Reversible Cerebral Metabolism Changes Using Proton Magnetic Resonance Spectroscopy in a Patient with Intracranial Dural Arteriovenous Fistula: A Case Report.
Reversible Cerebral Metabolism Changes Using Proton Magnetic Resonance Spectroscopy in a Patient with Intracranial Dural Arteriovenous Fistula: A Case Report.
复制标题
使用质子磁共振波谱检查颅内硬脑膜动静脉瘘患者的可逆性脑代谢变化：病例报告。
DOI：
10.1016/j.wneu.2016.05.058
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发表时间：
2016
影响因子：
2
通讯作者：
Tsuneo Shimizu
中科院分区：
文献类型：
--
作者：
Bikei Ryu;T. Kawamata;Takuma Wakai;Masahiro Shimizu;S. Yagi;Tsuneo Shimizu
背景颅内硬脑膜动静脉瘘（DAVF）患者的静脉充血可能会扰乱大脑代谢，这可能会导致不良的神经系统结果。然而，目前尚无明确的指标来指导 DAVF 病例的脑部评估和治疗选择。我们描述了一名 DAVF 患者，其质子磁共振波谱 (1H-MRS) 结果与临床状态的改善相关。病例描述一名有心肌梗塞病史的老年妇女，出现进行性痴呆、失语和严重头痛。我们在 1 H-MRS 中检测到横乙状窦 DAVF，以及乳酸和 N-乙酰天冬氨酸 (NAA) 水平异常，并通过手术窦骨架化成功治疗了该患者。然而，后续 1 H-MRS 显示乳酸和 NAA 水平的逆转不一致。此外，我们还计算了手术前后的 NAA/肌酐比率，结果显示术后左颞叶、右顶叶和左顶叶区域的比率有所增加。这些增加与患者认知功能的改善同时发生。 结论 1 H-MRS 可用于治疗前检测乳酸水平升高、NAA 水平降低和/或 NAA/肌酐比值降低。这些发现可能表明大脑代谢较差，并需要更积极的治疗。此外， 1 H-MRS 可用于评估保守治疗的效果并指示转向更积极的治疗。
BackgroundCerebral metabolism can be disrupted by venous congestion in patients with intracranial dural arteriovenous fistula (DAVF), which may lead to adverse neurological outcomes. However, there are no clear indicators to guide cerebral evaluation and treatment selection in cases of DAVF. We describe a patient with a DAVF whose proton magnetic resonance spectroscopy (1H-MRS) findings were associated with improvements in clinical status.Case DescriptionAn elderly woman with a history of myocardial infarction presented with progressive dementia, aphasia, and a severe headache. We detected a transverse-sigmoid sinus DAVF, as well as abnormal levels of lactate andN-acetylaspartic acid (NAA) in the1H-MRS, and successfully treated the patient using surgical sinus skeletonization. However, follow-up1H-MRS revealed inconsistent reversals in the levels of lactate and NAA. In addition, we calculated the NAA/creatinine ratios from before and after surgery, which revealed postoperative increases in the ratios for the left temporal, right parietal, and left parietal regions. These increases occurred concurrently with improvements in the patient's cognitive function.Conclusions1H-MRS may be useful for pretreatment detection of increased lactate levels, decreased NAA levels, and/or decreased NAA/creatinine ratios. These findings may indicate poorer cerebral metabolism, and show a need for more aggressive treatment. Furthermore,1H-MRS may be useful for evaluating the effect of conservative treatment and for indicating conversion to a more aggressive treatment.