縊頸によると考えられる頸部総頸動脈狭窄の1例

A Case of Common Carotid Artery Stenosis due to Hanging

I．はじめに

　鈍的外傷による頸部頸動脈の閉塞で，重篤な脳梗塞をきたした症例の報告はしばしば見られる^4,8）が，外傷に起因する頸部頸動脈の狭窄により，一過性の虚血症候をきたしたという報告は少ない．今回，われわれは，縊頸により頸部総頸動脈の中膜に解離を生じ，一過性脳虚血発作（TIA）を呈した症例を経験したので，文献的考察を加えて報告する．

We report a case of a 50-year-old woman with trauma-tic dissection of the right common carotid artery secon-dary to attempted suicidal hanging. Initial examination showed marks of strangulation on the neck, facial ede-ma, and multiple conjunctival petechiae accompanied by difficulty in breathing and loss of consciousness. She gra-dually recovered except for her left upper limb weak-ness. Rehabilitation, with a diagnosis of left brachial plex-us injury, was started. Two years later, she occasionally felt numbness of the left upper extremity. On her second admission, a bruit was heard on the right side of her neck. Neurological examination did not reveal any change. CT scan showed atrophic changes. Angiography demonstrated approximately 80% stenosis of the right common carotid artery which was thought to be re-sponsible for the attacks of numbness. Right carotid end-arterectomy was performed. Histological findings re-vealed dissection of the medial layer of the arterial wall. Complaints of numbness disappeared postoperatively, and angiography showed good patency at a follow-up examination.

We conclude that the stenosis of the common carotid artery was not due to atherosclerosis but clue to the dis-section as a result of hanging.