縊頸により片側頸部内頸動脈解離性損傷ならびに同側の多発性脳梗塞を来した1例

Unilateral dissection of the cervical portion of the internal carotid artery and ipsilateral multiple cerebral infarctions caused by suicidal hanging:a case report

I．はじめに

　縊頸による自殺企図は多く，救急搬送されてくる例の多くが既に死亡しているかあるいは短時日に死亡する．本稿では，縊頸後約4時間を経て急に右片麻痺で発症し，片側の内頸動脈起始部付近に解離性狭窄ならびに同側大脳半球に多発性脳梗塞を来したが，中等度程度の転帰となった1例の臨床症状，狭窄病変部の血管像とドプラー所見，脳および脳血管の画像の経時的変化を報告する．

This paper presents a case of traumatic dissection of the unilateral internal carotid artery of the cervical por-tion caused by hanging. A 63-year-old man attempted suicide by hanging and was rescued immediately after. No neurological deficits were detected for the first 4 hours. But then, right hemiplegia, aphasia and dis-turbed consciousness suddenly developed. On the 2nd day, MRI revealed multiple infarctions in the left cere-bral hemisphere. MR angiography demonstrated severe stenosis at the cervical portion of the left internal caro-tid artery clue to dissection. The left middle cerebral artery was not demonstrated. The patient was conser-vatively treated with fibrinolytic agents and regained consciousness gradually. But aphasia and right hemiple-gia remained. During the next few weeks, the stenosis at the ICA slightly improved and the MCA was com-pletely recanalized. Extracranial Doppler sonography revealed chronological hemodynamic changes of mean flow velocity and pulsatility index at the proximal and distal portion of the ICA stenosis.