183.A Case Review Series : Case3

Case3

Bilateral Petrous Apex ICA Aneurysms, Partially Thrombosed

双侧岩尖部颈内动脉瘤，部分形成血栓

Clinical

May present with sensorineural hearing loss (most common), cranial neuropathy，pulsatile tinnatus，epistaxis, stroke

Underlying causes (i.e. connective tissue disorder) are atypical

Possible causes of acquired aneurysm: radiation therapy to the skull base, prior trauma, skull base infection

Important to evaluate for additional intracranial aneurysms, especially with those suspected to be congenital

临床表现：可能表现为感觉神经性耳聋（最常见），颅内神经性疾病，搏动性耳鸣，鼻出血，卒中。潜在病因（比如结缔组织病）不是很典型。获得性动脉瘤的可能病因包括：颅底的放射治疗、创伤、颅底感染等。评估颅内伴随的动脉瘤很重要，特别是怀疑其为天生性时。

Imaging

CT: Osseous erosion, curvilinear calcification, enhancement

MRI: T1 and T2 heterogeneous, may see a swirl pattern on T2, clot may bloom on GRE, enhancement

CTA preferred diagnostically; MRA can demonstrate hyperintense T1 signal with cholesterol granuloma that appears as flow-related signal

CT：骨质破坏、曲线样钙化、有强化。 MRI：T1T2信号混杂，T2可见“漩涡征”，血凝块在GRE上可呈“开花征”，有强化。

CTA可进一步明确诊断，MRA中病灶T1号信号，伴低信号的胆固醇肉芽肿。

DDx: Cholesterol granuloma, fibrous dysplasia, encephalocele, petrous apicitis

鉴别诊断：胆固醇肉芽肿、纤维发育不良、脑膨出、岩部根尖炎。

Tx: Balloon trapping, stent placement, sacrifice of ICA with ECA to MCA bypass

治疗：球囊诱捕、支架置入、夹闭颈内动脉并建立颈外动脉到大脑中动脉旁路。

Notes：

1. Petrous Apex [ˈpɛtrəs ˈepɛks] 岩尖部

2. ICA Internal Carotid Artery 颈内动脉

3. Aneurysm [ˈænjəˌrɪzəm] n. 动脉瘤

4. Thrombose [θrɒm'boʊz] v.（使）形成血栓

5. sensorineural [ˌsensəri:'njʊrˌsensəri:'nʊrəl] adj. 感觉神经的

6. cranial [ˈkreniəl] adj. 颅骨

7. pulsatile tinnatus ['pʌlsətəl] [tɪˈnaɪtəs, ˈtɪnɪ-] 搏动性耳鸣

8. epistaxis [ˌepɪ'stæksɪs] n. 鼻出血，鼻衄

9. cholesterol [kəˈlestərɔ:l] n. 胆固醇

10. granuloma [ˌgrænjə'loʊmə] n. 肉芽肿

11. dysplasia [dɪs'pleɪʒə] n. 发育异常，发育不良

12. encephalocele [en'sefəloʊˌsi:l] n. 脑膨出

13. apicitis [æpɪ'sɪtɪs] 根尖炎

来源：每天朗读一段医学影像学英语文章