第1例征集脉络膜前后动脉相关图片.doc

第1例：征集脉络膜前（后）动脉相关图片Yyzzhh:临床医生定位诊断的时候，经常忽略脉络膜前（后）动脉。现在征集脉络膜前（后）动脉相关图片，让大家对他们有新的认识。 C 原来一直也在思考这个问题，但给人的感觉是临床上变异挺大的！先占个位置! Yyzzhh：先抛砖 D. Axial T2-weighted image(2500/80) reveals the presence of an inhomogeneous mass in the right lateral ventricle. The low signal intensity suggets the presence of calcification and hemorrhage. E. Angiogram of the right internal carotid artery obtained on day 3 demonstrates a hypervascular mass fed from the right anterior choroidal artery (arrows). Yyzzhh：A 9-year-old previously healthy girl was admitted to the Emergency Room with an eight-hour history of sudden onset of severe headache. The pain was pulsatile and bilateral and not accompanied by other symptoms. There is no history of migraine, epilepsy or stroke. Parents reported that soon after the onset of the headache the patient became drowsy for about one hour. No trigger factor was identified. On the neurological examination, the patient was alert and well oriented with no other abnormalities but mild nuchal rigidity.Computed tomography of the brain revealed hemorrhage in the right lateral ventricle (Fig 1) and gadolinium-enhanced magnetic resonance imaging study of the brain disclosed a heterogeneous lesion in the mesial portion of the right temporal lobe, above and inside the temporal horn of the lateral ventricle. The lesion extended until the subependimary area of the trigono of the right ventricle. The lesion was hypointense on T1 and T2-weighted images and enhanced with the contrast. Other hyperintense T1 and T2-weighted images lesions were seen in the right lateral ventricle suggesting bleeding. Magnetic resonance angiography and cerebral angiography disclosed an arteriovenous malformation in part of the choroid plexus, supplied by the anterior choroidal artery (Figs 2 and 3). The AVM was classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2). A surgical procedure was done resulting in an almost complete excis