大脑中动脉分支闭塞表现为动脉瘤一例报告并文献复习

Occluded middle cerebral artery vascular stump mimicking aneurysm： case report and review of literature

目的 报告1例大脑中动脉分支闭塞表现为动脉瘤的病例，以提高对此种疾病的认识。方法患者，男，57岁。以短暂性脑缺血发作（TIA）发病，CTA及DSA显示右侧大脑中动脉起始部闭塞；左侧大脑中动脉相当于分叉部可见囊状突起，双侧大脑中动脉远端血管呈烟雾样改变。予以手术治疗，术中证实此“动脉瘤”为一动脉盲端，未予处理，仅行脑-硬膜-动脉-肌肉血管融合术（EDAMS）。结果术后患者恢复良好，随访至半年时，TIA未发作。结论当大脑中动脉分叉部存在动脉瘤样改变，远端发生烟雾样现象并伴有缺血症状时，要考虑到动脉闭塞形成残端的可能。

Objective The purpose of the current study was to report the stump of an occluded middle cerebral artery （ MCA ） mimicking aneurysm in a case so that the diagnosis could be improved. Methods A 57 - year - old male was admitted to our department due to recurrent onset of transient ischemic attack during the past week. Brain computed tomography angiography （CTA） and digital subtraction angiography （DSA） showed a total obstruction in the fight MCA with moyamoya phenomenon at distal trunks and a protruding lesion in the left MCA bifurcation. The patient was diagnosed with left MCA bifurcation aneurysm on the basis of the neuroimaging findings. Intraoperatively, the lesion was found to be an occluded right MCA stump, and encephalo - duro - arterio - myo - synangiosis （EDAMS） was performed. Results The prognosis was good. The patient remained symptom - free at the 6 - month follow - up. Conclusion The possibility of a vascular stump should be considered when an aneurismal lesion is present at the MCA bifurcation with moyamoya phenomenon at distal trunks in TIA patients.