- 期刊
外傷性顱內假性動脈瘤引起的瀰漫性蜘蛛膜下腔出血診斷與治療－病例報告
Diagnosis and Treatment of Diffuse Subarachnoid Hemorrhage caused by Traumatic Intracranial Pseudoaneurysm- Case Report
摘要
外傷性顱內假性動脈瘤引起的瀰漫性蜘蛛膜下腔出血為一種罕見且危險的情況。腦部動脈瘤常指的是腦部的動脈壁出現異常擴張，形成一個囊狀結構。擴張的動脈壁可能變得薄弱，增加破裂的風險。由於血管壁結構的變弱，無法承受正常的血流壓力，導致血管壁膨出。動脈瘤分為真性動脈瘤與假性動脈瘤。真性動脈瘤（True Aneurysm），其壁由三層血管壁組織構成，在動脈血不斷衝擊下，而動脈血管壁彈性降低，血管壁變薄等等的因素，導致血管壁區域性擴張、膨脹的病變，常見於腹腔主動脈及其分支、頸動脈等血管。然而假性動脈瘤（Pseudoaneurysm）則是因動脈壁破損，動脈血從破口流出形成血腫，並在動脈壓力下形成血腫腔與動脈血管腔連通，多為創傷性、感染性等等的原因造成。此患者為外傷性瀰漫性蜘蛛膜下腔出血的病例，是一名從高處跌落的急診病患。由外院匯入的頭部未施打顯影劑腦部電腦斷層掃描顯示硬腦膜外出血、瀰漫性蜘蛛膜下腔出血、左上頜骨和顏面骨骨折。由於瀰漫性蜘蛛膜下腔出血較多數與腦動脈破裂有關，腦神經外科醫師懷疑可能是顱內腦動脈瘤破裂引起，立即安排進行施打顯影劑頭頸部電腦斷層影像檢查，並由頭頸部血管電腦斷層動脈攝影（CTA）診斷出基底動脈的血管剝離和假性動脈瘤。所以安排患者接受頭頸部介入性血管攝影診斷與治療。介入性血管攝影診斷確認左側椎動脈連接處的假性動脈瘤，並由放射診斷科醫師立即進行血管介入治療，於假性動脈瘤位置用三個線圈以栓塞假性動脈瘤的血流並實施止血。線圈栓塞後，在介入性血管攝影儀器下施打顯影劑檢查，並確認假性動脈瘤已完全栓塞，無異常出血。在外傷性引起的顱內假性動脈瘤，介入性血管攝影治療是一種有效、快速且立即性的治療方法，可以迅速阻止血流，改善患者外傷性瀰漫性蜘蛛膜下腔出血情況。
並列摘要
Diffuse subarachnoid hemorrhage caused by traumatic intracranial pseudoaneurysm is a rare and dangerous condition. A brain aneurysm is an abnormal expansion of the artery wall in the brain, forming a sac-like structure. The walls of the dilated artery may become weak, increasing the risk of rupture. Due to the weakening of the blood vessel wall structure, it cannot withstand normal blood flow pressure, causing the blood vessel wall to bulge. Aneurysms are divided into true aneurysms and pseudoaneurysms. The wall of a true aneurysm is composed of three layers of blood vessel wall tissue. Under the constant impact of arterial blood, factors such as reduced elasticity of the arterial blood vessel wall, thinning of the blood vessel wall, etc., lead to regional expansion and expansion of the blood vessel wall. Lesions are common in the celiac aorta and its branches, carotid arteries and other blood vessels. However, pseudoaneurysm is caused by the damage of the artery wall, the arterial blood flows out from the breach to form a hematoma, and the hematoma cavity is formed under the arterial pressure to communicate with the arterial blood vessel cavity. It is mostly caused by trauma, infection, etc. This patient is a case of traumatic diffuse subarachnoid hemorrhage and is an emergency patient who fell from a height. A brain computed tomography scan without contrast agent on the head brought in from an outside hospital showed epidural hemorrhage, diffuse subarachnoid hemorrhage, and left maxillary and facial bone fractures. Since diffuse subarachnoid hemorrhage is mostly related to cerebral artery rupture, the neurosurgeon suspected that it might be caused by a ruptured intracranial cerebral aneurysm and immediately arranged for a head and neck computed tomography examination with contrast agent and a head and neck examination. Vascular computed tomography arteriography (CTA) diagnosed vascular dissection and pseudoaneurysm of the basilar artery. Therefore, the patient was arranged to receive interventional angiography diagnosis and treatment of the head and neck. Interventional angiography diagnosed a pseudoaneurysm at the junction of the left vertebral artery, and a diagnostic radiologist immediately performed vascular interventional treatment. Three coils were used at the position of the pseudoaneurysm to embolize the blood flow of the pseudoaneurysm and Implement hemostasis. After coil embolization, contrast agent was used for examination under interventional angiography equipment, and it was confirmed that the pseudoaneurysm had been completely embolized and there was no abnormal bleeding. For intracranial pseudoaneurysms caused by trauma, interventional angiography is an effective, fast and immediate treatment method that can quickly stop the blood flow and improve the patient's traumatic diffuse subarachnoid hemorrhage.