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초급성 허혈뇌졸중 환자에서 정맥내혈전용해 치료 이후 나타난 고신호강도급성재관류표지자

Hyperintense Acute Reperfusion Marker after Intravenous Thrombolysisin a Patient with Hyperacute Ischemic Stroke

Article information

J Korean Neurol Assoc. 2018;36(4):417-418
Publication date (electronic) : November 1, 2018
doi : http://dx.doi.org/10.17340/jkna.2018.4.38
Jongsoo Kang, MD, Chang Hun Kim, MD, Nack-Cheon Choi, MD, Soo-Kyoung Kim, MD, PhD
Gyeongsang Institute of Health Sciences, Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea
강종수, 김창헌, 최낙천, 김수경
경상대학교 의과대학 신경과학교실 건강과학연구원
Address for correspondence: Soo-Kyoung Kim, MD, PhD Gyeongsang Institute of Health Sciences, Department of Neurology, Gyeongsang National University School of Medicine, 15 Jinju-daero 816beon-gil, Jinju 52727, Korea Tel: +82-55-750-8077 Fax: +82-55-755-1709 E-mail: skkim.stroke@gmail.com
received : May 21, 2018 , rev-recd : July 3, 2018 , accepted : July 3, 2018 .

69세 남자가 3시간 전 시작한 우측 위약감과 언어장애로 내원하여, 신경학적 진찰에서 NIH 뇌졸중척도(National Institutes of Health Stroke Scale, NIHSS)는 5점이었다. 두개내외혈관의 협착은 없었으나(Fig. A), 확산강조영상에서 좌측의 급성기 허혈병변들이 관찰되었다(Fig. B). 재조합조직플라스미노겐활성제(recombinant tissue plasminogen activator, r-tPA) 투여 완료 3시간 이후 생체활력징후 등은 정상이었으나, 의식저하 및 우측 반신의 완전마비가 발생하였다(NIHSS 12점). 증상 악화 3시간째 액체감쇠역전회복영상, T1 조영증강영상, 기울기에코영상에서 좌측 대뇌 반구 피질을 따라 고랑과 수조의 고신호 음영이 관찰되었다(Fig. C). 고신호강도급성재관류표지자(hyperintense acute reperfusion marker, HARM)로 진단하여, 두개내압 및 혈압을 조절하였다[1,2]. 사흘만에 의식을 포함하여 우측마비와 언어장애가 호전되었다. r-tPA혈전용해치료 이후 급격한 임상적 악화와 영상검사에서 재관류손상으로 인한 HARM을 확인하여 이를 보고하고자 한다.

Figure.

Initial MRA, MRI (A, B) and follow up MRI (C) after recombinant tissue plasminogen activator (r-tPA) infusion. (A) Enhanced MRA showed no definite steno-occlusive lesions during IV r-tPA infusion. (B) Initial DWI shows multiple high signal lesions on the left cerebral hemisphere (arrows). (C) Brain MRI, performed 6 hours after IV r-TPA infusion revealed newly appeared hyperintense signal within the whole sulci and cisterns of the left hemisphere on T2 FLAIR, T1-enhanced and GRE images. MRA; magnetic resonance angiography, MRI; magnetic resonance imaging, DWI; diffusion-weighted image, FLAIR; fluid-attenuation inversion recovery, GRE; gradient echo image.

References

1. Köhrmann M, Struffert T, Frenzel T, Schwab S, Doerfler A. The hyperintense acute reperfusion marker on fluid-attenuated inversion recovery magnetic resonance imaging is caused by gadolinium in the cerebrospinal fluid. Stroke 2012;43:259–261.
2. Lee KM, Kim JH, Kim E, Choi BS, Bae YJ, Bae HJ. Early stage of hyperintense acute reperfusion marker on contrast-enhanced FLAIR images in patients with acute stroke. AJR Am J Roentgenol 2016;206:1272–1275.

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Copyright © 2018 Korean Neurological Association

Figure.

Figure.

Initial MRA, MRI (A, B) and follow up MRI (C) after recombinant tissue plasminogen activator (r-tPA) infusion. (A) Enhanced MRA showed no definite steno-occlusive lesions during IV r-tPA infusion. (B) Initial DWI shows multiple high signal lesions on the left cerebral hemisphere (arrows). (C) Brain MRI, performed 6 hours after IV r-TPA infusion revealed newly appeared hyperintense signal within the whole sulci and cisterns of the left hemisphere on T2 FLAIR, T1-enhanced and GRE images. MRA; magnetic resonance angiography, MRI; magnetic resonance imaging, DWI; diffusion-weighted image, FLAIR; fluid-attenuation inversion recovery, GRE; gradient echo image.