PDF(Pubmed)
Abstract：
We present a case of a spontaneous second intraparenchymal hemorrhage (IPH) following patient admission for a traumatic brain injury with an initial traumatic IPH. After a subsequent review of all imaging, it was concluded that the patient had a traumatic middle meningeal associated dural arterial venous fistula (MMAVF) which re-ruptured during admission, and the MMAVF was overlooked as a potential contributor to the initial traumatic IPH for which the patient was admitted. A 49-year old man presented with right temporal IPH following an ATV accident and was found to have a right MMAVF on cerebral angiography. The MMAVF appeared on angiography to be unruptured, and therefore was not immediately treated. Later in admission, the patient suffered a new spontaneous IPH ipsilateral to the MMAVF, suggesting a re-rupture. Endovascular transarterial embolization with ethyl vinyl alcohol resulted in complete obliteration of the MMAVF. The patient tolerated treatment well and went on to make a good recovery as of last post-operative imaging at 8 months. Hence, MMAVFs may be present in the setting of IPH following a traumatic brain injury which warrants maintaining a high level of suspicion and low threshold for intervention as they can cause secondary spontaneous intracranial hemorrhage. The absence of notable subdural or extradural hemorrhage on imaging should not exclude rupture. Transarterial embolization with an ethylene vinyl alcohol copolymer is an effective treatment modality.
摘要：
我们介绍了一例自发性第二次实质内出血（IPH）的病例，该患者因初次创伤性IPH而入院。在对所有成像进行后续检查后，结论是该患者患有创伤性中脑膜相关硬脑膜动脉静脉瘘（MMAVF），在入院期间再次破裂，并且MMAVF被忽略为患者入院的初始创伤性IPH的潜在原因。一名49岁的男子在ATV事故后出现了右颞叶IPH，并在脑血管造影中发现了正确的MMAVF。血管造影显示MAVF未破裂,因此没有立即治疗。在入院后，患者在MMAVF同侧遭受了新的自发性IPH，暗示再次破裂。用乙烯醇进行血管内经动脉栓塞导致MMAVF完全消失。患者耐受治疗良好，并在8个月的最后一次术后影像学检查中恢复良好。因此，MMAVF可能存在于创伤性脑损伤后的IPH中，这需要保持高度怀疑和低干预阈值，因为它们可能导致继发性自发性颅内出血。影像学上没有明显的硬膜下或硬膜外出血，不应排除破裂。用乙烯-乙烯醇共聚物经动脉栓塞是一种有效的治疗方式。
