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DAVF?
和這個類似

1.MoyaMoya:ivy征
http://www.rhammer.cn/forum/view.asp?id=3220
2.Sturge-Weber綜合癥
http://www.rhammer.cn/forum/view.asp?id=3901
3.DAVF

如果是硬腦膜動靜脈漏（DAVF），如何解釋患者的白質(zhì)腦??？

應(yīng)該是典型的MoyaMoya病的ivy征（常青藤征）
看下面是以前收集的一個病例，幾乎一樣：

白質(zhì)腦病+T2相多發(fā)短T2異常信號（血管影，增粗的血管，靜脈可能性大）：硬腦膜動靜脈瘺

下面是一個文獻報道：
Dural arteriovenous fistula mimicking leukoencephalopathy.Neurology 2000;54:1123

A 49-year-old man had headache and fever for 1 month.Neurologic examination showed cognitive dysfunction: recent memory loss, dyscalculia, and disorientation. Muscle stretch reflexes were increased with Babinski signs. Sensory and cerebellar function were normal without meningeal signs. T2-weighted MRI revealed hyperintense signal areas in the internal capsules, globus pallidus, and subcortical white matter regions (A). Normal flow void appearance was not seen in the superior sagittal sinus (A, arrow).Diffusion-weighted imaging also disclosed diffuse hyperintensity in the subcortical white matter. In addition, T1-weighted MRI showed abnormal flow void sign in the cerebellum with gadolinium enhancement (B). Brain MR angiography suggested arteriovenous shunts. Arterial phase of the right external carotid arteriogram indicated dural arteriovenous fistula in the straight and transverse sinus (C). The venous phase of arteriogram demonstrated prominent venous collaterals and congestion in the great vein of Galen, inferior sagittal, and straight sinus (D). The internal carotid angiogram did not define the superior sagittal,transverse, and sigmoid sinus obviously. These images strongly support that perturbation of the venous outflow and sinus thrombosis could induce diffuse brain edema or infarction. Dural arteriovenous fistula occasionally causes a unique distribution of MRI lesions mimicking acute leukoencephalopathy.

圖C提示：右側(cè)頸外動脈直接和橫竇和乙狀竇相通
圖D提示：直竇、下矢狀竇和Galen靜脈顯影。

都是高手，的確就是硬腦膜動靜脈瘺。
從MRI上可以發(fā)現(xiàn)很多血管的流空信號：


補充病史：A 67-year-old woman had in her medical history
an operation for an acoustic neurinoma on the right. She presented
with a rapid cognitive decline.The T2-weighted images
(first two rows) show a diffuse signal increase in the deep white
matter of both cerebral hemispheres.Abnormal flow voids are
visible on the cerebral surface and in the brain parenchyma,
especially in the temporal lobes and in the posterior fossa.The
T1-weighted images after contrast (third and fourth rows) show
extensive enhancement of cortical and parenchymal veins

公布DSA：

Angiography of the patient
presented in Fig. 101.2. Selective
injection of the external carotid artery
(first row, left) shows hypertrophy of
the superficial temporal artery and
middle meningeal artery. Immediate
enhancement of the superior sagittal
sinus is seen, suggesting the presence
of a DAVF. Selective internal carotid
artery injection (first row, right; middle
row, left) shows filling of the artery of
the falx cerebri through a (hypertrophied)
ophthalmic artery (first row,
right).There is early enhancement of
the superior sagittal sinus, consistent
with a DAVF.There is slow passage of
contrast through the brain parenchyma
because of venous congestion,
resulting in a late parenchymal and
venous phase.This is also illustrated
by the poor visibility of peripheral
arteries in the early phase (middle row,
left) and by the “pseudo-phlebitic”
aspect of the brain parenchyma in a
later phase of the angiogram (middle
row, right).After treatment by both an
endovascular approach (selective glue
injections in external carotid branches
feeding the arteriovenous fistula) and
by direct placement of coils in the
superior sagittal sinus (third row, left;
middle row, right), there is a marked
reduction in the size of external carotid
artery branches.The internal carotid
artery injection after treatment shows
abnormal drainage of the brain due to
occlusion of the superior sagittal sinus
(third row, right).The brain is no longer
using the superior sagittal sinus for its
drainage.However the transit time of
contrast is much shorter.The cognitive
symptoms of the patient have disappeared
almost completely

好病例，學習了。

ivy征一例：


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