Nontraumatic intracranial internal carotid artery dissection: A case report

The case presented offers a demonstration of a rare yet devastating condition that may go unrecognized and incompletely worked up by the emergency physician. Internal carotid artery dissection is seen most often in previously healthy, young patients and thus all efforts toward diagnosing this condition and providing proper stabilization must be made. Unfortunately, little advancement in the therapeutic progress of this frequently fatal condition has been made over the past decades. To date, both medical management and surgical techniques have been utilized with variable success. This case should serve to remind physicians evaluating young patients with stroke symptoms or other neurological findings that a negative head CT scan may not be the last test necessary for the definitive diagnosis.     

超声漏诊主动脉夹层1例

患者,男,38岁,11小时前于睡眠中突然出现胸背疼痛,呈撕裂样,伴大汗,向双肩及腰部放射,持续不缓.既往高血压病3年,最高180/120 mmHg.体格检查:BP 160/110 mmHg,HR110次/分.临床诊断:高血压病极高危组,2型糖尿病.超声心动图所见:各房室腔大小正常,左室壁增厚,室壁运动正常.主动脉窦部增宽,升主动脉及主动脉弓降部内径正常,管腔内未见明显异常回声.彩色多普勒示主动脉管腔内血流信号充盈良好.     

Cerebral microembolism and extracranial internal carotid artery dissection.

Although extracranial ICA dissection is recognized as a cause of cerebral infarction, 1-3 the pathogenesis of ischemic symptoms in an individual patient with the condition is not always understood, making treatment decisions difficult. We describe a patient with traumatic cervical ICA dissection diagnosed on the basis of noninvasive tests, in whom TCD ultrasonography was used to detect ipsilateral distal microembolization associated with clinical deterioration.     

长节段颈内动脉夹层动脉瘤1例

病例女,38岁,因反复发作右侧肢体活动不灵伴左侧头痛1周入院。1周前晚间大量饮酒后跌倒,出现短暂意识丧失,清醒后出现右侧肢体活动不灵、言语笨拙。急诊行头颅CT未见异常,给予扩张血管药半小时后症状完全缓解。3d前上述症状再次发作并伴有头左侧颞部剧烈胀疼,恶心,呕吐数次为胃内容物,半小时后症状完全缓解,复查头颅CT并行头颅MRI均未见异常。     

Contrast‐enhanced transoral carotid ultrasonography for the diagnosis and follow‐up of extracranial internal carotid artery dissection: A case report

A 56‐year‐old woman was admitted to our hospital because of amaurosis fugax. The carotid angiogram showed irregularly stenotic lesions of the left and right internal carotid arteries (ICAs), suggestive of dissection. Follow‐up evaluation was performed by transoral carotid ultrasonography (TOCU) with contrast enhancement (CE), which yielded better vessel lumen and intramural hematoma visualization than color Doppler imaging. CE‐TOCU is useful for evaluating ICA dissections that extends to the high cervical portion.     

超声诊断钝性外伤致颈动脉全层夹层1例

病例男,30岁.否认高血压、糖尿病及心脏病史,无吸毒冶游史,因左颈部被重物撞击而就诊,当时感左颈部疼痛,无头痛、肢体活动障碍及呼吸困难等.查体:生命体征稳定.左侧颈部稍肿胀,表皮破溃不明显,可触及震颤在,并闻及血管杂音,神经系统检查阴性.     

Hybrid surgery for symptomatic chronic complete occlusion of the internal carotid artery: A case report

Currently, there are antiplatelet drugs, extracranial-intracranial (EC-IC) vascular bypass, carotid endarterectomy (CEA), endovascular intervention (EI), and other revascularization procedures for symptomatic chronic internal carotid artery occlusion (CICAO). In consulting the literature, we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment. We reported the case of a 50-year-old male patient with blurred vision, headache, and weakness in the right upper limb. After the exclusion of other neurological diseases, he was diagnosed with symptomatic CICAO; the occlusion segment was long and the stump was too short. We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting. After 6 months of follow-up, computed tomography angiography (CTA) confirmed that the left internal carotid artery was unobstructed, and the symptoms were relieved. A brief review of the literature is presented in addition to this report.     

Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report

Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China. Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke. Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion. Medical management is regarded as the standard treatment for this disease. With the development of endovascular treatment, some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy. We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery. Simple balloon angioplasty was performed, and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications. At 4 months follow-up, the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically. In addition, we briefly reviewed the relevant literature.     

先天性颈内动脉发育不良1例报告

先天性颈内动脉发育不良是一种非常罕见的疾病,通常无任何症状,但后期可出现与脑血管供血不足相关的症状.先天性颈内动脉发育不良的诊断主要依靠影像学检查,本文报道了1例因车祸外伤意外发现的左侧先天性颈内动脉发育不良患者的影像学特点,旨在提高介入科、神经外科及影像科医师对本病的认识,避免误诊或漏诊.     

主动脉夹层累及颈动脉导致脑梗死1例

病例女,49岁,工人.因发作性胸闷、气短1年,加重1周入院.患者剧烈咳嗽后突然昏迷,持续10min左右,醒来后发现左侧肢体偏瘫就诊.否认梅毒病史,无家族遗传病史.     

Bilateral spontaneous internal carotid artery dissection with both early and very late recanalization: A case report

Spontaneous bilateral internal carotid artery dissection has frequently been described in the literature as a cause of stroke. In more than half of the patients with internal carotid artery dissection, recanalization occurs early after the event and is unusual later than 6 months after onset of the dissection. We describe a patient with ischemic stroke due to left internal carotid artery occlusion in the extracranial segment. The patient was treated with anticoagulants and early vessel recanalization did not occur. Ten months later, he developed contralateral internal carotid occlusion in the intracranial tract, which was followed by early complete recanalization. Anticoagulation therapy was continued and, 16 months after the initial event, the left internal carotid artery unexpectedly also reopened.     

颈内动脉先天缺如1例

患者男,47岁。阵发性头痛、左下肢麻木2周,伴阵发性右下肢无力、右眼疼痛1周。症状于平卧时可明显减轻。体格检查:右半身少汗。既往高血压史20年,糖尿病史4年。颈部3DCE-MRA显示左颈总动脉直接延续为颈外动脉,颈内动脉残迹未见确切显示(图1A)。头部3D TOF MRA显示左侧大脑前动脉和大脑中动脉分别由右侧大脑前动脉、左侧大脑后动脉通过前交通动脉和后交通动脉供血(图1B、C)。颅底CT薄扫:左侧颈动脉管未见显示(图1D)。讨论本例先天性颈内动脉缺如通过MRA和颅底CT检查做出诊断。MRA能显示颈内动脉缺如、颅内侧支循环及可能存在的其…     

Left internal carotid artery agenesis with trans-sellar collateral and a right aortic arch: Case report

We present a case of unilateral internal carotid artery (ICA) agenesis with trans-sellar anastomosis associated with a right aortic arch, and discuss the embryonic development and clinical implications of this condition. A 26-year-old woman without significant medical history was referred to our hospital complaining of tinnitus. She denied any other symptoms, and examination did not reveal any other neurological deficits. Radiological examinations showed agenesis of the right ICA with trans-sellar anastomosis, and a right aortic arch. This vascular configuration reflects the anatomical homology with avian vascular structure. Recognition of this anomaly has important implications for clinical situations, such as the planning of carotid or transsphenoidal surgery, the management of thromboembolic disease, and the surveillance and detection of associated cerebral aneurysms.     

右侧颈总动脉走行扭曲合并颈内静脉血栓形成超声表现1例

患者女,43岁,因"头痛、右侧颈部触及搏动性包块"接受颈部血管超声检查采用Sequoia512超声诊断仪,高频探头15L8W、10.0 MHz进行探测,见右侧颈总动脉下段自头背干发出向上走行约2.4 cm,之后折向下行1.7 cm后再折向上走行,呈"S"型折叠,折叠段管腔未见明显增宽和狭窄段,折叠段局部管壁可见稍强回声附着,该处可见血流信号充盈缺损.使用4C1探头3.5 MHz,VA条件探查见折叠段管腔内可探及血流信号(图1),部分为涡流.