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目的 探讨Moyamoya病脑出血与侧支循环的关系。资料与方法 分析 37例脑出血型Moyamoya病患者的临床资料及DSA、MRA、MRI和CT结果。结果 全部病例在DSA和MRA像上均显示颈内动脉分叉以上狭窄或闭塞 ,其中双侧病变 2 5例 ,单侧 12例。在 6 2个病变侧中 ,5 3侧基底节区可见异常血管网形成 ,其中丰富者 43侧 ,较少者 10侧 ,极少或没有者 9侧。 32个病变侧显示扩张的软脑膜吻合支 ,后交通动脉增粗 2 3支 ,眼动脉增粗 2 6支 ,通过前交通动脉供血 5侧。所有造影像上均未见血管造影可显示的动脉瘤。在MRI和CT像上显示基底节脑出血 12例 ,脑叶内出血 7例 ,丘脑出血 2例 ,蛛网膜下腔出血 6例 ,脑室内出血 10例。脑出血以突发头痛、神志不清、失语、偏瘫为主要症状。结论 Moyamoya病临床表现与其侧支循环有密切关系。丰富的侧支循环对脑循环起重要代偿作用 ,可以保护缺血的脑组织 ;另一方面 ,如果异常扩张的侧支血管破裂 ,可引起脑出血。笔者认为Moyamoya病脑出血与其丰富的侧支循环关系密切 ,基底节、丘脑及脑室出血与脑底异常血管网有关 ,脑叶内出血可能与扩张的软脑膜吻合支破裂有关。而这两种侧支血管破裂均可引起蛛网膜下腔出血。
Objective To investigate the relationship between cerebral hemorrhage and collateral circulation in Moyamoya disease. Materials and Methods Clinical data and DSA, MRA, MRI and CT findings of 37 patients with cerebral hemorrhage with Moyamoya disease were analyzed. Results All the cases showed stenosis or occlusion of internal carotid bifurcation on DSA and MRA images, including 25 cases of bilateral lesions and 12 cases of unilateral lesions. Of the 62 lesions, abnormal vascular networks were found in 53 basal ganglia, with 43 on the rich side, 10 on the lesser side, and 9 on the less. Thirty-two lesions showed dilated leptomeningeal branches, 23 thickening of the communicating artery, 26 thickening of the ophthalmic artery, and 5 flares through the anterior communicating artery. Angiography showed no aneurysm on all the images. 12 cases of basal ganglia hemorrhage, 7 cases of intracerebral hemorrhage, 2 cases of thalamic hemorrhage, 6 cases of subarachnoid hemorrhage and 10 cases of intraventricular hemorrhage were shown on MRI and CT images. Intracerebral hemorrhage with sudden headache, confusion, aphasia, hemiplegia as the main symptoms. Conclusion The clinical manifestations of Moyamoya disease are closely related to collateral circulation. Abundant collateral circulation plays an important compensatory role in cerebral circulation, can protect ischemic brain tissue; the other hand, if the abnormal expansion of collateral vessels rupture, can cause cerebral hemorrhage. I believe that Moyamoya disease cerebral hemorrhage and its rich collateral circulation are closely related to the basal ganglia, thalamic and ventricular hemorrhage and abnormal brain network vascular network, intracerebral hemorrhage may be related to the expansion of the anastomotic plexiform rupture. Both of these collateral vessels can cause subarachnoid hemorrhage.