肺动静脉瘘致青年缺血性脑卒中及偏头痛1例

A case of acute cerebral infarction and migraine caused by pulmonary arteriovenous fi stula

肺动静脉瘘(PAVF)是一种直接将肺循环与体循环连接起来的少见血管畸形。引起反常脑栓塞不伴有遗传性毛细血管扩张症的单纯型PAVF较少见。本文报道1例青年单纯PAVF导致反常性脑梗死患者,该患者因突发失语入院。既往有10余年偏头痛病史,头颅磁共振成像提示脑梗死,对患者完善发泡试验及肺动脉CT血管造影,结果显示为少见的单纯PAVF。治疗上行急诊静脉溶栓治疗和PAVF封堵术后,失语症状消失,偏头痛症状缓解,提示本例PAVF不仅导致脑梗死,也参与患者偏头痛的发病过程。

Pulmonary arteriovenous fistula(PAVF)is a rare vascular malformation directly connecting pulmonary circulation to systemic circulation.Simple PAVF without hereditary telangiectasia(HHT)causing paradoxical cerebral embolism is less common.This article reports a young patient with paradoxical cerebral embolism caused by simple PAVF.The patient was admitted to hospital due to sudden onset of aphasia.She had a history of migraine for more than 10 years.Magnetic resonance imaging(MRI)showed the cerebral infarction.The patient completed contrast transcranial Doppler test and pulmonary artery CTA.The results showed that it was a rare simple PAVF.After the treatment of emergency intravenous thrombolysis and pulmonary arteriovenous fistula occlusion,both the aphasia and migraine symptoms are resolved.It suggests that PAVF in this case not only causes cerebral infarction,but also participates in the pathogenesis of migraine.