Neurology: 前哨性头痛发作前和发作期间的高分辨MRI证实动脉瘤壁出血

2020-09-03 zyx整理 神经科病例撷英拾粹

48岁女性,表现为进行性头痛,行3T脑MRI证实存在20mm未破裂的囊状基底动脉瘤。

48岁女性,表现为进行性头痛,行3T脑MRI证实存在20mm未破裂的囊状基底动脉瘤。高分辨血管壁MRI可见慢性壁血栓和周围动脉瘤壁强化(图),这是动脉瘤不稳定的影像学标志。2天后,患者出现了短暂的雷击样头痛,被认为是有史以来最严重的头痛。复查3T MRI可见急性壁出血,无蛛网膜下腔出血。在动脉瘤破裂前1/4的患者报告有前哨性头痛(sentinel headache),可解释为蛛网膜下腔渗出或结构性壁改变(如拉伸或急性壁出血)的警示。

(图:A:磁共振血管成像可见巨大的基底动脉尖动脉瘤;在前哨性头痛发作前[B-C]和发作期间[D-E]进行的高分辨血管壁成像之间的比较表明,动脉瘤壁血肿可表现为T1新月型高信号和强化[箭],以及可见增厚的环状动脉瘤壁强化;F-G:动脉瘤弹簧圈栓塞前后的数字减影血管造影成像)

原始出处:Ait Chalal R, Edjlali M, Ben Hassen W, et al. Teaching NeuroImages: High-resolution MRI before and during a sentinel headache demonstrates aneurysm wall hemorrhage. Neurology. 2020 Jul 14;95(2):e224-e225. 

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