脑动静脉畸形栓塞术后迟发性脑炎1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.02.013

摘要/Abstract

摘要：

目的探讨栓塞材料相关性脑炎这一罕见不良反应的诊断和治疗。方法回顾性分析脑动静脉畸形(brain arteriovenous malformations,BAVM)栓塞术后出现迟发性脑炎患者1例,并复习相关文献。结果患者男性,52岁,BAVM栓塞术后1个月内先后出现全身皮疹及左侧肢体无力,抗病毒治疗无效,排除其他疾病后考虑患者为栓塞材料相关的迟发性脑炎,经激素治疗后患者痊愈。结论血管内栓塞治疗可诱发严重的中枢神经系统迟发性炎症反应,有必要对患者延长术后随访期限。

关键词: 颅内动静脉畸形, 脑炎, 栓塞治疗

Abstract:

Objective To investigate the diagnosis and treatment of the rare embolic material-associated encephalitis. Methods Clinical data of a patient with delayed encephalitis after embolization of brain arteriovenous malformations (BAVM) were analyzed retrospectively, and the relevant literature was reviewed. Results The 52-year-old male patient with BAVM developed systemic rash and left-sided weakness within 1 mouth after embolization. The symptoms were gradually worsen after antiviral infection. After excluding other diseases, the patient was considered as delayed encephalitis associated with embolic materials, who was cured by a hormone therapy. Conclusion Endovascular embolization can induce severe delayed inflammatory response in the central nervous system. It is necessary to prolong the postoperative follow-up period of patients.

Key words: intracranial arteriovenous malformations, encephalitis, embolization

中图分类号:

R743.4

董思语, 孙美, 田宇飞, 程虹, 何川. 脑动静脉畸形栓塞术后迟发性脑炎1例并文献复习[J]. 临床荟萃, 2023, 38(2): 170-174.

Dong Siyu, Sun Mei, Tian Yufei, Cheng Hong, He Chuan. Delayed encephalitis after embolization of brain arteriovenous malformations: A case report and literature review[J]. Clinical Focus, 2023, 38(2): 170-174.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.02.013

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I2/170

图/表 1

图1 患者治疗前后影像学对比 a. 头颅CTA示右侧顶叶动静脉畸形栓塞术后,可见残余AVM。右侧大脑前动脉(ACA)迂曲扩张,多发动脉瘤;b. 头颅MRI示术区可见团块状混杂信号影,邻近脑实质见片状长T2水肿区(箭头所示水肿区);c. 出院1个月后复查示原脑水肿区已基本消失(箭头所示)

Fig. 1 Imaging comparison before and after treatment a. Cranial CTA showed residual AVM after embolization of right parietal arteriovenous malformation. The right anterior cerebral artery (ACA) was tortuously dialted with multiple aneurysms; b. Cranial MRI showed mass mixed signal shadow and long T2 edema area adjacent to the cerebral parenchyma (shown by arrow); c. Reexamination 1 mouth after discharge showed that the procerebral edema area had basically disappeared (shown by arrow)

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