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IR@PKUHSC  > 北京大学第一临床医学院  > 神经内科  > 期刊论文
学科主题: 神经病学
题名:
反常栓塞导致以隐源性卒中为首发表现的肺动静脉畸形的诊治
其他题名: Diagnosis and treatment of pulmonary arteriovenous malformation with cryptogenic stroke caused by paradoxical embolism as the first manifestation
作者: 孙葳1; 周知1; 孙丽丽1; 刘凤君1; 邢海英1; 杨敏1; 齐丽彤1; 邹英华1; 黄一宁1
关键词: 动静脉畸形 ; 脑梗死 ; 肺动脉 ; 肺静脉 ; 栓塞,反常 ; 超声,多普勒,经颅 ; Arteriovenous malformation ; Brain infarction ; Pulmonary artery ; Pulmonary veins ; Embolism,paradoxical ; Ultrasonography,doppler,transcranial
刊名: 中华神经科杂志
发表日期: 2012
DOI: 10.3760/cma.j.issn.1006-7876.2012.06.013
卷: 45, 期:6, 页:409-413
收录类别: 中国科技核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 分析以隐源性卒中为首发表现的肺动静脉畸形(pulmonary arteriovenous malformation,PAVM)患者的临床和影像学特点,探讨发病机制,总结诊断流程.方法 对2例隐源性卒中患者行经颅多普勒超声( transcranial Doppler,TCD)微泡试验、普通或增强经胸或经食道超声心动图、胸部增强CT、肺血管造影,对PAVM行介入栓塞治疗和术后随访.结果 2例患者经TCD微泡试验发现体内右向左分流,有以下分流特点:持续性分流、早期分流、分流量大、Valsalva动作对分流程度影响很小.确诊1例为PAVM,另1例为PAVM合并卵圆孔未闭.经介入治疗栓塞肺畸形血管.术后复查TCD微泡试验分流较前明显减轻,分别随访3年及1年无临床症状.结论 对于怀疑反常栓塞导致隐源性卒中患者,可行TCD微泡试验筛查体内右向左分流,除较常见的卵圆孔未闭心内分流之外,还应考虑到另一新分流通道——PAVM心外分流的可能. Objective To investigate the clinical and radiological features of the patients with cryptogenic stroke as the first manifestation of pulmonary arteriovenous malformation (PAVM),and to explore the mechanism and summarize the diagnostic strategy.Methods Transcmnial Doppler (TCD) bubble tests,non-contrast or contrast-enhanced transthoracic and transesophageal echocardiography,contrast-enhanced thoracic CT and pulmonary angiography were performed in 2 patients with cryptogenic stroke for the detection of right to left shunt (RLS) and the diagnosis of PAVM.Then interventional catheter embolization of PAVM and postoperative follow-up were arranged.Results TCD bubble tests in these 2 patients showed the following characteristics indicating RLS:spontaneous continuous shunt at rest,earlystage shunt appeared rapidly after injection,considerable large amount of shunt volume as a shower of microbubble,the extent of shunt volume not attenuated by Valsalva Maneuver (VM).One patient was diagnosed as PAVM,the other was PAVM plus patent foramen ovale (PFO).Both patients of PAVM were successfully treated with interventional catheter embolizations.Then TCD bubble test was repeated and showed significantly decreased amount of RLS.They remained asymptomatic during the 3-year and 1-year follow-up.Conclusions In patients with cryptogenic stroke due to suspected paradoxical embolism,TCD bubble test should be performed for screening RLS.Besides PFO,a traditional access to intracardiac shunt,PAVM should be considered as a new access to extracardiac shunt in paradoxical embolism.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/41205
Appears in Collections:北京大学第一临床医学院_神经内科_期刊论文

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作者单位: 1.100034,北京大学第一医院神经内科
2.卫生部中日友好医院干部医疗科
3.100034,北京大学第一医院介入血管外科
4.100034,北京大学第一医院心内科
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