2025年 · 第105卷第05期

The patient was a 32-year-old female, Han nationality. He was admitted to Linyi Maternal and Child Health Hospital (the First Affiliated Hospital of Shandong Medical College) due to "repeated dizziness for more than 10 years and 2 days again". Past history: history of repeated "urinary tract infections"; Deny history of hypertension and diabetes; Family history denied. Physical examination and laboratory tests showed no significant abnormalities. Cranial MR: No normal MCA shape was seen in the running area of the right middle cerebral artery (MCA), and there were multiple tortuous plexiform small vessels (Figure 1); There were no abnormalities in the left internal carotid artery and MCA (Figure 2). DSA: The main trunk of M1 segment of right MCA was replaced by plexiform and reticular small vessels, and the distal vessels of M2 segment were roughly normal (Figure 3), and no extracranial-intracranial compensated blood supply was observed; There were no abnormalities in the left internal carotid artery and MCA, and the anterior communicating artery was open. According to young women, cerebral angiography showed: (1) right MCA occlusion; (2) The proximal end of right M1 is replaced by a plexiform vascular network, and the abnormal blood vessel is located in the subarachnoid space and runs parallel to M1; (3) The lenticulostriate artery originates from the plexiform vascular network; (4) The M2 segment is roughly normal in the form of distal vessels, with anterior blood flow and normal cortical branches; (5) The blood flow at the distal end of MCA is reduced, the anterior cerebral artery and posterior cerebral artery are compensated by meningeal branches, and there are no extracranial-intracranial collaterals. Diagnosis: shoot-like/reticular MCA (grade II). There were no changes in 2-year MRA follow-up and no cerebrovascular events. Shoot-like/reticular MCA is rare, and it is important to differentiate shoot-like/reticular MCA from moyamoya disease (MMD) when occlusive changes in MCA are found on MRA and CTA, or abnormal compensatory vessels are found on DSA, so as to avoid unnecessary interventional or surgical treatment.