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Neurology:病例:见于脑循环停止的视网膜中央动脉振荡波

2020-03-26 zyx 神经科病例撷英拾粹

49岁女性,在严重的颅脑外伤后出现了脑死亡的征象。

49岁女性,在严重的颅脑外伤后出现了脑死亡的征象。基于临床神经系统检查,在大脑功能停止后4小时进行的经颅多普勒(TCD)检查可见脑前循环(图1A)和后循环(未显示)存在振荡波(reverberating flow),提示脑循环停止(CCA)。同时,双侧视网膜中央动脉(CRA)表现出相似的TCD模式(图1B)。

在脑死亡的儿童患者中,已经报道了CRA中CCA的多普勒血流模式。但是,缺少在成年患者中的经验。CRA可以提供一种简单的方法来评估脑前循环中的CCA,在无法通过颅骨获得血流信号时可能十分有用(图2,操作方法)。


(图1:A:右侧[和左侧,未显示]大脑中动脉[MCA]的振荡波;B:右侧[和左侧,未显示]CRA可见与MCA相似的波形)


(图2:A:将线性传感器放在眼球上方的轴向位置,使眼睑闭合并用大量凝胶覆盖;B:在彩色多普勒仪中,CRA[a]被标记为红色,表示血流向着眼球[G]移动,而视网膜中央静脉[v]标记为蓝色,表示血流从眼球离开;C:在频谱多普勒仪中,CRA通常显示低阻力速度波形[以顺行通道表示],而视网膜中央静脉存在相流[phasic flow][以逆行通道表示])

原始出处:Blanco P, Menéndez MF, Figueroa L. Reverberating flow pattern in the central retinal artery in cerebral circulatory arrest.Neurology. 2020 Feb 11;94(6):276-277.

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    2020-08-03 yinhl1978
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    2020-03-27 zutt

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