半球播散性皮质表面含铁血黄素沉积,脑微出血和非对称性白质高信号。右侧顶叶还可见亚急性cSAH,伴蛛网膜下腔弥散受限和强化。

患者符合CAA-ri诊断标准,并接受静脉注射甲基强的松龙治疗,临床和影像学表现改善(图G)。



(图:磁敏度加权成像[SWI]可见凸面蛛网膜下腔出血[红箭,A];可见蛛网膜下腔强化[B]和FLAIR上不对称白质高信号[C];右侧顶叶弥散限制病灶[绿箭,D-E);SWI上亦可见脑皮质微出血[黄箭,F];皮质类固醇激素治疗后,右侧顶叶白质高信号消退[G])

原始出处:Theodorou A1, Lachanis S2, Alexopoulos P2, et al. Teaching NeuroImages: Acute convexity subarachnoid hemorrhage: An underrecognized presentation of CAA-ri. Neurology. 2019 Jul 30;

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    2020-01-18 晓辰
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    2020-03-09 yinhl1978
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    2019-08-14 huangdf