• suffered from paroxysmal dizziness, slurred speech accompanied with right limb weakness (V-) 6 months, with the sequela of right hand inflexibility. Though antiplatelets were taken, recurrent TIA remained.
• EMG shows possible nerve damage. Local hospital MRI confirmed left parietal infarctions. CTA visualized Left M2 segment severe stenosis.
• Past medical history: HTN for 15 years, well-controlled. No DM or alcohol consumption, smoking for 30 years and quitting for 4 months. History of gastric bleeding and fecal occult blood positive, so Aspirin was ceased.
• Medication: Cilostazol, Clopidogrel, Atorvastatin, Felodipine Sustained-Release Tablets, Tamsulosin Sustained-Release Capsules, Finasteride.
• NE: inflexible right hand.
• 主诉:发作性头晕、言语不清伴右侧肢体无力(V-)6月,遗留右手不灵活。尽管口服双抗,仍有反复发作性TIA。
• 外院肌电图提示神经损伤可能。当地医院头颅MRI提示左侧顶叶脑梗死,CTA提示左侧大脑中M2段重度狭窄。
• 既往史:高血压15年,平素血压控制好;否认糖尿病及饮酒史,吸烟30年戒烟4月。胃出血病史,服用阿司匹林后血便隐血阳性,故停用阿司匹林。
• 药物:西洛他唑,氯吡格雷,非洛地平缓释片,坦索罗辛缓释片,非那雄胺。
• 神经查体:右手不灵活。
Figure 1. DWI revealed acute infarctions on the left parietal lobe.图 1. DWI提示左侧顶叶急性脑梗死。
Figure 2. CTA depicted left middle cerebral artery M2 segment severe stenosis with no calcification.图 2. CTA提示左侧大脑中动脉M2段重度狭窄,狭窄处未见明显钙化。
Figure 3 GIF. SWI did not demonstrate obvious microhemorrhage.图 3 GIF. SWI未见明显微出血。
Figure 4 GIF. HR MRI showed the stenotic vascular wall significant enhancement.图 4 GIF. 高分辨MRI提示左侧大脑中动脉狭窄段管壁明显强化。
Figure 5. No obvious hypo-perfusion was detected on CTP.图 5. CTP未见明显低灌注。
Figure 6. No stenosis was observed from bilateral vertebrate arteries and basilar artery.图 6. 双侧椎动脉及基底动脉未见狭窄。
Figure 7. Left internal carotid artery cervical segment and right internal carotid artery did not demonstrate obvious stenosis.图 7. 左侧颈内动脉颈段及右侧颈内动脉未见明显狭窄。
Figure 8 GIF. Angiography revealed the left middle cerebral artery M2 segment severe stenosis.图 8 GIF. 造影证实左侧大脑中动脉M2段重度狭窄。