脉络膜前动脉

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。Chinastroke: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.AxialT2-weightedimage(2500/80)revealsthepresenceofaninhomogeneousmassintherightlateralventricle.Thelowsignalintensitysuggetsthepresenceofcalcificationandhemorrhage.E.Angiogramoftherightinternalcarotidarteryobtainedonday3demonstratesahypervascularmassfedfromtherightanteriorchoroidalartery(arrows).Yyzzhh：A9-year-oldpreviouslyhealthygirlwasadmittedtotheEmergencyRoomwithaneight-hourhistoryofsuddenonsetofsevereheadache.Thepainwaspulsatile['pʌlsətail]脉动的,悸动的,跳动的andbilateralandnotaccompaniedbyothersymptoms.Thereisnohistoryofmigraine['maigrein]偏头疼,epilepsyorstroke.Parentsreportedthatsoonaftertheonsetoftheheadachethepatientbecamedrowsy[ˈdrauzi]昏昏欲睡的foraboutonehour.Notriggerfactorwasidentified.Ontheneurologicalexamination,thepatientwasalertandwellorientedwithnootherabnormalitiesbutmildnuchal['nju:kəl]项的,颈背的rigidity.[riˈdʒidəti]固执，坚定，僵化Computedtomographyofthebrainrevealedhemorrhageintherightlateralventricle(Fig1)andgadolinium-enhancedmagneticresonanceimagingstudyofthebraindisclosedaheterogeneouslesioninthemesial['mi:ziəl]中央的,中间的portionoftherighttemporallobe,aboveandinsidethetemporalhornofthelateralventricle.Thelesionextendeduntilthesubependimaryareaofthetrigonooftherightventricle.ThelesionwashypointenseonT1andT2-weightedimagesandenhancedwiththecontrast.OtherhyperintenseT1andT2-weightedimageslesionswereseenintherightlateralventriclesuggestingbleeding.Magneticresonanceangiographyandcerebralangiographydisclosedanarteriovenousmalformationinpartofthechoroidplexus,suppliedbytheanteriorchoroidalartery(Figs2and3).TheAVMwasclassifiedaccordingtoSpetzlergradingsystemasgrade3(deepvenousdrainage:1;eloquencearea:0andsize:2).Asurgicalprocedurewasdoneresultinginanalmostcompleteexcision[ek'siʒən]切除,删除,切除之物oftheAVMandwithoutsequelae[si'kwi:li:]后遗症,结局.Thepatientremainsasymptomaticafteroneyearoffollow-up.ThisreportwasapprovedbytheHospitalEthicsCommitteeandherparentssignedtheinformedconsent.Yyzzhh：Quote:以下是引用潜水换气于2007-9-321:10:48的发言脉络膜前动脉，1～4支，以3支最多，为一组较细小而恒定的血管，在后交通动脉起始远侧2mm处由颈内动脉脉直接发出。该动脉在未穿入侧脑室下脚之前，除发1～3个皮质支外，还发出2～3个穿支，1支穿视神经内侧至大脑脚，另两支即为纹状体内囊动脉。此动脉主要营养尾状核尾，行程长，管径较小，易发生栓塞。脉络膜后动脉，多为1支，占81%。该动脉恒定地平大脑脚外侧面从大脑后动脉外侧段发出，向外行，进入海马裂至侧脑室下脚，形成脉络丛，由丛发支至尾状核Yyzzhh:：Angiogramsobtainedina49-year-oldwomanpresentingwithaHuntandHessGradeIIISAH.Theaneurysmthathadrupturedcouldnotbeidentified.Allaneurysmsweretreatedinonesessiontopreventmistakentreatmentofonlytheunrupturedaneurysms.UpperLeft:LeftICAangiogramrevealinganeurysmsattheanteriorchoroidalartery(arrow),theICAbifurcation(openarrow),andthepericallosalartery(curvedarrow).UpperCenter:RightICAangiogramdemonstratingadditionalaneurysmsatthePCoA(arrow)andtheACoA(openarrow).UpperRight:LeftICAangiogramrevealingGDCsinthethreeleft-sidedaneurysms.LowerLeft:RightICAangiogramrevealingGDCsinthetworight-sidedaneurysms.LowerRight:Unsubtractedangiogram,anteroposteriorview,revealingGDCsinthefiveaneurysms.Yyzzhh::SelectivelateralvertebralangiogramidentifyingtheposteriorchoroidalarterysupplytoanintraventricularAVM.TheAVM(outlinedbyarrows)containsavenousaneurysm(V).ThisAVMhadpresentedwithanintraventricularhemorrhageandwasidentifiedbyselectiveangiography.Yyzzhh:A:PericallosalArteryB.AnteriorCerebralArteryC.MiddleCerebralArteryD.AnteriorChoroidalArteryE.OphthalmicArteryF.InternalCarotidArteryG.PosteriorCerebralArteryYyzzhh:你能从里面找到脉络膜前动脉吗？Yyzzhh:高山流水：多好的图片,感谢斑竹的辛勤耕耘.Yichaoqi:Yyzzhh:从外院转来实例一个，当地进行了动脉瘤夹闭术患者SAH，DSA提示后交通动脉瘤，从瘤体上发出脉络膜前动脉和胚胎性大脑后动脉。上图：术前的DSA。红圈代表脉络膜前动脉，箭头为后交通动脉瘤，可以看到从瘤体上发出脉络膜前动脉和胚胎性大脑后动脉下图：动脉瘤夹闭术后，箭头区域猜测应该是脉络膜前动脉供血区，框区为胚胎性大脑后动脉分布区。DOC80:脉络膜前动脉梗死稀里糊涂：都很漂亮，发一个特别的。脉络膜前动脉夹层：A：左侧内囊后肢梗死B:动脉瘤样扩张C：动脉瘤样扩张D：静脉期造影剂滞留E：发病118天时，DSA提示夹层消失F：静脉期没有发现造影剂滞留G：1年后，没有发现动脉瘤Yyzzhh:我很久前发的帖子，今天又被翻出来了。贡献一个精彩的:BasalviewofbrainaftertransversesectionofmidbrainandpartialexcisionoflefttemporallobetoshowmagnifiedportionsinFigure2(rectangleA)andinFigure4(rectangleB).Theopticchiasm(1).Theinternalcarotidartery(2).Theleftanteriorchoroidalartery(3).Themiddlecerebralartery(4).Theoptictract(5).Thehypothalamus(6).Thebasilarartery(7).Thecerebralpeduncle(8).Thetegmentum(9)andtheinferiorcolliculi(10)ofthemidbrain.Thepulvinar(11).Thelateralgeniculatebody(12).Thechoroidplexus(13)oftheinferiorhornoftheventricle.BasalviewofleftAChA(1)whichfollowstheoptictract(2).TheAChAgivesofffourperforatingbranches(3through6).Thefirstperforator(3)dividesintotwobranches(arrows).Thesecondone(4)entersthebrainjustmedialtotheoptictract.Thethirdperforator(5)representsthecapsulothalamicartery.Thefourthperforator(6)givesofftwotwigs(arrowheads)tothecerebralpeduncle(7).Thepremammillaryartery(8).Thecaudomedialpartoftheanteriorperforatedsubstance(9).TheopticbranchesoftheAChA(10).(ThemagnifiedpartcorrespondstorectangleAinFigure1).MedialandslightlyobliqueviewoftherightAChA(1)ofvascularcast.Noteperforatingbranch(2)arisingclosetotheAChAorigin;remainingperforators(arrows);anduncalbranch(arrowhead).Internalcarotidartery(3)anditsperforators(4).Basalviewofalarg